3 Orientation Agenda Morning: Lunch: Afternoon: Video/Tour Clerkship Overview and ExpectationsPelvic ModelPicturesResident presentationLunch: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 Orientation Monday, April 8th, @ 5 pmAll students assigned to Methodist for OBReport to: Methodist Women’s Hospital707 N. 190th St. main desk in lobby)Linda Spittler (L&D)Park in parking lot.You will be given ID cards at orientation (PLEASE: Return to Mrs. Ingraham at end of rotation).
5 Methodist Site Training Monday, April 15th, @ 5 pmAll students assigned to Methodist for OBReport to: Methodist Hospital84th and Dodge Street (south tower):Kim ThorsonCERNER Training will begin at 5 pmPlease try to be at Methodist 5-10 minutes before appointed time. (call Kristi and she will come down and get you )Park in parking lot.
6 Subspecialties in Ob-Gyn General Ob-Gyn4 year residencyMaternal-Fetal Medicine3 year fellowshipOncologyReproductive EndocrinologyUrogynecology/pelvic and reconstructive surgeryMinimally Invasive GYN Surgery2 year fellowshipPediatric and Adolescent Gynecology
13 Educational materials Click Education tabLecture materials located hereClick M3 StudentsClick LecturesOrientation/Resident’s Power Point presentationClick Orientation
14 4 Required Educational Resources 1.uWISE – APGO educational testing moduleCreate user name/password to accessunmc.edu extension gives access2. Pelvic Examination
15 4 Required Educational Resources 3. Fetal Heart Tones*www.ob-efm.com*Intrapartum Fetal Heart Rate Monitoring: Nomenclature, Interpretation, and General Management Principles ACOG Practice Bulletin No. 1064. Advanced Colposcopy CD*check out CD from Ms. Teresa Ingraham*available on clinic computer (bubble room)*Luikart library computers
16 Great Resources Free for students to join uWise APGO American Congress of Obstetricians and Gynecologists (ACOG)Free for students to joinAssociation of Professors of Gynecology and Obstetrics (APGO)uWiseAPGOMedical 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 Faculty assigned to supervise resident clinicsStaffs all inpatient and ED consultsMay be same as OB RounderVaries during the weekOB RounderFaculty staffing UNMC inpatient OB serviceGeneralist of MFM
20 Who will teach, supervise, and evaluate you? Obstetrics 2 weeksUNMC: OB team-rounder, staff, and residentsMethodist-MFM faculty, generalists, and residentsGynecology 2 weeksBenign:gyn residentsfaculty in OR casesOncologyonc residentsDrs. Remmenga & RodabaughOutpatient Clinics 2 weeks~Two faculty per week
21 Who are the Chief Residents? Abby Delaney, MDUNMC OBLibby Crockett, MDUNMC ONCJean Huff Chakraborty, MDUNMC GYNValerie French, MDUROG at Methodist
22 Who are the Methodist Residents? Ashley Thorson, MDOBCurrently until 5/1Heather Said, MDHigh Risk OBCurrently until 5/1Jake Gibbens, MDOBBeginning 5/1Amanda Buskevicius, MDHigh Risk OBBeginning 5/1
23 Methodist MFMs Dr. Robert Bonebrake Dr. Katherine Foley Dr. Michael LevineDr. Hemant SatpathyDr. Andrew RobertsonDr. Neil HamillDr. Todd Lovgren
24 Methodist Generalists Mark Carlson, M.D.Paige Berryman, M.D.Craig Bassett, M.D.Julia Bishop, M.D.Judith A. Scott, DOSarah Gernhart, M.D.Brianne M. Kling, MD
26 Methodist Generalists Michelle S. Knolla, MDTifany L. Somer-Shely, MDLanette Guthmann, M.D.Rebecca L. Jacobi, MDThomas E. Martin, MDAllison Phillips, M.D.
27 Methodist physicians consistently identified by previous students as great teachers:
28 Obstetrics “Block” 2 weeks on In-patient team service UNMC or MethodistStudents follow labor patients and post-partum patientsPelvic exams – not doneOutline for note formats included in packetBe prepared for morning topics
29 OB Block NotesSchedule: On-call 3-4 nights (1 weekend night). next day students go home after morning rounds completedAppropriate attire: SCRUBSIntroduce yourself to patients, nursesBe available for checks, labor assessments, and pushing phase and deliveriesMake 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/ 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
31 Preparing for Morning Rounds Talk with residents about abnormal assessments before morning report to faculty- for example, wound drainageHave notes written on time
32 UNMC Inpatient OB Service: Scheduled OB Teaching Conferences Monday-Thursday 0700 (L&D MD Interaction Rm)Morning teaching roundsPatient presentationsScheduled OB topicsFridays 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 servicesGynecology notes and post-op course outlined in your orientation packetGYN teamERIn-patient consultationsOR casesGYN-OncDr. Remmenga’s and Dr. Rodabaugh’s clinics
34 Gynecology Block: Appropriate attire Students presentations (2) scrubs when scheduled to be in ORno scrubs when going to clinicsStudents presentations (2)Benign Gyn weekOnc 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-up involved 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, abdominal, laparoscopic)
37 Outpatient Clinics “Block” 2 weeks of outpatient clinic exposure:One on one with 1-2 faculty/ weekLook at faculty schedule the day beforeprepare, for example- postmenopausal bleedingRoutine OB careHands-on opportunities for examsReview Gynecology clinic progress note in orientation packetScrubs never appropriateStudy sessions assigned during this blockNeed 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 RoundsDRC 1004 (sign in)9:00-12:00Lectures – DOC 4608schedule in notebookNo matter which clinical block or hospital currently assigned to, every student should attendNO scrubs, please
42 UNMC Benign GYN Service: Scheduled GYN Teaching Conferences Wednesdays 7:00 (time will vary!) Pre-op conference (Luikart)Thursdays 7:00 (time will vary!) GYN Topic-based sessionFridays 7:00 Diagnostics in OB/GYN (DOC 4608)Friday: GYN student presentation (gyn topic)Time and place will vary5-10 minute prepared presentation with handout-use evaluation form provided-staple copy of handout to formPresent to gyn rounder and gyn team5 point of final grade
43 UNMC GYN-ONC Service: Scheduled GYN Teaching Conferences Daily AM/PM work roundsFriday: ONC student presentationOncology topic5-10 minute prepared presentation with handout-use evaluation form provided-staple copy of handout to formPresent to oncology team5 points of final grade
44 *ALL rotations except GYN ONC and Methodist 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 Towards the end of your 6-weeksDr. Remmenga usually hostsAll students are expected to attendLunch is provided Luikart library, MSB 45119Your feedback is highly appreciated!
46 Communication Please read your email We all communicate byNotes 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 notification to Dr. Karen Carlson as soon as you know you will be absentIf you leave during the day due to illness, please notify Dr. Karen Carlson via .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 50 % clinical evaluationsBased on faculty and resident evaluationsDepartment grading meetingClinic advisors, residents, and faculty40% written examShelf Exam: NBME 2 hour and 30 min examlast Friday of the 9 AM5% GYN presentation5% ONC presentation
49 PASS, HIGH PASS, HONORSOur department complies with the College of Medicine’s recommended grade distribution of20% = Honors20% = High Pass60% = Pass
50 Criteria for Passing Clerkship: *Receiving ≥ 10th% scaled percentile score on the NBME shelf examNational scaled percentile scoresApproximately 64 raw scoreAND*Receiving satisfactory resident & faculty evaluationsclinical grade of Pass or better
52 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 examStudent 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 MARGINALFAIL Grade:A student may receive a FAIL grade if significant professionalism/clinical issues have occurred on the rotation.
53 Grade AppealsAll students have the right to appeal a clerkship grade and/or comments for the Dean’s letterInitial requests must be made by to MrsRequests must be made within 30 days of grades being ed to studentsOB/Gyn department has committee to evaluate these requests
54 Professionalism Expectations: AttendanceBe on-time to activitiesTake your professional role seriouslyDemonstrate respectpatientsancillary staffnursessupervising residentsfacultyfellow students
55 Professionalism Problems: Examples Being late/not writing notes on assigned patientsTalking about patient information in public areas (i.e. elevators, Facebook, etc.)Laughing/talking out of turn during lecturesTexting during Grand Rounds or lecturesInappropriate discussions in front of patients during pelvic exams, labor and delivery, etc.
56 Professionalism Problems: Other examples Use of cell phones during conferences/lecturesInappropriate treatment of clinic or nursing staffNot following patients after surgery/deliveryMissing deliveries/surgeries when notified by resident/staffResidents and/or faculty will give appropriate feedback and notify Clerkship director of this interaction if problems arise
57 Feedback Mid Clerkship meeting: End of rotation comments: Dr. Finney or Dr. Carlson will meet with each student.Mandatory.Informal 10 min. meeting to give you feedback and receive feedback from you regarding the first half of the clerkship.See schedule in your binder.Please let Teresa know right away if you have any conflicts during your scheduled time.End of rotation comments:You will receive written comments in your Sorrell Center mailbox.
58 COM Professionalism Forms: Will be filled out on each student and sent to Sue Pope along with your grade at the end of the clerkship.NOTE: This is separate from your actual “letter” grade received at the end of the clerkship.
59 Evaluations for Students to Complete Department evaluationsEvaluations of lecturesEvaluations of individual faculty and residentsCOM on-line evaluation**We value your input!!
60 Student of the WeekOne student may be chosen each week as Student of the WeekWeeks 2-6Announced at Grand RoundsNominations by house staff and facultyUNMC and Methodist students