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Welcome to the OB/Gyn 3rd
Year
Medical Student rotation
The following orientation materials should
be used to better familiarize yourself with how your rotation will be
structured. This information
will assist you in making the most of your experience with us.
OB/Gyn services do not typically spend hours each day in structured rounds . . . therefore
“open” or unstructured time should be used wisely.
Students have only 6 weeks to cover a wide range of clinical problems
seen by Ob/Gyn's so it is important that students use “down-time” for
directed studying. Learning
objectives and recommendations on directed studying for each of our three
(3) clinical blocks on our teaching services has been provided.
Please refer to these before, during, and after each two-week session
to confirm that you are directing your learning experience appropriately.
Visit the OB/Gyn Department’s student web page to be linked to the
sites listed under the directed studying portion of these materials.
A note about Methodist student rotation:
during the six-week rotation, only 3 weeks will be spent on the
Methodist campus- Obstetrics block on Labor and Delivery and the one- week
of Benign Gynecology participating in the private OB/Gyn’s cases.
The Gynecology Oncology week and your two-week Outpatient Clinics
block will take place on UNMC campus or satellite clinics.
Dr. Craig Bassett is the support faculty member at Methodist Hospital
and he will more thoroughly describe the assignments for the obstetrics and
benign gynecology blocks at that location.
Good luck and remember to have fun.
General
Topics
Students are encouraged to not only
understand the clinical problems seen by Obstetrician/ Gynecologists, but
also gain exposure to other system issues facing the field.
These suggested areas are usually not to be found in textbooks, but
lend themselves to web-based learning:
* National OB/Gyn organizations
American College of Obstetricians and Gynecologists (ACOG) (www.acog.org)
Visiting this web site is a must for anyone attempting to learn about the
field of Ob/Gyn. On the right
hand side of the ACOG home page is a set of news releases that summarize
important studies or educational bulletins published by ACOG.
Please visit this site at least once during the rotation and learn
one way that practicing OB/Gyn’s keep updated on information in the field.
* Medical Malpractice/ Morbidity and
Mortality reviews:
All fields in medicine report difficulties in dealing with
the effects of medical malpractice. Please
take time to review the following sites to learn more about how the legal
system affects the field of OB/Gyn:
The U.S. Department of Health and
Human Services, Agency for Healthcare Research and Quality and UCSF School
of Medicine recently advertised a new web site.
Every month this site presents five interesting cases of medical
errors and patient safety issues- one of which is in the OB/ Gyn field.
Please review at the following address: http://www.webmm.ahrq.gov
This next web
site was developed by lawyers and may be used by the public to understand
more about legal options related to medical occurrences
http://www.medicalmalpracticefyi.com/
The following
link brings you to an example of cases in the field of OB/Gyn as summarized
in the Contemporary OB/Gyn journal.
http://www.contemporaryobgyn.net/be_core/search/show_article_search.jsp?
searchurl=/be_core/content/journals/g/data/1998/0300/g3a180.html&navtype=g&
query=malpractice+cases&heading=g&title=MALPRACTICE
Obstetrics Block
Two-week rotation on the in-patient
services which combines daytime work and night on-call responsibilities
(work rounds, teaching rounds, admissions, following laboring patients and
participating in deliveries and postpartum care).
All on Obstetrics block will attend daily morning and evening Labor
and Delivery unit team rounds. The
Chief Resident will release the student on night call to home after morning
rounds. Each student will be
scheduled on-call 3 week days and one weekend night.
Two students will be expected to attend work/teaching rounds on
Saturday and Sundays, and if not on-call that day will be off for the rest
of the day when rounds have been completed.
The OB Chief Resident on service will make
daily student work assignments (labor and delivery, Ultrasound clinic, high
risk OB clinic) keeping in mind the expectation that while on this 2 week
block, UNMC students should spend at least 2 ˝ days in ultrasound and one
˝ day seeing high risk OB patients (either in MFM or High Risk OB clinic). A similar arrangement will be set-up at Methodist Hospital.
Learning Objectives for Obstetrics
Block:
Cognitive:
Students should become familiar with the following topics:
Normal Obstetrics-
Preconception Counseling
Diagnosis of Pregnancy
Physiology and Maternal
Adaptation of Pregnancy
Antepartum Care including
Prenatal Diagnosis
Labor and Delivery including
induction of labor
Obstetric Analgesia and
Anesthesia
The Puerperium
Postpartum Care and
Lactation
Abnormal Obstetrics-
Bleeding in Pregnancy- second
and third trimester
Fetal Death in Utero
Dystocia
Breech
Cesarean section and VBAC
Hypertensive Disorders in
Pregnancy- Preeclampsia
Isoimmunization
Multiple Gestation
Intrauterine Growth Restriction
Premature Rupture of Membranes
Preterm Labor
Postpartum hemorrhage
Puerperal Fever
Medical and Surgical
Complications of Pregnancy:
Anemia, Cardiac Disease, Diabetes,
Pyelonephritis,
other Counseling on Male Circumcision
Ultrasound Clinic
Students will have exposure to ultrasound
and prenatal diagnosis in pregnancy by spending time with the High Risk
Obstetricians (MFM) and ultrasound technicians during ultrasound clinic. Students should focus on the following goals while spending time in
ultrasound clinic:
1) Understand the
components of an anatomic obstetric survey
2) Be familiar with
first trimester screening.
3)
Be familiar with
the QUAD screen testing and how normal or abnormal results affect counseling and testing
at time of ultrasound
4) Understand the
types of antenatal surveillance (such as NST (non-stress test), AFI (amniotic fluid index),
BPP (biophysical profile) available; understand indications for these tests
Some
students will get to see some unusual ultrasound findings and it would be
expected that the student would perform extra research into that anomaly.
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/ faculty
2)
Interpret and document fetal heart rate monitoring strips
3)
Assess and document labor course in patients, postpartum assessments
4)
Write appropriate post-delivery orders (vaginal and C/S)
5)
Understand the normal hospital course for the patient after a normal
vaginal delivery or operative C/S delivery
Gynecology
Block
This clinical block will give students
experience with benign and malignant gynecological problems.
During this two-week rotation, students will join the Benign
Gynecology and the Gynecology Oncology teams and assist in caring for
emergency room consultations, in-patient consultations from other services,
and pre-operative, intra-operative, and postoperative care of Gynecologic
surgical cases.
On the Gynecology Oncology service students
will attend morning and afternoon rounds as scheduled daily, Tuesday morning
Tumor conference, Chapter Review session on Friday afternoon, and will round
on Gyn-Onc patients one of the weekend days while on service.
On the Benign Gynecology week, students
will round with Residents daily on weekdays, and on one weekend day with the
team. They will be expected to
attend and participate in Gyn faculty teaching sessions scheduled at 0700AM
weekdays. Students will be
expected to participate in surgical cases:
review the preoperative work-up prior to the case, introduce
themselves to patient, be available to observe the case, and assist in
documentation, orders, and postoperative checks.
Learning Objectives for Gynecology
Block:
Cognitive:
Students should become familiar with the
following topics:
Normal menstrual
cycle, amenorrhea, and abnormal
uterine bleeding
Normal and
Abnormal Puberty
Contraception and
Sterilization
First Trimester
Bleeding and Abortion
Uterine fibroids
Menopause
Infections- vaginitis, sexually transmitted diseases, PID
Infertility
Hirsuitism and
Polycystic Ovarian Syndrome
Vulvar disorders
Pelvic relaxation and urinary
incontinence
Pelvic Pain including
dysmenorrhea, endometriosis,
ectopic pregnancy
Neoplasms of Vulva, Cervix,
Uterus, Ovaries, Gestational
Trophoblastic Disease
Sexual Assault
Gynecological
Procedures: Tubal ligation and
laparoscopy,
Hysteroscopy and D & C, Hysterectomy (vaginal,
abdominal,
laparoscopic), Surgery
for Urinary
incontinence and pelvic relaxation, Surgery for Gyn
Cancers
Knowledge and Skills expectations:
By the end of the Gynecology block students
will be expected to competently
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)
Out-patient Clinics Block
During this two-week clinical block,
students will learn about outpatient care of the pregnant and non-pregnant
female patient. Students will
be assigned to seven (7) ˝ days in the clinics, one ˝ day of structured
educational activities on Wednesday mornings, and two ˝ days of study time
each week of this block. Each
student will be assigned to a faculty Clinic Advisor and will do the
majority of their outpatient clinics with that advisor.
To get to the expected 7 ˝ days in clinic, each student will, in
addition to their clinic advisor’s clinics, be scheduled in other
“filler” clinics to round out their outpatient experiences.
Every attempt will be made to make sure all students have some
exposure to both outpatient gynecology and obstetric patients.
Clinic advisors have been given a list of the clinical block
objectives, knowledge and skills expectations, and recommended directed
studying assignments and will help guide students into fulfilling these
goals. Students on the outpatient clinics block will be expected to
attend daily GYN teaching rounds at 7 a.m. at
UNMC. Expceptions to this include Tuesday mornings for Methodist
students who meet with Dr. Basset.
Learning Objectives:
Students should become familiar with the
following topics: Obstetrics:
Prenatal
Care in the low risk patient
i.
New OB visit, schedule of testing and clinic visits
ii.
Weight gain recommendations
iii. Prenatal Diagnosis
iv. Counseling Vaginal Birth after Cesarean
section (VBAC)
Gynecology:
Contraception
and Sterilization
Spontaneous
and Induced Abortions
Medical and Surgical
Alternatives to Hysterectomy
Care of the Aging Female
Patient
Hormone Replacement Therapy
Annual
exam recommendations by different age groups
Sexually
Transmitted Disease counseling, testing,
and treatment
Triage
of abnormal Pap smears
Abnormal
Uterine Bleeding
Vulvar
Diseases
Minor
clinic procedures: IUD
placement, pessary fitting
and cleaning, biopsies
of vulva, cervix, uterus,
Counseling
on genetic testing
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
appropriate 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 smears
4)
Discuss indications for vulvar biopsy and endometrial biopsy
5)
Appropriately counsel patients on choices of contraception/
sterilization
6)
Discuss issues related to risks and benefits of hormone replacement
therapy
Last Updated: August 23, 2007 |