Welcome! Please help yourself to refreshments provided. M3 OB/GYN Clerkship Welcome! Please help yourself to refreshments provided.

Welcome to OB/GYN M3 Clerkship *Katherine Ijames - Undergrad Coordinator *Karen Carlson, MD -Clerkship Director -Generalist Faculty *Katherine Finney, MD -Assistant Clerkship Director

Orientation Agenda Morning: Lunch: Afternoon: Video/Tour Clerkship Overview and Expectations Pelvic Model Pictures M3 Survival Guide (Dr. Cudzilo) Resident presentation Lunch: Women’s Health History (Dr. Carlson) Afternoon: Lectures: Lecture (Dr. Tomich) Fetal Heart Rate/Physiological Changes

Methodist Site Training Monday, of Orientation, @ 5 pm All students assigned to Methodist for OB Report to: Medical Office Bldg (left of main hospital) 717 N. 190th St. 2nd Floor Stasny Rm CERNER Training will begin at 5 pm (Kim Thorson) Please try to be at the staff office 5-10 minutes before appointed time. See instructions in your booklet Park in parking lot.

Methodist Site Orientation Following CERNER training, someone will take you for your Methodist Wmn’s Hospital orientation. Orientation at MH will begin promptly at 6-7 pm (Kristen Koseluk) You will be given ID cards at orientation. PLEASE: Return to Methodist Security at end of rotation (Office is located next to Emergency receptionist).

Subspecialties in Ob-Gyn General Ob-Gyn 4 year residency Maternal-Fetal Medicine 3 year fellowship Oncology Reproductive Endocrinology Urogynecology/pelvic and reconstructive surgery Minimally Invasive GYN Surgery 2 year fellowship Pediatric and Adolescent Gynecology

Overview: Clerkship “Blocks” Obstetrics Block (2 weeks) UNMC or Methodist Women’s Hospital Gynecology Block (2 weeks) Gynecologic Oncology- 1 week Benign Gynecology – 1 week Outpatient Clinics Block (2 weeks)

OB Methodist Students Obstetrics block done at Methodist team with residents and MFM’s Gynecology block and Outpatient Clinic blocks at UNMC and Durham Outpatient

OB SHIFTS Roughly 12 hour shifts plus am rounds at Methodist Expect approximately 8-11 shifts Days and nights The hours may be long on the 2 weeks of OB, but for the 6 week rotation, you should NOT average over 80 hours per week.

L&D Call Schedule 12 - 14 hr Week 1 Monday Tuesday Wednesday Thursday Friday Saturday Sunday UNMC: am Orientation AB Lectures/L&D A pm “ XXXX B Methodist: am ABC A/C C A/B   Week 2 Week 3 Week 4 B/C Week 5 Week 6 Shelf NOTE: After lectures on Wednesday, all should go to L&D until after rounds that evening except for post call, lectures then off.

Course Textbook

Educational materials www.unmc.edu/obgyn Click Education tab Lecture materials located here Click M3 Students Click Lectures Orientation/Resident’s Power Point presentation Click Orientation

4 Required Educational Resources 1. uWISE – APGO educational testing module http://www.apgo.org/student/uwise2.html Create user name/password to access unmc.edu extension gives access 2. Pelvic Examination http://www.nejm.org/doi/full/10.1056/NEJMvcm061320

4 Required Educational Resources 3. Fetal Heart Tones *www.ob-efm.com *Intrapartum Fetal Heart Rate Monitoring: Nomenclature, Interpretation, and General Management Principles ACOG Practice Bulletin No. 106 4. Colposcopy website http://www.slideshare.net/drsubir/colposcopy

Great Resources Free for students to join uWise APGO American Congress of Obstetricians and Gynecologists (ACOG) Free for students to join Association of Professors of Gynecology and Obstetrics (APGO) uWise APGO Medical Student Education Objectives, 9th ed.

Clerkship Expectations: *www.apgo.org/members/medical- students.cfm

Clerkship Expectations *Specific expectations for each part of clerkship in binder

Clerkship Expectations Medical Knowledge Explain normal physiologic changes of pregnancy including interpretation of common diagnostic studies Describe common problems in obstetrics Demonstrate knowledge of intrapartum care Describe menstrual cycle physiology, and discuss puberty and menopause Describe the etiology and evaluation of infertility Explain normal and abnormal bleeding Demonstrate knowledge of preconception care, including the impact of genetics, medical conditions and environmental factors on maternal health and fetal development Describe common breast conditions and outline evaluation of breast complaints Demonstrate knowledge of perioperative care and familiarity with gynecological procedures Describe gynecologic malignancies including risk factors, signs and symptoms, and initial evaluation

Clerkship Expectations Patient Care Illustrate proficiency in the medical interview and physical examination of women, incorporating ethical, social, and diversity perspectives to provide culturally competent health care Demonstrate knowledge of common benign gynecological conditions Formulate a differential diagnosis of the acute abdomen and chronic pelvic pain Provide a preliminary assessment of patients with sexual concerns

Clerkship Expectations Interpersonal & Communication Skills Apply understanding of contraception, including sterilization Apply recommended prevention strategies to women throughout the life span Professionalism Demonstrate the attitudes and professional behaviors appropriate for clinical practice during ambulatory and inpatient settings Practice-based Learning and Improvement Recognize their role as leaders and advocates for women

GYN Rounder and OB Rounder Faculty assigned to supervise resident clinics Staffs all inpatient and ED consults May be same as OB Rounder Varies during the week OB Rounder Faculty staffing UNMC inpatient OB service Generalist or MFM

Who will teach, supervise, and evaluate you? Obstetrics 2 weeks UNMC: OB team-rounder, staff, and residents Methodist-MFM faculty, generalists, and residents Gynecology 2 weeks Benign: Gyn residents faculty in OR cases Oncology Onc residents Drs. Remmenga & Rodabaugh Outpatient Clinics 2 weeks ~Two faculty per week

Who are the Chief Residents? Catherine Brockmeier, MD Jesse Loeffler, MD Jamie Seeman, MD Gina Torpin, MD

Who are the Methodist Residents? Catherine Brockmeier, MD Jenna Rehmer, MD Rachel Peterson, MD Jill Westcott, MD

Methodist MFMs Robert Bonebrake, MD Michael Levine, MD Hemant Satpathy, MD Joshua Dahlke, MD Andrew Robertson, MD Todd Lovgren, MD Dan Connealy, MD Neil Hamill, MD

Methodist Generalists Mark Carlson, MD Paige Berryman, MD Craig Bassett, MD Julia Bishop, MD Judith A. Scott, DO Abby Lankhorst, MD Sarah Gernhart, MD Brianne M. Kling, MD

Methodist Generalists Megan Prickett, MD (Irwin) Carolee Jones, MD Amber Cohn, MD Nancy Mathews, MD William D. Weidner, MD Susan Westcott, MD Kristen Hoffman, MD

Methodist Generalists Michelle S. Knolla, MD Tifany L. Somer-Shely, MD Lanette Guthmann, MD Rebecca L. Jacobi, MD Thomas E. Martin, MD Allison Phillips, MD

Methodist physicians consistently identified by previous students as great teachers 2014-15: Robert Bonebrake, MD Hemant Satpathy, MD Tiffany Somer-Shely, MD Neil Hamill, MD Sarah Gernhardt, MD Paige Berryman MD William Weidner MD

Methodist physicians consistently identified by previous students as great teachers: 2014-15

Obstetrics “Block” 2 weeks on In-patient team service UNMC or Methodist Students follow labor patients and post-partum patients Pelvic exams – not done Outline for note formats included in packet Be prepared for morning education topics

OB Block Notes Appropriate attire: SCRUBS Introduce yourself patients nurses Be available for checks, labor assessments, and pushing phase and deliveries Make sure your gloves and an extra gown are pulled for you; we want you involved! Try not to get upset with interns who are learning how to do deliveries

UNMC Inpatient OB Service: Scheduled OB Teaching Conferences Monday-Thursday 0700 (L&D MD Interaction Rm) Morning teaching rounds Patient presentations Scheduled OB teaching topics Fridays 0700: Diagnostics in OB/GYN (DOC 4608) Fridays 0800: Morning teaching rounds (as above) Additional OB topic teaching sessions based on L&D activity

Gynecology Block: Benign and GYN-Onc 2 weeks of in-patient team services Gynecology notes and post-op course outlined in your orientation packet GYN team ER In-patient consultations OR cases GYN-Onc Dr. Remmenga’s and Dr. Rodabaugh’s clinics

Gynecology Block: Appropriate attire Students presentations (1) scrubs when scheduled to be in OR no scrubs when going to clinics Students presentations (1) Benign Gyn week Student daily patient notes Should be COMPLETE by rounds

Preparing for an OR case: - Background history on patient -why is this surgery being done? -read chart -review labs -review ultrasounds, pathology, etc. - Read about that particular surgery - Introduce yourself -to patient in pre-op before surgery -to OR staff - Assist with moving/positioning of the patient - Get your own gloves out - After the case -write the brief op note with help of resident/staff -visit the patient 4 hours postop -read the op note -review the pathology

Outpatient Clinics “Block” 2 weeks of outpatient clinic exposure: One on one with 1-2 faculty/ week Look at faculty schedule the day before prepare, for example- postmenopausal bleeding Routine OB care Hands-on opportunities for exams Review Gynecology clinic progress note in orientation packet Scrubs never appropriate Study sessions assigned during this block Need to attend all assigned clinic sessions

Patient Log on Oasis

Patient Log on Oasis *Non-patient care activity should be “last choice”.

What if I feel uncomfortable with pelvic exams? - You are not alone- many physicians do not feel comfortable with pelvic exams - Today is the practice pelvic exam session - We expect you to become more familiar with the mechanics of the exam and how to appropriately talk to your patient during the exam- all exams should be supervised - It takes a lot of practice to do them well. - “How I Learned to Stop Worrying and Do Breast and Pelvic exams”

How can I make the most of my outpatient experience? Be flexible and keep an open mind. . . -your schedule is an outline -be available if opportunities to learn come up

Wednesday Morning Teaching 8:00AM Grand Rounds MSC 1005/2018 (sign in) Begins August 6, 2014 9:00-12:00 Lectures – DOC 4608 schedule in notebook No matter which clinical block or hospital currently assigned to, every student should attend NO scrubs, please

UNMC Benign GYN Service: Preop conference Fridays 7:00 Diagnostics in OB/GYN (DOC 4608) Friday: GYN student presentation (Gyn topic) Time and place will vary 5-10 minute review of assigned article Present to Gyn rounder and Gyn team Use Ob-Gyn resources other than Up to Date 5 points of final grade No handout required Read weekly emails for updated schedule

UNMC GYN-ONC Service: Daily AM/PM work rounds

*ALL rotations except GYN ONC and Methodist DOG Conference - Friday 7:00am Diagnostics in Obstetrics and Gynecology (DOG) in DOC 4608 (OB classroom) No preparation required for students *ALL rotations except GYN ONC and Methodist

Vice Chairman’s Luncheon Towards the end of your 6-weeks Dr. Remmenga usually hosts All students are expected to attend Lunch is provided - -Luikart library, WH 4029 Your feedback is highly appreciated!

Communication Please read your email We all communicate by email

Policies: Attendance/Absences If you are ill, please contact: Contact your current assigned service faculty or chief resident as soon as you know you will be absent.   Send email notification both to Dr. Karen Carlson and Katherine Ijames as soon as you know you will be absent If you leave during the day due to illness, please notify both Dr. Karen Carlson and Katherine Ijames via email. If you miss more than 1 day in the 6-week clerkship you must make up this time. Katherine will coordinate any needed make up time. *Do not rely on a classmate to relay your information. *Efforts will be made to reschedule your clinic sessions if missed.

Clerkship Grading Structure 50 % clinical evaluations Based on faculty and resident evaluations Department grading meeting Clinic advisors, residents, and faculty 40% written exam Shelf Exam: NBME 2 hour and 30 min exam last Friday of the clerkship @ 8 AM 5% GYN presentation 5% orange card/patient log/effort/attendance

PASS, HIGH PASS, HONORS Our department complies with the College of Medicine’s recommended grade distribution of 20% = Honors 20% = High Pass 60% = Pass

Criteria for Passing Clerkship: *Receiving ≥ 10th% scaled percentile score on the NBME shelf exam National scaled percentile scores Approximately 64 raw score AND *Receiving satisfactory resident & faculty evaluations clinical grade of Pass or better

UNMC Shelf scores compared to National average

Policies: Marginal or Fail Grades MARGINAL Grade: Students receiving a “M” on the clinical portion of the rotation < 10th% scaled score on the NBME shelf exam Student may opt to re-take the shelf exam: If they pass second exam then his/her grade sheet will have an addendum noting the improved exam performance, but the grade remains MARGINAL FAIL Grade: A student may receive a FAIL grade if significant professionalism/clinical issues have occurred on the rotation.

Grade Appeals All students have the right to appeal a clerkship grade and/or comments for the Dean’s letter Initial requests must be made by email to Coordinator@ katherine.ijames@unmc.edu Requests must be made within 30 days of grades being mailed to students OB/Gyn department has committee to evaluate these requests

Professionalism Expectations: Attendance Be on-time to activities Take your professional role seriously Demonstrate respect patients ancillary staff nurses supervising residents faculty fellow students

Professionalism Problems: Examples Being late/not writing notes on assigned patients Talking about patient information in public areas (i.e. elevators, Facebook, twitter, etc.) Laughing/talking out of turn during lectures Texting during Grand Rounds or lectures Inappropriate discussions in front of patients during pelvic exams, labor and delivery, etc. Up to 5 points will be deducted from your grade AND Clinical grade will decrease one grade Example: High Pass down to Pass

Professionalism Problems: Other examples Use of cell phones during conferences/lectures/in patient rooms Inappropriate treatment of clinic or nursing staff Not following patients after surgery/delivery Missing deliveries/surgeries Residents and/or faculty will give appropriate feedback and notify Clerkship director of this interaction if problems arise

Feedback Mid Clerkship meeting: End of rotation comments: Dr. Carlson or Dr. Finney will meet with each student. Mandatory. Informal 15/20 min. meeting to give you feedback and receive feedback from you regarding the first half of the clerkship. PRINT YOUR PATIENT ENCOUNTER LOG AND BRING TO MEETING Fill out expectation sheet from orientation and bring See schedule in your binder. Please let Katherine know right away if you have any conflicts during your scheduled time. End of rotation comments: You will receive written comments in your Sorrell Center mailbox.

Evaluations for Students to Complete Department evaluations Evaluations of lectures Evaluations of individual faculty, residents, aprn’s, cnm’s, and staff COM on-line evaluation **We value your input!!

Student of the Week One student may be chosen each week as Student of the Week Weeks 2-6 Announced Wednesdays Nominations by house staff and faculty UNMC and Methodist students

Student Permission Form

The END QUESTIONS???