OB-GYN 251 Clinical Clerkship in Obstetrics and Gynecology Learning Unit VI
OB-GYN 251 o Clinical exposure in a hospital setting o Duration of rotation: 1 month
OB - GYN 251 o Course Coordinators: Sybil Lizanne R. Bravo, M. D. Joey Santiago, M. D. o Resident Monitors: 3 rd yr: May Domingo, Lui Tanchoco, Char Flores 2 nd yr: Maan De Castro, Febi De Ramos, Miko Chan 1 st yr: Gen Ortega, She Lagonilla, Raissa Tud
Learning Objectives At the end of the clinical rotation, the student should be able to: o Proper history taking o Complete physical examination
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
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
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
Teaching Strategies 1. Departmental Conferences 2. Small Group Discussions / Bioethics Discussion 3. Public Health Fora 4. Lectures 5. Clinical Exposure
Teaching Strategies Priorities o College Activities o Department Conferences o Small Group Discussion/Public Health Forum o Patient for OR o Posts
1. Departmental Conferences o Summary Rounds (weekdays 77: 30) o Staff Conference (Tuesdays 7: 309: 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
2. Small Group Discussion n Grouped into three’s or four’s. Total of 5 groups / block n A topic for the small group discussion (SGD) will be assigned today: 3 ob topics, 2 gynecologic topics n Look for a case, submit a case protocol with guide questions n Deadline: Friday 1 st week send to Dr. Domingo’s email: maynilamd@gmail. com / myedomingo@yahoo. com. sg Distribute to all members of the block to study the case and prepare for the SGD. n * Schedule will be announced, date and time of activities are subject to consultants availability
2. Small Group Discussion n Assign from the group in charge: n 1 moderator n 1 secretary n 1 who will summarize n All the students will be graded
2. Small Group Discussion Bioethics Case: The Art of Medicine n Case will be given n Consultant will be the moderator n All the students will be graded n Can use LU V bioethics module as a reference
2. Small Group Discussion Sexual Assault Case n Case will be given n Consultant will be the moderator n All the students will be graded n Lecture to be given
2. Small Group Discussion Criteria for Evaluation During a Small Group Discussion (20%) Quality of Participation …………………. 40% n Makes significant contributions n Asks intelligent/relevant questions n Respects the opinion of others Frequency of Participation ……………… 30% Logical Approach to Problem Solving…. 30% n Has initiative and resourcefulness n Has relevance n Has organization
3. Public Health Forum n n n Divide into 3 groups Topics o (A) Myths and misconceptions in the postpartum period W 15 o (B) Postsurgical care and concerns W 14 B o (C) Breastfeeding W 16 Only reporters are required to be present
3. Public Health Forum Criteria for Evaluation During a Public Health Forum (10%) Manner of Presentation………………. 50% n n Use of visual aids (10%) Stage Presence (10%) Manner of delivery, note on emphasis (10%) Creativity (20%) Content………………. . ……………… n n 30% Organization (15%) Completeness (15%) Audience Impact…………………. . …. 30%
4. Lectures n Sexual Assault n Art of Medicine o Power dressing, grooming o Visual aids and speech delivery o Output: Topic Conference at the end of the rotation Ø Submit case and topic for presentation by 3 rd week
5. Clinical Exposure o o o 3 services (5 -5 -5) 24 -hour duties, every 3 days Preduty: Wards Duty: OBAS / LR-DR Post-duty
Clinical Exposure Preduty Day: Wards o Ward 15: o Ward 16: o Ward 14 B: o IMU: o Floater 1 clerk
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 12 - 4 pm
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
Clinical Exposure Preduty Day: Wards o Elective Admissions o OB elective (W 15 or 16): deck, and accomplish OB sheet for all obstetric elective admissions o Gyne elective (W 14 B): deck o Decked student: SIC: do history and PE, accomplish necessary paperwork
Clinical Exposure Preduty Day: Wards o Responsibilities for own patient: o Clinical history, clinical abstract, discharge summary should be incorporated into the patient’s chart within 24 hours from the patient’s 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 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.
Clinical Exposure Duty Day o OB admitting section – 2 clerks o LR/DR/RR – 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
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)
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.
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
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
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 patient’s chart
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
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 PM on weekdays o 8 AM weekends o Must be properly endorsed, all forms must be accomplished (death certificate, histopath forms, endorsement sheet) prior to leaving
Clinical Exposure Criteria for Evaluation of Ward (30%) Surgical Technique ---------10% Background Knowledge ------25% Responsibility and Reliability -------20% Attitude ---------------20% Communication ----------10% Attendance -------------15%
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
Groupings o 3 Services o SGD: 5 groups of 3 -4 students each o Public Health Forum: 3 groups (per service)
Evaluation Scheme Comprehensive examination Written examination OSCE Ward performance Average of SGD grade Public health forum Total 10% 15% 30% 20% 100%
Evaluation Scheme Conversion of final grade 60 -64. 99 3. 0 65 -69. 99 2. 75 70 -74. 99 2. 5 75 -79. 99 2. 25 80 -84. 99 2. 0 85 -89. 99 1. 75 90 -93. 99 1. 5 94 -97. 99 1. 25 98 -100 1. 0
Ob. Gyn 251 o 1 - 3 x 5 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
Ob. Gyn 251 o Attendance: o Clerk’s attendance logbook: 1 per service o Summary rounds: 7: 06 – late 7: 15 - absent
Ob. Gyn 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
Ob. Gyn 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
o Lockers are provided for the duty team. o Get the key from the charge nurse before you start your duty and return them when duty ends.
References Required: Cunningham FG, et al. William’s Obstetrics, 23 rd Ed. Mc. Graw-Hill, New York, 2009. Stenchever, MA et al. Comprehensive Gynecology, 5 th Ed. Mosby, St. Louis, 2007. Others: Sumpaico, et al. Textbook of Obstetrics (Physiologic and Pathologic), 2 nd Ed. Graphic Line Enterprises, Makati, 2002. Managing Complications in Pregnancy and Childbirth: A Guide for Midwives and Doctors. World Health Organization, India, 2003.
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
Today… o Pig’s legs o Rounds on patients endorsed by the previous set of clerks o Questions?
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