Obstetrics and Gynecology

Download as PDF
Internal Medicine
Pediatrics

Core Clerkship

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 web based resources.

  •  Firecracker
    • Students can start on either the obstetric floors for the first 3 weeks then the Gynecology clinics the last 3 weeks or vice versa, we would like students to study the topics in the correct order. (If you are not sure start with obstetrics  first). Therefore, students must determine which sequence of topics to study. Students should wait until the first day of orientation before choosing.
    • The following choices will be available in Firecracker SGU Clerkship selection:
      • OB/GYN I - covers OB topics first
      • OB/GYN II - covers GYN topics first
  • UWorld Ob/Gyn Qbank
  • Communication Modules - Domestic Violence and Exploring Sexual Issues modules must be completed prior to completing the clerkship. 
  • Ethics modules

Your patient log along with these three 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.

We are looking forward to meeting you, getting to know you and teaching you.

Portions of this overview were based on the University of North Carolina and University of Florida clerkship overview.

1.  MISSION AND INTRODUCTION

  • 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. 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.

2.  GUIDELINES

  1. Length: minimum six weeks.
  2. Site: 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.
  3.  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 SGU 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.
  4. 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
  5. 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.
  6. 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 structure independent study.
  7. 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.
  8. 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.
  9.  A formal one-on-one  mid-core  evaluation is required. The student  is required  to  bring  all  case evaluations, write-ups and the student log to the meeting. This is required to be reported to the DME with a signature acknowledgement by the student.
  10. Each student will maintain an electronic log of all required clinical experiences with diagnosis they admit, evaluate   or follow.  
  11.  All students must take the NBME Clinical Subject Examination in ob/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.
  12. 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.)

    3.  EDUCATIONAL OBJECTIVES *

 Medical Knowledge:  The student will learn:

  1. 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.
  2. Acute and chronic conditions common in women’s general and reproductive health, including their diagnosis and treatment.
  3. Principles of physiology and pharmacology applicable to women from puberty  through their reproductive life and menopause, especially pregnancy and age-related changes.
  4. 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:

  1. 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.
  2. 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.
  3. 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.
  4. 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.
  5. Clinical Problem Solving: Using data from history, physical, labs and studies to define problems, develop a differential diagnosis, and identify associated risks.
  6. Clinical Decision Making:   Incorporating  patient data with patient needs and desires when formulating diagnostic and therapeutic plans incorporating cultural and ethical issues.
  7. 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.
  8. Self-Education:  Recognizing knowledge deficits and learning needs through a reflective self-assessment process, plan or seek assistance in strengthening knowledge deficits, develop key critical thinking and problem solving skills. Seek feedback.   

     Professional Behavior:  The student will be expected to:

  1. Demonstrate compassion, empathy  and respect toward patients,  including respect for the patient’s modesty, privacy, confidentiality and cultural beliefs.
  2. Demonstrate communication skills with patients that convey respect, integrity, flexibility, sensitivity and compassion.
  3. Demonstrate respect for patient attitudes, behaviors  and lifestyle, paying particular attention to cultural, ethnic and socioeconomic influences and values.
  4. Function as an effective member of the  health care team, demonstrating collegiality and respect for all members of the health care team.
  5. 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.
  6. Identify and explore personal strengths, weaknesses and goals.  These objectives are based with permission on the 3rd year Ob/Gyn clerkship objectives from the University of Michigan Ob/Gyn.

WEB BASED EDUCATIONAL ASSIGNMENTS FOR INDEPENDENT LEARNING

The school requires the successful completion of web-based assignments in order to receive credit for this clerkship. Students should log into Sakai and complete the following assignments:

  • Firecracker
  • Uworld
  • Communication Modules
  • Ethics Modules

The Office of the Dean monitors student performance on these assignments. The completion of these assignments will be sent to the Clerkship Directors for incorporation into the final clerkship grade. The clinical faculty feels these assignments are excellent preparation for the NBME clinical subject exams as well as Step 2. In addition, a student’s diligence in completing these assignments reflects a commitment to excellence, a component of professional behavior grade.

CORE TOPICS

General

  1. History
  2. Physical exam
  3. Patient write up
  4. Differential Diagnosis and management plan
  5. Preventive care
  6. Professional behavior and communication skills
  7. Domestic violence and sexual assault

Obstetrics

  1. Maternal-fetal physiology
  2. Preconception care
  3. Antepartum care
  4. Intrapartum care
  5. Care of Newborn in labor and delivery
  6. Postpartum care
  7. Breastfeeding
  8. Abortion (spontaneous, threatened, incomplete, missed)
  9. Hypertensive disorders of pregnancy
  10. Isoimmunization
  11. Multifetal gestation
  12. Normal and abnormal labor
  13. Preterm labor
  14. Preterm rupture of membranes
  15. Third trimester bleeding
  16. Postpartum hemorrhage
  17. Postdates pregnancy
  18. Fetal growth restriction
  19. Antepartum and intrapartum fetal surveillance
  20. Infection

Gynecology

  1. Ectopic pregnancy
  2. Contraception
  3. Sterilization
  4. Abortion
  5. Sexually transmitted diseases
  6. Endometriosis
  7. Chronic pelvic pain
  8. Urinary incontinence
  9. Breast disease
  10. Vulvar disease and neoplasm
  11. Cervical disease and neoplasm
  12. Uterine disease and neoplasm
  13. Ovarian disease and neoplasm

Endocrinology and Infertility

  1. Menarche
  2. Menopause
  3. Amenorrhea
  4. Normal and abnormal uterine bleeding
  5. Infertility
  6. Hirsutism and Virilization

READING

Students should use the most recent edition of the following textbooks:

Required

  • Obstetrics/Gynecology for the Medical Student
  • Beckman, et al Lippincott Williams & Wilkins

Supplementary

  • Williams Obstetrics

Cunningham et al, Appleton

  • Danforth’s Obstetrics and Gynecology

Scott et al Lippincott, Williams and Wilkins

  • Clinical Gynecologic Oncology

DiSaia & Creasman, Mosby

  • Gynecology by Ten Teachers and Obstetrics by Ten Teachers

Monga & Baker, Arnold

  • Problem Based Obstetrics and Gynecology

Groom and Cameron, Blackwell

  • Reproductive Endocrinology

Speroff et al, Lippincott Williams and Wilkins

Other Helpful Review Texts:

  • OB/GYN Mentor: Your Clerkship and Shelf Exam Companion

Benson, F. A. Davis Company

  • First Aid for the Wards: Insider Advice for the Clinical Years

Le et al, Appleton & Lange

  • First Aid for the USLME Step 2 CK and CS

Le et al, McGraw-Hill

  • Kaplan Lecture Book Series (OB/GYN) Available only through Kaplan

On-Line References

Required Clinical Encounters and the Patient Encounter Log

The list below of complaints and diagnoses must be entered into your Patient Encounter Log (PEL) Program during each Core and Family Medicine Clerkship

Link: PEL     https://myapps.sgu.edu/PEL/Admin/Account/Login?ReturnUrl=%2fPEL

The faculty in each specialty have identified specific clinical experiences that are a requirement for the clerkship. The PEL program is designed to track each student’s patient encounters, clinical setting in which the encounter occurs, and level of responsibility. This program allows the school to standardize the curriculum. All patient’s complaints and/or diagnosis encountered during clinical rotations must be entered into the (PEL) program. Entering the required clinical encounters “Must See List” is required during clinical rotations and will be displayed to the clerkship director for review on the final clerkship evaluation. Whenever possible incorporate the Communication Skill course topic for each required encounter. Never place patients’ names or any patient identifying information in this program, this would be a HIPPA violation.

If students are unable to see a required clinical encounter, they must view the virtual visit link and watch the video. Once the encounter video is viewed, add the virtual encounter in the PEL as a Virtual visit.

Ob/gyn

Internal Medicine
Pediatrics