M3 OB/GYN ClerkshipWelcome! Please help yourself to refreshments provided.

WELCOME!

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-Generalist Faculty

Orientation AgendaMorning:

▫ 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

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. (ask @ 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).

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. 402 354-4038)

•Park in parking lot.

Subspecialties in Ob-Gyn• General Ob-Gyn

▫ 4 year residency• Maternal-Fetal Medicine

▫ 3 year fellowship• Oncology

▫ 3 year fellowship• Reproductive Endocrinology

▫ 3 year fellowship• Urogynecology/pelvic and reconstructive surgery

▫ 3 year fellowship• Minimally Invasive GYN Surgery

▫ 2 year fellowship• Pediatric and Adolescent Gynecology

▫ 2 year fellowship

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)

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

Sample Schedule

• Student A:

• Weeks 1-2 Weeks 3-4 Weeks 5-6Obstetrics Gynecology Clinics(UNMC or MWH) 1 wk Gyn Onc/1 wk Gyn Surg see advisor schedule

* Clinic schedule found on Weekly Advisor Schedule

*Sample Advisor Schedule:

Week 1 AM----

Week 1 PM -----

Monday Tuesday Wednesday Thursday Friday        700AM DOG Conf     

   

800AM Grand Rounds 

STUDY TIME STUDY TIMELectures 9am-12:00

 

OCWH 8 am-12pm STUDY TIME

       

         

         

    clinic    

STUDY TIMEOCWH 1pm-

5pmVillage Pointe

1pm-5pm OCWH 1pm-5pmOCWH 1 pm-

5pm         

• 24 hour call• Expect approximately• 3 weeknights and one weekend night

• During OB• Methodist Hospital • UNMC

Night Call

Course Textbooks

Educational materials

•www.unmc.edu/obgyn

•Click Education tab▫Lecture materials located here

Click M3 Students Click Lectures

▫Orientation/Resident’s Power Point presentation Click M3 Students Click Orientation

4 Required Educational Resources

1.uWISE – APGO educational testing module http://www.apgo.org/student/uwise2.html

▫ Create user name/password to access ▫ unmc.edu extension gives access

2. Pelvic Examination

http://www.nejm.org/doi/full/10.1056/NEJMvcm061320

4 Required Educational Resources3. Fetal Heart Tones

*www.ob-efm.com*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

Great Resources• 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.

Clerkship Expectations:

*www.apgo.org/members/medical-students.cfm

Specific expectations for each part of clerkship

*in folder

Review Books

•Should be used as a supplement to text•Please read required text!

GYN Rounder and OB Rounder

• GYN 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▫ Varies during the week

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

Who are the Chief Residents?

Abby Delaney, MDUNMC OB

Valerie French, MDUROG at Methodist

Jean Huff Chakraborty, MDUNMC GYN

Libby Crockett, MDUNMC ONC

Who are the Methodist Residents?

Ashley Thorson, MD

OBCurrently until 5/1

Jake Gibbens, MDOB

Beginning 5/1

Heather Said, MD

High Risk OBCurrently until 5/1

Amanda Buskevicius, MD

High Risk OBBeginning 5/1

Dr. Michael Levine

Dr. Neil Hamill

Dr. Robert Bonebrake

Dr. Katherine Foley

Dr. Andrew Robertson

Methodist MFMs

Dr. Todd Lovgren

Dr. Hemant Satpathy

Methodist Generalists

Craig Bassett, M.D. Paige Berryman, M.D.

Julia Bishop, M.D.

Mark Carlson, M.D.

Sarah Gernhart, M.D. Brianne M. Kling, MD

Judith A. Scott, DO

Methodist Generalists

• Susan Wescott, M.D.

Kristen Hoffman, M.D.

Megan Prickett, M.D. (Irwin)

Carolee Jones, M.D.

Nancy Mathews, M.D.

William D. Weidner, MD

Methodist Generalists

Lanette Guthmann, M.D.

Allison Phillips, M.D.

Tifany L. Somer-Shely, MD

Rebecca L. Jacobi, MD

Michelle S. Knolla, MD

Thomas E. Martin, MD

Methodist physicians consistently identified

by previous students as great teachers:

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

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

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/ faculty2)  Interpret and document fetal heart rate monitoring strips3)  Assess and document labor course in patients, postpartum assessments4)  Understand the normal hospital course for the patient after a normal vaginal delivery or operative C/S delivery

Preparing for Morning Rounds▫Talk with residents about abnormal

assessments before morning report to faculty

- for example, wound drainage▫Have notes written on time

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

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 ▫ OR cases ▫ Dr. Remmenga’s and Dr. Rodabaugh’s clinics

Gynecology Block:

•Appropriate attire▫scrubs when scheduled to be in OR▫no scrubs when going to clinics

•Students presentations (2)▫Benign Gyn week▫Onc week

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

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)

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

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 smears4)  Discuss indications for vulvar biopsy and

endometrial biopsy5)  Appropriately counsel patients on choices of

contraception/sterilization6)  Discuss issues related to risks and benefits of

hormone replacement therapy

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”

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

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

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

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

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

Vice Chairman’s Luncheon

•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!

Communication

•Please read your email▫We all communicate by email

•Notes on board on Wednesday am at lectures

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 email 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 email.

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.

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 clerkship @ 9 AM

• 5% GYN presentation

• 5% ONC presentation

PASS, HIGH PASS, HONORS

•Our department complies with the College of Medicine’s recommended grade distribution of

▫20% = Honors▫20% = High Pass▫60% = Pass

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

676869707172737475767778

2001-02

2002-03

2003-04

2004-05

2005-06

2006-07

2007-08

2008-09

2009-10

2010-11

2011-12

Nat'l

UNMC

UNMC Shelf scores compared to National average

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.

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 email to Mrs Ingraham @ ningraham@unmc.edu

•Requests must be made within 30 days of grades being emailed to students

•OB/Gyn department has committee to evaluate these requests

Professionalism Expectations:

• Attendance• Be on-time to activities• Take your professional role seriously• Demonstrate respect

▫ patients ▫ ancillary staff▫ nurses▫ supervising residents▫ faculty ▫ fellow students

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.

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

Feedback

• Mid Clerkship meeting:▫ 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.

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.

Evaluations for Students to Complete•Department evaluations

▫Evaluations of lectures▫Evaluations of individual faculty and residents

•COM on-line evaluation

**We value your input!!

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

Student Permission Form

The END

QUESTIONS???