Curriculum Tools

---

Evaluation Tools

Evaluation is an essential part of any new program. We have provided you with a variety of ways with which to evaluate the implementation of this residency curriculum and your residents' performance. You will find tools that will help you to show the overall success of incorporating breastfeeding education in to your curriculum.

Pre-test (with Answers) and Post-test (with Answers)

The Pre- and Post-test (with Answers) are evaluation tools that allow you to access the knowledge, practice patterns, and confidence of your residents before they begin learning about breastfeeding and after. The Pre- and Post-tests (with Answers) provide explanations and the AAP position on the questions. The Pre and Post-tests can be printed and residents can fill them out by hand or can be put into an online format using a survey tool such as Surveymonkey or Zoomerrang. The Pre- and Post-tests are not the same. This will help to ensure that your residents are able to choose their answers from knowledge rather than memorization.

Resident Care Evaluation: Communication Skills

Evaluate your residents' ability to communicate with a patient about breastfeeding. It can be used during an Observed Structured Clinical Examination or during a real patient encounter. Observe the resident while counseling the patient. Record your observations using this form and discuss the results with the resident following the interaction. If you are observing a real encounter, all of the questions may not be applicable.

Resident Care Evaluation: Patient History and Education

Evaluate your residents' ability to take a patient history and educate a patient about breastfeeding. It can be used during an Observed Structured Clinical Examination or during a real patient encounter. Observe the resident while counseling the patient. Record your observations using this form and discuss the results with the resident following the interaction. If you are observing a real encounter, all of the questions may not be applicable.

Resident Care Evaluation: ACGME Core Competencies

Evaluate your residents' breastfeeding care skills according to the ACGME Core Competencies. It can be used as a final evaluation to determine your residents' competence in breastfeeding care. It can also supplement the data you are collecting to show your residents' overall ACGME Core Competency proficiency. The form is designed to be simple, using a number scale and yes/no answers, with room for comments when needed.

---

Planning Tools

Developing a Breastfeeding Residency Curriculum can be a daunting task. To help, we have provided planning tools to make it easier.

Data Collection Guide
It is helpful to document the impact of breastfeeding interventions at your institution and the benefit of the Breastfeeding Residency Curriculum. If your institution does not collect breastfeeding data for their entire patient population, the Data Collection Guide will help you develop a method to measure breastfeeding rates.

General Implementation Strategy
The Breastfeeding Residency Curriculum has been designed to be flexible and to fit in to your existing residency program. This General Implementation Strategy provides a step-by-step guide to starting your own curriculum.

---

Teaching Tools

These teaching tools will help promote discussion and learning and gathers proven materials for the development of your residency curriculum.

Observed Structured Clinical Examination: Set up

Many residency programs use Observed Structured Clinical Examinations (OSCE) to assess their residents' ability to counsel and treat a patient on a certain topic. To develop an OSCE on breastfeeding in the classroom, use the Objective Structured Clinical Examination Case Study: Set Up. After the OSCE case is explained, you can use the Resident Handouts, Objective Structured Clinical Examination Case Study: Standardized Patient Description and Script and Objective Structured Clinical Examination Case Study: Performance Assessment, to provide guidance on the enactment of the case and evaluation of the how well the resident performed. See Resident Handouts for more information.

Clinical Case Studies

These Clinical Case Studies cover common breastfeeding issues and concerns that your residents will encounter. They can be used during grand rounds, noon lecture, journal club, or 1-on-1 with residents. To facilitate discussion, begin by reading the case to the residents. Then either share the mother's concerns or ask the residents what they think the mother's concerns might be. Once you think the case is well understood by the residents, use the probing questions to get them to think about the possible solutions and courses of treatment. If you do not have the opportunity for a live interaction or a resident is not able to participate, consider giving a case to the resident and request a written report, presentation, or poster about how he or she would approach the case. You (or the residents) can also create your own cases as you become more familiar with what breastfeeding issues you see in your hospital.

Use of Anti-depressants and Breastfeeding
This case will help the residents to work through the case of a mother who is being treated with anti-depressants and breastfeeding. It highlights the need to use available resources to determine the safety of drugs during lactation and the issues surrounding post partum depression.

Slow Weight Gain and Breastfeeding
This case will familiarize the residents with the normal growth pattern for breastfed infants. It highlights the difference between the current Centers for Disease Control Growth Charts and the new World Health Organization Growth Charts and their implications for breastfed children.

Low Milk Supply and Breastfeeding
Real and perceived low-milk supply are common issues facing breastfeeding mothers. This case will help the residents to understand the difference and how to counsel and treat the mother.

Oversupply of Milk and Breastfeeding
At times, mothers have an oversupply of milk that leaves her and the infant unhappy due to issues with reflux and leaking. This case will ask the residents to describe how to address an oversupply of milk with a mother.

Jaundice and Breastfeeding
This two-part case deals with jaundice in an exclusively breastfed infant and the appropriate and inappropriate interventions to correct this condition.

Food Allergies and Breastfeeding
This case will help the residents to understand the appropriate course of treatment for an infant that is exhibiting food allergy symptoms.

Cultural Cases Studies

The Cultural Case Studies are designed to help the residents understand cultural effectiveness as it relates to breastfeeding.

They can be used during grand rounds, noon lecture, journal club, or 1-on-1 with residents. To facilitate discussion, begin by reading the case to the residents. Then either share the mother's concerns or ask the residents what they think the mother's concerns might be. Once you think the case is well understood by the residents, use the probing questions to get them to think about the possible solutions and courses of treatment. If you do not have the opportunity for a live interaction or a resident is not able to participate, consider giving a case to the resident and request a written report, presentation, or poster about how he or she would approach the case. You (or the residents) can also create your own cases as you become more familiar with what breastfeeding issues you see in your hospital.

Mrs Rust – African American
This case helps residents to understand some of the beliefs within the African American culture as they pertain to breastfeeding. It also describes the concerns surrounding a mother who is breastfeeding following an uncontrollable case of gestational diabetes.

Ms Martinez – Hispanic
This case helps the residents to understand some of the beliefs within the Hispanic culture as they pertain to breastfeeding. It is also describes the issues pertaining to pain management and breastfeeding following childbirth.

Ms Nguyen – Vietnamese Teenager
This case helps the residents to understand some of the beliefs within the Vietnamese culture as they pertain to breastfeeding. The young mother in this case also does not speak English and has recently emigrated.

Ms Weeks – African American Teenager
This case helps the residents to understand the unique challenges of an African American teenager as they pertain to breastfeeding. It will help the residents to practice counseling an adolescent with inadequate nutrition and apprehension about parenting, aside from just breastfeeding.

Prepared Presentations

These presentations can be used during grand rounds, for faculty development, at noon conferences, or in any lecture-type format. They can be given by a faculty member, preferably a physician, or a well-versed resident. Each presentation includes a slide set and notes for the speaker. The presentations may be copied for educational purposes and can be submitted to an institution's individual Continuing Medical Education administrator to apply for CME credits. Individual slides from the presentations may be extracted for use in other presentations without permission from the AAP. Please credit the AAP when these slides are used in this manner. Alterations made to the presentations are permitted, but mention should be made that the alterations were made by an individual and are not those of the AAP.

Disclaimer:
The recommendations listed in these presentations, and cited, do not indicate an exclusive course of treatment or serve as standard of medical care. Variations, taking into account individual circumstances, may be appropriate. These presentations and the materials mentioned within them discuss titles published by organizations other than the American Academy of Pediatrics. Statements and opinions expressed in these publications are those of the authors and not necessarily those of the American Academy of Pediatrics.

---

Resident Handouts

Pre-test and Post-test

The Pre- and Post-test are tools that allow you to access the knowledge, practice patterns, and confidence of your residents before they begin learning about breastfeeding and after. The Pre- and Post-tests can be printed and residents can fill them out by hand or can be put into an online format using a survey tool such as Surveymonkey or Zoomerrang. The Pre- and Post-tests are not the same. This will help to ensure that your residents are able to choose their answers from knowledge rather than memorization. The correct answers and the AAP position on the questions are provided on Pre-tests (with Answers) and Post-tests (with Answers)

Observed Structured Clinical Examination Case Study: Standardized Patient Description and Script

Many residency programs use Observed Structured Clinical Examinations (OSCE) to assess their residents' ability to counsel and treat a patient on a certain topic. Once you have explained the OSCE on breastfeeding, using the Objective Structured Clinical Examination Case Study: Set Up, provide the Objective Structured Clinical Examination Case Study: Standardized Patient Description and Script to the actors or other residents who will play the standardized patient. The Objective Structured Clinical Examination Case Study: Standardized Patient Description and Script provides the necessary information for the person playing the patient.

Objective Structured Clinical Examination Case Study: Performance Assessment

After the enactment of the Observed Structured Clinical Examination Case Study: Standardized Patient Description and Script, the person playing the patient should fill out the Objective Structured Clinical Examination Case Study: Performance Assessment to evaluate how well the resident performed. The Objective Structured Clinical Examination Case Study: Performance Assessment should be reviewed with the resident following the interaction and he or she should have the opportunity to provide comments.