Dear Sarah,

How exciting to be able to create a portion of your residency to fit your interests!!
If one or more of the lactation consultants you have contacted works in a hospital
setting with a designated lactation center, NICU and med-surg units as well as
maternity, you have a great opportunity ahead.  At the hospital where I work as a
lactation consultant, it is seen as "enough" if the residents get to observe one
consult - a bonus to see more than one.  They tend to spend less than one hour with one
of us.  This is partly due to how tight and intense their schedules are but also
reflects the value placed on breastfeeding.

I would hope that by the end of four weeks in such a setting you would be able to see
the lactation consultant work with antepartum and postpartum mothers, NICU situations
(which can range from full tgerm with low glucose issues to very-low-birth-weight
premies and babies with special needs), readmissions for mastitis, and out patient
concerns with older babies.  Specific skills you would benefit from observing would
be:  basic latch and positioning, instruction on pumping with electric pump, use of a
supplemental nutrition system (Medela's term) or LactAid (commercial name) for
breastfed babies needing supplements, the rationale for any "gadget" interventions,
phone helping skills, communication skills (such as active listening, empathetic
responses, how to talk to distraught mother, how to help a mother who is non-English
speaking), suck assessment.  This is by no means an exhaustive list :-)

I hope you will consider writing up your experience once the four weeks are completed
so that others in the healthcare professions may benefit from what you observe and
learn.

Cindy Garrison BS IBCLC
Magee-Womens Hospital
Pittsburgh, PA


>
>
> Subject: Resident rotation in breastfeeding medicine
> Date: Fri, 27 May 2005 00:55:33 -0400
> From: Sarah Reece-Stremtan <[log in to unmask]>
>
> I start my internship this summer in internal medicine, and the department
> has given me tentative approval to do 4 weeks of breastfeeding medicine as
> my elective this year.  I have spoken with a couple of local LCs and will
> likely be spending some time with them, along with probably one day a week
> with one of the breast surgeons (who told me flat-out when I saw her as a
> patient that I knew more than she did about breastfeeding and pumping
> issues -- so should be interesting!)
>
> I'm curious if anyone has participated in a program that had medical
> residents rotate through?  Did you use a certain curriculum or have defined
> objectives?  The medicine department here just wants me to give them a
> proposal with aims/objectives and detailed info about where I'll be and who
> I'll be working with when so they can make sure I'm actually putting in
> realistic hours of work.  I'd appreciate hearing any suggestions for
> specific issues I might want to make sure I cover -- I imagine that the
> medicine department wants me to focus mostly on "mom" issues since I'll be
> doing adult medicine.  One LC mentioned looking at the IBCLC clinical
> competencies, but that seems quite exhaustive given I'll only be doing this
> for 4 weeks.  I'm *hoping* to have a good enough experience that I can
> organize something formal and try to make it an available 2 or 4 week
> rotation for the 4th-year medical students.
>
> Any ideas???
>
> And as a sidenote, I start my anesthesiology residency next summer, and
> look forward to exploring more about how anesthesia in labor affects
> immediate and later breastfeeding success -- I know nothing as of yet so
> haven't been able to comment on the preceding discussions about this. :)
>
> Thanks so much,
> Sarah Reece-Stremtan, M.D. (who's hurriedly trying to finish her MPH and
> CLE before she starts working)
> George Washington University
> Washington DC

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