Transcript Welcome to OB/GYN - University of Nebraska Medical Center

M3 OB/GYN Clerkship
Welcome! Please help yourself to
refreshments provided.
Welcome to OB/GYN M3 Clerkship
*Karen Carlson, MD
-Clerkship Director
-Generalist Faculty
*Mrs. Teresa Ingraham
- Undergrad
Coordinator
*Katherine Finney, MD
-Assistant Clerkship Director
-Generalist Faculty
*Ms. Sarah Matya
-Residency
Coordinator
Orientation Agenda
Morning:
▫
▫
▫
▫
▫
Video/Tour
Clerkship Overview and Expectations
Pelvic Model
Pictures
Resident presentation
Lunch:
▫ Women’s Health History (Dr. Carlson)
Afternoon:
▫ Lectures:
 Lecture (Dr. Tomich)
 Fetal Heart Rate Monitoring and Physiological Changes
 M3 Survival Guide (Dr. Cudzilo)
Methodist Site Training
• Monday, September 29th, @ 5 pm
• All students assigned to Methodist for OB
• Report to: Medical Office Bldg
▫ (left of main hospital)
717 N. 190th St.
2nd Floor Stasny Rm
▫ CERNER Training will begin at 5 pm
(Kim Thorson)
▫ Please try to be at the staff office 5-10 minutes
before appointed time. See instructions in your
booklet
• Park in parking lot.
Methodist Site Orientation
• Following CERNER training, someone will take
you for your Methodist Wmn’s Hospital
orientation.
▫ Orientation at MH will begin promptly at 6-7 pm
(Kristen Koseluk)
• You will be given ID cards at orientation.
PLEASE: Return to Methodist Security at end of
rotation (Office is located next to Emergency
receptionist).
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
OB SHIFTS
• 12 hour shifts
• Expect approximately
• 8-11 shifts
• Days and nights
• Methodist Hospital or UNMC
Group 1 Call Schedule
7/07/2014-8/17/2014
12 hour
Week 1 7/7-13/2014
Monday 7/7
Tuesday
Wednesday
Thursday
Friday
UNMC:
am
Orientation
All Three
XXXX
Wichers/Brotkowski
Wichers/Brotkowski
Wichers
Wichers
pm
“
XXXX
XXXX
Gruhl
Gruhl
Gruhl/Brotkowski
Brotkowski/Gruhl
Orientation
All Three
XXXX
Schenk/Gurney
Schenk/Gurney
Schenk
Schenk
“
XXXX
XXXX
Schneider
Schneider
Schneider/Gurney
Gurney/Schneider
Methodist: am
pm
Week 2 7/14-20/2014
UNMC:
Saturday
Sunday 7/13
Monday 7/14
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday 7/20
am
Wichers
Brotkowski
XXXX
Gruhl/Brotkowski
Gruhl/Brotkowski
Gruhl/Brotkowski
Brotkowski
pm
Brotkowski
Brotkowski/Wichers
XXXX
Wichers
Wichers
Wichers
XXXX
Methodist: am
Schnek
Schneider
XXXX
Schneider/Gurney
Schneider/Gurney
Schneider/Gurney
Schneider
pm
Gurney
Gurney/Schnek
XXXX
Schnek
Schnek
Schnek
XXXX
Week 3 7/21-27/2014
Monday 7/21
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday 7/27
am
All Three
Nelson
XXXX
Nelson/Blount
Nelson/Blount
Nelson
Nelson
pm
XXXX
Chiu/Blount
XXXX
Chiu
Chiu
Chiu/Blount
Blount
All Three
Smith
XXXX
Smith/Dietle
Smith/Dietle
Smith
Smith
XXXX
Lukens/Dietle
XXXX
Lukens
Lukens
Lukens/Dietle
Dietle
Week 4 7/28-8/3/2014
Monday 7/27
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday 8/3
UNMC:
am
Chiu/Nelson
Chiu
XXXX
Chiu/Blount
Chiu/Blount
Chiu/Blount
Chiu
pm
Blount
Blount/Nelson
XXXX
Nelson
Nelson
Nelson
XXXX
Lukens/Smith
Lukens
XXXX
Lukens/Dietle
Lukens/Dietle
Lukens/Dietle
Lukens
Dietle
Dietle/Smith
XXXX
Smith
Smith
Smith
XXXX
UNMC:
Methodist: am
pm
Methodist: am
pm
Week 5 8/4-10/2014
UNMC:
Monday 8/2
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday 8/10
am
Burt
Burt
XXXX
Burt
Burt
XXXX
Kelly
pm
Kelly
Kelly
XXXX
Kelly
Kelly
Burt
Burt
Johnson/Rees
Johnson
XXXX
Sutton/Johnson
Sutton/Johnson
Sutton
Sutton
Sutton
Rees/Sutton
XXXX
Rees
Rees
Rees/Johnson
Johnson
Methodist: am
pm
Week 6 8/11-17/2014
Monday 8/11
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday 8/17
am
Kelly
Kelly
XXXX
Kelly
Shelf
XXXX
XXXX
pm
Burt
Burt
XXXX
XXXX
“
XXXX
XXXX
Methodist: am
Rees
Rees
XXXX
Rees
Shelf
Johnson/Sutton
Johnson/Sutton
XXXX
XXXX
“
XXXX
XXXX
UNMC:
pm
Course
Textbook
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 Resources
3. 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
*checked out CD from Ms. Teresa Ingraham
*available on clinic computer (bubble room)/*Luikart library
computers
http://www.slideshare.net/drsubir/colposcopy
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/medicalstudents.cfm
*
Should be used as a supplement to text
Please read required text!
Clerkship Expectations
*Specific expectations for each part of
clerkship in folder
Clerkship Expectations
• Medical Knowledge
▫ Explain normal physiologic changes of pregnancy including
interpretation of common diagnostic studies
▫ Describe common problems in obstetrics
▫ Demonstrate knowledge of intrapartum care
▫ Describe menstrual cycle physiology, and discuss puberty and
menopause
▫ Describe the etiology and evaluation of infertility
▫ Explain normal and abnormal bleeding
▫ Demonstrate knowledge of preconception care, including the
impact of genetics, medical conditions and environmental factors
on maternal health and fetal development
▫ Describe common breast conditions and outline evaluation of
breast complaints
▫ Demonstrate knowledge of perioperative care and familiarity with
gynecological procedures
▫ Describe gynecologic malignancies including risk factors, signs
and symptoms, and initial evaluation
Clerkship Expectations
• Patient Care
▫ Illustrate proficiency in the medical interview and physical
examination of women, incorporating ethical, social, and
diversity perspectives to provide culturally competent health
care
▫ Demonstrate knowledge of common benign gynecological
conditions
▫ Formulate a differential diagnosis of the acute abdomen and
chronic pelvic pain
▫ Provide a preliminary assessment of patients with sexual
concerns
Clerkship Expectations
• Interpersonal & Communication Skills
▫ Apply understanding of contraception, including sterilization
▫ Apply recommended prevention strategies to women throughout
the life span
• Professionalism
▫ Demonstrate the attitudes and professional behaviors
appropriate for clinical practice during ambulatory and inpatient
settings
• Practice-based Learning and Improvement
▫ Recognize their role as leaders and advocates for women
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 or 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?
Jake Gibbens, MD
ONC Methodist
11/1: OB UNMC
Ashley Thorson, MD
GYN UNMC
11/1 ONC Methodist
Sarah Lundin, MD
OB UNMC
11/1: ONC UNMC
Morgan Morton, MD
ONC UNMC
11/1 GYN UNMC
Who are the Methodist Residents?
Jamie Seeman, MD
Elective
11/1 AMB/GYN
Gina Torpin, MD
Night Float
11/1: High Risk OB
Jessie Loeffler, MD
GYN
11/1 GYN/AMB
Catherine Brockmeier, MD
High Risk OB
11/1 Night Flat
Methodist MFMs
Robert Bonebrake, MD
Michael Levine, MD
Hemant Satpathy, MD
Neil Hamill, MD
Andrew Robertson, MD
Todd Lovgren, MD
Methodist Generalists
Mark Carlson, MD
Craig Bassett, MD
Paige Berryman, MD
Julia Bishop, MD
Judith A. Scott, DO
Abby Lankhorst, MD
Sarah Gernhart, MD
Brianne M. Kling, MD
Methodist Generalists
Megan Prickett, MD (Irwin)
Carolee Jones, MD
Amber Cohn, MD
Nancy Mathews, MD
William D. Weidner, MD
Kristen Hoffman, MD
Susan Westcott, MD
Methodist Generalists
Michelle S. Knolla, MD
Lanette Guthmann, MD
Tifany L. Somer-Shely, MD
Rebecca L. Jacobi, MD
Allison Phillips, MD
Thomas E. Martin, MD
Methodist physicians
consistently identified by
previous students as great
teachers 2013-14:
☼ Robert Bonebrake, MD
☼ Hemant Satpathy, MD
☼ Tiffany Somer-Shely, MD
☼ Neil Hamill, MD
☼ Sarah Gernhardt, MD
☼ Paige Berryman MD
☼ William Weidner MD
Methodist physicians
consistently identified by
previous students as great
teachers: 2012-13
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
• Appropriate attire: SCRUBS
• Introduce yourself
▫ 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
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
• GYN-Surg/Onc
▫ 2nd and 3rd wks of month attend 1* pm teaching with residents in
DOC 4608 prior to resident clinic on Mon. – Wed. – Fri.
*Check time with residents…start varies depending on day from
12:30 to 1 pm
Gynecology Block:
• Appropriate attire
▫ scrubs when scheduled to be in OR
▫ no scrubs when going to clinics
• Students presentations (1)
▫ Benign Gyn 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
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
Patient Log on Oasis
Patient Log on Oasis
What if I feel uncomfortable with pelvic exams?
- You are not alonemany 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
▫ MSC 1005/2018 (sign in) Begins August 6, 2014
• 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/day will vary!) Pre-op conference (Luikart
WH 4029)
• 2nd and 3rd wks of month attend 1* pm teaching with residents in
DOC 4608 prior to resident clinic on Mon. – Wed. – Fri.
*Check time with residents…start varies depending on day from 12:30
to 1 pm
• Thursdays 7:00 (time/day 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
• 2nd and 3rd wks of month attend 1* pm teaching with
residents in DOC 4608 prior to resident clinic on
Mon. – Wed. – Fri. (depending on ONC cases)
*Check time with residents…start varies depending on day from
12:30 to 1 pm
• Oncology topics will be provided by resident
▫ Oncology topic
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
▫
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▫
▫
Towards the end of your 6-weeks
Dr. Remmenga usually hosts
All students are expected to attend
Lunch is provided
-Luikart library, WH 4029
▫ 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 @ 8 AM
• 5% GYN presentation
• 5% orange card/patient log
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
UNMC Shelf scores compared to National average
78
77
76
75
74
73
72
71
70
69
68
67
Nat'l
UNMC
20 20 20 20 20 20 20 20 20 20 20
01- 02- 03- 04- 05- 06- 07- 08- 09- 10- 1102 03 04 05 06 07 08 09 10 11 12
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 @ [email protected]
• Requests must be made within 30 days of grades
being mailed 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 15/20 min. meeting to give you feedback and
receive feedback from you regarding the first half of the
clerkship.
▫ PRINT YOUR PATIENT LOG AND BRING TO MEETING
▫ 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 Citizenship 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,
residents, aprn’s, cnm’s, and staff
• 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???