M3 OB/GYN Clerkship

1. welcome! M3 OB/GYN Clerkship Welcome! Please help yourself to refreshments provided.

2. Welcome to OB/GYN M3 Clerkship *Mrs. Teresa Ingraham - Undergrad Coordinator *Ms. Sarah Matya -Residency Coordinator *Karen Carlson, MD -Clerkship Director -Generalist Faculty *Katherine Finney, MD -Assistant Clerkship Director -Generalist Faculty

3. 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)

4. 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 StasnyRm • 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.

5. 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).

6. 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

7. 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)

8. 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

9. OB SHIFTS • 12 hour shifts • Expect approximately • 8-11 shifts • Days and nights • Methodist Hospital or UNMC

11. Course Textbook

12. 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

13. 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

14. 4 Required Educational Resources 3. Fetal Heart Tones *www.ob-efm.com *IntrapartumFetal 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

15. 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.

17. Clerkship Expectations: *www.apgo.org/members/medical-students.cfm Should be used as a supplement to text Please read required text!

18. Clerkship Expectations *Specific expectations for each part of clerkship in folder

19. 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

20. 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

21. 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

23. 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

24. 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

25. 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

26. 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

27. Methodist MFMs Michael Levine, MD • Robert Bonebrake, MD Hemant Satpathy, MD Neil Hamill, MD • Andrew Robertson, MD Todd Lovgren, MD

28. Methodist Generalists Mark Carlson, MD Paige Berryman, MD Julia Bishop, MD Craig Bassett, MD Judith A. Scott, DO Abby Lankhorst, MD Sarah Gernhart, MD Brianne M. Kling, MD

29. Methodist Generalists Susan Westcott, MD Kristen Hoffman, MD Megan Prickett, MD (Irwin) Amber Cohn, MD Carolee Jones, MD Nancy Mathews, MD William D. Weidner, MD

30. Methodist Generalists Michelle S. Knolla, MD Tifany L. Somer-Shely, MD Lanette Guthmann, MD Rebecca L. Jacobi, MD Thomas E. Martin, MD Allison Phillips, MD

31. Methodist physicians consistently identified by previous students as great teachers 2013-14: • Robert Bonebrake, MD • HemantSatpathy, MD • Tiffany Somer-Shely, MD • Neil Hamill, MD • Sarah Gernhardt, MD • Paige Berryman MD • William Weidner MD

32. Methodist physicians consistently identified by previous students as great teachers: 2012-13

33. 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

34. 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

35. 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

36. 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

37. Gynecology Block: • Appropriate attire • scrubs when scheduled to be in OR • no scrubs when going to clinics • Students presentations (1) • Benign Gyn week

38. 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

39. 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

40. Patient Log on Oasis

41. Patient Log on Oasis

43. What if I feel uncomfortable with pelvic exams? - You are not alone- many 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”

44. 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

45. 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

46. 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

47. 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

48. 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

49. Vice Chairman’s Luncheon • Luncheon • 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!