Transcript Ob-Gyn 251

OB-GYN 251
Integrated 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 Espinosa
2nd yr: Zedrix Gallito, Tes Alferez
1st yr: Ryan Joseph Lirazan,
Gia Pastorfide,
Limavel Ann Veloso
Learning Objectives
At the end of the clinical rotation, the
student should be able to:
o Proper history taking
o Complete physical examination
Learning Objectives
Take 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 examinations
o SVD with episiotomy and repair
o Diagnose common pathologic conditions
o Propose a plan of management
o Counsel regarding breastfeeding
o 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 steps
o Assist in various operative procedures in
obstetrics and gynecology
Learning Objectives
To develop the following attitudes:
o Good bedside manners
o Gender sensitivity
o Compassion
o Responsibility
o Initiative
o Teamwork
o Self-initiated learning
Teaching Strategies
1. Departmental Conferences
2. Small Group Discussions /
Bioethics Discussion
3. Public Health Fora
4. Clinical Exposure
Teaching Strategies
Priorities
o Department Conferences
o Small Group Discussion/Public
Health Forum
o Patient for OR
o Posts
1. Departmental Conferences
o Summary Rounds (weekdays 77:30)
o Staff Conference (Tuesdays 7:309:00)
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
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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%
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Use of visual aids (10%)
Stage Presence (10%)
Manner of delivery, note on emphasis (10%)
Creativity (20%)
Content………………..………………
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30%
Organization (15%)
Completeness (15%)
Audience Impact…………………..…. 30%
4. Clinical Exposure
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o
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3 services (5-5-6)
24-hour duties, every 3 days
Preduty:
Wards
Duty:
OBAS / LR-DR
Post-duty
Clinical Exposure
Preduty Day: Wards
o Ward 15: 1 clerk
o Ward 16: 1-2 clerks
o Ward 14B: 1 clerk
o IMU:
1 clerk
o Reproductive Biology Center
(RBC)/floater: 1 clerk
Clinical Exposure
Preduty Day: Wards
o Receive endorsement from the outgoing
students
o Accompany the ward resident as she
makes rounds
o 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: Wards
o Accompany patients for diagnostic
examinations
o 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 Exposure
Preduty Day: Wards
o 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 clerk
Ward 16 clerk
IMU clerk
RBC 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 Exposure
Preduty 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 postoperative 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 Day
o OB admitting section – 3 clerks
o 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: OBAS
o History, physical and internal
examination
o Formulates a working diagnosis and plan
of management
o 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: OBAS
o 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 Exposure
Duty 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 codecked intern (buddy) to guide you, but
the patient is ultimately, still the clerks
responsibility
Clinical Exposure
Duty Day: LR/DR
o SIC does a complete history and
physical examination
o Monitors progress of labor
o 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 Exposure
Duty 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 Exposure
Duty 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 Day
o 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 weekdays
o 7 AM weekends
o 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 Services
o SGD: 5 groups of 3-4 students
each
o Public Health Forum: 3 groups
(per service)
Evaluation Scheme
Comprehensive examination
Written examination
OSCE
Ward performance
Average of SGD grade
Public health forum
Total
10%
15%
15%
30%
20%
10%
100%
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
ObGyn 251
o 1- 8x10 index card: with picture
o Information card: to be submitted
today
oName
oNickname
oBlock
oDate of rotation
oService
oContact 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 251
o Absence in a 24-hour or ward
duty
o Excused absence: 1:1
o Unexcused absence: 1:2
o Tardiness or absence in a
departmental conference:
o 3 Lates: 1 absence
o Absent: 4 hours AS duty
ObGyn 251
o 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: 1:2
o Other demerits / deficiencies will be
discussed with the consultant monitor
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.
Before you leave, must have:
o Submitted your index cards and
block folder
o Have the list of SGD topics,
assign
o Have a copy of the bioethics
case
o Have a copy of grading sheets
o Have a copy of the WHO book,
for sharing among the block
o 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?