Clerkship
Welcome to the Obstetrics and Gynecology Clerkship at the University of Michigan Medical School.
- General Guidelines
- Professionalism
- Rotation
- Team Responsibilities
- Class Schedule
- Conferences/Lectures
- Patient Write-ups
- Progress Notes
- Patient Charts
- Evaluation Process
- Ob/Gyn Recommended Textbook List
- Student Responsibilities
General Guidelines
The U-M Department of Obstetrics and Gynecology is a unique educational experience that involves close interaction with house staff and faculty, and a hands-on approach to learning by doing. A physician specializing in obstetrics or gynecology often is considered a woman’s primary care provider, and with this in mind, students are encouraged to learn not only obstetrics and gynecology, but anything involved in women’s health in general. During the six-week clerkship, most students will encounter a multitude of clinical problems. Knowledge gained while solving a particular patient problem is knowledge that is retained and applicable to other patients with similar problems.
Professionalism
In addition to the Medical School’s definition of "‘professionalism" in the Student Handbook, the following guidelines should be followed in all disciplines, not just Obstetrics/Gynecology.
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Students are expected to display the utmost discretion and highest caliber of conduct at all times. Specifically, students should refrain from using language inappropriate in a professional atmosphere and discussing problems of a sensitive or controversial nature within earshot of patients, hospital visitors or hospital staff.
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Students are expected to introduce themselves (as a medical student) to nurses, patients, residents and attending physicians. For the laboring patient, a student should always meet both patient and attending as early in the process as possible and get verbal permission from both to participate in the patient's care.
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Professional appearance and conduct are, to say the least, expected. This means appropriate dress on clinic days, including for men neat/clean pants, shirt and tie, and for women, appropriate length dresses and skirts or pants. Hair styles are many and varied, but should not interfere with examinations or detract from professional demeanor. In addition, good personal hygiene also is expected because a lack thereof can distract from one's ability to perform assigned duties. It is expected that a student will address residents and attendings as "Dr. ________," unless they have been specifically told by that physician that they may be more informal and address them by their first name.
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When entering a patient's room for an examination, always knock on the door, then wait for the patient to acknowledge you and give you permission to enter.
Rotation
The clerkship is divided into two three-week periods. All students will spend three weeks on an obstetrics rotation (labor and delivery) and another three weeks in a gynecology rotation, part of which will be spent on gynecology/oncology.
Team Responsibilities
You will be an active member of the Obstetrics, Gynecology or Gynecology Oncology service. The attending physician has overall responsibility for the care of the patients and the teaching of housestaff. The attending physician has the legal responsibility and is ultimately in charge of all patient care. Consequently, any question regarding patient management, or communication of medical opinion, should be deferred to the house officers or the attending physician.
You should keep in mind that although we wish you to become as involved with the care of your patients as possible, it is your principle obligation to use this clerkship to its full advantage to develop a pattern of self-education that will serve you well for many years to come. This means that although the day-to-day "busy work" of ward activity may give you the instant appearance of a physician, it is the continual acquisition of information and development of judgment that will help you become an excellent physician.
Class Schedule
We consider being on-call during the Obstetrics/Gynecology clerkship an essential and rewarding feature of the clerkship. The experience of being on-call is necessary and is not received in any other format.
Conferences/Lectures
Formal teaching conferences are presented throughout the rotation and offer a variety of topics which include: pregnancy and loss, hypertension in pregnancy, pre-term labor, ectopic pregnancy, diabetes in pregnancy, sexually transmitted diseases, abnormal pap smears, pelvic masses, maternal mortality, postpartum hemorrhage, puberty and menopause, sexuality, etc. You are expected to attend these conferences.
Patient Write-ups
Students will be required to perform satisfactory obstetrical/gynecological histories and physicals, and are responsible for knowing patient histories and for writing notes on charts (co-signed by house officer).
Progress Notes
A daily note should be written on each patient you are following. This note should summarize the patient's progress that day, including results of laboratory tests, changes in physical findings, response to therapy, etc. New physical findings, unexpected laboratory results, and any important developments should be discussed, including an appropriate assessment of their meaning and importance as well as a plan for further work-up or therapy. Each note should be discussed with and countersigned by the house officer responsible for the patient.
Patient Charts
Patient charts will be kept in the patient care center (nursing station). When using a chart, it should not leave the immediate patient care center area.
Evaluation Process
The primary goal of the third-year Obstetrics/Gynecology Clerkship is to expose each student to as many patients with as wide a spectrum of medical disorders as possible. Each student is expected to focus on the pregnancy or gynecologic processes of his or her individual patients and to learn as much as possible about each patient’s problems/procedures. This will enhance the student's retention of information and enable him or her to "learn how to learn" to care for future patients with problems they have not yet encountered.
The department assesses students' capabilities in several ways. The final grade is based on performance in all categories:
Clinical Evaluation Forms: The Clinical Evaluation forms are completed by the attending physician and house officers on each service, as well as mentors and attendings in clinics. These evaluations assess the student's ability to function in 10 categories, including attendance, effort and enthusiasm. In addition to the evaluations, a meeting is held immediately following the end of the clerkship with all attending physicians and house officers for verbal evaluations on each student. A passing grade for the clinical portion of the clerkship is "C." The clinical portion of the clerkship is 55 percent of the grade.
Off-Site Clinic Evaluations: Attending physicians evaluate the student’s performance at an off-site clinic location.
Shelf Examination: At the end of their six-week rotation, each student will take a Shelf Examination (the Obstetrics/ Gynecology portion of the National Board Medical Exam), which provides a standardized assessment of the student's medical knowledge base. A score of 58 is required for passing. The Shelf Examination is 20 percent of the grade.
Essay Exam: An essay question requiring an answer of no more than 500 words (or an outline) will be given in addition to the objective portion (Shelf Exam). A score of 65 is required for passing. The Essay Exam is 20 percent of the grade.
Small Group Case Studies: Students will be given two case studies, quizzed on the material, and divided into two discussion groups. Grade will be determined by a combined quiz and participation score, which is five percent of the final grade.
SPI Experience: All students will be required to pass a session with a Standardized Patient Instructor or SPI.
The top 15 percent of students per rotation receive Honors, the next 35 percent receive High Pass and the remainder receive Pass.
The final grade is determined by:
- clinical work on the Obstetrics, Gynecology and Gynecology/Oncology services (compilation of Clinical Evaluation Forms and verbal evaluations)
- evaluations by physicians at off-site clinic locations
- written exams (the Shelf Exam and the Essay Exam)
The written exams are used to differentiate students with similar clinical performance to meet grade percentiles.
Ob/Gyn Recommended Textbook List
- Beckmann, Obstetrics & Gynecology for Medical Students, 5th edition, Williams & Wilkins, 2006.
- Hacker & Moore, Essentials of Obstetrics & Gynecology, 4th edition, Saunders, 2004
Additional texts:
- Cunningham, William's Obstetrics, 21st edition, Appleton & Lange, 2001.
- Rock, TeLinde’s Operative Gynecology, 9th edition, Lippincott, 2003.
- Speroff, Clinical Gynecologic Endocrinology & Infertility, 6th edition, Williams & Wilkins, 1999.
- DiSaia, Clinical Gynecologic Oncology, 6th edition, CV Mosby Co, 2002.
- Mishell, Comprehensive Gynecology, 3rd edition, CV Mosby Co, 1997.
- Kurman, Blaustein’s Pathology of the Female Genital Tract, 5th edition, Springer Verlag, 2002.
Student Responsibilities
Outpatient Obstetrics
- Complete prenatal work-ups on new patients.
- Examine prenatal patients with house officers and faculty.
- Attend PeriCU Rounds.
- Attend teaching conferences.
- Attend Obstetrics/Gynecology Grand Rounds.
- Attend Obstetrics Rounds.
Obstetric Intensive Care Unit (Labor and Delivery)
- Students assigned to Obstetric Intensive Care Unit will be there during assigned hours.
- Admission work-ups of assigned patients (i.e., primigravida in early labor, but not rapidly progressing multipara).
- Follow patients in labor.
- Scrub on every delivery by assignment.
- Participate in care of patients with complications.
- Participate in decision-making (i.e., interpretation of X-rays, consultations, etc.).
- Attend teaching conferences.
- Attend Obstetrics/Gynecology Grand Rounds.
- Rotation nights on call.
- Attend Obstetrics Rounds.
Inpatient Obstetrics
- Admission work-ups of patients admitted.
- Participate in care of pre- and postnatal patients.
- Rotate nights on call.
- Work as second student in the Obstetric Intensive Care Unit during entire week (nights).
- Attend teaching conferences.
- Attend Obstetrics/Gynecology Grand Rounds.
- Attend PeriCU Rounds.
- Attend Obstetrics Rounds.
Outpatient Gynecology
- Attend all general and special gynecology clinics.
- Work-up selected new patients who will be assigned on the basis of educational value.
- Accompany house officers while they are seeing return patients.
- Attend Gynecology Rounds.
- Attend teaching conferences.
- Attend Obstetrics-Gynecology Grand Rounds.
Inpatient Gynecology
- Basic inpatient assignment to Benign Gynecology.
- Work-up new patients who will be assigned on the basis of educational value. (Suggested maximum of two new patients in one day.)
- Primary responsibility for care of own patients.
- Accompany own patients to Operating Room and assist at operations.
- Assist at operations of other patients as indicated.
- Attend ward rounds on all patients.
- Attend Gynecology Rounds.
- Attend teaching conferences.
- Attend Obstetrics/Gynecology Grand Rounds.
- Rotate nights on call.
Gynecology Oncology Service
- Schedule to be arranged by Gynecology Oncology.
- Attend Gynecology Tumor Conferences.
- Attend teaching conferences.
- Attend Obstetrics/Gynecology Grand Rounds.
Expectations
While on Obstetrics (Labor and Delivery) - Labor and Delivery, or L&D, can be a very busy place; therefore, you may not always get direction as on other services. You need to be proactive (not pushy!!) in your role. The more involved you are in the patients’ care, the more likely it is you will get to do deliveries. When on call, you remain on the floor and you should make every attempt to meet the patients on the floor. We suggest you pick a few patients in labor and follow them closely. We don’t encourage that you attend a vaginal delivery if you have not met the patient prior to the delivery. You should follow patients until discharge if you are involved in their delivery. You should see your patients and write your notes prior to morning rounds even if you have to get here at 6 a.m. Residents will not be able to wait for you to write notes if they are ready to do so and one is not in the chart.
While on Gynecology - Rounds are at different times each day and vary according to the number of patients. Please check with your chief on service for the times of rounds. A weekly schedule of cases will be given out the preceding Friday or in the Monday morning pre-op conference. The patients you are expected to follow are the ones that you were in surgery with and the ones who were admitted while you were on call. You will be expected to see them before rounds and have a note written on them and be ready to present them for morning rounds.
Please ask your chiefs how they would like your presentations in the morning and afternoon. If you have questions, please do not hesitate to ask them.
Ask one of the residents to go through OR paperwork with you and then help fill out what you can.
While on Gynecology/Oncology - Rounds are at different times each day and vary according to the number of patients. Please check with your chief on service for the times of rounds. The patients you are expected to follow are the ones whose surgeries you participated in and the ones admitted to the service while you were on call. You will be expected to see your patients before rounds and have a note written on them. Please be ready to present your patients in morning rounds. If you have questions on your role on the service or expectations, please check with your chief.
In clinic, in general, you will see patients with the residents or the fellow and then with the attending. If you have any questions, please ask.
Also, if you are following ante-partum patients, they need to be seen and have notes written prior to rounds. Please be ready to briefly present your patients at morning rounds.
