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Decel Defense! Teaching Interns to Tackle Category II Fetal Heart Rate Tracings

Purpose: To teach interns a standardized approach to management of Category II fetal heart rate (FHR) tracings.


Background: Many interns feel trepidation when facing Category II FHR tracings.  We designed a workshop to allay initial anxiety interns may feel at the start of training.


Methods: During Orientation we conducted a flipped classroom workshop.  Interns practiced applying a novel mnemonic device when managing FHR tracings in a variety of common clinical scenarios.


Results: Confidence level managing Category II FHR tracings was assessed pre and post-workshop.  Mean baseline confidence level was 1.83 on a 1-4 scale  of “not confident to very confident”.  Mean confidence level increased to 3 immediately post-workshop.  Evaluations of the workshop were very positive, mean rating 5.0 out of 5.0.  Residents appreciated the opportunity to manage FHR decelerations in a simulated, low-risk setting prior to caring for actual patients. 

A follow up survey one month after the workshop found that 33% of interns used the mnemonic ”sometimes” and 33% reported “often” use when managing Category II FHR tracings in real time.  Mean confidence level rose to 2.83 on the 1-4 scale.  On average, participants recalled 7.67 of 13 elements in the mnemonic tool.  At six months, 66% of interns used the mnemonic ”sometimes” and 33% “often” when managing FHR tracings.  Mean confidence level rose to 3.33 and interns recalled 8.33 of 13 elements.


Discussions: Interns found coaching in a small group setting with simulated cases and a mnemonic device to be an effective method for building confidence in managing Category II FHR tracings.

Topics: CREOG & APGO Annual Meeting, 2019, Resident, Faculty, Residency Director, Residency Coordinator, Patient Care, Medical Knowledge, Practice-Based Learning & Improvement, GME, Virtual Patient, Simulation, Problem-Based Learning,

General Information

Resident,Faculty,Residency Director,Residency Coordinator,
Patient Care,Medical Knowledge,Practice-Based Learning & Improvement,
Virtual Patient,Simulation,Problem-Based Learning,
Clinical Focus

Author Information

Rini Ratan, MD, Columbia University Medical Center; Katherine Palmerola, MD    

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