M3 OB/GYN Clerkship

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

2. Welcome to OB/GYN M3 Clerkship • Mrs. Teresa Ingraham Student Education Coordinator - M3’s • Mrs. Janice Golka - M4’s • Karen Carlson, MD Clerkship Director Generalist Faculty • Katherine Finney, MD Assistant Clerkship Director Generalist Faculty

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

4. Methodist Site Training • Monday, September 24th @ 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 • 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 Women’s Hospital orientation. • Orientation at MH will begin promptly at 6-7 pm • You will be given ID cards at orientation (PLEASE: Return to Mrs. Ingraham at end of rotation).

6. 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)

7. OB Methodist Students • Obstetrics block done at Methodist • on team with residents and MFM’s • Gynecology block and Outpatient Clinics blocks done at University Hospital

8. Sample Schedule • Student A: • Weeks 1-2 Weeks 3-4 Weeks 5-6 Obstetrics Gynecology Clinics 1 wkGynOnc(Carlson & 1 wkGynSurg Olesh) * Call expected approx2 weeknights (Mon-Fri) and one weekend night (Sat-Sun) during OB * Clinic schedule found on Weekly Advisor Schedule

9. *Sample Advisor Schedule: *Sample only, please see actual advisor schedule in your packet

10. Course Textbooks

11. 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 • You may access resident education information from this address by clicking the Residency Tab.

12. Required Educational Resources 1. uWISE – APGO educational testing module http://www.apgo.org/student/uwise2.html • Individual subject modules • Comprehensive exam • Create User name/password to access (unmc.edu extension gives access) 2. Pelvic Examination http:// www.nejm.org/doi/full/10.1056/NEJMvcmo61320 3. Fetal Heart Tones www.ob-efm.com • Intrapartum Fetal Heart Rate Monitoring: Nomenclature, Interpretation, and General Management Priciples. ACOG Practice Bulletin No. 106 4. Advanced Colposcopy CD • CD to be checked out from Ms. Teresa Ingraham • Available on clinic computer (bubble room) and Luikart library computers. ***You are required to complete all listed educational resources before the end of the rotation.

13. 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.

14. Clerkship Expectations: http://www.apgo.org/clerkship/coordinators.html

15. Review Books • Should be used as a supplement to text • Please read texts!

16. 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 • OB Rounder • Faculty staffing UNMC inpatient OB service • Generalist: Mondays, Tuesdays, Thursdays, and Fridays • MFM: Wednesdays

17. GYN Rounder and OB Rounder • It is possible the faculty assigned as GYN Rounder or OB Rounder will vary from day to day during your week on that rotation. • Therefore, you may work with more than one faculty during the week.

18. Who will teach, supervise, and evaluate you? • Obstetrics 2 weeks • UNMC: OB Rounder faculty and service team • Methodist: MFM faculty, residents, and teaching sessions with generalists • Gynecology 2 weeks • Benign: gyn resident team and faculty in cases • Oncology: Drs. Remmenga and Rodabaugh and ONC Resident team • Outpatient Clinics 2 weeks * One (or two) faculty per week

19. Who are the Chief Residents? Valerie French, MD UNMC ONC Beginning 10/1: Jean Huff Chakraborty, MD Abby Delaney, MD UNMC GYN Beginning 10/1: Valerie French, MD Jean Huff Chakraborty, MD UNMC OB Beginning 10/1: Libby Crockett, MD Libby Crockett, MD UROG at Methodist Beginning 10/1: Abby Delaney, MD

20. Who are the Methodist Residents? Amanda Buskevicius, MD OB Laura Watters, MD GYN Heather Said, MD Beginning 10/1

21. Methodist MFMs • Dr. Michael Levine • Dr. Neil Hamill • Dr. Robert Bonebrake • Dr. Andrew Robertson • Dr. Katherine Foley

22. Methodist Generalist Craig Bassett, MD

23. Obstetrics “Block” • 2 weeks on In-patient team service • UNMC or Methodist • Students follow labor patients and post-partum patients, usually not antepartums • Pelvic exams usually limited to labor cervix checks when patients have epidural • Be familiar with ACOG antepartum record form used for all patients • Outline for note formats included in packet • Be prepared for morning topics

24. OB Block Notes • Schedule: On-call 3-4 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

25. 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/ faculty 2)  Interpret and document fetal heart rate monitoring strips 3)  Assess and document labor course in patients, postpartum assessments 4)  Understand the normal hospital course for the patient after a normal vaginal delivery or operative C/S delivery

26. Preparing for Morning Rounds • Talk with residents about abnormal assessments before morning report to faculty - for example, wound drainage • Keep the charts out at nursing station/wall chart holders while visiting with patients • Try to organize in SOAP format • Have notes written on time

27. 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

28. 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 covers ER and in-patient consultations as well as OR cases • GYN-Onc team does OR cases and also will go to Dr. Remmenga’s and Dr. Rodabaugh’s clinics

29. Gynecology Block: • Appropriate attire: wear scrubs when scheduled to be in OR, no scrubs when going to GYN-Onc clinics • Students expected to prepare one presentation for both Benign and Onc weeks

30. Preparing for an OR case: - Read background history on that patient, review ultrasounds, pathology, etc. - Read about that particular surgery - Introduce yourself in pre-op before surgery - Assist with moving/positioning of the patient - Introduce yourself to OR staff, offer to get your own gloves - Visit the patient after the case, read the op note dictation, and review the pathology findings

31. Gynecology: Knowledge and Skills Expectations By the end of the Gynecology block students will be expected to competently 1)  Write a complete 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 bleeding 5)  Briefly describe the differences between types of hysterectomies (supracervical, simple, radical, vaginal, laparoscopic)

32. Outpatient Clinics “Block” • 2 weeks of outpatient clinic exposure: students assigned to 1-2 faculty/ week • Look at faculty schedule the day before to get a sense of topics to prepare, for example- postmenopausal bleeding • Variable 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

33. 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/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

34. 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”

35. 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

36. Wednesday Morning Teaching • No matter which clinical block or hospital currently assigned to, every student should attend 0800AM Grand Rounds – DRC 1004 (sign in) 0900-1200 noon Lectures – DOC 4608 √ schedule in notebook • NO scrubs, please

37. UNMC Benign GYN Service:Scheduled GYN Teaching Conferences • Wednesdays 0700: Pre-op conference (Luikart) • Thursdays 0700: GYN Topic-based session • Location and time may vary (TBA by gyn team) • Fridays 0700: Diagnostics in OB/GYN (DOC 4608) • Friday: GYN student presentation (gyn topic) • 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

38. UNMC GYN-ONC Service:Scheduled GYN Teaching Conferences • Daily AM/PM work rounds • Friday: ONC student presentation (onc topic) • 5-10 minute prepared presentation with handout use evaluation form provided; staple copy of handout to form. • Present to oncology team • 5 point of final grade

39. DOG Conference ALL rotations except GYN ONC and Methodist - - Friday 0700AM 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/month: GYN topic

40. Vice Chairman’s Luncheon • Dr. Remmenga usually hosts a luncheon towards the end of the 6-week clerkship. • All students are expected to attend. • Dr. Remmenga will host in the Luikart library, MSB 45119.

41. Communication • You will be responsible for reading your email. • Drs. Finney, Carlson and Ms. Ingraham will communicate all information by email.

42. Policies: Attendance/Absences • If you are ill, you must 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, she will forward information to Dr. Finney and Mrs. Ingraham.* • 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 weeks if missed.

43. Clerkship Grading Structure • 50 % 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 @ 9 AM • 5% GYN presentation • 5% ONC presentation

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

45. Criteria for Passing Rotation: • Minimum requirements for passing this clerkship include: • Receiving ≥ 10th% scaled percentile score on the NBME shelf exam • Bases on national scaled percentile scores • Approx 64 raw score AND • Receiving satisfactory resident & faculty evaluations (clinical grade of “P” or better)

46. Policies: Marginal or Fail Grades • MARGINAL Grade: • Students receiving a “M” on the clinical portion of the rotation • < 10th% scaled score on the NBME shelf exam • Student may opt to re-take the shelf exam: • If they pass second exam then his/her grade sheet will have an addendum noting the improved exam performance, but the grade remains MARGINAL • FAIL Grade: A student may receive a FAIL grade if significant professionalism/clinical issues have occurred on the rotation.

47. Grade Appeals • All students have the right to appeal a clerkship grade and/or comments for the Dean’s letter • Initial requests must be made by email to Mrs Ingraham @ ningraham@unmc.edu • Requests must be made within 30 days of grades being emailed to students • OB/Gyn department has committee to evaluate these requests

48. OB/Gyn Clerkship Expectations • Expectations for each Block -Website listing of areas to focus on for each Clinical Block

49. Professionalism Expectations: • Attendance, on-time to activities • Take your professional role seriously • Demonstrating respect for patients, staff, and supervising residents, faculty, and fellow students

50. Professionalism Problems: Examples • Being late/not writing notes on assigned patients • Talking about patient information in public areas (i.e. elevators, Facebook, etc.) • Laughing/talking out of turn during lectures • Texting during Grand Rounds or lectures • Inappropriate discussions in front of patients during pelvic exams, labor and delivery, etc.