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

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

3. 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

4. Methodist Site Training
Monday, of 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.

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
Reproductive Endocrinology
Urogynecology/pelvic and reconstructive surgery
Minimally Invasive GYN Surgery
2 year fellowship
Pediatric and Adolescent Gynecology

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. 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.

10. L&D Call Schedule 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.

11. Course Textbook

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

13. 4 Required Educational Resources
1. uWISE – APGO educational testing module
Create user name/password to access
unmc.edu extension gives access
2. Pelvic Examination

14. 4 Required Educational Resources
3. Fetal Heart Tones *
*Intrapartum Fetal Heart Rate Monitoring: Nomenclature, Interpretation, and General Management Principles ACOG Practice Bulletin No. 106
4. Colposcopy website

15. 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.

16. Clerkship Expectations:
* students.cfm

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

18. 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

19. 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

20. 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

21. 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

22. 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

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

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

25. 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

26. 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

27. 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

28. 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

29. 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

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

31. 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

32. 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

33. 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

34. 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

35. 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

36. 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

37. 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

38. Patient Log on Oasis

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

41. 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”

42. 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

43. 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

44. 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 s for updated schedule

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

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

47. 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!

48. Communication
Please read your
We all communicate by

49. 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 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 .
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.

50. 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 8 AM
5% GYN presentation
5% orange card/patient log/effort/attendance

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

52. 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

53. UNMC Shelf scores compared to National average

54. 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.

55. 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 to
Requests must be made within 30 days of grades being mailed to students
OB/Gyn department has committee to evaluate these requests

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

57. 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

58. 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

59. 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.

60. 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!!

61. 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

62. Student Permission Form

63. The END
QUESTIONS???