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OB-GYN 251

OB-GYN 251. Integrated Clinical Clerkship in Obstetrics and Gynecology Learning Unit VI. OB-GYN 251. Clinical exposure in a hospital setting Duration of rotation: 1 month. OB - GYN 251. Course Coordinators: Sybil Lizanne R. Bravo, M.D. Joey Santiago, M.D. Resident Monitors:

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OB-GYN 251

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  1. OB-GYN 251 Integrated Clinical Clerkship in Obstetrics and Gynecology Learning Unit VI

  2. OB-GYN 251 • Clinical exposure in a hospital setting • Duration of rotation: 1 month

  3. OB - GYN 251 • Course Coordinators: Sybil Lizanne R. Bravo, M.D. Joey Santiago, M.D. • Resident Monitors: 3rd yr: Andrea Gaddi, Johanna Espinosa 2nd yr: ZedrixGallito, TesAlferez 1st yr: Ryan Joseph Lirazan, GiaPastorfide, Limavel Ann Veloso

  4. Learning Objectives At the end of the clinical rotation, the student should be able to: • Proper history taking • Complete physical examination

  5. Learning Objectives Take part in the diagnosis and management of obstetric patients • Diagnose normal pregnancy, and identify abnormalities during labor, delivery and the postpartum period • Interpret laboratory examinations • SVD with episiotomy and repair • Diagnose common pathologic conditions • Propose a plan of management • Counsel regarding breastfeeding • Advise patients regarding contraception

  6. Learning Objectives Take part in the diagnosis and management of gynecologic patients • Diagnose common pathologic conditions • Propose a plan of management Discuss the various operative procedures done in obstetrics and gynecology • Discuss the indications and contraindications • Enumerate possible complications • Outline the steps • Assist in various operative procedures in obstetrics and gynecology

  7. Learning Objectives To develop the following attitudes: • Good bedside manners • Gender sensitivity • Compassion • Responsibility • Initiative • Teamwork • Self-initiated learning

  8. Teaching Strategies • Departmental Conferences • Small Group Discussions / Bioethics Discussion • Public Health Fora • Clinical Exposure

  9. Teaching Strategies Priorities • Department Conferences • Small Group Discussion/Public Health Forum • Patient for OR • Posts

  10. 1. Departmental Conferences • Summary Rounds (weekdays 7-7:30) • Staff Conference (Tuesdays 7:30-9:00) • Pre-operative conference (Thursdays 7:30-9:00) *After departmental conferences, the clerks are given 30 minutes to make rounds on their patients

  11. 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

  12. 2. Small Group Discussion • Assign from the group in charge: • 1 moderator • 1 secretary • 1 who will summarize • All the students will be graded

  13. 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

  14. 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

  15. 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

  16. 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%

  17. 4. Clinical Exposure • 3 services (5-5-6) • 24-hour duties, every 3 days • Preduty: Wards • Duty: OBAS / LR-DR • Post-duty

  18. Clinical Exposure Preduty Day: Wards • Ward 15: 1 clerk • Ward 16: 1-2 clerks • Ward 14B: 1 clerk • IMU: 1 clerk • Reproductive Biology Center (RBC)/floater: 1 clerk

  19. Clinical Exposure Preduty Day: Wards • Receive endorsement from the outgoing students • Accompany the ward resident as she makes rounds • Follow-up results or scheduling of diagnostic tests • Monitor patients at the wards and refer problematic patients • Will become TICs and assists in gynecologic cases of post-duty clerks from 12- 4 pm

  20. Clinical Exposure Preduty Day: Wards • Accompany patients for diagnostic examinations • Administration of intravenous medications unless otherwise specified • Insertion of intravenous lines and urethral catheters • Endorse problematic cases and patients for monitoring to the next students on duty

  21. Clinical Exposure Preduty Day: Wards • Elective Admissions • OB elective (W15 or 16): deck, and accomplish OB sheet for all obstetric elective admissions • Gyne elective (W14B): deck • Decked student: SIC: do history and PE, accomplish necessary paperwork • Decking order: Ward 14B clerk Ward 15 clerk Ward 16 clerk IMU clerk RBC clerk • Students’ responsibility at ward 15, 16 and 14b to check with the nurses the list of patients admitted until seven AM the following day

  22. Clinical Exposure Preduty Day: Wards • Responsibilities for own patient: • Clinical history, clinical abstract, 2 discharge summaries should be incorporated into the patient’s chart within 24 hours from the patient’s admission • 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 • Progress notes, except ob-normal and NSNI abortion cases • Nontoxic patient: daily for the first 3 days, then every 3 days • Toxic patients: daily • All paperwork should be accomplished prior to discharge.

  23. 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.

  24. Clinical Exposure Duty Day • OB admitting section – 3 clerks • 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

  25. Clinical Exposure Duty Day: OBAS • History, physical and internal examination • Formulates a working diagnosis and plan of management • Patient for admission: inserts IV catheter and foley catheter, collects laboratory specimens, makes the flag, and lab requests • The student who managed patient at the OBAS endorses the case to the SIC (I.e. diagnosis, cervical dilatation, plan)

  26. Clinical Exposure Duty Day: OBAS • 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.

  27. Clinical Exposure Duty Day: LR/DR • Clerks are decked twice, interns decked once for each rotation of OB normal and NSNI abortions • Clerks will NOT be decked gynecologic cases admitted at the emergency room, as well as IMU admissions • During the 1st week, will have a co-decked intern (buddy) to guide you, but the patient is ultimately, still the clerks responsibility

  28. Clinical Exposure Duty Day: LR/DR • SIC does a complete history and physical examination • Monitors progress of labor • Makes a partogram and inserts into chart before transfer to the wards • Interpret the results of intrapartal traces and has it counterchecked by a resident on duty

  29. Clinical Exposure Duty Day: LR/DR • Assist residents in normal deliveries and towards the end of the rotation, may be allowed to become the primary attendant, supervised by a resident • Complete the OB sheet and incorporate it into the patient’s chart

  30. Clinical Exposure Duty Day: LR/DR • 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 • Students are in-charge of submitting their patients’ specimen for histopathologic study • Monitors patients in the recovery room

  31. Clinical Exposure Post Duty Day • With unresolved cases at the labor/delivery room, must remain with their patients • Endorse their cases to the clerks on duty: • 12 PMon weekdays • 7 AM weekends • Must be properly endorsed, all forms must be accomplished (death certificate, histopath forms, endorsement sheet) prior to leaving

  32. Clinical Exposure Criteria for Evaluation of Ward (30%) Surgical Technique -----------------10% Background Knowledge -----------25% Responsibility and Reliability -------20% Attitude ------------------------------20% Communication --------------------10% Attendance -------------------------15%

  33. Clinical Exposure • 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 ) • Inform monitor of your preferred dates

  34. Groupings • 3 Services • SGD: 5 groups of 3-4 students each • Public Health Forum: 3 groups (per service)

  35. Evaluation Scheme

  36. Evaluation Scheme Conversion of final grade 60-64.99 3.0 65-69.99 2.75 70-74.99 2.5 75-79.99 2.25 80-84.99 2.0 85-89.99 1.75 90-93.99 1.5 94-97.99 1.25 98-100 1.0

  37. ObGyn 251 • 1- 8x10 index card: with picture • Information card: to be submitted today • Name • Nickname • Block • Date of rotation • Service • Contact number • Leave in envelope in clerks’ pigeonhole

  38. ObGyn 251 • Attendance: • Clerk’s attendance logbook: 1 per service • Summary rounds: 7:06 – late 7:15 - absent

  39. ObGyn 251 • Absence in a 24-hour or ward duty • Excused absence: 1:1 • Unexcused absence: 1:2 • Tardiness or absence in a departmental conference: • 3 Lates: 1 absence • Absent: 4 hours AS duty

  40. ObGyn 251 • Tardiness or absence in a public health forum or SGD • Absent: 4 hours AS duty + written report • Failure to accomplish required paperwork: • 4 hours extra duty for every paper work, for each day it is not submitted or incorporated into the chart (as reported by RIC) • Sunday/Holidays: 1:2 • Other demerits / deficiencies will be discussed with the consultant monitor

  41. References Required: • 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.

  42. Before you leave, must have: • Submitted your index cards and block folder • Have the list of SGD topics, assign • Have a copy of the bioethics case • Have a copy of grading sheets • Have a copy of the WHO book, for sharing among the block • Re-deck patients that were endorsed by the last block

  43. Today… • Pig’s legs • Rounds on patients endorsed by the previous set of clerks • Questions?

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