M 3 Obstetrics and Gynecology Clerkship Welcome Please

M 3 Obstetrics and Gynecology Clerkship Welcome! Please help yourself to the breakfast provided.

OB/GYN Clerkship Directors and Coordinator • Karen Carlson, MD • Clerkship Director • Generalist Faculty • Katherine Finney, MD • Assistant Clerkship Director • Generalist Faculty • Bridgette Hallock bridgette. hallock@unmc. edu 402 -559 -8133 • Clerkship Coordinator

Orientation Agenda 8: 00 - 8: 10 8: 15 - 8: 30 8: 35 - 9: 35 9: 40 - 10: 00 10: 05 - 11: 10 11: 15 - 11: 45 - 12: 00 - 12: 30 Video: “Why OB/GYN”/ Breakfast 12: 30 – 1: 00 - 2: 00 Resident Presentation Clinic Tour, Gina Walsh Introduction to Clerkship, Dr. Carlson Pelvic Examination Lecture- Video Pelvic Exams/Pictures/Schedule Review Introduction to Obstetrics: M 3 Survival Guide, Dr. Cudzilo Break APGO Videos/ Lunch Care of the Aging Woman and Menopause, Dr. Ziegenbein

Methodist Site Training Monday, May 14, 2018 at 5: 00 PM All students assigned to Methodist for OB are required to attend CERNER Training will begin at 5: 00 PM Report to: Medical Office Building (Left of main hospital) Park in parking lot 717 North 190 th Plaza 2 nd Floor Stasny Room Ask for: Kathy Klein kathleen. klein@nmhs. org 402 -354 -6453

Methodist Site Orientation Following CERNER training, someone will take you for your Methodist Women's Hospital Orientation starts promptly at 6: 00 PM-7: 00 PM Methodist Women’s Hospital 707 North 190 th Plaza Kristen Koseluk, RN (L&D) kristen. koseluk@nmhs. org 402 -815 -1243 You will be given ID cards at orientation PLEASE: Return to ID cards to Methodist Security at end of your 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 – 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

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 Clinic Block (2 weeks)

OB Methodist Students • Obstetrics block done at Methodist by teaming with residents and MFM’s • Gynecology block and Outpatient Clinic blocks at UNMC and Durham Outpatient Center

OB Shifts • Roughly 12 hour shifts • plus am rounds at Methodist • Expect approximately • 5 -6 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 Hour Week 1 Monday Tuesday Wednesday Thursday Friday Saturday UNMC: am Orientation A/B/C A/B XXXX A/B Sunday C pm “ XXXX Education C C A/B XXXX Methodist: am Orientation A/B/C A/B XXXX A/B C pm “ XXXX Education C C A/B XXXX Week 2 Monday Tuesday Wednesday Thursday Friday Saturday Sunday UNMC: am XXXX C C XXXX pm A/B XXXX Education A/B XXXX Methodist: am XXXX C C XXXX pm A/B XXXX Education A/B XXXX Sunday Week 3 Monday Tuesday Wednesday Thursday Friday Saturday UNMC: am A/B XXXX A/B C pm C XXXX Education XXXX C A/B XXXX Methodist: am A/B XXXX A/B C pm C XXXX Education XXXX C A/B XXXX Week 4 Monday Tuesday Wednesday Thursday Friday Saturday Sunday UNMC: am C C C XXXX pm A/B XXXX Education A/B XXXX Methodist: am C C C XXXX pm A/B XXXX Education A/B XXXX Week 5 XXXX Monday Tuesday Wednesday Thursday Friday Saturday UNMC: am A/B XXXX A/B C pm C XXXX Education XXXX C A/B XXXX Methodist: am A/B XXXX A/B C pm C XXXX Education XXXX C A/B XXXX Week 6 Sunday Monday Tuesday Wednesday Thursday Friday Saturday Sunday UNMC: am C C C XXXX Shelf XXXX pm A/B Education XXXX Methodist: am C C C XXXX Shelf XXXX pm A/B Education XXXX

Course Textbook

Educational materials www. unmc. edu/obgyn • Click Education tab – Lecture materials located here • Click M 3 Students • Click Lectures – Orientation/Resident’s Power Point presentation • Click M 3 Students • Click Orientation

4 Required Educational Resources 1. u. WISE – APGO educational testing module https: //apgo. mycrowdwisdom. com/diweb/institution? guid=4771 d 0 b 1 -70 a 1 -4 a 37 -afd 2 -f 287 ae 51 c 879 Create user name/password to access (use unmc. edu) – Will receive an email with instructions 2. Pelvic Examination http: //www. nejm. org/doi/full/10. 1056/NEJMvcm 061320

4 Required Educational Resources 3. Fetal Heart Tones *https: //ncc-efm. org/game/efmgame. cfm *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 American Congress of Obstetricians and Gynecologists (ACOG) – Free for students to join Association of Professors of Gynecology and Obstetrics (APGO) – u. Wise – APGO • Medical Student Education Objectives, 9 th ed.

Clerkship Expectations: www. apgo. org/members/medica l-students. cfm

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

Clerkship Expectations Cont. Medical Knowledge – Explain normal physiologic changes of pregnancy including interpretation of common diagnostic studies – Describe common problems in obstetrics, including the following: • history taking • female genital exam (includes pelvic exam) • diabetes in pregnancy • gestational hypertension • pap smear • uterine bleeding • clinical course of labor • minimally invasive surgery • postpartum care • benign vulvovaginal disease • contraceptive and permanent sterilization counseling • annual well-woman exam • perform pelvic exam (including speculum and bimanual exam) • pelvic pain (acute or chronic) • STI screening • new OB prenatal care visit • routine prenatal care follow-up visit • vaginal delivery (observe) • cesarean delivery (observe) • Gyn Onc surgery (observe) • vaginitis • interpretation of fetal monitoring • uterovaginal prolapse – Discuss intrapartum care, including interpretation of fetal heart rate monitor strips – Synthesize knowledge of perioperative care and familiarity with gynecological procedures

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 – Formulate a differential diagnosis and management strategy of the acute abdomen and chronic pelvic pain – Apply recommended prevention strategies to women throughout the life span – Demonstrate competence in technical procedures appropriate for their level of training – Utilize technology, including electronic medical record, to review, deliver and document care of patients

Clerkship Expectations Interpersonal & Communication Skills – Demonstrate effective oral and written communication skills with patients, colleagues, and family members – Participate actively in lectures, rounds, and teaching sessions – Integrate feedback to continue to develop their professional skills – Adapt communication skills to the specific professional setting – Deliver concise and accurate assessments of patients Professionalism – Incorporate sensitivity and responsiveness to the uniqueness of each patient. – Implement compassion and respect for patients – Attend mid-clerkship meeting to reflect on patient care activities and improve future performance – Dress appropriately for activities – Complete requirements in a timely manner – Demonstrate punctuality in all activities Practice-based Learning and Improvement – Recognize their role as leaders and advocates for women – Provide formative feedback of preceptors, lecturers, and the clerkship – Define personal learning objectives by filling out mid-clerkship forms – Prepare a presentation, involving researching the literature bases – Describe health policy and reform principles to improve health care systems

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

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 -One-on-one clinic sessions with a faculty member

Chief Residents/Rotation Assignments Kirsten Sholes, MD OB UNMC-May ONC UNMC-June Melissa Deer, DO GYN UNMC-May ONC Methodist. June Jenna Rehmer, MD ONC UNMC-May GYN UNMC-June Kimberly Huhmann, MD ONC Methodist-May OB UNMC-June

Residents Rotating at Methodist Kimberly Huhmann, MD ONC -May Emily Abele, MD Gyn-May/June Melissa Deer, DO ONC -June Marissa Decker, MD High Risk OB-May/June Luke Wenzel, MD OB-May/June

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

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

Methodist Generalists Carolee Jones, MD Brian Karre, MD William D. Weidner, MD Nancy Mathews, MD Megan Prickett, MD Susan Westcott, MD

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

Methodist physicians consistently identified by previous students as great teachers 2015 -2016: Robert Bonebrake, MD Dan Connealy, MD Tifany L. Somer-Shely, MD Hemant Satpathy, MD Todd Lovgren, MD Neil Hamill, MD

Methodist physicians consistently identified by previous students as great teachers: Paige Berryman, MD Robert Bonebrake, MD Sarah Gernhart, MD Tifany L. Somer-Shely, MD Hemant Satpathy, MD Neil Hamill, MD

Obstetrics “Block” 2 weeks on In-patient team service – UNMC or Methodist Students follow labor patients and postpartum 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 (UT 4234 Conference 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 – OR cases – Dr. Remmenga’s and Dr. Rodabaugh’s clinics

Gynecology Block: • Appropriate attire – 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 Each clerkship will have a list of conditions/diagnoses you are required to log during the clerkship. You only have to log one to receive credit. Midclerkship if you have several that have not been completed, you will need to talk to the clerkship administration about how to meet the requirement. After highlighting it, select “Add Entry”. To log an encounter, select the one you need to log by clicking on it to highlight the box.

Patient Log on Oasis 1) Enter the date, setting, type, gender, age range, and your role. 3) Submit encounter. 2) Complete the encounter by selecting student role. Please mark the encounter as Complete or Focused H&P for all encounters where you see a patient. Select Limited/Observation ONLY if you substitute a didactic for the encounter. *Scrubbing in = Complete or Focused *

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 are to 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 Afternoon Teaching 1: 00 PM Grand Rounds – MSC 1005/2018 (sign in sheet will be in room) 2: 00 -5: 00 PM – Lectures – DOC 4608 – SIM Lab – Sim Center • Schedule in folder and OASIS • No matter which clinical block or hospital currently assigned to every student should attend • NO scrubs, please

UNMC Benign GYN Service: Pre-op 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

DOG Conference • Friday 7: 00 am • Diagnostics in Obstetrics and Gynecology (DOG) in DOC 4608 • No preparation required for students • ALL rotations except GYN ONC and Methodist • If you are scheduled for a study session during clinic rotation weeks you do not have to attend

Vice Chairman’s Luncheon • 5 th Thursday of the Clerkship • Dr. Remmenga usually hosts • All students are expected to attend • Lunch is provided • Located in UT 4234 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 Bridgette Hallock 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 Bridgette Hallock via email. If you miss more than 1 day in the 6 -week clerkship you must make up this time. Bridgette 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 45 min exam – last Friday of the clerkship @ 8: 30 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 ≥ 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

UNMC Shelf Scores Compared to National Average 80 78 76 74 72 70 68 Nat'l UNMC 20 20 20 10 13 05 06 07 08 09 12 11 14 15 -1 -1 -0 -0 -1 -1 -2 1 4 6 7 8 9 0 3 2 5 01 6

Policies: Marginal or Fail Grades MARGINAL Grade: • Students receiving a “M” on the clinical portion of the rotation • Less than 10 th percentile 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 bridgette. hallock@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 o patients o ancillary staff o nurses o supervising residents o faculty o 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 Mandatory Mid-Clerkship meeting: • Dr. Carlson or Dr. Finney will meet with each student • Informal 15/20 minute meeting to give you feedback and for us to receive feedback from you regarding the first half of the clerkship • PRINT YOUR PATIENT ENCOUNTER LOG AND BRING TO MEETING • Complete goals and evaluation form in folder • See schedule in your binder End of rotation comments: • You will receive evaluations via email

Evaluations for Students to Complete Department evaluations • Evaluations of lectures OASIS evaluations • Evaluations of individual faculty, residents, APRN’s, CNM’s, and staff College of Medicine online evaluation We value your input!!

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