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M3 OB/GYN Clerkship

welcome!. M3 OB/GYN Clerkship. Welcome! Please help yourself to refreshments provided. . Welcome to OB/GYN M3 Clerkship. *Mrs. Teresa Ingraham -M3 Student Education Coordinator *Ms. Erin Blaszak -Residency Coordinator. *Karen Carlson, MD -Clerkship Director -Generalist Faculty

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M3 OB/GYN Clerkship

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  1. welcome! M3 OB/GYN Clerkship Welcome! Please help yourself to refreshments provided.

  2. Welcome to OB/GYN M3 Clerkship *Mrs. Teresa Ingraham -M3 Student Education Coordinator *Ms. Erin Blaszak -Residency Coordinator *Karen Carlson, MD -Clerkship Director -Generalist Faculty *Katherine Finney, MD -Assistant Clerkship Director -Generalist Faculty

  3. Orientation Agenda Morning: • Video/Tour • Clerkship Overview and Expectations • Pelvic Model • Pictures • Resident presentation Lunch: • Life Course Approach to Women’s Health (Dr. Marvin Stancil) Afternoon: • Lectures: • Lecture (Dr. Tomich) • Fetal Heart Rate Monitoring and Physiological Changes • Women’s Health History (Dr. Carlson) • M3 Survival Guide (Dr. Cudzilo)

  4. Methodist Site Training • Monday, February 17th, @ 5 pm • All students assigned to Methodist for OB • Report to: Medical Office Bldg • (left of main hospital) 717 N. 190th St. 2nd Floor StasnyRm • CERNER Training will begin at 5 pm (Kim Thorson) • Please try to be at the staff office 5-10 minutes before appointed time. See instructions in your booklet • Park in parking lot.

  5. Methodist Site Orientation • Following CERNER training, someone will take you for your Methodist Wmn’s Hospital orientation. • Orientation at MH will begin promptly at 6-7 pm (Linda Spittler) • You will be given ID cards at orientation. (PLEASE: Return to Methodist Security at end of rotation).

  6. Subspecialties in Ob-Gyn • General Ob-Gyn • 4 year residency • Maternal-Fetal Medicine • 3 year fellowship • Oncology • 3 year fellowship • Reproductive Endocrinology • 3 year fellowship • Urogynecology/pelvic and reconstructive surgery • 3 year fellowship • Minimally Invasive GYN Surgery • 2 year fellowship • Pediatric and Adolescent Gynecology • 2 year fellowship

  7. Overview: Clerkship “Blocks” • Obstetrics Block (2 weeks) • UNMC or Methodist Women’s Hospital • Gynecology Block (2 weeks) • Gynecologic Oncology- 1 week • Benign Gynecology – 1 week • Outpatient Clinics Block (2 weeks)

  8. OB Methodist Students • Obstetrics block done at Methodist • team with residents and MFM’s • Gynecology block and Outpatient Clinic blocks at UNMC and Durham Outpatient

  9. Sample Schedule • Student A: • Weeks 1-2 Weeks 3-4Weeks 5-6 Obstetrics Gynecology Clinics (UNMC or MWH) 1 wkGynOnc/1 wkGynSurg see advisor schedule * Clinic schedule found on Weekly Advisor Schedule

  10. *Sample Advisor Schedule: Week 1 AM---- Week 1 PM -----

  11. Night Call • 24 hour call • Expect approximately • 1 Mon/Fri, 1 Midweek and 1 Sat/Sun night • During OB • Methodist Hospital • UNMC

  12. Course Textbooks

  13. Educational materials • www.unmc.edu/obgyn • Click Education tab • Lecture materials located here • Click M3 Students • Click Lectures • Orientation/Resident’s Power Point presentation • Click M3 Students • Click Orientation

  14. 4 Required Educational Resources 1.uWISE – APGO educational testing module http://www.apgo.org/student/uwise2.html • Create user name/password to access • unmc.edu extension gives access 2. Pelvic Examination http://www.nejm.org/doi/full/10.1056/NEJMvcm061320

  15. 4 Required Educational Resources 3. Fetal Heart Tones *www.ob-efm.com *IntrapartumFetal Heart Rate Monitoring: Nomenclature, Interpretation, and General Management Principles ACOG Practice Bulletin No. 106 4. Advanced Colposcopy CD *CD from Ms. Teresa Ingraham – also available on clinic computers (bubble room)/Luikart library computer *Or the following link: http://www.slideshare.net/drsubir/colposcopy

  16. Great Resources • American Congress of Obstetricians and Gynecologists (ACOG) • Free for students to join • Association of Professors of Gynecology and Obstetrics (APGO) • uWise • APGO • Medical Student Education Objectives, 9th ed.

  17. Clerkship Expectations: *www.apgo.org/members/medical-students.cfm Specific expectations for each part of clerkship *in folder

  18. Review Books • Should be used as a supplement to text • Please read required text!

  19. GYN Rounder and OB Rounder • GYN Rounder • Faculty assigned to supervise resident clinics • Staffs all inpatient and ED consults • May be same as OB Rounder • Varies during the week • OB Rounder • Faculty staffing UNMC inpatient OB service • Generalist or MFM • Varies during the week

  20. Who will teach, supervise, and evaluate you? • Obstetrics 2 weeks • UNMC: OB team-rounder, staff, and residents • Methodist-MFM faculty, generalists, and residents • Gynecology 2 weeks • Benign: • gyn residents • faculty in OR cases • Oncology • onc residents • Drs. Remmenga & Rodabaugh • Outpatient Clinics 2 weeks ~Two faculty per week

  21. Who are the Chief Residents? Amanda Buskevicius, MD GYN UNMC Beginning 3/1: UROG Heather Said, MD OB UNMC Beginning 3/1: GYN Sarah Lundin, MD ONC UNMC Beginning 3/1: OB Laura Watters, MD ONC Methodist Beginning 3/1: ONC

  22. Who are the Methodist Residents? • Jake Gibbens, MD • High Risk OB • Beginning 3/1: ONC Methodist • Ashley Thorson, MD • OB D/N • Beginning 3/1: Elective Morgan Morton, MD GYN Beginning 3/1: High Risk OB

  23. Methodist MFMs Michael Levine, MD • Robert Bonebrake, MD • Katherine Foley, MD Hemant Satpathy, MD • Andrew Robertson, MD Neil Hamill, MD Todd Lovgren, MD

  24. Methodist Generalists Mark Carlson, MD Paige Berryman, MD Julia Bishop, MD Craig Bassett, MD Judith A. Scott, DO Sarah Gernhart, MD Brianne M. Kling, MD

  25. Methodist Generalists Susan Wescott, MD Kristen Hoffman, MD Megan Prickett, MD (Irwin) Carolee Jones, MD William D. Weidner, MD Nancy Mathews, MD

  26. Methodist Generalists Michelle S. Knolla, MD Tifany L. Somer-Shely, MD Lanette Guthmann, MD Rebecca L. Jacobi, MD Thomas E. Martin, MD Allison Phillips, MD

  27. Methodist physicians consistently identified by previous students as great teachers:

  28. Obstetrics “Block” • 2 weeks on In-patient team service • UNMC or Methodist • Students follow labor patients and post-partum patients • Pelvic exams – not done • Outline for note formats included in packet • Be prepared for morning topics

  29. OB Block Notes • Schedule: On-call 3 nights (1 weekend night). next day students go home after morning rounds completed • Appropriate attire: SCRUBS • Introduce yourself to patients, nurses • Be available for checks, labor assessments, and pushing phase and deliveries • Make sure your gloves and an extra gown are pulled for you; we want you involved! • Try not to get upset with interns who are learning how to do deliveries

  30. Obstetrics: Knowledge and Skills Expectations By the end of the Obstetrics block students will be expected to competently:1)  Obtain, present, and document a relevant history on patients being evaluated or admitted; examinations will be done with supervising resident/ faculty2)  Interpret and document fetal heart rate monitoring strips3)  Assess and document labor course in patients, postpartum assessments4)  Understand the normal hospital course for the patient after a normal vaginal delivery or operative C/S delivery

  31. Preparing for Morning Rounds • Talk with residents about abnormal assessments before morning report to faculty - for example, wound drainage • Have notes written on time

  32. UNMC Inpatient OB Service:Scheduled OB Teaching Conferences • Monday-Thursday 0700 (L&D MD Interaction Rm) • Morning teaching rounds • Patient presentations • Scheduled OB topics • Fridays 0700: Diagnostics in OB/GYN (DOC 4608) • Fridays 0800: Morning teaching rounds (as above) • Additional OB topic teaching sessions based on L&D activity

  33. Gynecology Block: Benign and GYN-Onc • 2 weeks of in-patient team services • Gynecology notes and post-op course outlined in your orientation packet • GYN team • ER • In-patient consultations • OR cases • GYN-Onc • OR cases • Dr. Remmenga’s and Dr. Rodabaugh’s clinics

  34. Gynecology Block: • Appropriate attire • scrubs when scheduled to be in OR • no scrubs when going to clinics • Students presentations (1) • Benign Gyn week

  35. Preparing for an OR case: - Background history on patient -why is this surgery being done? -read chart -review labs -review ultrasounds, pathology, etc. - Read about that particular surgery - Introduce yourself -to patient in pre-op before surgery -to OR staff - Assist with moving/positioning of the patient - Get your own gloves out - After the case -write the brief op note with help of resident/staff -visit the patient 4 hours postop -read the op note -review the pathology

  36. Gynecology: Knowledge and Skills Expectations By the end of the Gynecology block students will be expected to competently: 1)  Write a brief operative note and formulate postoperative plan 2)  Discuss the normal hospital course after a routine Gyn surgical procedure 3)  Discuss the appropriate work-up and differential for postoperative common problems: low urine output, fever, and wound problems 4)  Discuss the relevant history, examination, and laboratory or radiology work-upinvolved in ER assessments of 1) pelvic pain and 2) abnormal vaginal bleeding5)  Briefly describe the differences between types of hysterectomies (supracervical, simple, radical, vaginal, abdominal, laparoscopic)

  37. Outpatient Clinics “Block” • 2 weeks of outpatient clinic exposure: • One on one with 1-2 faculty/ week • Look at faculty schedule the day before • prepare, for example- postmenopausal bleeding • Routine OB care • Hands-on opportunities for exams • Review Gynecology clinic progress note in orientation packet • Scrubs never appropriate • Study sessions assigned during this block • Need to attend all assigned clinic sessions

  38. Outpatient Clinics:Knowledge and Skills Expectations • By the end of this clinical block, students will be expected to competently: 1)  Conduct a normal annual GYN examination: obtain and present history, under supervision do an appropriate physical exam, and counsel patient appropriately on screening recommended by age group 2)  Conduct a new and return obstetric patient clinic visit (exam with supervision of faculty or resident) 3)  Discuss appropriate triage of abnormal Pap smears 4)  Discuss indications for vulvar biopsy and endometrial biopsy 5)  Appropriately counsel patients on choices of contraception/sterilization 6)  Discuss issues related to risks and benefits of hormone replacement therapy

  39. What if I feel uncomfortable with pelvic exams? - You are not alone- many physicians do not feel comfortable with pelvic exams - Today is the practice pelvic exam session - We expect you to become more familiar with the mechanics of the exam and how to appropriately talk to your patient during the exam- all exams should be supervised - It takes a lot of practice to do them well. - “How I Learned to Stop Worrying and Do Breast and Pelvic exams”

  40. How can I make the most of my outpatient experience? • Be flexible and keep an open mind. . . -your schedule is an outline -be available if opportunities to learn come up

  41. Wednesday Morning Teaching • 8:00AM Grand Rounds • MSC 2018 (sign in) • 9:00-12:00 • Lectures – DOC 4608 • schedule in notebook • No matter which clinical block or hospital currently assigned to, every student should attend • NO scrubs, please

  42. UNMC Benign GYN Service:Scheduled GYN Teaching Conferences • Wednesdays 7:00 (time/day will vary!) Pre-op conference (Luikart UT4113) • Thursdays 7:00 (time/day will vary!) GYN Topic-based session • Fridays 7:00 Diagnostics in OB/GYN (DOC 4608) • Friday: GYN student presentation (gyn topic) • Time and place will vary • 5-10 minute prepared presentation with handout -use evaluation form provided -staple copy of handout to form • Present to gyn rounder and gyn team • 5 point of final grade

  43. UNMC GYN-ONC Service:Scheduled GYN Teaching Conferences • Daily AM/PM work rounds • Oncology topics will be provided by resident • Oncology topic

  44. DOG Conference - Friday 7:00am  Diagnostics in Obstetrics and Gynecology (DOG) in DOC 4608 (OB classroom) - Topics based on diagnostic imaging and/or testing -3 Fridays/month: OB topic -1 Friday : gyn topic *ALL rotations except GYN ONC and Methodist

  45. Vice Chairman’s Luncheon • Luncheon • Towards the end of your 6-weeks • Dr. Remmenga usually hosts • All students are expected to attend • Lunch is provided - -Luikart library, UT 4113 • Your feedback is highly appreciated!

  46. Communication • Please read your email • We all communicate by email • Notes on board on Wednesday am at lectures

  47. Policies: Attendance/Absences • If you are ill, please contact: • Contact your current assigned service faculty or chief resident as soon as you know you will be absent. • Send email notification to Dr. Karen Carlson as soon as you know you will be absent • If you leave during the day due to illness, please notify Dr. Karen Carlson via email. • If you miss more than 1 day in the 6-week clerkship you must make up this time. Mrs. Ingraham will coordinate any needed make up time. *Do not rely on a classmate to relay your information. *Efforts will be made to reschedule your clinic sessions if missed.

  48. Clerkship Grading Structure • 55 % clinical evaluations • Based on faculty and resident evaluations • Department grading meeting • Clinic advisors, residents, and faculty • 40% written exam • Shelf Exam: NBME 2 hour and 30 min exam • last Friday of the clerkship @ 8 AM • 5% GYN presentation

  49. PASS, HIGH PASS, HONORS • Our department complies with the College of Medicine’s recommended grade distribution of • 20% = Honors • 20% = High Pass • 60% = Pass

  50. Criteria for Passing Clerkship: *Receiving ≥ 10th% scaled percentile score on the NBME shelf exam • National scaled percentile scores • Approximately 64 raw score AND *Receiving satisfactory resident & faculty evaluations • clinical grade of Pass or better

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