Teacher-Learner Contract: Gyn-Oncology Block

MAHEC 3rd year Ob-Gyn Clerkship – Department of Obstetrics and Gynecology, Asheville, NC

Student Name: ______Rotation: ______

Instructions: The student should review this document with each resident-teacher on the team. Any changes to this document must be agreed to by all.

Gyn- Oncology: Wards

CURRENT GOAL: Students assigned to the Gyn-oncology Block should attend daily work rounds with the Gyn-oncology team. Students should contribute to the care of their assigned patients by performing daily rounds, writing progress notes in the medical record, interpreting laboratory and imaging studies, and presenting those patients at team rounds.

  1. Where and when should the students report?

The student should arrive at the Women’s surgery floor nurse’s station for work rounds generally 5:30 am. Check with the PGY2 the day prior to confirm expected arrival time.

  1. Who should the students report to- who assigns patients to the students?

The student should report to the 2nd year resident who will assign 2-3 post-operative patients to the student each morning. Students will see postoperative patients only.

  1. Should the student initially see the patients by themselves during morning rounds and then present them to the resident, or should the student wait for a resident to accompany him/her to see the patients?

The student should first evaluate assigned patients independently. The student should obtain a pertinent history and perform a focused physical exam (excluding breast or pelvic). The student should then report this data to the supervising resident who will then evaluate the patient with the student and confirm the history and physical exam findings, and also perform a breast or pelvic exam if indicated. The student may assist the resident in removing bandages and/or drains only if specifically advised to do so. Student should be prepared to fully present patient at rounds.

  1. Should the student write a progress note? If yes, who will review the student’s notes, co-sign them and provide feedback to the student?

The student should write progress notes on assigned patients in the chart using the pre-printed Gyn-oncology form. The supervising resident will review the note and provide immediate feedback. Students should sign the note with MS3 after name.

  1. Should the students complete any tasks on patients they are not assigned to see? If yes, what?

The student’s first priority is his/her assigned patients. Once finished providing care for the assigned patients or when other learning opportunities are lacking, the student may assist in following up with laboratory and imaging studies for any gyn-oncology patient.

  1. Are there any general tasks that the students can help the team with?

When other learning opportunities are lacking, the student may be asked to assist in preparation of preop list for the next day. Also update the list on their patient’s labs/ images, etc.

  1. When do rounds with the Attending occur? What should be the student’s role during rounds?

Attending rounds are at 7am. This may vary slightly according to the daily operating schedule. When attending rounds are taking place, the student is expected to present his/her assigned patient to the attending, and listen to presentations about the other patients on service. The student is also expected to participate in bedside rounds and teaching with the attendings.

  1. When do PM rounds occur? What should be the student’s role during PM rounds?

There is no formal PM rounds with the attending, however every patient does have an afternoon evaluation. The student may be assigned to perform PM rounds on one or more patients by the residents. The student will be expected to evaluate the patient(s), assess their progress toward post-operative goals, report on any laboratory or imaging studies, and write a progress note in the chart in SOAP format.

Gyn-oncology: OR

CURRENT GOAL: Students will have the opportunity to participate in the perioperative care of patients from the Gyn-oncology service. In general, the student should expect to participate in as great a number and variety of cases as possible.

  1. Who assigns the cases to the students? When should case assignment occur?

The chief resident will assign cases to the student the day prior to surgery.

  1. What kinds of cases should the students expect to see ?

The goal is for the student to see the breadth of surgical problems, procedures and techniques. The student can expect to be in the operating room for the majority of scheduled cases, which can include robotic assisted laparoscopy, traditional laparoscopy, open abdominal surgery, breast surgery, vulvar or vaginal excisional or laser procedures, hysteroscopy, and other procedures.

  1. What role should the student have in the pre-op care of the patients? Who will review the student’s evaluations and provide feedback to the student? Can this be consistently done?

The student should accompany the resident to the Pre-op area. They will assist in preparing the patient for surgery, counseling the patient, and expediting the transfer of the patient to the OR.

  1. What role should the student have in the immediate post-op care of the patients? Who will review the student’s evaluations and provide feedback to the student? Can this be consistently done?

The student should follow assigned patients post-operatively. The student should perform post-operative assessment and follow-up and document all perioperative labs and imaging studies. The resident who confirms the pm note will provide feedback.

  1. What are the specific tasks that the students should complete on the patients when they are in the operating room?

The student may be asked to assist in tasks such as transferring the patient to the operating table, positioning the patient, and placing a urinary catheter. In addition, the student may be provided the opportunity to perform an exam under anesthesia. Depending on the type of surgery and potential for learning, the student may be asked to scrub in for the case. The student should assure that a gown and surgical gloves are available for them by bringing their own from the sterile core for the day’s cases. Appropriate intraoperative tasks include holding retractors, cutting suture and driving the uterine manipulator. For the surgically advanced student, appropriate tasks include sewing peritoneum, sewing fascia, and sewing skin. The supervising resident or faculty member will decide if a student is prepared for these tasks. Students should be familiar with the patient’s history, diagnosis and indication for surgery if the case is assigned in advance. Help undrape and transfer the patient as directed by residents and circulating/scrub RN. Write the op note after the case as directed by the resident.

  1. What should the students do when there are no cases in which to participate?

The student should see hospital consults with the gyn-oncology team or assist with the care of other admitted patients. If there are no cases or consults and all floor work is completed including PM rounds, check with the residents. If everything is ready for the next day, the resident may send the student for self-study.

General Guidelines

  1. What should the students do when there are no learning opportunities in which they can participate (i.e. “downtime”)?

The student should use this time for self-study, but remain available. Always check in with the resident prior to leaving.

  1. Where should the students spend down time?

The student may spend their down time in the surgeon’s lounge or the 7th floor resident’s area. In all cases, the student should remain available by pager. The student should remember to communicate with the chief resident regarding his/her whereabouts, other assigned duties, scheduled didactics, excused absences (as pre-arranged with the clerkship director) and any other obligations.