Lloyd Holm, DO Clerkship Director Generalist Faculty Sonja Kinney, MD Assistant Clerkship Director Generalist Faculty Jill Ramsdell Student Education Coordinator M3’s, M4’s Welcome to OB/GYN Orientation Agenda Morning: Clerkship Overview and Expectations
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Obstetrics Gynecology Clinics
(Kinney & Amoura)
* Call expected approx 3 weeknights and one weekend night during Weeks 1-2 (OB)
* Weeks 5-6 schedule found on Kinney & Amoura clinic advisor handout
*Sample only, please see actual advisor schedule in your packet
*UNMC- 1 faculty/week and service team
*Methodist- MFM faculty, one resident
* Benign- resident team and faculty in cases
* Oncology- Dr. Remmenga and team
* One faculty per week
Joshua Sampson, DO Allison Sampson, DO Maria Gondra, MD OB ONC GYN
Matthew Bruner, MD Sara Gross, MD
0800AM Grand Rounds –University
√ schedule in notebook
Students on OB rotation at Methodist
Tuesday 0700AM meet with Dr. Bassett
Students on Outpatient Clinics and Benign Gyn
Monday 0700AM GYN - Chapter
Tuesday 0700 AM GYN – Preop Conf DOC 4608
Wednesday 0700AM – Questions
Thursday 0700AM GYN – Student presentations
Thursday (once/month) 12-1 Dysplasia conf.
Friday 0700AM Diagnostics Obstetrics and Gynecology (DOG) in DOC 4608 (OB classroom).
- Friday 12 noon FHT Tracing Rounds
Beckman, Obstetrics and Gynecology
Reading assignments listed for each lecture.
Other suggested text:
Hacker, Essentials of Obstetrics and Gynecology
- Student Education
- Lecture schedule
- Click for Power Point presentations
* Read, read, read – try to focus on mechanisms of disease
- Clinic advisors, Gyn chief, OB chief and faculty
(nursing staff comments do not count towards final grade points)
- if they pass second exam then his/her grade sheet will have an addendum noting the improved exam performance, but the grade remains MARGINAL
- if they fail the second exam then his/her grade will be changed to a FAIL and the entire rotation must be repeated.
A student may also receive a FAIL grade if significant professionalism issues have occurred on the rotation.
-Website listing of areas to focus on for each Clinical Block
By the end of the Obstetrics block students will be expected to competently:1) Obtain, present, and document a relevant history on patients being evaluated or admitted; examinations will be done with supervising resident/ faculty2) Interpret and document fetal heart rate monitoring strips3) Assess and document labor course in patients, postpartum assessments4) Write appropriate post-delivery orders (vaginal and C/S)5) Understand the normal hospital course for the patient after a normal vaginal delivery or operative C/S delivery
but enjoy your time with us!
Last Menstrual Period
- Sure date, unsure date
- concordant with EGA
- best in 1st trimester (good within one week)
- Gravity- total number of pregnancies
* Total term deliveries (>= 37 weeks EGA)
* Total preterm deliveries (20- 37 weeks EGA)
* Total deliveries/ abortions under 20 weeks
* Total living children
dilatation & effacement
“19-year-old Caucasian Gravida 1 Para 0 at 39 4/7 weeks presents to L&D reporting painful contractions every 5 minutes for the past 3 hours and blood-tinged mucus from the vagina. Her baby is active and she denies any loss of fluid. Her pregnancy has been uncomplicated except she is Group B strep positive. She desires an epidural for labor.”
“Maternal VS are stable,she is afebrile. Fetal heart tones are in the 120s and reactive.
“Contractions are showing on the monitor every 7 minutes . Her cervix is 4-5 centimeters dilated, 100% effaced, with the fetal vertex at -1 station and a bulging bag of water.
“Assessment is 19 yo at term in labor who is GBS + and requests an epid. Fetal and maternal assessment is reassuring.”
“My plan would be to admit her to L&D, continue routine monitoring, get routine labs, start an IV, start penicillin for Group B strep prophylaxis, and notify Anesthesia for placement of an epidural.”
cervix is not dilated, not effaced = NOT IN LABOR
1st stage of labor- regular contractions, cervix dilates
1st stage continues: cervix is 8 cms dilated, 100% effaced = ACTIVE LABOR
fully dilated, fully effaced, fetus in birth canal = SECOND STAGE LABOR
BIRTH OF THE HEAD
breast or bottle feeding?
urination / defecation
heart & lungs
- for example, wound drainage
laboratory and imaging testing
(Assessment and Plan should be separate)
- Read background history on that patient, review ultrasounds, pathology, etc.
- Read about that particular surgery
- Introduce yourself in pre-op before surgery
- Assist with moving/positioning of the patient
- Introduce yourself to OR staff, offer to get your own gloves
- Visit the patient after the case, read the op note dictation, and review the pathology findings
By the end of the Gynecology block students will be expected to competently1) Write a complete operative note and postoperative orders2) Discuss the normal hospital course after a routine Gyn surgical procedure3) Discuss the appropriate work-up and differential for postoperative low urine output, fever, and wound problems4) Discuss the relevant history, examination, and laboratory or radiology work-up involved in ER assessments of 1) pelvic pain and 2) abnormal vaginal bleeding5) Briefly describe the differences between types of hysterectomies (supracervical, simple, radical, vaginal, laparoscopic)
- 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.
- Advanced Colposcopy (abnormal pap smear work-up and management)
- Blackboard questions
your schedule is an outline - be available if opportunities to learn come up