OB-GYN 251Integrated 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:3rd yr: Andrea Gaddi, Johanna

Espinosa2nd yr: Zedrix Gallito, Tes Alferez1st yr: Ryan Joseph Lirazan, Gia Pastorfide, Limavel Ann Veloso

Learning ObjectivesAt the end of the clinical rotation,

the student should be able to:

o Proper history taking

o Complete physical examination

Learning ObjectivesTake 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 examinationso SVD with episiotomy and repairo Diagnose common pathologic

conditionso Propose a plan of managemento Counsel regarding breastfeedingo 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 stepso Assist in various operative procedures

in obstetrics and gynecology

Learning ObjectivesTo develop the following

attitudes:o Good bedside mannerso Gender sensitivityo Compassiono Responsibilityo Initiativeo Teamworko Self-initiated learning

Teaching Strategies

1. Departmental Conferences2. Small Group Discussions /

Bioethics Discussion 3. Public Health Fora4. Clinical Exposure

Teaching Strategies

Prioritieso Department Conferences o Small Group

Discussion/Public Health Forum

o Patient for OR o Posts

1. Departmental Conferences

o Summary Rounds (weekdays 7-7:30)

o Staff Conference (Tuesdays 7:30-9:00)

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

Grouped into three’s or four’s. Total of 5

groups / block

A topic for the small group discussion (SGD) will be assigned today: 3 ob topics, 2 gynecologic topics

Look for a case, submit a case protocol with guide questions Deadline: Friday 1st week send to dr.

Gaddi’s email: drei_2006@yahoo.com

Distribute to all members of the block to study the case and prepare for the SGD.

* Schedule will be announced, date and time of activities are subject to consultants availability

2. Small Group Discussion

Assign from the group in charge: 1 moderator 1 secretary 1 who will summarize

All the students will be graded

2. Small Group Discussion

Bioethics Case: The Art of Medicine

Case will be given

Consultant will be the moderator

All the students will be graded

Can use LU V bioethics module as a reference

2. Small Group Discussion

Criteria for Evaluation During a Small

Group Discussion (20%)Quality of Participation ………………….

40% Makes significant contributions Asks intelligent/relevant questions Respects the opinion of others

Frequency of Participation ………………30%

Logical Approach to Problem Solving….30%

Has initiative and resourcefulness Has relevance Has organization

3. Public Health Forum

Divide into 3 groups Topics

(A) Myths and misconceptions in the postpartum period W15

(B) Postsurgical care and concerns W14B

(C) Breastfeeding W16 Only reporters are required to be

present

3. Public Health Forum

Criteria for Evaluation During a Public Health Forum (10%)

Manner of Presentation………………. 50% Use of visual aids (10%) Stage Presence (10%) Manner of delivery, note on emphasis

(10%) Creativity (20%)

Content………………..……………… 30% Organization (15%) Completeness (15%)

Audience Impact…………………..….30%

4. Clinical Exposure

o 3 services (5-5-6)o 24-hour duties, every 3

days

o Preduty: Wardso Duty: OBAS / LR-DRo Post-duty

Clinical Exposure

Preduty Day: Wardso Ward 15: 1 clerko Ward 16: 1-2 clerkso Ward 14B: 1 clerko IMU: 1 clerk o Reproductive Biology Center

(RBC)/floater: 1 clerk

Clinical Exposure

Preduty Day: Wardso Receive endorsement from the

outgoing students o Accompany the ward resident as

she makes roundso 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: Wardso Accompany patients for diagnostic

examinationso 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 ExposurePreduty Day: Wardso Elective Admissions

o OB elective (W15 or 16): deck, and accomplish OB sheet for all obstetric elective admissions

o Gyne elective (W14B): deck o Decked student: SIC: do history and PE,

accomplish necessary paperwork o Decking order: Ward 14B clerk

Ward 15 clerkWard 16 clerk IMU clerkRBC clerk

o Students’ responsibility at ward 15, 16 and 14b to check with the nurses the list of patients admitted until seven AM the following day

Clinical ExposurePreduty Day: Wards

o Responsibilities for own patient:o Clinical history, clinical abstract, 2 discharge

summaries 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, except ob-normal and NSNI abortion cases

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

Preduty Day: RBC◦ Assist in the operations (commonly

involving surgical sterilization and manual vacuum aspiration) and monitor post-operative patients

*** If a student does not adhere to the practice of contraception, please inform the resident so she will be exempted from assisting in BTL

◦ No OR, the clerk assigned to the RBC goes to ward 15/16 or the more toxic ward to help the students assigned there.

Clinical Exposure

Duty Dayo OB admitting section – 3

clerkso LR/DR/RR – 2-3 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: OBASo History, physical and internal

examinationo Formulates a working diagnosis

and plan of managemento 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: OBASo 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 ExposureDuty 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 1st week, will have a co-decked intern (buddy) to guide you, but the patient is ultimately, still the clerks responsibility

Clinical ExposureDuty Day: LR/DR

o SIC does a complete history and physical examination

o Monitors progress of laboro 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 ExposureDuty 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 ExposureDuty 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 Dayo With unresolved cases at the

labor/delivery room, must remain with their patients

o Endorse their cases to the clerks on duty:

o 12 PMon weekdayso 7 AM weekendso 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 Serviceso SGD: 5 groups of 3-4

students eacho Public Health Forum: 3

groups (per service)

Evaluation Scheme

Comprehensive examination 10%

Written examination 15%

OSCE 15%

Ward performance 30%

Average of SGD grade 20%

Public health forum 10%

Total 100%

Evaluation SchemeConversion of final grade60-64.99 3.065-69.99 2.7570-74.99 2.575-79.99 2.2580-84.99 2.085-89.99 1.7590-93.99 1.594-97.99 1.2598-100 1.0

ObGyn 251

o 1- 8x10 index card: with pictureo Information card: to be

submitted todayoNameoNicknameoBlockoDate of rotationoServiceoContact number

o Leave in envelope in clerks’ pigeonhole

ObGyn 251

o Attendance:o Clerk’s attendance logbook: 1

per service

o Summary rounds: 7:06 – late

7:15 - absent

ObGyn 251o Absence in a 24-hour or

ward dutyo Excused absence: 1:1o Unexcused absence: 1:2

o Tardiness or absence in a departmental conference:o 3 Lates: 1 absence o Absent: 4 hours AS duty

ObGyn 251o 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: 1:2o Other demerits / deficiencies will be

discussed with the consultant monitor

ReferencesRequired: Cunningham FG, et al. William’s

Obstetrics, 22nd Ed. McGraw-Hill, New York, 2005.

Stenchever, MA et al. Comprehensive Gynecology, 4th Ed. Mosby, St. Louis, 2001.

Others:Sumpaico, et al. Textbook of Obstetrics

(Physiologic and Pathologic), 2nd 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 foldero Have the list of SGD topics,

assigno Have a copy of the bioethics

caseo Have a copy of grading sheetso Have a copy of the WHO book,

for sharing among the blocko 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?