1. OB-GYN 251 Integrated Clinical Clerkship in Obstetrics and Gynecology
Learning Unit VI

2. OB-GYN 251 Clinical exposure in a hospital setting
Duration of rotation: 1 month

3. OB - GYN 251 Course Coordinators: Resident Monitors:
Sybil Lizanne R. Bravo, M.D.
Joey Santiago, M.D.
Resident Monitors:
3rd yr: Andrea Gaddi, Johanna Espinosa
2nd yr: Zedrix Gallito, Tes Alferez
1st yr: Ryan Joseph Lirazan,
Gia Pastorfide,
Limavel Ann Veloso

4. Learning Objectives
At the end of the clinical rotation, the student should be able to:
Proper history taking
Complete physical examination

5. Learning Objectives
Take part in the diagnosis and management of obstetric patients
Diagnose normal pregnancy, and identify abnormalities during labor, delivery and the postpartum period
Interpret laboratory examinations
SVD with episiotomy and repair
Diagnose common pathologic conditions
Propose a plan of management
Counsel regarding breastfeeding
Advise patients regarding contraception

6. Learning Objectives
Take part in the diagnosis and management of gynecologic patients
Diagnose common pathologic conditions
Propose a plan of management
Discuss the various operative procedures done in obstetrics and gynecology
Discuss the indications and contraindications
Enumerate possible complications
Outline the steps
Assist in various operative procedures in obstetrics and gynecology

7. Learning Objectives To develop the following attitudes:
Good bedside manners
Gender sensitivity
Compassion
Responsibility
Initiative
Teamwork
Self-initiated learning

8. Teaching Strategies Departmental Conferences
Small Group Discussions / Bioethics Discussion
Public Health Fora
Clinical Exposure

9. Teaching Strategies Priorities Department Conferences
Small Group Discussion/Public Health Forum
Patient for OR
Posts

10. 1. Departmental Conferences
Summary Rounds (weekdays 7-7:30)
Staff Conference (Tuesdays 7:30-9:00)
Pre-operative conference (Thursdays 7:30-9:00)
*After departmental conferences, the clerks are given 30 minutes to make rounds on their patients

11. 2. Small Group Discussion
Grouped into three’s or four’s. Total of 5 groups / block
A topic for the small group discussion (SGD) will be assigned today: 3 ob topics, 2 gynecologic topics
Look for a case, submit a case protocol with guide questions
Deadline: Friday 1st week send to dr. Gaddi’s
Distribute to all members of the block to study the case and prepare for the SGD.
* Schedule will be announced, date and time of activities are subject to consultants availability

12. 2. Small Group Discussion
Assign from the group in charge:
1 moderator
1 secretary
1 who will summarize
All the students will be graded

13. 2. Small Group Discussion
Bioethics Case: The Art of Medicine
Case will be given
Consultant will be the moderator
All the students will be graded
Can use LU V bioethics module as a reference

14. 2. Small Group Discussion
Criteria for Evaluation During a Small Group Discussion (20%)
Quality of Participation …………………. 40%
Makes significant contributions
Asks intelligent/relevant questions
Respects the opinion of others
Frequency of Participation ……………… 30%
Logical Approach to Problem Solving…. 30%
Has initiative and resourcefulness
Has relevance
Has organization

15. 3. Public Health Forum Divide into 3 groups Topics
(A) Myths and misconceptions in the postpartum period W15
(B) Postsurgical care and concerns W14B
(C) Breastfeeding W16
Only reporters are required to be present

16. Criteria for Evaluation During a Public Health Forum (10%)
Manner of Presentation………………. 50%
Use of visual aids (10%)
Stage Presence (10%)
Manner of delivery, note on emphasis (10%)
Creativity (20%)
Content………………..……………… 30%
Organization (15%)
Completeness (15%)
Audience Impact…………………..…. 30%

17. 4. Clinical Exposure 3 services (5-5-6) 24-hour duties, every 3 days
Preduty: Wards
Duty: OBAS / LR-DR
Post-duty

18. Clinical Exposure Preduty Day: Wards Ward 15: 1 clerk
Ward 16: 1-2 clerks
Ward 14B: 1 clerk
IMU: 1 clerk
Reproductive Biology Center (RBC)/floater: 1 clerk

19. Clinical Exposure Preduty Day: Wards
Receive endorsement from the outgoing students
Accompany the ward resident as she makes rounds
Follow-up results or scheduling of diagnostic tests
Monitor patients at the wards and refer problematic patients
Will become TICs and assists in gynecologic cases of post-duty clerks from pm

20. Clinical Exposure Preduty Day: Wards
Accompany patients for diagnostic examinations
Administration of intravenous medications unless otherwise specified
Insertion of intravenous lines and urethral catheters
Endorse problematic cases and patients for monitoring to the next students on duty

21. Clinical Exposure Preduty Day: Wards Elective Admissions
OB elective (W15 or 16): deck, and accomplish OB sheet for all obstetric elective admissions
Gyne elective (W14B): deck
Decked student: SIC: do history and PE, accomplish necessary paperwork
Decking order: Ward 14B clerk
Ward 15 clerk
Ward 16 clerk
IMU clerk
RBC clerk
Students’ responsibility at ward 15, 16 and 14b to check with the nurses the list of patients admitted until seven AM the following day

22. Clinical Exposure Responsibilities for own patient: Preduty Day: Wards
Clinical history, clinical abstract, 2 discharge summaries should be incorporated into the patient’s chart within 24 hours from the patient’s admission
Assist in the OR of his/her patient/s, make a diagrammatic sketch of surgical findings, to be incorporated into the chart within 24 hours of the operation
Progress notes, except ob-normal and NSNI abortion cases
Nontoxic patient: daily for the first 3 days, then every 3 days
Toxic patients: daily
All paperwork should be accomplished prior to discharge.

23. Clinical Exposure Preduty Day: RBC
Assist in the operations (commonly involving surgical sterilization and manual vacuum aspiration) and monitor post-operative patients
*** If a student does not adhere to the practice of contraception, please inform the resident so she will be exempted from assisting in BTL
No OR, the clerk assigned to the RBC goes to ward 15/16 or the more toxic ward to help the students assigned there.

24. Clinical Exposure Duty Day OB admitting section – 3 clerks
LR/DR/RR – 2-3 clerks
Extra student may be asked to transfer from OBAS to LR/DR if it is more toxic in the LR/DR
Bring scrub suit, even if OBAS post

25. Clinical Exposure Duty Day: OBAS
History, physical and internal examination
Formulates a working diagnosis and plan of management
Patient for admission: inserts IV catheter and foley catheter, collects laboratory specimens, makes the flag, and lab requests
The student who managed patient at the OBAS endorses the case to the SIC (I.e. diagnosis, cervical dilatation, plan)

26. Clinical Exposure Duty Day: OBAS
Monitor patients who do not need immediate admission but must stay at the OBAS for observation
** Obstetric patients who are admitted but will eventually be transferred to the wards for further work-up and monitoring (IMU patients) are NOT assigned to a clerk and are instead decked to interns.

27. Clinical Exposure Duty Day: LR/DR
Clerks are decked twice, interns decked once for each rotation of OB normal and NSNI abortions
Clerks will NOT be decked gynecologic cases admitted at the emergency room, as well as IMU admissions
During the 1st week, will have a co-decked intern (buddy) to guide you, but the patient is ultimately, still the clerks responsibility

28. Clinical Exposure Duty Day: LR/DR
SIC does a complete history and physical examination
Monitors progress of labor
Makes a partogram and inserts into chart before transfer to the wards
Interpret the results of intrapartal traces and has it counterchecked by a resident on duty

29. Clinical Exposure Duty Day: LR/DR
Assist residents in normal deliveries and towards the end of the rotation, may be allowed to become the primary attendant, supervised by a resident
Complete the OB sheet and incorporate it into the patient’s chart

30. Clinical Exposure Duty Day: LR/DR
Assist in the operation of the patients and incorporate a detailed description of the intraoperative findings and specimen drawing when necessary, checked by the surgeon or assist present in the operation
Students are in-charge of submitting their patients’ specimen for histopathologic study
Monitors patients in the recovery room

31. Clinical Exposure Post Duty Day
With unresolved cases at the labor/delivery room, must remain with their patients
Endorse their cases to the clerks on duty:
12 PMon weekdays
7 AM weekends
Must be properly endorsed, all forms must be accomplished (death certificate, histopath forms, endorsement sheet) prior to leaving

32. Criteria for Evaluation of Ward (30%)
Clinical Exposure
Criteria for Evaluation of Ward (30%)
Surgical Technique %
Background Knowledge %
Responsibility and Reliability %
Attitude %
Communication %
Attendance %

33. Clinical Exposure
On 3 days of the rotation, the students will have only a 12 hour duty to enable them to prepare for the OSCE and their next rotation (7 AM – 7 PM )
Inform monitor of your preferred dates

34. Groupings 3 Services SGD: 5 groups of 3-4 students each
Public Health Forum: 3 groups (per service)

35. Evaluation Scheme Comprehensive examination 10% Written examination
15%
OSCE
Ward performance
30%
Average of SGD grade
20%
Public health forum
Total
100%

36. Evaluation Scheme
Conversion of final grade

37. ObGyn 251 1- 8x10 index card: with picture
Information card: to be submitted today
Name
Nickname
Block
Date of rotation
Service
Contact number
Leave in envelope in clerks’ pigeonhole

38. ObGyn 251 Attendance: Clerk’s attendance logbook: 1 per service
Summary rounds: 7:06 – late
7:15 - absent

39. ObGyn 251 Absence in a 24-hour or ward duty
Excused absence: 1:1
Unexcused absence: 1:2
Tardiness or absence in a departmental conference:
3 Lates: 1 absence
Absent: 4 hours AS duty

40. ObGyn 251 Failure to accomplish required paperwork:
Tardiness or absence in a public health forum or SGD
Absent: 4 hours AS duty + written report
Failure to accomplish required paperwork:
4 hours extra duty for every paper work, for each day it is not submitted or incorporated into the chart (as reported by RIC)
Sunday/Holidays: 1:2
Other demerits / deficiencies will be discussed with the consultant monitor

41. References
Required:
Cunningham FG, et al. William’s Obstetrics, 22nd Ed. McGraw-Hill, New York, 2005.
Stenchever, MA et al. Comprehensive Gynecology, 4th Ed. Mosby, St. Louis, 2001.
Others:
Sumpaico, et al. Textbook of Obstetrics (Physiologic and Pathologic), 2nd Ed. Graphic Line Enterprises, Makati, 2002.
Managing Complications in Pregnancy and Childbirth: A Guide for Midwives and Doctors. World Health Organization, India, 2003.

42. Before you leave, must have:
Submitted your index cards and block folder
Have the list of SGD topics, assign
Have a copy of the bioethics case
Have a copy of grading sheets
Have a copy of the WHO book, for sharing among the block
Re-deck patients that were endorsed by the last block

43. Today…
Pig’s legs
Rounds on patients endorsed by the previous set of clerks
Questions?