Presentation on theme: "OB-GYN 251 Integrated Clinical Clerkship in Obstetrics and Gynecology"— Presentation transcript:
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 Espinosa2nd yr: Zedrix Gallito, Tes Alferez1st yr: Ryan Joseph Lirazan,Gia Pastorfide,Limavel Ann Veloso
4 Learning ObjectivesAt the end of the clinical rotation, the student should be able to:Proper history takingComplete physical examination
5 Learning ObjectivesTake part in the diagnosis and management of obstetric patientsDiagnose normal pregnancy, and identify abnormalities during labor, delivery and the postpartum periodInterpret laboratory examinationsSVD with episiotomy and repairDiagnose common pathologic conditionsPropose a plan of managementCounsel regarding breastfeedingAdvise patients regarding contraception
6 Learning ObjectivesTake part in the diagnosis and management of gynecologic patientsDiagnose common pathologic conditionsPropose a plan of managementDiscuss the various operative procedures done in obstetrics and gynecologyDiscuss the indications and contraindicationsEnumerate possible complicationsOutline the stepsAssist in various operative procedures in obstetrics and gynecology
7 Learning Objectives To develop the following attitudes: Good bedside mannersGender sensitivityCompassionResponsibilityInitiativeTeamworkSelf-initiated learning
8 Teaching Strategies Departmental Conferences Small Group Discussions / Bioethics DiscussionPublic Health ForaClinical Exposure
9 Teaching Strategies Priorities Department Conferences Small Group Discussion/Public Health ForumPatient for ORPosts
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 / blockA topic for the small group discussion (SGD) will be assigned today: 3 ob topics, 2 gynecologic topicsLook for a case, submit a case protocol with guide questionsDeadline: Friday 1st week send to dr. Gaddi’sDistribute 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 moderator1 secretary1 who will summarizeAll the students will be graded
13 2. Small Group Discussion Bioethics Case: The Art of MedicineCase will be givenConsultant will be the moderatorAll the students will be gradedCan 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 contributionsAsks intelligent/relevant questionsRespects the opinion of othersFrequency of Participation ……………… 30%Logical Approach to Problem Solving…. 30%Has initiative and resourcefulnessHas relevanceHas 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 W16Only 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: WardsDuty: OBAS / LR-DRPost-duty
19 Clinical Exposure Preduty Day: Wards Receive endorsement from the outgoing studentsAccompany the ward resident as she makes roundsFollow-up results or scheduling of diagnostic testsMonitor patients at the wards and refer problematic patientsWill become TICs and assists in gynecologic cases of post-duty clerks from pm
20 Clinical Exposure Preduty Day: Wards Accompany patients for diagnostic examinationsAdministration of intravenous medications unless otherwise specifiedInsertion of intravenous lines and urethral cathetersEndorse 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 admissionsGyne elective (W14B): deckDecked student: SIC: do history and PE, accomplish necessary paperworkDecking order: Ward 14B clerkWard 15 clerkWard 16 clerkIMU clerkRBC clerkStudents’ 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 admissionAssist 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 operationProgress notes, except ob-normal and NSNI abortion casesNontoxic patient: daily for the first 3 days, then every 3 daysToxic patients: dailyAll 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 BTLNo 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 clerksExtra student may be asked to transfer from OBAS to LR/DR if it is more toxic in the LR/DRBring scrub suit, even if OBAS post
25 Clinical Exposure Duty Day: OBAS History, physical and internal examinationFormulates a working diagnosis and plan of managementPatient for admission: inserts IV catheter and foley catheter, collects laboratory specimens, makes the flag, and lab requestsThe 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 abortionsClerks will NOT be decked gynecologic cases admitted at the emergency room, as well as IMU admissionsDuring 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 examinationMonitors progress of laborMakes a partogram and inserts into chart before transfer to the wardsInterpret 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 residentComplete 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 operationStudents are in-charge of submitting their patients’ specimen for histopathologic studyMonitors patients in the recovery room
31 Clinical Exposure Post Duty Day With unresolved cases at the labor/delivery room, must remain with their patientsEndorse their cases to the clerks on duty:12 PMon weekdays7 AM weekendsMust 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 ExposureCriteria for Evaluation of Ward (30%)Surgical Technique %Background Knowledge %Responsibility and Reliability %Attitude %Communication %Attendance %
33 Clinical ExposureOn 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%OSCEWard performance30%Average of SGD grade20%Public health forumTotal100%
37 ObGyn 251 1- 8x10 index card: with picture Information card: to be submitted todayNameNicknameBlockDate of rotationServiceContact numberLeave in envelope in clerks’ pigeonhole
38 ObGyn 251 Attendance: Clerk’s attendance logbook: 1 per service Summary rounds: 7:06 – late7:15 - absent
39 ObGyn 251 Absence in a 24-hour or ward duty Excused absence: 1:1Unexcused absence: 1:2Tardiness or absence in a departmental conference:3 Lates: 1 absenceAbsent: 4 hours AS duty
40 ObGyn 251 Failure to accomplish required paperwork: Tardiness or absence in a public health forum or SGDAbsent: 4 hours AS duty + written reportFailure 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: 1:2Other demerits / deficiencies will be discussed with the consultant monitor
41 ReferencesRequired: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 folderHave the list of SGD topics, assignHave a copy of the bioethics caseHave a copy of grading sheetsHave a copy of the WHO book, for sharing among the blockRe-deck patients that were endorsed by the last block
43 Today…Pig’s legsRounds on patients endorsed by the previous set of clerksQuestions?
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