WELCOME!

M3 OB/GYN Clerkship
Welcome! Please help yourself to
refreshments provided.
Welcome to OB/GYN M3 Clerkship

*Mrs. Teresa Ingraham

*Karen Carlson, MD
- Undergrad
-Clerkship Director
Coordinator
-Generalist Faculty

*Katherine Finney, MD *Ms. Sarah Matya

-Assistant Clerkship Director -Residency
-Generalist Faculty Coordinator
Orientation Agenda
Morning:
Video/Tour
Clerkship Overview and Expectations
Pelvic Model
Pictures
Resident presentation

Lunch:
Womens Health History (Dr. Carlson)

Afternoon:
Lectures:
Lecture (Dr. Tomich)
Fetal Heart Rate Monitoring and Physiological Changes
M3 Survival Guide (Dr. Cudzilo)
 Methodist Site Training
Monday, September 29th, @ 5 pm
All students assigned to Methodist for OB
Report to: Medical Office Bldg
(left of main hospital) 717 N. 190th St.
2nd Floor Stasny Rm
CERNER Training will begin at 5 pm
(Kim Thorson)
Please try to be at the staff office 5-10 minutes
before appointed time. See instructions in your
booklet
Park in parking lot.
 Methodist Site Orientation

Following CERNER training, someone will take

you for your Methodist Wmns Hospital
orientation.
Orientation at MH will begin promptly at 6-7 pm
(Kristen Koseluk)

You will be given ID cards at orientation.

PLEASE: Return to Methodist Security at end of
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 Womens Hospital
Gynecology Block (2 weeks)
Gynecologic Oncology- 1 week
Benign Gynecology 1 week
Outpatient Clinics Block (2 weeks)
OB Methodist Students

Obstetrics block done at Methodist

team with residents and MFMs

Gynecology block and Outpatient Clinic blocks at

UNMC and Durham Outpatient
 OB SHIFTS

12 hour shifts
Expect approximately
8-11 shifts
Days and nights
Methodist Hospital or UNMC
 Group 1 Call Schedule
7/07/2014-8/17/2014 12 hour

Week 1 7/7-13/2014 Monday 7/7 Tuesday Wednesday Thursday Friday Saturday Sunday 7/13

UNMC: am Orientation All Three XXXX Wichers/Brotkowski Wichers/Brotkowski Wichers Wichers

pm XXXX XXXX Gruhl Gruhl Gruhl/Brotkowski Brotkowski/Gruhl
Methodist: am Orientation All Three XXXX Schenk/Gurney Schenk/Gurney Schenk Schenk

pm XXXX XXXX Schneider Schneider Schneider/Gurney Gurney/Schneider

Week 2 7/14-20/2014 Monday 7/14 Tuesday Wednesday Thursday Friday Saturday Sunday 7/20
UNMC: am Wichers Brotkowski XXXX Gruhl/Brotkowski Gruhl/Brotkowski Gruhl/Brotkowski Brotkowski

pm Brotkowski Brotkowski/Wichers XXXX Wichers Wichers Wichers XXXX

Methodist: am Schnek Schneider XXXX Schneider/Gurney Schneider/Gurney Schneider/Gurney Schneider

pm Gurney Gurney/Schnek XXXX Schnek Schnek Schnek XXXX

Week 3 7/21-27/2014 Monday 7/21 Tuesday Wednesday Thursday Friday Saturday Sunday 7/27
UNMC: am All Three Nelson XXXX Nelson/Blount Nelson/Blount Nelson Nelson
pm XXXX Chiu/Blount XXXX Chiu Chiu Chiu/Blount Blount
Methodist: am All Three Smith XXXX Smith/Dietle Smith/Dietle Smith Smith
pm XXXX Lukens/Dietle XXXX Lukens Lukens Lukens/Dietle Dietle

Week 4 7/28-8/3/2014 Monday 7/27 Tuesday Wednesday Thursday Friday Saturday Sunday 8/3
UNMC: am Chiu/Nelson Chiu XXXX Chiu/Blount Chiu/Blount Chiu/Blount Chiu
pm Blount Blount/Nelson XXXX Nelson Nelson Nelson XXXX
Methodist: am Lukens/Smith Lukens XXXX Lukens/Dietle Lukens/Dietle Lukens/Dietle Lukens
pm Dietle Dietle/Smith XXXX Smith Smith Smith XXXX

Week 5 8/4-10/2014 Monday 8/2 Tuesday Wednesday Thursday Friday Saturday Sunday 8/10
UNMC: am Burt Burt XXXX Burt Burt XXXX Kelly
pm Kelly Kelly XXXX Kelly Kelly Burt Burt
Methodist: am Johnson/Rees Johnson XXXX Sutton/Johnson Sutton/Johnson Sutton Sutton
pm Sutton Rees/Sutton XXXX Rees Rees Rees/Johnson Johnson

Week 6 8/11-17/2014 Monday 8/11 Tuesday Wednesday Thursday Friday Saturday Sunday 8/17
UNMC: am Kelly Kelly XXXX Kelly Shelf XXXX XXXX
pm Burt Burt XXXX XXXX XXXX XXXX
Methodist: am Rees Rees XXXX Rees Shelf
pm Johnson/Sutton Johnson/Sutton XXXX XXXX XXXX XXXX
Course
Textbook
 Educational materials

www.unmc.edu/obgyn

Click Education tab

Lecture materials located here
Click M3 Students
Click Lectures
Orientation/Residents Power Point presentation
Click M3 Students
Click Orientation
4 Required Educational Resources

1. uWISE APGO educational testing module http://

www.apgo.org/student/uwise2.html
Create user name/password to access
unmc.edu extension gives access

2. Pelvic Examination
http://www.nejm.org/doi/full/10.1056/NEJMvcm061320
4 Required Educational Resources
3. Fetal Heart Tones
*www.ob-efm.com
*Intrapartum Fetal Heart Rate Monitoring:
Nomenclature, Interpretation, and General Management
Principles ACOG Practice Bulletin No. 106

4. Advanced Colposcopy CD
*checked out CD from Ms. Teresa Ingraham
*available on clinic computer (bubble room)/*Luikart library
computers
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)
uWise
APGO
Medical Student Education Objectives, 9th ed.
Clerkship Expectations:

www.apgo.org/members/medical-
students.cfm

Should be used as a supplement to text

Please read required text!
Clerkship Expectations

*Specific expectations for each part of

clerkship in folder
Clerkship Expectations
Medical Knowledge
Explain normal physiologic changes of pregnancy including
interpretation of common diagnostic studies
Describe common problems in obstetrics
Demonstrate knowledge of intrapartum care
Describe menstrual cycle physiology, and discuss puberty and
menopause
Describe the etiology and evaluation of infertility
Explain normal and abnormal bleeding
Demonstrate knowledge of preconception care, including the impact of
genetics, medical conditions and environmental factors on maternal
health and fetal development
Describe common breast conditions and outline evaluation of breast
complaints
Demonstrate knowledge of perioperative care and familiarity with
gynecological procedures
Describe gynecologic malignancies including risk factors, signs and
symptoms, and initial evaluation
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
Demonstrate knowledge of common benign gynecological
conditions
Formulate a differential diagnosis of the acute abdomen and
chronic pelvic pain
Provide a preliminary assessment of patients with sexual
concerns
Clerkship Expectations

Interpersonal & Communication Skills

Apply understanding of contraception, including sterilization
Apply recommended prevention strategies to women throughout
the life span
Professionalism
Demonstrate the attitudes and professional behaviors
appropriate for clinical practice during ambulatory and inpatient
settings
Practice-based Learning and Improvement
Recognize their role as leaders and advocates for women
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
~Two faculty per week
 Who are the Chief Residents?

Jake Gibbens, MD Ashley Thorson, MD

ONC Methodist GYN UNMC
11/1: OB UNMC 11/1 ONC Methodist

Sarah Lundin, MD Morgan Morton, MD

OB UNMC ONC UNMC
11/1: ONC UNMC 11/1 GYN UNMC
 Who are the Methodist Residents?

Jamie Seeman, MD Gina Torpin, MD

Elective Night Float
11/1 AMB/GYN 11/1: High Risk OB

Jessie Loeffler, MD Catherine Brockmeier, MD

GYN High Risk OB
11/1 GYN/AMB 11/1 Night Flat
Methodist MFMs

Robert Bonebrake, MD

Michael Levine, MD

Hemant Satpathy, MD

Neil Hamill, MD

Andrew Robertson, MD

Todd Lovgren, MD
 Methodist Generalists

Mark Carlson, MD

Paige Berryman, MD
Craig Bassett, MD Julia Bishop, MD

Judith A. Scott, DO
Abby Lankhorst, MD
Sarah Gernhart, MD Brianne M. Kling, MD
 Methodist Generalists

Megan Prickett, MD (Irwin)

Carolee Jones, MD Amber Cohn, MD

Nancy Mathews, MD
William D. Weidner, MD
Kristen Hoffman, MD Susan Westcott, MD
Methodist Generalists

Michelle S. Knolla, MD
Tifany L. Somer-Shely, MD
Lanette Guthmann, MD

Rebecca L. Jacobi, MD
Thomas E. Martin, MD
Allison Phillips, MD
 Methodist physicians
consistently identified by
previous students as great
teachers 2013-14:
Robert Bonebrake, MD
Hemant Satpathy, MD
Tiffany Somer-Shely, MD
Neil Hamill, MD
Sarah Gernhardt, MD
Paige Berryman MD
William Weidner MD
 Methodist physicians
consistently identified by
previous students as great
teachers: 2012-13
 Obstetrics Block

2 weeks on In-patient team service

UNMC or Methodist
Students follow labor patients and post-partum
patients
Pelvic exams not done
Outline for note formats included in packet
Be prepared for morning 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 (L&D MD Interaction Rm)

Morning teaching rounds
Patient presentations
Scheduled OB 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. Remmengas and Dr. Rodabaughs clinics
GYN-Surg/Onc
2nd and 3rd wks of month attend 1* pm teaching with residents in DOC
4608 prior to resident clinic on Mon. Wed. Fri.
*Check time with residentsstart varies depending on day from 12:30 to 1
pm
Gynecology Block:

Appropriate attire
scrubs when scheduled to be in OR
no scrubs when going to clinics
Students presentations (1)
Benign Gyn week
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
Patient Log on Oasis
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 should 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 Morning Teaching
8:00AM Grand Rounds
MSC 1005/2018 (sign in) Begins August 6, 2014
9:00-12:00
Lectures DOC 4608
schedule in notebook

No matter which clinical block or hospital

currently assigned to, every student should attend
NO scrubs, please
 UNMC Benign GYN Service:
Scheduled GYN Teaching Conferences
Wednesdays 7:00 (time/day will vary!) Pre-op conference (Luikart
WH 4029)
2nd and 3rd wks of month attend 1* pm teaching with residents in
DOC 4608 prior to resident clinic on Mon. Wed. Fri.
*Check time with residentsstart varies depending on day from
12:30 to 1 pm
Thursdays 7:00 (time/day will vary!) GYN Topic-based session
Fridays 7:00 Diagnostics in OB/GYN (DOC 4608)
Friday: GYN student presentation (Gyn topic)
Time and place will vary
5-10 minute prepared presentation with handout
-use evaluation form provided
-staple copy of handout to form
Present to gyn rounder and gyn team
5 point of final grade
UNMC GYN-ONC Service:
Scheduled GYN Teaching Conferences
Daily AM/PM work rounds

2nd and 3rd wks of month attend 1* pm teaching with

residents in DOC 4608 prior to resident clinic on
Mon. Wed. Fri. (depending on ONC cases)
*Check time with residentsstart varies depending on day from
12:30 to 1 pm
Oncology topics will be provided by resident
Oncology topic
DOG Conference

- Friday 7:00am Diagnostics in Obstetrics and

Gynecology (DOG) in DOC 4608 (OB classroom)
- Topics based on diagnostic imaging and/or testing
-3 Fridays/month: OB topic
-1 Friday : gyn topic

*ALL rotations except GYN ONC and Methodist

Vice Chairmans Luncheon

Luncheon
Towards the end of your 6-weeks
Dr. Remmenga usually hosts
All students are expected to attend
Lunch is provided - -Luikart
library, WH 4029
Your feedback is highly appreciated!
Communication

Please read your email

We all communicate by email
Notes on board on Wednesday am at lectures
 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 to Dr. Karen Carlson as

soon as you know you will be absent

If you leave during the day due to illness, please

notify Dr. Karen Carlson via email.

If you miss more than 1 day in the 6-week clerkship

you must make up this time. Mrs. Ingraham 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 30 min exam
last Friday of the clerkship @ 8 AM

5% GYN presentation

5% orange card/patient log

PASS, HIGH PASS, HONORS

Our department complies with the College of

Medicines recommended grade distribution of

20% = Honors
20% = High Pass
60% = Pass
 Criteria for Passing Clerkship:
*Receiving 10th% 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
Policies: Marginal or Fail Grades

MARGINAL Grade:
Students receiving a M on the clinical portion of
the rotation
< 10th% 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 Deans letter
Initial requests must be made by email to Mrs
Ingraham @ ningraham@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
patients
ancillary staff
nurses
supervising residents
faculty
fellow students
Professionalism Problems: Examples
Being late/not writing notes on assigned
patients
Talking about patient information in public
areas (i.e. elevators, Facebook, 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.
Professionalism Problems: Other
examples
Use of cell phones during conferences/lectures
Inappropriate treatment of clinic or nursing
staff
Not following patients after surgery/delivery
Missing deliveries/surgeries when notified by
resident/staff
Residents and/or faculty will give appropriate
feedback and notify Clerkship director of this
interaction if problems arise
Feedback
Mid Clerkship meeting:
Dr. Finney or Dr. Carlson will meet with each student.
Mandatory.
Informal 15/20 min. meeting to give you feedback and receive
feedback from you regarding the first half of the clerkship.
PRINT YOUR PATIENT LOG AND BRING TO MEETING
See schedule in your binder.
Please let Teresa know right away if you have any conflicts
during your scheduled time.
End of rotation comments:
You will receive written comments in your Sorrell Center
mailbox.
COM Citizenship Forms:

Will be filled out on each student and sent to Sue

Pope along with your grade at the end of the
clerkship.

NOTE: This is separate from your actual letter

grade received at the end of the clerkship.
Evaluations for Students to Complete
Department evaluations
Evaluations of lectures
Evaluations of individual faculty,
residents, aprns, cnms, and staff
COM on-line evaluation

**We value your input!!

Student of the Week
One student may be chosen each week as
Student of the Week
Weeks 2-6
Announced at Grand Rounds
Nominations by house staff and faculty
UNMC and Methodist students
Student Permission Form
The END

QUESTIONS???