1. “Centering Pregnancy” as a Longitudinal Rotation A Recipe for Success
Building a curriculum and milestone based evaluations
Susan Hasti, MD
Michelle Karsten, MD
Anne DeNucci-Lushine, MA, IBCLC, ICCE

2. Our Centering Pregnancy Journey so far…
A brief history
Adding residents to the mix
Making it an “official rotation”

3. Our CP Recipe Start a Centering Pregnancy program 2008
One FM faculty, one FM Nurse Practitioner
Suboptimal space
Typical successes and “opportunities”
MK-CP prenatal assignments competed for resident assignments

4. Now add residents to the mix…
2013 residents assigned to CP groups
6 groups per year
2 residents per group
SH- Problems:
Who attends deliveries and gets “credit” for a primary delivery
Confusion of check ins
No clear ownership by the resident. Scheduling issues

5. Simmer residents with CP
Attempt to achieve “ownership”
In 2014 increased to 12 groups per year
Every resident got his/her “own” group
Recruited 2 additional faculty
problems:
Some residents “coasted”
Scheduling conflicts with “official rotations”
Persistent lack of ownership in some residents.
No formal way to give feedback, positive or negative to resident.

6. Promote resident to head chef
Development of written expectations
Formal evaluation of the residents
Building the rotation
Identification of milestones that fit CP
Goals and Objectives
Evaluation tools
Raised the profile of Centering within the curriculum

7. Which ingredients (milestones) to use???
Patient Care – we chose PC3
MK2
PBLI 2? 3?
SBP 1? 2? 3? 4?
PROF 2? 3? 4?
C 1? 2? 3? 4? SH

9. Has not achieved level 1 Level 1 ( Novice) Beginning resident
PC 3. Partners with the patient, family, and community to improve health through disease prevention and health promotion
Has not achieved level 1
Level 1 ( Novice)
Beginning resident
Level 2 ( Competent)
Junior resident
Level 3 (Proficient )
Senior resident
Level 4 ( Expert)
Graduating resident
Level 5 (Master)
Personal Physician
Resident takes a comprehensive prenatal intake history and identifies health risk factors and social determinants of health
Resident follows prenatal guidelines for appropriate testing throughout pregnancy and post-partum care
Resident actively participates in group, using facilitative techniques to promote healthy behaviors for pregnancy
Resident mobilizes the health care team for optimal prenatal care
Physician partners with the community to offer improvements to the Centering program at Whittier
Resident performs initial exam and subsequent prenatal exams
Resident manages health conditions and prenatal complications in a group visit
Resident actively participates in group to help patients identify barriers, manage conflicting needs and set goals for healthy pregnancies
Resident attends to patient privacy during the exam in group setting
Level selection

10. Our progress so far… 2 residents completed the formal rotation
Evaluations sent to faculty through RMS
Identified lack of MA and co-facilitator input (360 review)
New tool to be launched for MA/RN feedback

11. Dr. Yamanaka: our first head chef
“we had a very very intense event in this group… he was a very compassionate and competent provider to this patient throughout her pregnancy and she trusted him very much”

12. Contacts
Michelle Karsten Susan Hasti Anne DeNucci-Lushine