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1 Welcome! Please help yourself to refreshments provided.
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 *Mrs. Janice Golka -Residency Coordinator *Karen Carlson, MD -Clerkship Director -Generalist Faculty *Katherine Finney, MD -Assistant Clerkship Director

3 Orientation Agenda Morning: Lunch: Afternoon: Video/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 Orientation
Monday, April 8th, @ 5 pm All students assigned to Methodist for OB Report to: Methodist Women’s Hospital 707 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 pm All students assigned to Methodist for OB Report to: Methodist Hospital 84th and Dodge Street (south tower): Kim Thorson CERNER Training will begin at 5 pm Please 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-Gyn 4 year residency Maternal-Fetal Medicine 3 year fellowship Oncology Reproductive Endocrinology Urogynecology/pelvic and reconstructive surgery Minimally Invasive GYN Surgery 2 year fellowship Pediatric and Adolescent Gynecology

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 3-4 Weeks 5-6
Obstetrics Gynecology Clinics (UNMC or MWH) 1 wk Gyn Onc/1 wk Gyn Surg see advisor schedule * Clinic schedule found on Weekly Advisor Schedule

10 *Sample Advisor Schedule:
Monday Tuesday Wednesday Thursday Friday 700AM DOG Conf 800AM Grand Rounds STUDY TIME Lectures 9am-12:00 OCWH 8 am-12pm clinic OCWH 1pm-5pm Village Pointe 1pm-5pm OCWH 1 pm-5pm Week 1 AM---- Week 1 PM -----

11 Night Call 24 hour call Expect approximately
3 weeknights and one weekend night During OB Methodist Hospital UNMC

12 Course Textbooks

13 Educational materials
Click Education tab Lecture materials located here Click M3 Students Click Lectures Orientation/Resident’s Power Point presentation Click Orientation

14 4 Required Educational Resources
1.uWISE – APGO educational testing module Create user name/password to access extension gives access 2. Pelvic Examination

15 4 Required Educational Resources
3. Fetal Heart Tones * *Intrapartum Fetal Heart Rate Monitoring: Nomenclature, Interpretation, and General Management Principles ACOG Practice Bulletin No. 106 4. 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 join Association of Professors of Gynecology and Obstetrics (APGO) uWise APGO Medical Student Education Objectives, 9th ed.

17 Clerkship Expectations:
* 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 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 of MFM

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?
Abby Delaney, MD UNMC OB Libby Crockett, MD UNMC ONC Jean Huff Chakraborty, MD UNMC GYN Valerie French, MD UROG at Methodist

22 Who are the Methodist Residents?
Ashley Thorson, MD OB Currently until 5/1 Heather Said, MD High Risk OB Currently until 5/1 Jake Gibbens, MD OB Beginning 5/1 Amanda Buskevicius, MD High Risk OB Beginning 5/1

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

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

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

26 Methodist Generalists
Michelle S. Knolla, MD Tifany L. Somer-Shely, MD Lanette Guthmann, M.D. Rebecca L. Jacobi, MD Thomas E. Martin, MD Allison 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 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 3-4 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

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 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 Dr. Remmenga’s and Dr. Rodabaugh’s clinics

34 Gynecology Block: Appropriate attire Students presentations (2)
scrubs when scheduled to be in OR no scrubs when going to clinics Students presentations (2) Benign Gyn week Onc 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/ 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 DRC 1004 (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 will vary!) Pre-op conference (Luikart) Thursdays 7:00 (time 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 Friday: ONC student presentation Oncology topic 5-10 minute prepared presentation with handout -use evaluation form provided -staple copy of handout to form Present to oncology team 5 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-weeks Dr. Remmenga usually hosts All students are expected to attend Lunch is provided Luikart library, MSB 45119 Your feedback is highly appreciated!

46 Communication Please read your email
We all communicate by 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 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 . 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 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 9 AM 5% GYN presentation 5% ONC 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

51 UNMC Shelf scores compared to National average

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 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.

53 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 to Mrs Requests must be made within 30 days of grades being ed to students OB/Gyn department has committee to evaluate these requests

54 Professionalism Expectations:
Attendance Be on-time to activities Take your professional role seriously Demonstrate respect patients ancillary staff nurses supervising residents faculty fellow students

55 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.

56 Professionalism Problems: Other examples
Use of cell phones during conferences/lectures Inappropriate treatment of clinic or nursing staff Not following patients after surgery/delivery Missing deliveries/surgeries when notified by resident/staff Residents 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 evaluations Evaluations of lectures Evaluations of individual faculty and residents COM on-line evaluation **We value your input!!

60 Student of the Week One student may be chosen each week as Student of the Week Weeks 2-6 Announced at Grand Rounds Nominations by house staff and faculty UNMC and Methodist students

61 Student Permission Form


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