OB-GYN 251 Integrated Clinical Clerkship in Obstetrics and Gynecology Learning Unit VI.
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Transcript of OB-GYN 251 Integrated Clinical Clerkship in Obstetrics and Gynecology Learning Unit VI.
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OB-GYN 251Integrated Clinical Clerkship in
Obstetrics and Gynecology
Learning Unit VI
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OB-GYN 251
o Clinical exposure in a hospital setting
o Duration of rotation: 1 month
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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
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Learning ObjectivesAt the end of the clinical rotation,
the student should be able to:
o Proper history taking
o Complete physical examination
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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
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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
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Learning ObjectivesTo develop the following
attitudes:o Good bedside mannerso Gender sensitivityo Compassiono Responsibilityo Initiativeo Teamworko Self-initiated learning
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Teaching Strategies
1. Departmental Conferences2. Small Group Discussions /
Bioethics Discussion 3. Public Health Fora4. Clinical Exposure
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Teaching Strategies
Prioritieso Department Conferences o Small Group
Discussion/Public Health Forum
o Patient for OR o Posts
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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
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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
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2. Small Group Discussion
Assign from the group in charge: 1 moderator 1 secretary 1 who will summarize
All the students will be graded
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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
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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
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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
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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%
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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
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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
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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
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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
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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
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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.
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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.
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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
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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)
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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.
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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
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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
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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
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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
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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
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Clinical Exposure
Criteria for Evaluation of Ward (30%)
Surgical Technique -----------------10%Background Knowledge -----------25%Responsibility and Reliability -------20%Attitude ------------------------------20%Communication --------------------10%Attendance -------------------------15%
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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
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Groupings
o 3 Serviceso SGD: 5 groups of 3-4
students eacho Public Health Forum: 3
groups (per service)
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Evaluation Scheme
Comprehensive examination 10%
Written examination 15%
OSCE 15%
Ward performance 30%
Average of SGD grade 20%
Public health forum 10%
Total 100%
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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
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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
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ObGyn 251
o Attendance:o Clerk’s attendance logbook: 1
per service
o Summary rounds: 7:06 – late
7:15 - absent
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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
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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
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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.
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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
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Today…
o Pig’s legs o Rounds on patients
endorsed by the previous set of clerks
o Questions?