Postpartum Complications Modified TBL
Correspondence should be addressed to Lauren Lamparter, MD at laurenlamparter@gmail.com
DOI: https://doi.org/10.5070/M5.52264
ABSTRACT:
Audience: The intended audience for this modified TBL are resident physicians of all years, PGY1-4.
Introduction: Biological females represent 50% of the population we encounter in the emergency department (ED), and following delivery, the ED is often the main resource for postpartum patients to seek urgent/emergent care. The US is one of the most dangerous developed nations for pregnant women, with about 1/3 of pregnancy related deaths occurring in the postpartum period.1,2 It is presumed that many of these deaths are related to lack of support or insurance for close follow up after delivery.2 The three most common reasons for postpartum hospital readmission and mortality are cardiovascular related disorders (such as hypertension, eclampsia, and cardiomyopathy), hemorrhage, and infections.2,3 While most common, those are not exhaustive, and postpartum women are at risk for many other complications, such as breastfeeding related problems, which will cause them to present to the ED.
As the front lines for patients with limited support or access to medical care, emergency physicians (EPs) need to understand how to recognize and intervene on the common complications faced by postpartum women. It is paramount that resident physicians have adequate training to consider and treat the unique medical concerns of this vulnerable population. This team-based learning (TBL) activity will prepare resident EPs to recognize and manage common postpartum complications.
Educational Objectives: By the end of this session learners will be able to: 1) identify the timeline in which postpartum complications typically occur, 2) discuss the specific differential diagnoses common in the postpartum period, 3) recognize risk factors for endometritis and mastitis, 4) recognize the presentation of postpartum cardiomyopathy and pituitary infarction, 5) formulate a treatment plan for postpartum endometritis including appropriate antibiotics and disposition, 6) formulate a treatment plan for mastitis including appropriate antibiotics and disposition, 7) formulate an appropriate assessment plan for pituitary infarction with appropriate disposition, and 8) formulate an appropriate treatment plan and disposition for postpartum cardiomyopathy.
Educational Methods: This is a modified team-based learning (mTBL) activity in which learners do not have learner responsible content (LRC) prior to the educational session. The multiple-choice cases can be used as an individual readiness assessment test (iRAT) followed by group discussion in a group readiness assessment test (gRAT), or without an iRAT and completed in small groups as a gRAT followed by instructor feedback and summary. Following the gRAT, there is a group application exercise (GAE) with summary cases.
Research Methods: This mTBL was evaluated by learners immediately following the educational session using a post-participation survey. A Likert scale was used to assess the learner’s perception of the effectiveness of this educational format, relevance of the content to practice as EPs, and learner engagement with the mTBL.
Results: The post mTBL survey had a response rate of 82% with 29/35 participants completing the evaluation. Overall, the learners rated the mTBL highly with an average total score of 4.75/5 on the Likert scale. Seventy-nine percent of learners strongly agreed (5/5 on the Likert scale) that the mTBL was effective and valuable compared to other educational activities and engaged their attention. Eighty-three percent of the learners strongly agreed (5/5 on the Likert scale) that the content was relevant to their practice of emergency medicine (EM).
Discussion: Postpartum patients are a high risk, vulnerable population who present to the ED with a wide range of concerns. It is paramount that resident physicians are prepared to medically advocate for and treat these patients appropriately. This mTBL allowed the learners to practice engaging with and discuss the complex medical conditions faced by these patients to better serve them on their next ED shift. Learners found this content very relevant and directly relatable to their daily practice.
Topics: Postpartum, eclampsia, endometritis, postpartum cardiomyopathy, breastfeeding, mastitis.
