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

2. Welcome to OB/GYN M3 Clerkship *Mrs. Teresa Ingraham - Undergrad Coordinator *Ms. Sarah Matya -Residency Coordinator *Karen Carlson, MD -Clerkship Director -Generalist Faculty *Katherine Finney, MD -Assistant Clerkship Director -Generalist Faculty

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

4. Methodist Site Training Monday, September 29 th, @ 5 pm All students assigned to Methodist for OB Report to: Medical Office Bldg ▫(left of main hospital) 717 N. 190 th St. 2 nd 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.

5. 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).

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

7. 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)

8. 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

9. 12 hour shifts Expect approximately 8-11 shifts Days and nights Methodist Hospital or UNMC OB SHIFTS

10. Group 1 Call Schedule 7/07/2014-8/17/2014 12 hour Week 1 7/7-13/2014Monday 7/7TuesdayWednesdayThursdayFridaySaturdaySunday 7/13 UNMC: amOrientationAll ThreeXXXXWichers/Brotkowski Wichers pm“XXXX Gruhl Gruhl/BrotkowskiBrotkowski/Gruhl Methodist: amOrientationAll ThreeXXXXSchenk/Gurney Schenk pm“XXXX Schneider Schneider/GurneyGurney/Schneider Week 2 7/14-20/2014Monday 7/14TuesdayWednesdayThursdayFridaySaturdaySunday 7/20 UNMC: amWichersBrotkowskiXXXXGruhl/Brotkowski Brotkowski pmBrotkowskiBrotkowski/WichersXXXXWichers XXXX Methodist: amSchnekSchneiderXXXXSchneider/Gurney Schneider pmGurneyGurney/SchnekXXXXSchnek XXXX Week 3 7/21-27/2014Monday 7/21TuesdayWednesdayThursdayFridaySaturdaySunday 7/27 UNMC: amAll ThreeNelsonXXXXNelson/Blount Nelson pmXXXXChiu/BlountXXXXChiu Chiu/BlountBlount Methodist: amAll ThreeSmithXXXXSmith/Dietle Smith pmXXXXLukens/DietleXXXXLukens Lukens/DietleDietle Week 4 7/28-8/3/2014Monday 7/27TuesdayWednesdayThursdayFridaySaturdaySunday 8/3 UNMC: amChiu/NelsonChiuXXXXChiu/Blount Chiu pmBlountBlount/NelsonXXXXNelson XXXX Methodist: amLukens/SmithLukensXXXXLukens/Dietle Lukens pmDietleDietle/SmithXXXXSmith XXXX Week 5 8/4-10/2014Monday 8/2TuesdayWednesdayThursdayFridaySaturdaySunday 8/10 UNMC: amBurt XXXXBurt XXXXKelly pmKelly XXXXKelly Burt Methodist: amJohnson/ReesJohnsonXXXXSutton/Johnson Sutton pmSuttonRees/SuttonXXXXRees Rees/JohnsonJohnson Week 6 8/11-17/2014Monday 8/11TuesdayWednesdayThursdayFridaySaturdaySunday 8/17 UNMC: amKelly XXXXKellyShelfXXXX pmBurt XXXX “ Methodist: amRees XXXXReesShelf pmJohnson/Sutton XXXX “

11. Course Textbook

12. 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 M3 Students  Click Orientation

13. 4 Required Educational Resources 1. uWISE – APGO educational testing module http://www.apgo.org/student/uwise2.html 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

14. 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. Advanced Colposcopy CD *checked out CD from Ms. Teresa Ingraham *available on clinic computer (bubble room)/*Luikart library computers http://www.slideshare.net/drsubir/colposcopy

15. Great Resources 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, 9 th ed.

17. Clerkship Expectations: * www.apgo.org/members/medical- students.cfm Should be used as a supplement to text Please read required text!

18. *Specific expectations for each part of clerkship in folder Clerkship Expectations

19. 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

20. 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

21. 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

23. GYN Rounder and OB Rounder GYN 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 ▫Varies during the week

24. 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

25. Who are the Chief Residents? Sarah Lundin, MD OB UNMC 11/1: ONC UNMC Ashley Thorson, MD GYN UNMC 11/1 ONC Methodist Jake Gibbens, MD ONC Methodist 11/1: OB UNMC Morgan Morton, MD ONC UNMC 11/1 GYN UNMC

26. Who are the Methodist Residents? Jamie Seeman, MD Elective 11/1 AMB/GYN Gina Torpin, MD Night Float 11/1: High Risk OB Catherine Brockmeier, MD High Risk OB 11/1 Night Flat Jessie Loeffler, MD GYN 11/1 GYN/AMB

27. Michael Levine, MD Neil Hamill, MD Robert Bonebrake, MD Andrew Robertson, MD Methodist MFMs Todd Lovgren, MD Hemant Satpathy, MD

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

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

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

31. Methodist physicians consistently identified by previous students as great teachers 2013-14: ☼ Robert Bonebrake, MD ☼ Hemant Satpathy, MD ☼ Tiffany Somer-Shely, MD ☼ Neil Hamill, MD ☼ Sarah Gernhardt, MD ☼ Paige Berryman MD ☼ William Weidner MD

32. Methodist physicians consistently identified by previous students as great teachers: 2012-13

33. 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 topics

34. 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

35. UNMC Inpatient OB Service: Scheduled OB Teaching Conferences Monday-Thursday 0700 (L&D MD Interaction Rm) ▫Morning teaching rounds  Patient presentations  Scheduled OB 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

36. 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 ▫OR cases ▫Dr. Remmenga’s and Dr. Rodabaugh’s clinics GYN-Surg/Onc ▫2nd and 3rd wks of month attend 1* pm teaching with residents in DOC 4608 prior to resident clinic on Mon. – Wed. – Fri. *Check time with residents…start varies depending on day from 12:30 to 1 pm

37. Gynecology Block: Appropriate attire ▫scrubs when scheduled to be in OR ▫no scrubs when going to clinics Students presentations (1) ▫Benign Gyn week

38. 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

39. 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

40. Patient Log on Oasis

43. 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”

44. 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

45. 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

46. UNMC Benign GYN Service: Scheduled GYN Teaching Conferences Wednesdays 7:00 (time/day will vary!)  Pre-op conference (Luikart WH 4029) 2 nd and 3 rd wks of month attend 1* pm teaching with residents in DOC 4608 prior to resident clinic on Mon. – Wed. – Fri. *Check time with residents…start varies depending on day from 12:30 to 1 pm Thursdays 7:00 (time/day will vary!)  GYN Topic-based session Fridays 7:00  Diagnostics in OB/GYN (DOC 4608) Friday: GYN student presentation (Gyn topic) ▫Time and place will vary ▫5-10 minute prepared presentation with handout -use evaluation form provided -staple copy of handout to form ▫Present to gyn rounder and gyn team ▫5 point of final grade

47. UNMC GYN-ONC Service: Scheduled GYN Teaching Conferences Daily AM/PM work rounds 2nd and 3rd wks of month attend 1* pm teaching with residents in DOC 4608 prior to resident clinic on Mon. – Wed. – Fri. (depending on ONC cases) *Check time with residents…start varies depending on day from 12:30 to 1 pm Oncology topics will be provided by resident ▫Oncology topic

48. DOG Conference - Friday 7:00am  Diagnostics in Obstetrics and Gynecology (DOG) in DOC 4608 (OB classroom) - Topics based on diagnostic imaging and/or testing -3 Fridays/month: OB topic -1 Friday : gyn topic * ALL rotations except GYN ONC and Methodist

49. Vice Chairman’s Luncheon 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!

51. Communication Please read your email ▫We all communicate by email Notes on board on Wednesday am at lectures

52. 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 to Dr. Karen Carlson as soon as you know you will be absent  If you leave during the day due to illness, please notify Dr. Karen Carlson via email.  If you miss more than 1 day in the 6-week clerkship you must make up this time. Mrs. Ingraham 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.

53. 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

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

55. Criteria for Passing Clerkship: *Receiving ≥ 10 th % 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

56. UNMC Shelf scores compared to National average

57. Policies: Marginal or Fail Grades MARGINAL Grade: ▫Students receiving a “M” on the clinical portion of the rotation ▫< 10 th % 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.

58. 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 Mrs Ingraham @ ningraham@unmc.eduningraham@unmc.edu Requests must be made within 30 days of grades being mailed to students OB/Gyn department has committee to evaluate these requests

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

60. Professionalism Problems: Examples Being late/not writing notes on assigned patients Talking about patient information in public areas (i.e. elevators, Facebook, 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.

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

62. Feedback Mid Clerkship meeting: ▫Dr. Finney or Dr. Carlson 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 LOG AND BRING TO MEETING ▫See schedule in your binder. ▫Please let Teresa 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.

63. COM Citizenship Forms: Will be filled out on each student and sent to Sue Pope along with your grade at the end of the clerkship. NOTE: This is separate from your actual “letter” grade received at the end of the clerkship.

64. 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!!

65. Student of the Week One student may be chosen each week as Student of the Week ▫Weeks 2-6 ▫Announced at Grand Rounds Nominations by house staff and faculty UNMC and Methodist students

66. Student Permission Form

67. The END QUESTIONS???