Pain Relief in Childbirth

Credits: 4.00 CREDITS (Clinical Elective)
Sites: BIDMC
Directors: Hess, Philip E.
Prerequisites: HMS Principal Clinical Experience (Core Clinical Clerkships) or equivalent
Offered: Full time every month.
Open to Exclerks: Yes (may be restricted for international students)
This course covers the theory and practice of pain relief during childbirth and the medical management of high risk obstetrical patients. Special attention will be focused on the interaction between obstetric anesthetic techniques and maternal/fetal physiology. The student will work closely with the obstetric anesthesia team (residents, fellow, and attendings) in the daily activities including providing analgesia for labor and anesthesia for cesarean delivery. Students will be expected to perform medical assessments, play an active role in the anesthetic care, and round on their patients the following day. In addition, the students will be assigned to follow particular high risk patients and will be expected to research and discuss the anesthetic implications of their diseases. Schedule will be M-F 7am to 5pm. Students will attend all afternoon and morning lectures. Overnight and weekend call is optional at the discretion of the student.
Learning Goals:
Students will learn the theory and clinical application of various options for labor analgesia, including perenteral narcotics, intravenous narcotics, epidural and combined spinal-epidural analgesia. Students will learn about the acute changes in maternal physiology that occur during labor and delivery, and how those changes may affect the parturient.
Students will learn the theory and clincal practice of anesthesia for cesarean delivery, including regional anesthesia and general anesthesia. Additionally, students will learn about the options for post-cesarean pain relief.
Students will learn about the complications of labor analgesia and anesthesia. Particular emphasis will be on learning how to differentiate anesthetic from obstetric complications.
Students will learn about the process of birth of the neonate, with emphasis on the transition from fetal to neonatal circulation.
Incorporation of Basic Science Content and Evidence-Based Medicine:
Students will have daily lectures on either obstetric or general anesthesia. Discussion of topics will be expected to be defended by a thorough literature review and presentation of relevent published materials.
Students will be observed and evaluated daily. Students will receive daily feedback only if changes are required. Course feedback will be performed at the end of the rotation and will include a two-way communication of performance. The final grade will be delivered on the HMS evaluation form, along with a narrative of their performace.
Grade Criteria:
High Honors:
Student displays significant interest in the subjects being taught, and seeks supplemental learning. Student raises new topic of interest and leads discussion and/or research into the answers. Student actively participates in the care of the parturient and performs at the level of a beginning CA-1 resident. Presentations are well researched and thorough, and cleanly presented.
Student displays interest in the subjects being taught. Student ask questions and seek answers from multiple sources. Student participates in the care of the parturient by assisting the residents or fellow and attending. Presentations are thorough, and cleanly presented.
Student displays interest in the subjects being taught. Student asks questions whenever the hear or see something they do not know. Student participates in the care of the parturient and by assisting the residents or fellow and attending. Student presents 2 topic of interest during the rotation.
Student does not attend the daily clinical duties without an excuse. Students does not participate in the care of the patients or show initiative to perform basic tasks.
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