Fourth-Year Medical Student
Clerkships:
Goals and Objectives
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Morning discussion of patients with
Dr. Polly Vaughan (front, in green). |
Goals for Students
- To be the best
clerkship experience in your third year of medical school.
- To provide you
the didactic information required to pass the SHELF exam.
- To provide you
the opportunity to see the professional diversity within the
specialty and to expose you to as much of the day-to-day
responsibilities of an OB-GYN as possible, including the lifestyle.
- To increase
sensitivity and awareness of the special needs of the female
patient, including careful choice of language in discussing
sensitive issues.
- To learn proper
procedures in the operating room, including means of preventing
“splash” exposures and needle-stick injuries and maintenance of a
sterile field.
- To produce a
well-thought-out and organized H&PE for both an OB and GYN patient.
- To achieve
confidence in the performance of certain clinical skills such as
pelvic and breast exams, vaginal deliveries, assisting in C-section
deliveries, assisting in hysterectomies (by both laparoscopy and
laparotomy), routine prenatal care and annual GYN exams.
- To be aware of
potentially life-threatening medical conditions involving OB-GYN
patients, including appropriate diagnosis and treatment.
- To develop and/or
practice techniques for delivering “bad news” to patients in an
empathetic and sensitive way.
- To continue to
develop outstanding professional behavior in all aspects of your
daily activities, inside and outside the hospital.
- To provide a fair
and objective evaluation of student performance, including fund of
knowledge, professional behavior and clinical skills both during and
at the end of the rotation.
- To inspire
consideration of OB-GYN as a career.
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Objectives for Students
- Make clinical
assignments that are fair and varied, to assist the student in
maximizing exposure to all aspects of OB-GYN, including the practice
of our specialty in a community setting.
- Assignment of
on-call (night and weekend) duties to expose students to the
physical and emotional demands in this area.
- Provide a
complete didactic curriculum and protect time for preparation prior
to educational sessions to maximize learning and retention. Emphasis
will be placed on interactive learning from clinical scenarios. A
comprehensive syllabus will be provided to each student with
hard-copy handouts of the scheduled lectures and major topics in
both OB and GYN.
- Practice and
preparation for the OB-GYN SHELF exam with midterm exam and special
review sessions.
- Participation in
a suture workshop with pig feet, to learn technique of basic
surgery, handling of instruments and knot tying.
- Recognition of
life-threatening disease through standardized patient encounters.
- Developing
empathy in discussing difficult issues through standardized patient
encounters.
- Developing skills
in performing breast and pelvic exams through standardized patient
encounters with specially trained SPs and reinforcing these skills
in the clinic and hospital setting under the supervision of
primarily resident physicians.
- Developing skills
in normal vaginal delivery through use of a simulator and
reinforcing these skills in the hospital under the supervision of
resident physicians and attending faculty.
- Training sessions
specifically geared toward the OB and GYN H&PE, and submission of
practice H&PEs with one on one critiquing of such.
- Attempting to
individualize and tailor the clinical rotations to satisfy the
interest of students who have already chosen a particular career
path.
- Provide
individual feedback midway during the rotation by way of a
face-to-face conference with the clerkship coordinator, thereby
allowing enough time for remediation if necessary before the end of
the rotation.
- Practice in oral
presentation of cases to a variety of faculty in Professor Rounds.
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M4 Elective in
Maternal-Fetal Medicine
Goals:
- Immersion in
subspecialty of MFM
- Develop
proficiency in evaluation of the acute maternal transport patients,
including developing the appropriate plan of care in a timely manner
- Acquire basic
skills in OB sonography and medical record dictation
- Learn how to
integrate the outpatient and inpatient management of high-risk
antepartum patients and appropriate use of Home Health services
- Learn how to
correlate the results of testing in the Fetal Diagnostic Unit in the
day-to-day management of both in- and outpatients
- Assist in
delivery (if applicable) of antepartum patients for continuity of
care
- Begin to acquire
teaching skills with M3 students
- Sharpen skills in
documentation, pathophysiology, recognition of obstetrical disease
states and summarization of findings to formulate a reasonable plan
of care.
Objectives:
- Full time
assignment to SNGH 4A Antepartum Unit (5:30 am - 5:30 pm)
- Morning
rounds on every patient- report directly to PGY3 on AOS
- Presentation
of at least half of the service on daily Attending Rounds
- Continued
interaction with patient during the day, including management
decisions after results of ultrasound, antepartum testing,
consultations, etc.
- Coordinate
all results of all studies/consults done on 4A patient to keep
PGY3 or Chief up to date
- First call to
FDU for interpretation of testing - review ALL tests with RN and
confirm correct interpretation on a daily basis
- Physically
present for all sonograms performed on MT or 4A patients with
hands-on experience as time allows with MFM sonographer
- First call to
4A by nursing for any issues involving patient care
- Available
anytime to update Attending on status of 4A patients
- Initial
evaluation of MT patients as per AOS Chief (may share with OB
AI), including dictation of H&PE into EDIX (editing by Dr.
Sayegh)
- Update the
computer in Resident office as frequently as needed
- Dictation of MT
letters to referring physicians (editing by Dr. Sayegh or Dattel)
- Cover OB AI when
he/she is “post call”
- Oral presentation
on topic of your choice - 15 minutes - to M3 students and Dr. Sayegh
on third Wednesday of rotation
- Assist as
directed with M3 suture workshop or other activities
- On call as per
schedule (approximately once a week) - leave at noon post call
Evaluation:
- Oral Presentation
- 35% (grading by Dr. Sayegh)
- Evaluations by
Antepartum Charge Nurse, PGY3, AOS Chief, M3 students and Dr. Sayegh
- 65%
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M4 Elective in
Obstetrics - Acting Internship
Goals:
- Immersion in the
acute care of OB patients on L&D with a focus on complicated
patients
- Refine skills in
deliveries including NSVD, vacuum, forceps, C-section with emphasis
on complicated or difficult deliveries (such as twins, repeat
C-sections, vaginal breech etc.). Also acting as first assistant for
BTLs, D&C, cerclage
- Develop advanced
skills in the interpretation of FHR monitoring and bedside
sonography and how to incorporate the results of these tests in the
acute care of the OB patient
- Develop
proficiency in OB triage- understanding how to prioritize patients
based on acuity and understanding which patient require admission
versus outpatient care.
- Develop
communication skills with Chief on AOS and Charge Nurse and learn to
facilitate communications between residents, attending and nursing
(including anesthesia)
- First assistant
in second trimester D&Es (optional) - with Dr. Heyl
- Begin to acquire
teaching skills with M3 students
- Sharpen skills in
documentation, pathophysiology, recognition of obstetrical disease
states and summarization of findings to formulate a reasonable plan
of care
Objectives:
- Full-time
assignment is to SNGH L&D (all areas - labor rooms, Triage, PACU,
ORs) 5:30 am - 5:30 pm
- See all
patient on morning rounds with PGY2
- Evaluate all
admissions unless low-risk normal labor patient and/or other
case more appropriate for M3 student (as per Chief’s discretion)
- some MTs will be worked up by M4 MFM elective student if
applicable
- First call to OB
Triage with rapid communication with PGY2 (initially evaluate
patients together)
- Become the “go
to” person for Attendings, Chief, Charge Nurse for up-to-date status
on every patient on L&D, Triage and PACU
- Update the
computer in Resident office as needed
- Assist Chief in
collection of statistics and preparation of M&M case (second
Thursday of the month)
- Conduct small
group sessions with M3 students on AOS in FHR monitoring, normal
labor and normal delivery - assist in suture workshop if applicable
- Oral presentation
on topic of your choice - 15 minutes - to M3 students and Dr. Sayegh
on third Wednesday of rotation
- On call as per
schedule (approximately once a week) - leave at noon post call
Evaluation
- Oral Presentation
- 35% (grading by Dr. Sayegh)
- Evaluations by
L&D Charge Nurse, PGY2, AOS Chief, M3 students and Dr. Dattel - 65%
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M4 Elective in
Gynecology - Acting Internship
Goals:
- Immersion in the
field of Gynecology, including both inpatients and outpatients
- Learn the
appropriate preoperative and postoperative care of gynecologic
surgical patients
- Develop
gynecologic surgical skills in the OR
- Participation in
outpatient specialty clinics
- Involvement in
the acute care of gynecologic emergencies
- Integration of
pathology into the total care and management of patients
- Begin to acquire
teaching skills with M3 students
- Sharpen skills in
documentation, pathophysiology, recognition of gynecologic disease
states and summarization of findings to formulate a reasonable plan
of care
Objectives:
- Morning Rounds on
GYN patients as per Chief, but including patients in which you were
involved with the surgery - presentation to Chief (and Attending if
applicable) prior to starting the OR schedule
- Assist GYN Chief
in the OR with all surgical procedures to which he/she is assigned
- Attend and
actively participate in specialty clinics (Colpo, Teen, Pediatric,
etc.)
- Attend and
actively participate in ACC clinic (unless hospital duty precludes)
- First call to
PACU for pre- and post-operative complications/ concerns
- First call to ED
from 6:30 am to 5:00 pm
- Assist Chief in
collection of statistics and preparation of M&M conference (second
Thursday of each month)
- Presentation at
Path conference and Pre Op conference (at least half of cases)
- Oral presentation
on topic of your choice - 15 minutes - to M3 students and Dr. Sayegh
on third Wednesday of rotation
- On call as per
schedule (approximately once a week) - leave at noon post call
Evaluation:
- Oral Presentation
- 35% (grading by Dr. Sayegh)
- Evaluations by
GYN Chief, Clinic RN, M3 students and Dr. Davis (and other attending
if applicable) - 65%
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Expected Patient
Exposure/Experience on M3 OB-GYN Clerkship-EVMS
5-10 of the following
types of patients:
- Pre-eclampsia/pregnancy-induced
hypertension
- Preterm labor
- Preterm premature
rupture of membranes
- Obesity in
pregnancy
- Diabetes in
pregnancy
- Bleeding in
pregnancy
3-5 of the following
types of patients:
- Polycystic
ovarian syndrome
- Amenorrhea/Oligomenorrhea
- Abnormal Pap
smears
- Sexually
transmitted disease/GYN infections
- Inherited
disorders of coagulation (Thrombophyllias)
- Dysfunctional
uterine bleeding
- Dystocia in labor
1-3 of the following
types of patients:
- Incontinence
- Polycystic
ovarian syndrome
- Antiphospholipid
syndrome
- Acute abdomen
(includes ectopic pregnancy and tubo-ovarian abscess)
- Infertility
- Hirsutism
- Breast mass
- Fetal anomaly
- Multiple
gestations
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