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The UF Experience: Breastfeeding Curriculum Is Not Optional

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The UF Experience: Breastfeeding Curriculum Is Not Optional

Elizabeth Davis, DO1, Mary Ryngaert, ARNP, IBCLC1, Karen Bodnar, MD1, Meredith Mowitz, MD1, Randy Graff, PhD2and Sandra Sullivan, MD, IBCLC1, (1)Pediatrics (2)Academic Information Systems Support, University of Florida, Gainesville, FL




Case Report: We present our experience with a 2-phase implementation of a breastfeeding curriculum for pediatric residents. 

Discussion: Inclusion of breastfeeding material into the current residency curriculum was enthusiastically support by the program.  As is the case with many teaching institutions, our newborns are seen in the "acute clinic" until an opening is available with their continuity clinic resident.  For many reasons, including time constraints, infectious environment, lack of continuity, and absence of breastfeeding knowledge, we moved newborn visits into our new Breastfeeding and Newborn Clinic (BNC), staffed by a Pediatric Nurse Practitioner who is also an International Board Certified Lactation Consultant.  Patients are often recently discharged from the nursery by the same resident, improving the continuity of care.  We incorporated many components of the AAP Breastfeeding Residency Curriculum into our current Newborn Nursery (NBN) Rotation in 2 phases.  Phase 1 began July 2009 and included:  written pre- and post-tests for all residents.  Residents were required to attend 2 BNCs, complete Wellstart modules 1, 2 , and 3, choose 4 of 6 chapters from the Washington Breastfeeding Coalition discs, watch 2 videos and shadow the hospital lactation consultant for a half day.  This was to be completed over 2 years of residency.  BNC was overwhelmingly well-received by resident reports.  However, CDs and DVDs were difficult to keep secure yet allow easy access.  We did not have a useful way to track progress through the individual components of the curriculum and tests. Therefore, for phase 2, beginning July 2010, we enlisted the help of e-learning experts to develop an online course that would allow residents to work through the curriculum at their convenience and incorporate clinical experiences into the course requirements.  An online forum would allow for better utilization of videos, better tracking of pre- and post-tests, and potential chat/discussion rooms for residents.  Changes in specific components are anticipated as follows:   pre- and post-tests will be formatted as online surveys, with feedback, consisting of randomly selected questions from a bank of questions from the AAP curriculum, journal writing assignment of experiences in the clinic, addition of 3-5 question formative assessments from the Wellstart curriculum, and reflective writing assignments associated with other components will be required. Future Directions: One resident is monitoring progress of her colleagues as part of her advocacy project.  She will be analyzing pre- and post-test scores and attitudes after approval from IRB.  Another resident is developing an advanced elective and a medical student introduction to breastfeeding medicine. 

Pre-test in July each year

Post-test following NBN rotation each year


Attend 2 breastfeeding clinics, Shadow hospital IBCLC ½ day

       Complete Wellstart module 1

Complete 2 of the following from WBC discs: Immunology of human milk, Glucose, or Feeding the late preterm

Watch video: “Baby-led Breastfeeding: The Mother-Baby Dance”

Assemble and operate the manual/electric breast pumps provided by our hospital


    Attend 2 breastfeeding clinics

      Complete Wellstart module 2

Complete 2 of the following from WBC discs:  Medications and contraceptives, Breast pain, or Insufficient weight gain

Watch video: “Breastfeeding Management, Educational Tools for Physicians and Other Professionals”


Review case scenarios in Wellstart module 3



We present our experience with the first of a 2-phase implementation of breastfeeding curriculum for pediatric residents. We incorporated many components of the AAP Breastfeeding Residency Curriculum into our current Newborn Nursery (NBN) Rotation, while adding material from other sources and instituting a “Breastfeeding Clinic”.

Phase 1, July 2009: Institute curriculum in paper/CD format

Phase 2, July 2010; Development of an online course

  • Clinic was overwhelmingly well-received by resident reports
    • Expanded opportunities, 5 days per week 
  • Development of online course:
    • remedy access issues to CDs & DVDs, tracking of individual progress, tracking of test completion & scores
    • relieve labor intensive monitoring of each resident’s progress by Dr. Davis (her advocacy project)
    • enhance learning by:
      •  providing feedback for online pre- and post-tests
      • personalize clinic (and other) experiences with reflective writing assignments
      • incorporate 3-5 question formative assessments throughout the Wellstart modules
      • fostering more independent study of material at residents’ convenience
  • Advanced elective in breastfeeding medicine
  • Medical student introduction to breastfeeding medicine lecture


AAP Breastfeeding Residency Curriculum

The Revised 3rd Edition of Wellstart’s Lactation Management Self-Study Modules, Level 1, Wellstart International,

Lactation Education for Physicians 2 CD set, Washington Breastfeeding Coalition

“Baby-Led Breastfeeding: The Mother-Baby Dance”, Christina Smillie, MD

“Breastfeeding Management, Educational Tools for Physicians and Other Professionals”, Jane Morton, MD

This project was funded by grants from W. K. Kellogg Foundation, Thomas H. Maren Foundation, and Children’s Miracle Network.