OB/Gyn Student Clerkship Evaluation Form:

Gynecology Block

STUDENT NAME:____________________________  DATE:_____________                                 

Knowledge and Skills Expectations: (for your reference, will be tested on oral examination and shelf examination)

Students completing the Gynecology block should be able to do the following:   
1)  Write a complete operative note and postoperative orders
2)  Discuss the normal hospital course after a routine Gyn surgical procedure
3)  Discuss the appropriate work-up and differential for postoperative 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, laparoscopic)

Final Grade:  _______________(Honors, High Pass, Pass, Marginal)

Summary Comments
(comments suggested for Dean’s Letter of Recommendation): 

Constructive Comments
(comments intended for use by student and advisor in planning future study; not for use in Dean’s letter): 

Updated Last:  August 3, 2003