UNIVERSITY OF ALABAMA SCHOOL OF MEDICINE
TUSCALOOSA, ALABAMA
OBSTETRICS & GYNECOLOGY CLERKSHIP
MANUAL
DANIEL M. AVERY, MD
CLERKSHIP DIRECTOR
REVISED MARCH 2006
TABLE OF CONTENTS
1. Program Overview
2. Orientation Schedule
3. 2006-2007 OB/GYN Clerkship Orientation Packet
4. Daily Schedule
5. OB/GYN Clinic Schedule
6. Duties of Third Year Medical Students
7. Lectures for Medical Students
8. OB/GYN Medical Student Presentations
9. Clinical Case Presentations
10. Medical Student Grading Policy
11. Policy on Student Contact Hours and Clinical Duty Hours
12. Mid-Clerkship Evaluation
PROGRAM OVERVIEW
Direct patient-student contact in clinical settings, both inpatient and outpatient, will be utilized to illustrate curricular content. Small group discussions, lectures by full-time and part-time faculty, audiovisual aids and computer programs will be used to supplement patient-student contacts.
The basic text is Obstetrics & Gynecology by Beckmann, et al, fifth edition. This single text contains the basic elements of the core curriculum. A copy of the text is available for each student to borrow during the clerkship. Additional texts in Obstetrics, Gynecology, Maternal-Fetal Medicine, Reproductive Endocrinology, Gynecologic Oncology, Pelvic Surgery, Anatomy, Pathology and Pharmacology are available in the Department Library in the medical students’ work area, Clerkship Director’s office, Health Sciences Library and Labor & Delivery. Textbooks must returned to the department before receiving final grades.
Students will learn:
1. To make a diagnosis of pregnancy;
2. To identify and manage usual problems occurring during the prenatal period and to identify high-risk obstetrics patients
3. To manage normal labor and to recognize and develop a management plan for abnormal labor;
4. To utilize fetal monitoring equipment and to be competent to interpret basic abnormalities of fetal heart rate tracings.
Students will participate in vaginal deliveries, cesarean sections, tubal ligations, repair of episiotomies and observe circumcision of normal newborn male infants.
Students will gain experience in seeing gynecologic patients and performing pelvic examinations. Experience in contraception, neoplasia, infectious disease and endocrinology and psychosomatic diseases affecting women is available. The identification, evaluation and treatment of gynecologic problems is stressed. Students will participate in a wide range of invasive diagnostic and therapeutic techniques.
Students will assist in gynecologic surgical procedures performed in the hospital and in the ambulatory facilities, participating in both elective and emergency surgery for both benign and malignant diseases.
ORIENTATION SCHEDULE
ORIENTATION & DEMONSTRATION ON DAY 1
6:30 AM---7:30 AM ORIENTATION TO FLOOR, LABOR & DELIVERY,
CHARTS, EMERGENCY ROOM BY HOUSESTAFF
7:30 AM---9:00 AM ORIENTATION TO MORNING REPORT, STUDENT
PRESENTATIONS & ROUNDS BY ATTENDINGS
9:00 AM---11:00 AM ADMINISTRATIVE ORIENTATION WITH CALL,
SCHEDULES, HANDBOOKS, VIDEO PRESENTATIONS
WITH MS. JACKIE NUCKOLS, ADMINISTRATIVE
ASSISTANT AND CLERKSHIP COORDINATOR
11:00 AM---12 NOON ORIENTATION TO CLINIC AND ELECTRONIC
MEDICAL RECORD BY FELLOWS & RESIDENTS
12 NOON---1:30 PM CLERKSHIP DIRECTOR MEETS WITH STUDENTS IN
OB/GYN CONFERENCE AREA
FIRST FRIDAY OF CLERKSHIP, INTRODUCTORY FETAL HEART RATE MONITORING CLASS TAUGHT BY KATHY ROBERTS, RN, CRNP, MSN, CERTIFIED EFM INSTRUCTOR IN 3RD FLOOR OB/GYN CLASSROOM AT 1:30 PM.
***INITIALLY STUDENTS OBSERVE ATTENDINGS, FELLOWS AND HOUSESTAFF PERFORMING PELVIC AND BREAST EXAMINATIONS FOLLOWED BY SUPERVISED PERFORMANCE BY STUDENTS.
2006-2007 CLERKSHIP ORIENTATION PACKET
CLERKSHIP DIRECTOR: Daniel M. Avery, MD
Office 348-1398
Home 345-4444
Pager 464-5046
Cell 393-1020
Clinic 348-1270/1266
L&D 759-7450
Winfield 205-487-2004
ATTENDINGS: Dr. Daniel M. Avery—Chairman of OB/GYN
Dr. Dwight E. Hooper—Division Chief of GYN
Dr. Will Lenahan—Part time OB/GYN
Dr. Cathy Avery Skinner—Family Med/OB
Dr. John B. Waits—Family Med/OB
Dr. Louis Payne—occasionally covers GYN
Dr. Cindy Dedmon—Private Family Med/OB
Dr. Beverly Joseph—Private Family Med/OB
Dr. David B. Partlow, Jr.—Private OB/GYN
Dr. Karl Harbin—Private OB/GYN
Dr. Jim Poist—Private OB/GYN
Dr. Steve Madden—Private OB/GYN; Chair
of OB/GYN for DCH Regional Medical Center
Dr. Charles Mentel—Private OB/GYN
FELLOWS: Dr. Clifton Garris, Instructor in OB/GYN
FETAL MONITOR INSTRUCTOR: Kathryn Roberts, RN, CRNP, MSN, Adjunct Assistant Professor
ADMINISTRATIVE ASST/CLERKSHIP COORDINATOR/
OBSTETRICS FELLOWSHIP COORDINATOR:
Jackie Nuckols 348-1398
NURSES: Becky Tierce, LPN, Charge Nurse
Essie McCollins, LPN
Ginger Lovin, LPN
RECEPTIONIST: Sylvia Bostic; Sheila Mullinex; 348-1270
SPANISH INTERPRETER: Maria Hollingsworth
RESIDENTS: Family Practice Residents vary by the month
Usually two interns; one or two senior residents
UAB OB/GYN Senior residents on Mondays in OR
SAMPLE BOARD QUESTIONS ON CDs
CALL: Every 4th night; call is 12 PM to 12 PM on weekdays; 8AM to 8 AM on weekends. CANNOT leave hospital while on call. Can go home after lunch after noon conference but must return for any lecture if on call night before. Leave pager number on board in Labor & Delivery. Wear scrubs. Maximum 80 hour work week.
SURGICAL SCRUBBING: If you have never scrubbed in surgery and do not know surgical technique go to scrub course in OR first day of clerkship at noon
IF YOU HAVE TO LEAVE OR GO HOME FROM CALL, MISS SCHOOL, HAVE A DEATH IN YOUR FAMILY, GET SICK: Tell me or attending on call.****SEE NEW ATTENDANCE POLICY****
****SEE NEW WORK HOURS POLICY****
OBJECTIVES: We will go over; copy on CD, Manual & Web site
TEXTBOOK: You will receive a copy of Beckmann et all to use during the clerkship. There is a reading schedule. We will discuss 10 chapters per week. You must read material before lectures. Return Textbook and Question CD after clerkship. I have a study guide and a summary if you want one for review at the end of the course before exams
LECTURES: Monday 1 PM Conference Table At Faculty Offices by
Dr. Avery; 1 hour; reading schedule supplied; Textbook
chapters
Tuesday 1 PM Conference Table at Faculty Offices by Dr.
Avery; Instrumental Obstetrics & Surgical Gynecology
Wednesday 1 PM: Board Review Questions, High Risk
Obstetrics, Intensive Care Medicine; Conference Table at
Faculty Offices; Dr. Avery
Thursday 1 PM: Case Presentations with Attendings &
Fellows; location TBA
Friday 1 PM: Textbook chapters with Fellows
FETAL HEART RATE MONITORING COURSE: first Friday afternoon of clerkship at 1:30 in 3rd floor conference room in hospital; Mrs. Roberts
STD/SURGICAL KNOT TYING/SURGICAL CLOSURE TESTS: must do pretest the first week of the clerkship and the posttest the last week of the clerkship
GRAND ROUNDS: Friday at noon in Willard Auditorium in hospital; always try to attend; lunch provided
RESIDENT NOON CONFERENCES: Go if possible; location varies; always go if OB/GYN Attendings giving lecture; lunch provided
PERINATAL MORBIDITY & MORTALITY CONFERENCE: Monthly on Tuesdays at hospital at noon; Required; lunch served
ORAL EXAMINATION REVIEW: Mon at 1 PM after textbook completed
STUDENT PRESENTATION: following morning report each morning; OB conference room on 3rd floor in hospital; see schedule. 2 page maximum handout. 10-15 min. If I am not present at rounds, put a copy of your presentation under my door; samples available
CASE PRESENTATIONS: 1 PM Thursdays in Classrooms with Fellows; one student presents on a topic; last 45-60 minutes
MORNING ROUNDS: everyday; 7:30 AM in OB conference room on 3rd FLOOR. Must arrive at hospital 6:30 and see your patients and write notes before morning report. Present patients>student lectures>see patient with attending, fellows & residents. NO FOOD IN THE CONFERENCE ROOM. PLEASE CLEAN UP ANY MESS LEFT AFTER ROUNDS. DO NOT BRING PATIENT CHARTS TO ROUNDS. NO NOTES AFTER FIRST TWO WEEKS UNLESS PATIENT IS VERY COMPLICATED.
DRESS: Always wear scrubs if in hospital on call; there is usually not time to change for a delivery; in clinic wear scrubs or appropriate street clothes with a lab coat.
SURGERY: Monday and Friday 7 AM usually in Outpatient surgery in tower; can be main OR on 2nd floor if emergency, weekend or nights
CLINIC: All students except those on call in the hospital go to clinic in UMC OB/GYN every day after rounds; starts at 9 AM. Try not to be late. There will be orientation to clinic. Clinic every morning and Wed and Thurs afternoon which starts at 1:30
TYPES OF CLINIC PATIENTS & NOTES:
**ALWAYS DOCUMNENT FETAL HEART TONES ON/AFTER 15 WEEKS. ALWAYS DOCUMENT KICK COUNT INSTRUCTION ON/AFTER 20 WEEKS.
New Obstetrics Patient (NOB): Comprehensive H&P + labs +/- sonar
Return Obstetrics Patient (ROB): Brief visit with flow sheet + brief note;
+/- periodic labs, sonar, tests + FHTs
High Risk Obstetrics Patient/Obstetrics Patient with Problems: same + more comprehensive note + FHTs
Early Pregnancy Patient with Problems: Comprehensive visit if first visit or brief GYN visit if return visit; i.e., early pregnant with bleeding
New Gynecologic Patient/Yearly Well Woman Visits/Referred Patient/Office Consultation/Hospital or Emergency Room Referrals: Comprehensive H&P + ancillary studies
Family Planning: New or Established Annual Visit: like yearly well woman visit
Periodic Visit: brief visit
Brief Visit for Oral Contraceptives or depoProvera
Test Results: Visit to give patient test results; usually no charge visit
Established Patient/Follow Up Visit: Patient returns for a specific reason
Visit for a Procedure: Sonar, colposcopy, cryptherapy, Endometrial biopsy, IUD Placement, LEEP, Vulvar Biopsy, etc.
Staple Removal: Visit after surgery or Cesarean Section to remove staples; brief visit and note
Preoperative Visit: Usually need a comprehensive H&P, discussion of surgery and many need to see Ms. Nuckols about surgery scheduling
MOST COMMONLY ASKED QUESTION IN CLINIC: Do I need to do a pelvic exam?Do cardiologists listen to the heart? Do pulmonologists listen to the lungs? Do general surgeons feel of the abdomen or diseased part of the body? MOST OF OUR PATIENTS NEED A PELVIC EXAM!!!!!!
Complete History & Physical including Pelvic Examination:
New Patients: Obstetrics & Gynecologic
Consultations
Referrals
Yearly Well Woman Visits
Annual Family Planning
Hospital Referrals
CODING & BILLING: Directions for both taught during clerkship; Most all of prenatal care is global care; Code is Prenatal Care
CLINIC ATTENDINGS: Try to work with a single attending for a single patient.
E*VALUE LISTS: MUST DO DAILY; I will give you a list to go by; Must be up to date by midclerkship evaluation at 4 weeks; has to be completed before grade can be given; regardless of rest of grades, final grade is incomplete and not passing without completed and reasonable E*Value List. We will go over at length. Must complete required numbers. Turn in list at 4, 6 and 8 weeks to me for review.
WEB SITES: available at Tuscaloosa Campus link or through UAB;
www.obgyn.uab.edu
GRADE: ALL GRADES ARE FINAL AND WILL NOT BE CHANGED
1/2 grade from clinical performance; ¼ oral exam; ¼ miniboard
HAVE TO PASS MINIBOARD TO PASS CLERKSHIP; Oral exams may be taken earlier than scheduled date if desired. May retake Oral Exam in 24 hours if unsatisfactory performance or unsatisfactory testing
MIDCLERKSHIP EVALUATION: at 4-5 weeks; let me immediately if you are having any type of problem
MID-COURSE EVALUATION: evaluation of clerkship at 4 weeks with immediate feed-back; done by students; evaluated by UA Faculty Development Office
DAILY SCHEDULE: attached
MENTOR PROGRAM: I am mentor and faculty advisor for OB/GYN and Pathology; please call me if you have any career interest in either field
EVALUATIONS: Attendings, fellows and residents evaluate students; students evaluate course, residents, fellows, attendings. PLEASE BE HONEST AND CONSTRUCTIVE!!!I will change clerkship each rotation based on your comments
RESEARCH PROJECTS AND PAPERS: Let me know if you are interested in working on a research project or paper for publication
CHAPERONES: Code of Alabama requires a female chaperone for a male or female examining a patient’s breasts or genital region in the clinic, ER, L&D, floor, OR, ICU, triage
RAP UP SESSION: At end of clerkship on last day; lasts 20 minutes. BE HONEST!
DAILY SCHEDULE
FOUR TO SIX STUDENTS PER CLERKSHIP: CALL EVERY 4TH NIGHT; 1-2 STUDENTS STAY IN THE HOSPITAL; REST GO TO CLINIC
6:30 AM---7:30 AM SEE PATIENTS ON THE FLOOR AND COMPLETE
PROGRESS NOTES
7:00 AM---12 NOON SURGERY ON MONDAYS AND FRIDAYS IN THE
MEDICAL TOWER OPERATING ROOMS
7:30 AM---9:00 AM MORNING REPORT WITH ATTENDINGS
STUDENTS PRESENT PATIENTS & PLAN OF CARE
STUDENT PRESENTATIONS (15 MINUTES)
DISCUSSION OF PRESENTATION
FLOOR, LABOR & DELIVERY, ICU ROUNDS
9:00AM---12 NOON CLINIC AT UNIVERSITY MEDICAL CENTER
(SCHEDULE ATTACHED)
12 NOON---1:00 pm NOON LECTURES AT HOSPITAL
PERINATAL MORBIDITY & MORTALITY-TUESDAY
GRAND ROUNDS-FRIDAYS
1:00 PM---2:00 PM CHAPTER LECTURES: DR. AVERY-MONDAY
1:00 PM---2:00 PM INSTRUMENTAL OBSTETRICS/SURGICAL
GYNECOLOGY: DR. AVERY-TUESDAY
1:00 PM---2:00 PM BOARD QUESTION REVIEW/INTENSIVE CARE
MEDICINE/HIGH RISK OBSTETRICS/ORAL
EXAM REVIEW/BOARD EXAMINATION TECHNIQUE:
DR. AVERY-WEDNESDAY
1:00 PM---2:00 PM CASE PRESENTATION WITH ATTENDINGS &
FELLOWS-THURSDAY
1:00 PM---2:00 PM CHAPTER LECTURES WITH FELLOWS-FRIDAY
1:30 PM---4:30 PM AFTERNOON CLINIC ON WEDNESDAYS &
THURSDAYS
OB/GYN CLINIC SCHEDULE
AM PM
MONDAY OBSTETRICS *PRIVATE OB/GYN
*NEW WOMENS CLINIC
TUESDAY GYNECOLOGY *PRIVATE OB/GYN
COLPOSCOPY
WEDNESDAY GYNECOLOGY OBSTETRICS
COLPOSCOPY
THURSDAY HIGH RISK OB GYNECOLOGY
COMPLICATIONS
CLINIC
*WINFIELD *WINFIELD
FRIDAY OBSTETRICS *PRIVATE OB/GYN
COLPOSCOPY
(FELLOW)
DUTIES OF THIRD YEAR MEDICAL STUDENTS
OBSTETRICS
1. Staff Labor & Delivery
2. Get involved with as many patients as possible
3. Assist and accompany the residents during the day in Labor & Delivery
4. Make rounds on all vaginal deliveries. To assist the residents, please write a daily progress note and bring it to the attention of the resident.
5. Make rounds on ANY postoperative patient: cesarean section, tubal, ectopic, hysterectomy or any gynecologic patient with whom you may have been involved.
All patients admitted to Labor & Delivery should have a student History & Physical. All patients must have a resident admit note (RAN).
GYNECOLOGY
All gynecologic admissions must also have a History & Physical. All patients must have a both a resident and medical student history and physical. The upper level resident writes a resident admit note (RAN). The intern dictates a comprehensive history and physical.
ALL ORDERS MUST BE SIGNED BY A RESIDENT, FELLOW OR ATTENDING.
What Medical students are not expected to do:
1. See patients in the Emergency Room without the resident, fellow or attending being physically present.