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OB-GYN 251 Clinical Clerkship in Obstetrics and Gynecology Learning Unit VI 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 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 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 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 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 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 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 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 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: 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 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: [email protected] com / [email protected] 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 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 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 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 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) 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 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 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, 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 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 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 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 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 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 – 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 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 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 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 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 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 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 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% 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 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 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 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 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 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 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 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 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 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 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 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 Today… o Pig’s legs o Rounds on patients endorsed by the previous set of clerks o Questions?