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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: - PowerPoint PPT Presentation
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OB-GYN 251Integrated Clinical Clerkship in
Obstetrics and Gynecology
Learning Unit VI
OB-GYN 251
o Clinical exposure in a hospital setting
o Duration of rotation: 1 month
OB - GYN 251
o Course Coordinators: Sybil Lizanne R. Bravo, M.D.Joey Santiago, M.D.
o Resident Monitors:3rd yr: Andrea Gaddi, Johanna
Espinosa2nd yr: Zedrix Gallito, Tes Alferez1st yr: Ryan Joseph Lirazan, Gia Pastorfide, Limavel Ann Veloso
Learning ObjectivesAt the end of the clinical rotation,
the student should be able to:
o Proper history taking
o Complete physical examination
Learning ObjectivesTake part in the diagnosis and
management of obstetric patients
o Diagnose normal pregnancy, and identify abnormalities during labor, delivery and the postpartum period
o Interpret laboratory examinationso SVD with episiotomy and repairo Diagnose common pathologic
conditionso Propose a plan of managemento Counsel regarding breastfeedingo Advise patients regarding
contraception
Learning Objectives
Take part in the diagnosis and management of gynecologic patients
o Diagnose common pathologic conditions o Propose a plan of management
Discuss the various operative procedures done in obstetrics and gynecology
o Discuss the indications and contraindications
o Enumerate possible complications o Outline the stepso Assist in various operative procedures
in obstetrics and gynecology
Learning ObjectivesTo develop the following
attitudes:o Good bedside mannerso Gender sensitivityo Compassiono Responsibilityo Initiativeo Teamworko Self-initiated learning
Teaching Strategies
1. Departmental Conferences2. Small Group Discussions /
Bioethics Discussion 3. Public Health Fora4. Clinical Exposure
Teaching Strategies
Prioritieso Department Conferences o Small Group
Discussion/Public Health Forum
o Patient for OR o Posts
1. Departmental Conferences
o Summary Rounds (weekdays 7-7:30)
o Staff Conference (Tuesdays 7:30-9:00)
o Pre-operative conference (Thursdays 7:30-9:00)
*After departmental conferences, the clerks are given 30 minutes to make rounds on their patients
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: [email protected]
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
2. Small Group Discussion
Assign from the group in charge: 1 moderator 1 secretary 1 who will summarize
All the students will be graded
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
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
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
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%
4. Clinical Exposure
o 3 services (5-5-6)o 24-hour duties, every 3
days
o Preduty: Wardso Duty: OBAS / LR-DRo Post-duty
Clinical Exposure
Preduty Day: Wardso Ward 15: 1 clerko Ward 16: 1-2 clerkso Ward 14B: 1 clerko IMU: 1 clerk o Reproductive Biology Center
(RBC)/floater: 1 clerk
Clinical Exposure
Preduty Day: Wardso Receive endorsement from the
outgoing students o Accompany the ward resident as
she makes roundso Follow-up results or scheduling of
diagnostic tests o Monitor patients at the wards and
refer problematic patients
o Will become TICs and assists in gynecologic cases of post-duty clerks from 12- 4 pm
Clinical Exposure
Preduty Day: Wardso Accompany patients for diagnostic
examinationso Administration of intravenous
medications unless otherwise specified
o Insertion of intravenous lines and urethral catheters
o Endorse problematic cases and patients for monitoring to the next students on duty
Clinical ExposurePreduty Day: Wardso Elective Admissions
o OB elective (W15 or 16): deck, and accomplish OB sheet for all obstetric elective admissions
o Gyne elective (W14B): deck o Decked student: SIC: do history and PE,
accomplish necessary paperwork o Decking order: Ward 14B clerk
Ward 15 clerkWard 16 clerk IMU clerkRBC clerk
o Students’ responsibility at ward 15, 16 and 14b to check with the nurses the list of patients admitted until seven AM the following day
Clinical ExposurePreduty Day: Wards
o Responsibilities for own patient:o Clinical history, clinical abstract, 2 discharge
summaries should be incorporated into the patient’s chart within 24 hours from the patient’s admission
o 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
o Progress notes, except ob-normal and NSNI abortion cases
o Nontoxic patient: daily for the first 3 days, then every 3 days
o Toxic patients: daily
o All paperwork should be accomplished prior to discharge.
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.
Clinical Exposure
Duty Dayo OB admitting section – 3
clerkso 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
Clinical Exposure
Duty Day: OBASo History, physical and internal
examinationo Formulates a working diagnosis
and plan of managemento Patient for admission: inserts IV
catheter and foley catheter, collects laboratory specimens, makes the flag, and lab requests
o The student who managed patient at the OBAS endorses the case to the SIC (I.e. diagnosis, cervical dilatation, plan)
Clinical Exposure
Duty Day: OBASo 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.
Clinical ExposureDuty Day: LR/DR
o Clerks are decked twice, interns decked once for each rotation of OB normal and NSNI abortions
o Clerks will NOT be decked gynecologic cases admitted at the emergency room, as well as IMU admissions
o During the 1st week, will have a co-decked intern (buddy) to guide you, but the patient is ultimately, still the clerks responsibility
Clinical ExposureDuty Day: LR/DR
o SIC does a complete history and physical examination
o Monitors progress of laboro Makes a partogram and inserts
into chart before transfer to the wards
o Interpret the results of intrapartal traces and has it counterchecked by a resident on duty
Clinical ExposureDuty Day: LR/DR
o Assist residents in normal deliveries and towards the end of the rotation, may be allowed to become the primary attendant, supervised by a resident
o Complete the OB sheet and incorporate it into the patient’s chart
Clinical ExposureDuty Day: LR/DR
o 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
o Students are in-charge of submitting their patients’ specimen for histopathologic study
o Monitors patients in the recovery room
Clinical Exposure
Post Duty Dayo With unresolved cases at the
labor/delivery room, must remain with their patients
o Endorse their cases to the clerks on duty:
o 12 PMon weekdayso 7 AM weekendso Must be properly endorsed, all forms
must be accomplished (death certificate, histopath forms, endorsement sheet) prior to leaving
Clinical Exposure
Criteria for Evaluation of Ward (30%)
Surgical Technique -----------------10%Background Knowledge -----------25%Responsibility and Reliability -------20%Attitude ------------------------------20%Communication --------------------10%Attendance -------------------------15%
Clinical Exposure
o 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 )
o Inform monitor of your preferred dates
Groupings
o 3 Serviceso SGD: 5 groups of 3-4
students eacho Public Health Forum: 3
groups (per service)
Evaluation Scheme
Comprehensive examination 10%
Written examination 15%
OSCE 15%
Ward performance 30%
Average of SGD grade 20%
Public health forum 10%
Total 100%
Evaluation SchemeConversion of final grade60-64.99 3.065-69.99 2.7570-74.99 2.575-79.99 2.2580-84.99 2.085-89.99 1.7590-93.99 1.594-97.99 1.2598-100 1.0
ObGyn 251
o 1- 8x10 index card: with pictureo Information card: to be
submitted todayoNameoNicknameoBlockoDate of rotationoServiceoContact number
o Leave in envelope in clerks’ pigeonhole
ObGyn 251
o Attendance:o Clerk’s attendance logbook: 1
per service
o Summary rounds: 7:06 – late
7:15 - absent
ObGyn 251o Absence in a 24-hour or
ward dutyo Excused absence: 1:1o Unexcused absence: 1:2
o Tardiness or absence in a departmental conference:o 3 Lates: 1 absence o Absent: 4 hours AS duty
ObGyn 251o Tardiness or absence in a public health
forum or SGD Absent: 4 hours AS duty + written
report
o Failure to accomplish required paperwork:o 4 hours extra duty for every paper work,
for each day it is not submitted or incorporated into the chart (as reported by RIC)
o Sunday/Holidays: 1:2o Other demerits / deficiencies will be
discussed with the consultant monitor
ReferencesRequired: 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.
Before you leave, must have:o Submitted your index cards
and block foldero Have the list of SGD topics,
assigno Have a copy of the bioethics
caseo Have a copy of grading sheetso Have a copy of the WHO book,
for sharing among the blocko Re-deck patients that were
endorsed by the last block
Today…
o Pig’s legs o Rounds on patients
endorsed by the previous set of clerks
o Questions?