2. Obstetrics and Gynecology Core Clerkship

Mission and Introduction

The Department of Obstetrics and Gynecology offers an educational experience, which entails close interaction with house staff and faculty, and a ‘hands-on’ approach to learning by doing. A physician specializing in obstetrics or gynecology is often considered a woman’s primary care provider. With this in mind, students are encouraged to learn not only obstetrics and gynecology but anything involved in women’s health in general. Over the six-week clerkship most students will encounter, through their patients, a multitude of clinical problems. It is anticipated that the knowledge gained in learning about and solving a particular patient problem will be retained and applicable to other patients with similar problems.

Obstetrics and gynecology is a fast-paced, diverse field of medicine practiced in a variety of settings, both outpatient and inpatient. As a clerk on our service, you will have the opportunity to see patients who are healthy, seeking prenatal or preventive care, those who are having an acute life-threatening gynecologic problem and everything in between!

Our goal is to provide you with a well-rounded, solid experience in general obstetrics and gynecology. Each student will spend time on labor and delivery, in the operating room participating in gynecologic surgery and in the outpatient setting. You may have the opportunity to work with subspecialists including Reproductive Endocrinologists, Gynecologic Oncologists, Maternal – Fetal Medicine specialists and more.

It is not the purpose of the rotation to prepare students for an OB/GYN residency but rather to assure that graduates will be competent to initiate a level of care for women that routinely addresses their gender-specific needs. Consequently, the clerkship curriculum is competency based, using practice expectations for a new intern pursuing a primary care residency as the endpoint.

The ob/gyn clerkship requires that students record their patient contacts in the school’s online patient encounter log. Along with your hands on experience, your learning will be augmented by three web based resources.

• E-coach and access medicine
• UWorld OB/GYN Qbank
• Communication Skills Course-The domestic violence and sexual assault modules must be completed prior to completing the clerkship.

Your patient log along with these web-based resources will constitute your OB/GYN portfolio included in your final evaluation.

We hope that you become familiar with what the general obstetrician/gynecologist does, have the opportunity to be exposed to common obstetric and gynecologic procedures, solidify pelvic exam skills and learn about important topics in women’s health to serve you in whatever specialty you ultimately choose.

The curriculum of the department of obstetrics and gynecology is designed to assist students in achieving the following educational goals:

• To understand the role played by the obstetrician/gynecologist within the scope of women’s health care and when medical issues outside their expertise requires a medical or other specialty consultation.
• To gain a base of knowledge in normal as well as abnormal obstetrics and gynecology and acquire the skills needed to evaluate and treat patients responsibly.
• To learn the value of routine health surveillance as a part of health promotion and disease prevention by incorporating age-appropriate screening procedures at the recommended time intervals.
• Through the use of written and clinical cases, to acquire a knowledge base in the causes, mechanisms and treatment of human reproductive illnesses, as well as in the behavioral and non-biological factors that influence a woman’s health.
• To demonstrate a fundamental knowledge of the most common clinical, laboratory, and pathologic diagnostic manifestations of diseases common to women.
• To gain an understanding of the principles of bioethics and how they affect patient care.
• To become aware of the effect of health care disparities on patient care.
• To provide a curriculum for the department that promotes the highest standards of competence and does so in a professional culture that prepares the student for the practice of the discipline internationally.
• To provide a foundation which integrates the basic science in the understanding of normal and abnormal pregnancy as well as the causes, diagnosis, prevention and treatment options for diseases of the female reproductive system and to the problems of women’s health generally.
• To provide a solid foundation in the discipline of obstetrics and gynecology that will enable the student to decide if the discipline is an appropriate career choice and if so to enable the student to succeed in postgraduate training and a professional career as an obstetrician gynecologist.
• To combine medical knowledge with clinical and communication skills providing a solid foundation on which students can learn to provide quality obstetrical and gynecologic care.

Guidelines

• Length: minimum six weeks.
• Labor and delivery suite including ob triage, the operating room, gynecology inpatient units and the ante-partum, post-partum and post-operative units, outpatient clinics , private MD offices and the Emergency Department.
• At the start of the clerkship, an orientation is given. This includes a discussion of the expectations and responsibilities of the students and their schedules and assignments to residency teams and preceptors. The XUSOM clerkship director for Obstetrics and Gynecology and the student coordinator participate in this orientation. During the Orientation students will be advised how to obtain scrubs, lab coats, and ID Badges and a tour of the OB/GYN areas including call rooms.
• Students take night call no more than every third night, and one weekend call not to exceed 24 hours or one night float schedule, not to exceed residents’ hours on call. The student will do a maximum of 6 calls during the 6 week rotation.
• Students participate in attending rounds for house staff and students at least once a week and work rounds with house staff at least twice a week.
  • A schedule of teaching conferences including staff conferences, residents’ conferences, grand rounds, subspecialty conferences and didactic sessions pertinent to the needs of the students is presented at the orientation. Approximately 30% of the clerkship should be allocated to protected academic time for teaching conferences and structured independent study.
  • Each student is required to complete a minimum of two clinical write-ups, including one obstetrical and one gynecological case. Each write-up must include the admission history, physical examination, review of laboratory and imaging studies impression, assessment and diagnostic/therapeutic plan. The history must include any cultural issues that may affect the patient’s treatment and compliance. Students must include a discussion of the patient’s social supports and any recognizable limits of the doctor-patient relationship, e.g. beliefs. The write-up should also mention any limitation of the patient: mental, physical, financial or emotional. When pertinent, the labor and delivery record, operative findings, post-operative progress notes, and pathology should be included. Each clinical      write-up will include a one page summary of the topic chosen by the student on any aspect of the clinical case study. This requires a literature search to respond to the clinical question posed by the student. Critiques of the write-ups are provided to the student by the preceptor. Each student will do a case presentation based on an interesting topic that was encountered during her/his rotation.
  • Direct preceptor/faculty supervision of the students for at least 3-4 hours per week should include case presentations by the students, bedside rounds, physical examinations and interactive sessions.
  • A formal one-on-one mid core evaluation is required. The student is required to bring all case evaluations and the student log to the meeting. This is required to be reported to the program Director with a signature acknowledgement by the student.
  • Each student will maintain an electronic log of all patients with diagnosis they admit, evaluate or follow.
  • All students must take the NBME Clinical Subject Examination in ON/GYN during the last week of the rotation. They must have the day off prior to the exam as well as the day of the exam. If you do not take the exam, you have to take it within one week.

Special emphasis is placed on the development of certain skills. By the completion of the clerkship, the student should be able to competently perform a complete history relevant to the obstetric/gynecologic patient and a physical examination of the breast and pelvis. (These examinations must always be performed only when a “chaperone” is present.)

Educational Objectives*

Medical Knowledge:

The student will learn:

• Health maintenance and preventive care for women, including age-related issues in cancer screening, screening for other common adult-onset illnesses, nutrition, sexual health, vaccination and risk factor identification and modification.
• Acute and chronic conditions common in women’s general and reproductive health, including their diagnosis and treatment.
• Principles of physiology and pharmacology applicable to women from puberty through their reproductive life and menopause, especially pregnancy and age-related changes.
• Prenatal, intra-partum and post-partum care of normal pregnancy and common pregnancy-related complications as well as the care of women with acute or chronic illness throughout pregnancy.

Clinical Skills:

The student will demonstrate competence in:

• Communication skills: Interacting effectively and sensitively with patients, families, and with health care teams in verbal and written presentations. Recognize the important role of patient education in prevention and treatment of disease.
• Verbal Presentations: Organize a case presentation to accurately reflect the reason for the evaluation, the chronology of the history, the details of physical findings, the differential diagnosis and the suggested initial evaluation. Include age specific information and precise description of physical findings. Justify the thought process that led to the diagnostic and therapeutic plan.
• Written Documentation: Document the independent clinical thinking of the student. When using templates, or their own prior documentation, students should carefully adjust the note to reflect newly completed work and to ensure the note is a useful addition to the medical record. In settings where students are not permitted to document in the EMR, an alternative form of documentation needs to be established and evaluated by a preceptor.
• History Taking: patients in more complex situations such as in the emergency and labor setting, collecting complete and accurate information and focusing appropriately. Describe how to modify the interview depending on the clinical situation— inpatient, outpatient, acute and routine settings including Physical Exams which are complete and focused depending on the indication and condition.
• Clinical Problem Solving: Using data from history, physical, labs and studies to define problems, develop a differential diagnosis, and identify associated risks.
• Clinical Decision Making: Incorporating patient data with patient needs and desires when formulating diagnostic and therapeutic plans incorporating cultural and ethical issues.
• Evidence - Based Medicine: Ability to conduct an evidence-based search surrounding a specific clinical question and to appropriately evaluate the literature to answer such question.
• Self - Education: Recognizing knowledge deficits and learning needs through a reflective self-assessment process, plan or seek assistance in remediation of knowledge deficits, develop key critical thinking and problem solving skills. Seek feedback.

Professional Behavior:

The student will be expected to:

• Demonstrate compassion, empathy and respect toward patients, including respect for the patient’s modesty, privacy, confidentiality and cultural beliefs.
• Demonstrate communication skills with patients that convey respect, integrity, flexibility, sensitivity and compassion.
• Demonstrate respect for patient attitudes, behaviors and lifestyle, paying particular attention to cultural, ethnic and socioeconomic influences and values.
• Function as an effective member of the health care team, demonstrating collegiality and respect for all members of the health care team.
• Demonstrate a positive attitude and regard for education by demonstrating intellectual curiosity, initiative, honesty, responsibility, dedication to being prepared, maturity in soliciting, accepting and acting on feedback, flexibility when differences of opinion arise and reliability.
• Identify and explore personal strengths, weaknesses and goals.