GUIDELINES FOR OB/GYN STUDENTS
Welcome to the OB/GYN clerkship! We hope this rotation will be fun and educational for you. Things may seem confusing and overwhelming at first - but do not worry - this is normal. We know that you know nothing about our specialty and look forward to teaching you all about it. Remember that enthusiasm on your part will make others want to teach you even more!
The Teams
The residents rotate on a team system that practices both OB and GYN at the same time. One day Team A covers L&D and the next day Team B covers L&D. Both teams may be in clinic at the same time. One team will be in the OR for one of our block times and the other team will be in the OR the next time. This can be confusing. The residents follow their schedule that is called the "matrix". Team A and Team B are our active teams and Team C is composed of the off service residents which include oncology, reproductive endocrinology and infertility, urogyn, medicine, ER, etc.
The students rotation is in a block fashion and you will do a mixture of OB and GYN. The OB time includes L&D, clinic, and the Prenatal Diagnostic Center. The GYN time includes clinic, OR, Private OR, Oncology and Urogyn.
Expectations
Work Rounds
You will help with work rounds on the postpartum and postop patients. This means seeing the patients along with the residents initially, and then more independently. You will write progress notes in the chart. On most days, you should start seeing patients at 6 AM and the residents will join you around 6:30 AM and go over teaching points. If you have a lecture at 7:30 AM, you can leave work rounds to grab breakfast at 7 AM to be on time for lecture. If your assignment is GYN Oncology or Urogynecology you will not round on Labor and Delivery. Please round with the resident assigned to that service. Please reference your Student Daily Schedule for further instructions.
Morning Report
This is also referred to as "sit down rounds". This will be with both Teams, the Attendings & students. The patients are presented and discussed. Morning Report or Rounds is held in the 3rd Floor Main Lobby conference room of Carilion Roanoke Community Hospital. (CRCH). If your assignment is GYN Oncology or Urogynecology you will not attend morning report. Please reference your Student Daily Schedule for further instructions.
L&D (Labor and Delivery)
When you are assigned to L&D, you will help with work rounds on the patients and go to morning report. Then you will be with the intern and the second call resident assigned to L&D. You will follow the laboring patients and meet all patients that you might get to deliver! Assist in C-sections and do the post-op checks. See patients in triage with the residents. You may also go to the ER to see patients with the residents. You may also scrub on the postpartum BTL's and the D&C's for miscarriages.
In general, you will see 3 types of patients: antepartum, intrapartum and postpartum.
Antepartum patients have not yet delivered. This includes patients with preeclampsia, premature rupture of membranes, pyelonephritis, preterm labor, etc.
Intrapartum patients are currently laboring.
Postpartum patients have already delivered either by SVD (spontaneous vaginal delivery), C-section, Forceps assisted vaginal delivery or Vacuum assisted Vaginal delivery. In this packet are examples of how to write delivery and op notes.
Learning goals - include antepartum disease processes (preeclampsia, PROM, PTL), normal labor & delivery, postpartum care & complications and fetal monitoring.
Prenatal Diagnostic Center (PDC)
Our perinatologist (Dr. Dennis) and the genetic counselors are located in the PDC (Suite 455). They see a lot of patients referred for high risk reasons such as multiple gestations, advanced maternal age, genetic conditions in the family, etc. You will have the opportunity to observe ultrasounds, genetic amniocentesis and genetic counseling. You will still help with work rounds and go to morning report and go to the PDC around 9 AM.
Learning goals - include seeing ultrasounds (may be on your boards), experiencing the genetic counseling process and seeing high-risk patients and learning about their disease processes.
Clinic
When you are assigned to the clinic, you will still help with work rounds and go to morning report. Then we start seeing patients in clinic around 9 AM. With the first few patients you should go in with the resident and see the patient together. Then you may see the patients first and get the history and then present to the resident assigned to that patient and examine the patient together. If it is an OB patient, you may listen to FHT's (fetal heart tones) and measure the fundal height and then report to the resident. Afternoon clinic starts at 1 PM.
Clinic cont...
On Fridays, clinic is only in the afternoon since lectures are schedule in the morning. Clinic is in two separate locations - OB Clinic (clinic on the corner of Reid and Jefferson) and GYN Clinic (Suite 303 MOB). You will be assigned on your clinic days to a particular clinic and the resident or nurse practitioners that you will be working with that day.
Learning goals - learn basic gyn disease processes as well as annual exams and contraception. You should perform pelvic exams, PAP smears, obtain cervical cultures, and perform wet prep/KOH preps.
OR
When you are assigned to the OR, you will still help with work rounds and go to morning report. Then you will go with the Team to the OR. You should introduce yourself to the patient in the pre-anesthesia area along with the rest of the team. One student will be allowed to perform an exam under anesthesia on the patient unless the patient has indicated that she does not want this.
Learning goals - surgical management of benign gyn problems. Practice your knot tying!
Private OR
Even if we are not in the OR, many of our private physicians may be operating. The residents or attending will be glad to help direct you that day as to which private attending to go with. Introduce yourself to that physician. In general, you should be in the OR around 7:15 AM unless you have a lecture that day.
Learning goals - more surgical experience and you will be able to see different surgical techniques.
Oncology
Dr. Dennis Scribner & Dr. Natalie Gould are our GYN Oncologists. One resident is assigned to them for the month. Your responsibilities will include going to the OR & also seeing patients in their office. You should page the resident on that service in the morning prior to the day that you are scheduled to find out where to report.
Learning goals - typical presentation and treatment of gyn cancers. Learn about staging. Practice your knot-tying. Post op management and complications.
Urogynecology
Dr. Janet Li & Nina Dereska are our urogynecologists. When you are assigned to urogyn, please call 985-4099 & ask for the Drs. schedule the morning prior to starting to find out if you need to report to the OR or to the office.
Learning goals - see the office work up of incontinence & prolapse and possibly see some of the surgical repairs.
VA Hospital
Dr Sterling Ellsworth goes to the VA Hospital on most Tuesdays. He usually operates on the first & third Tuesday of the month and sees clinic patients on the other Tuesdays. One chief resident also goes. One student may also go & this is encouraged especially on OR days! Talk with each other & let John know the schedule change.
LECTURES
Lectures are usually at 7:30 AM but the times may vary. Please refer to your student lecture schedule. Your attendance at lectures is mandatory unless you are on GYN Oncology or at the VA with Dr. Ellsworth.
PRESENTATIONS
During the rotation, you are expected to prepare a formal 8 - minute talk on an OB/GYN topic. This will be presented on the third Friday morning of your rotation to the attendings, residents and other students. The topic may be of your choosing but should be sufficiently narrow that it can be well presented in the time allowed. Residents as well as the entire faculty, are available to assist with topics. You must discuss your proposed topic with Dr. McCuin before proceeding.
PASSPORTS
Mandatory completion. Must be handed in at exam. Final grade will not be released until passport is signed and returned per UVA policy.
PATIENT LOGS (ED-2)
Remember it is your responsibility to have your Patient Logs (ED-2) completed before you leave Roanoke. It is mandatory completion. Web site is http://www.med-ed.virginia.edu/patientlogs/login.cfm
OSCE
At the end of the clerkship each student will be expected to complete an Observed Structured Clinical Exam (OSCE) as part of their grade. The exam will have Six 8-minute stations to complete. Some stations may be interactive in nature. The exam will be administered between 1:00 - 5:00 pm the afternoon after your written examination. You will be randomly assigned a time slot for this exam and it is NOT subject to change.
H & P
Two write-ups are required to be turned in at the time of your exam. One on an obstetrical patient and one on a gynecological patient. The format will be as follows:
•· History
•· Expanded OB history for OB patient
•· Expanded pertinent GYN history for GYN patient
•· Physical Examination
•· Labs / Diagnostic Tests
•· Assessment
•· Plan
•· Discussion
•· 1 page discussion of topic relative to specific patient
FINAL GRADES
45% Clinical (Oasis Evaluations by residents & attendings)
25% Exam (<59 equals failure of exam and therefore the course)
10% OSCE
10% H&P Write-up - 1 OB patient and 1 GYN patient
10% Attendance and Case Presentation
Post Call Duty Hour Rules
1. No more than 80 hours / week averaged over 4 weeks
2. In house call no more than 24 hours [consecutive] plus 6 additional
hours of daily duty [conferences, rounding, etc]
3. There must be 10 hours respite between shifts
WRITTEN EXAM BACK AT UVA
You will receive an e-mail from Tammy Lull (Education Coordinator @ UVA) with information regarding when & where your written exam will be during the last week of your rotation.
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Clerkship Coordinator for Roanoke John Johnson Phone 853-0418 (70418) |
The Generalist Attendings in Roanoke
Dr. L. Wayne Hess - Chair, OB/GYN
Dr. Sterling Ellsworth - Program Director
Dr. Elizabeth McCuin - Student Clerkship Director
emccuin@carilion.com
Beeper 201-0880
Dr. Joanna Stacey
Dr. Steven Waller-Smith
Dr. David Williams
UVA CONTACT INFORMATION:
Clerkship Director: Dr. Megan Bray
PIC 6538
mjb7c@virginia.edu
Dr. Bray will calculate your final grade for your OB/GYN rotation. She performs a mathematical calculation on the OASIS evaluations that are submitted. Dr. McCuin will submit a summary of the comments that were made to Dr. Bray and will submit your presentation grade. Dr. Bray and Yvonne Newberry will grade your H&P's and the topic discussions that you will submit and will grade the OSCE.
Assistant Director: Yvonne Newberry, FNP
PIC 4146
ygn7w@virginia.edu
UVA Clerkship Coordinator: Tammy Lull
434-924-9930
Do not contact Tammy Lull for Roanoke specific questions. John Johnson is your clerkship coordinator in Roanoke.