COURSE REQUIREMENTS
A. ATTENDANCE POLICY
Your attendance is expected at all didactic sessions as well as clinical assignments! This is required for all students. The clerkship lecture/didactic schedule is included in IX.OTHER INFORMATION. You must contact the course director or clerkship coordinator if you need to miss a session. UNEXPLAINED/UNEXCUSED ABSENCES FROM DIDACTIC SESSIONS MAY AFFECT YOUR GRADE!. If you are scheduled for clinical activities on Fridays, you should return for your clinical duties AFTER conference ends.
If the lecturer for the session does not arrive within 10 minutes of the scheduled start time, please call Roz at 662-2459.
You will be alerted via e-mail of any changes to the schedule so please check email periodically.
Clinical: Attendance and involvement in assigned clinical duties is required including night float or overnight call. The Course Director’s office (Ann Honebrink MD, 215-662-2459, ) and the course coordinator at your site must be notified if you are unable to fulfill your clinical responsibilities or you are requesting time off for personal reasons. Unapproved absences are not acceptable. University and religious holidays will be respected (see Holiday Policy in IV D). If you are ill please notify the attending on duty and contact the course director as well.
Clinical care in Ob Gyn often involves fairly sensitive physical exams. In consideration of both patients and our students, it is our policy that whenever you are performing a breast or pelvic exam, this should be done with the patient’s permission and under direct supervision by an attending or resident. Please also see appended policy for pelvic exams under anesthesia in SECTION V.
B. PATIENT ENCOUNTER SYSTEM
During this rotation you are required to maintain a log of the patients and procedures you observe and do. This will be available on line and we encourage you to enter your encounters regularly throughout the course of the rotation. In addition, you must complete the patient identifier in writing to allow authentication of each patient encounter you enter in your log. Your log must be completed by the Monday following the rotation. The course director will review every log and if you have not entered a required encounter by the Monday after the end of the rotation, you will need to complete remedial work before you can get a final grade on the course (see below). Logs will be audited periodically to be sure encounters entered are authentic (see below). While there are minimum encounter requirements, we encourage you to enter all significant patient encounters. While this may seem to be a cumbersome process, it is an important component of our ability to be sure you have been exposed to important clinical experiences. In addition, as you become a resident and then an attending, keeping track of your clinical activity will be an ongoing process.
Specific Patient Encounter Directions for the OB/GYN Clerkship
To enter a patient encounter on line, go to: http://ptlog.med.upenn.edu/source/home_web.asp.
A patient encounter will most often be a procedure/history/physical you directly perform (with supervision), participate in or observe. For less commonly seen conditions/patient types, it also may be something you hear about and discuss actively in a case presentation or conference. For this course, the following encounter types and clinical skills are required, along with a specific target number. This rotation’s log is designed to facilitate entry of these specific encounters. However, we do want you to enter all significant patient encounters you are involved in during your rotation. If your particular patyient doesn’t easily fit into a log “type”, please enter as appropriate type: ob, gyn or family planning, level of involvement and use “other” category and free text to briefly describe patient type.
Encounter / Method for completion (patient encounter/case conference) / Number (minimum)Spec exam/pap smear/wet mount/pelvic exam- / Perform, with supervision / 2
Labor and normal vaginal delivery- / Participate in patient care / 3
Labor and c-section / Participate in patient care / 1
Ectopic/1st Trimester loss / Participate in patient care or discuss case / 1
STD Dx and Rx / Participate in patient care or discuss case / 1
Pelvic Mass Evaluation / Participate in patient care or discuss / 1
Sexual History / Interview patient with supervision / 1
Family Planning Options / Discuss with patient or in case presentation / 1
Major Gyn Surgery / Scrub on case and review patient history / 2
Age Appropriate Preventive Exam / Perform history and discuss exam, testing, participate in exam with supervision / 2
Initial Prenatal visit / Perform history and discuss exam, testing, participate in exam with supervision / 2
Evaluate and treat abnormal vaginal bleeding in a gyn patient / Participate in patient care or discuss case / 1
Evaluate and treat a Gyn patient with pelvic pain / Participate in patient care or discuss case / 1
Entering the data into the system
As the patient encounter system is web based, it is unlikely you will be able to record an encounter in ‘real time’. Rather, it is much more likely that you will enter the encounters at some point at the end of the day. In order to assist you in keeping track of your encounters, please use the attached form for note taking. It is imperative that you make note of the patient’s medical record number when recording your encounter so we can verify the encounter.
Once you enter your patient encounter into the online system, a unique identifier will be generated for that encounter. The system will return that number to you. Please enter this number on the note form discussed above with the appropriate encounter. You will have up till a week after the close of the clerkship to complete your encounters.
At the end of your clerkship, please hand in the note form to Ann Honebrink MD/Roslyn Levit, Room 585 Dulles Building. We will randomly perform verification checks for each student at the end of the clerkship. If it is found that you have entered a patient encounter that is not verifiable, you will be asked to meet with the Associate Dean for Student Affairs.
Please contact John Ellingsworth, , for any technical questions related to the patient encounter system.
C. FEEDBACK CARDS:
The School of Medicine requires that all students have documented feedback sessions throughout the rotation. The requirement for this clerkship is 8 cards. The expectation is that you will get 2 cards completed each week with the exception of the first and final weeks of the rotation. The purpose of these cards is to promote formative feedback from residents and attendings to medical students. Feedback cards will be handed out to you at orientation. These will be used to document that the sessions occurred. The contents of the card will not be factored into your grade, but it is mandatory that you hand the cards in to the clerkship coordinator each week. While it is a good idea to seek feedback from as many sources as possible, you can seek feedback from the same resident or attending on more than one occasion. The cards can be brought to Friday didactics where the coordinator will pick them up from you, or they can be delivered to the coordinator’s office. If you do not hand in at least 8 cards by the end of the rotation, you will not be eligible for HONORS.
D. PROFESSIONALISM:
Professionalism in a clerkship setting is measured by the following behaviors:
Altruism
Commitment to Competence and Excellence
Dependability/Punctuality
Empathy
Honesty/Integrity
Respect for Others
Respect for Patients
Responsibility/Reliability
Self Assessment/Self Improvement
In addition for these behaviors there are expectations for attendance, appropriate attire and general professional maturity.
You will be observed during the rotation, in the clinical setting, lectures, and small groups, and you will be evaluated. Evaluators will reply to the following question:
Has the student met minimal competency in ALL domains on professionalism?
No
Yes but with concerns
Yes
Answers of ‘No’ or ‘Yes but with concerns’ will be brought to Dr. Morris’ attention.
E. STUDENT EVALUATIONS OF COURSE AND FACULTY
Students are required to complete the course and faculty/resident evaluation forms prior to receiving their final evaluation and grade from the Dean's office. In addition, students are asked to complete the evaluation forms of each teaching session the week following the session. Constructive written comments are appreciated. The forms are available on-line and are reported in aggregate, without student identifiers.
F. MINI-CEX
The mini-clinical evaluation exercise (CEX)/Oral case presentation (OCP) focuses on the core skills that students demonstrate in patient encounters and presentations. You are required to have a minimum of 1 of each (one green and one pink) completed during the rotation by a faculty preceptor, clinic attending or resident. Not all skills will be observed in all encounters. These cards will be provided to students at orientation, and must be turned in to Roz Levit by the last day of the rotation.
G. WRITTEN HISTORY AND PHYSICAL EXAM
Each student is required to hand in a minimum of one written history and physical exam to either the course director or coordinator at your assigned site. Students may be asked to do additional histories at the discretion of the course coordinator, particularly in the first 6 months. This should include every component of the history, exam findings, summary sentence or two, differential diagnosis (minimum of 3) with discussion and supporting evidence for and against each diagnosis, problem list and plan.
During this rotation breast and pelvic exams should be supervised by attending or resident physicians. They will provide you with feedback.
Every student is encouraged to examine patients under the supervision of faculty and housestaff, and in accordance with the department’s policy on pelvic examinations under anesthesia.