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

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Presentation on theme: "OB-GYN 251 Integrated Clinical Clerkship in Obstetrics and Gynecology Learning Unit VI."— Presentation transcript:

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

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

3 OB - GYN 251 o Course Coordinators: Sybil Lizanne R. Bravo, M.D. Joey Santiago, M.D. o Resident Monitors: 3 rd yr: Andrea Gaddi, Johanna Espinosa 2 nd yr: Zedrix Gallito, Tes Alferez 1 st 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: o Proper history taking o Complete physical examination

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

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

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

8 Teaching Strategies 1.Departmental Conferences 2.Small Group Discussions / Bioethics Discussion 3.Public Health Fora 4.Clinical Exposure

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

10 1. Departmental Conferences o Summary Rounds (weekdays 7- 7:30) o Staff Conference (Tuesdays 7:30- 9:00) o 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 threes or fours. 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 1 st week send to dr. Gaddis 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 3. Public Health Forum 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 o 3 services (5-5-6) o 24-hour duties, every 3 days o Preduty:Wards o Duty: OBAS / LR-DR o Post-duty

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

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

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

21 Clinical Exposure Preduty Day: Wards o Elective Admissions o OB elective (W15 or 16): deck, and accomplish OB sheet for all obstetric elective admissions o Gyne elective (W14B): deck o Decked student: SIC: do history and PE, accomplish necessary paperwork o Decking order:Ward 14B clerk Ward 15 clerk Ward 16 clerk IMU clerk RBC clerk o 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 Preduty Day: Wards o Responsibilities for own patient: o Clinical history, clinical abstract, 2 discharge summaries should be incorporated into the patients chart within 24 hours from the patients admission o 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 o Progress notes, except ob-normal and NSNI abortion cases o Nontoxic patient : daily for the first 3 days, then every 3 days o Toxic patients: daily o 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 o OB admitting section – 3 clerks o 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 o History, physical and internal examination o Formulates a working diagnosis and plan of management o Patient for admission: inserts IV catheter and foley catheter, collects laboratory specimens, makes the flag, and lab requests o 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 o 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 o Clerks are decked twice, interns decked once for each rotation of OB normal and NSNI abortions o Clerks will NOT be decked gynecologic cases admitted at the emergency room, as well as IMU admissions o During the 1 st 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 o SIC does a complete history and physical examination o Monitors progress of labor o Makes a partogram and inserts into chart before transfer to the wards o Interpret the results of intrapartal traces and has it counterchecked by a resident on duty

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

30 Clinical Exposure Duty Day: LR/DR o 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 o Students are in-charge of submitting their patients specimen for histopathologic study o Monitors patients in the recovery room

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

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

33 Clinical Exposure o 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 ) o Inform monitor of your preferred dates

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

35 Evaluation Scheme Comprehensive examination10% Written examination15% OSCE15% Ward performance30% Average of SGD grade20% Public health forum10% Total 100%

36 Evaluation Scheme Conversion of final grade

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

38 ObGyn 251 o Attendance: o Clerks attendance logbook: 1 per service o Summary rounds: 7:06 – late 7:15 - absent

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

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

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

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

43 Today… o Pigs legs o Rounds on patients endorsed by the previous set of clerks o Questions?

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