Since 1934, Kern Medical has been training residents and
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Academics
Third Year Medical Student Obstetrics & Gynecology Clerkship
Department Chair: Juan Lopez, MD, FACOG
Clerkship Director: Petre P Motiu, MD, FACOG
Clerkship Coordinator: Carol Sue Perez
Email:
Carol.Perez@kernmedical.com
Questions about OB-GYN Clerkship?
Email:
petre.motiu@kernmedical.com
Welcome!
Welcome to the Third-Year Medical Student Pediatric Clerkship at Kern Medical.
Welcome to your Obstetrics and Gynecology Clerkship at Kern Medical. Our faculty, residents in training and staff hope that the next six weeks will be an enjoyable and productive time for you.
We hope to underscore for you the importance of dedicating careers and lifelong efforts of protecting, and a preoccupation with improving women’s health, irrespective of the field of medicine you will be choosing.
Our goal is to provide you with some of the basic knowledge along with a set of the needed clinical skills, that will allow a foundational understanding of women (from development to maturity, through fertility and pregnancy, to perimenopause, menopause, aging) and their health challenges going through various age stages, as well as the spectrum of the most common diseases and health conditions they will ask to receive care for.
This amazing diversity of conditions demanded an equally complex diversity of healthcare needs and clinical situations, and a wide berth of medical treatments and surgical procedures had to be mastered by the general gynecologist and obstetrician, and created over time the need for other four deeply complex subspecialties:
- High-risk obstetrics (perinatology/maternal fetal medicine)
- Gynecologic oncology
- Reproductive endocrinology and infertility
- Urogynecology
It will all begin with orientation usually on the first Monday of each rotation start date in OB Conference Room 4025 after morning conference. The detailed guide you are receiving will help you navigate through your OB-GYN Clerkship requirements for the next six weeks. We encourage you to fully experience the challenge, complexity and excitement that can be so rewarding when engaged in obstetrics and gynecology.
It will be your responsibility to read, understand the schedule, and fulfill all the required clinical tasks as daily assigned by your team leaders. Also, from day one use the protected study time to complete the required readings from your syllabus and do take weekly APGO practice tests. These efforts will help you understand your patients clinical presentations, how to treat them, as well as prepare yourself for, and ace the final NBME exam.
Last but not least, we expect that professionalism in the field of medicine will guide your attitudes and behaviors and provide a basis for conduct in your encounters with the patients, residents, faculty and others you will work with during your rotation.
Specific Clerkship Educational Targets
Understand the basic science and clinical knowledge needed to diagnose the most common obstetric and gynecologic conditions and their two-tier approach: 1. the primary care extent of treatment and 2. the endpoints to consult with and transfer care to a trained OB/GYN physician.
- Learn to use nuanced questioning and your powers of observation to interview and clinically investigate.
- Use OB/GYN H&P specific algorithms for data collection, and evaluate pertinent symptoms and signs.
- Build specific Physical Exam skills (breast, ext genitalia, cervix, pelvic bimanual, adjacent organs, etc)
- Acquire diagnostic and procedural skills specific to outpatient OB/GYN care (speculum exam, Pap, viral/bacterial screening, IUD placement, punch biopsy, etc)
- Acquire skills to order and interpret laboratory, pathology results, imaging studies, etc.
- Strive to get incipient data organizing skills, and how to stratify by relevance the distinct elements.
(Next will help you learn to put them together via contextual reasoning, so you can shape your initial assessment, and a working diagnosis supported by the evidence you obtained.)
- Challenge your own clinical reasoning with each patient you see: [what if its not what I think it is?1] & consider 1-2 additional differential diagnoses when justified, supported your findings!
- Use what you learned about your patient to plan how to treat! Think of a two step initial (what to do first?)& follow-up plan of treatment(what to do next?) addressing your working diagnosis/es.
(Also aim here to begin building the ability to recognize when you need OB/GYN specialty help: when to refer to an OB/GYN consultant for treatment and care.)
The general OB/GYN and Subspecialty Services that cover women health care needs are as follows:
Hospital based: 1. AM & PM inpatient rounds, rotating on night calls, weekly didactics
- Labor & Delivery (including OB surgery)
- Surgery (GYN, Oncology, Urogynecology, Reproductive Endocrinology & Infertility)
- Weekly didactics, free study time
Outpatient based: Sagebrush 1. High Risk OB Attending/Resident Clinic & 2. Resident OB/GYN Clinic,
- Continuity Resident clinic, 4. Attending (one-on-one) Faculty Clinics.
Private Attending (one-on-one) Faculty Clinics
Continuity of care is best understood and becomes a learning experience when you follow patients through all the phases of care, be it prenatal OB visits, or outpatient/preop GYN visits, and be part of their OB delivery, GYN surgery, and as possible, complete the care cycle with their postpartum or postop convalescence visits.
Therefore, constantly think and read around your patients’ problems, then organize, interpret and relevance rank their symptoms, signs, peruse lab values, imaging studies, all pertinent negatives. ALWAYS think HOW the underlying physiology, and anatomy have evolved into what kind of pathology, and how you address it?
It is not uncommon that the medical students in the team (who read with interest around the pathophysiology underlying the signs and symptoms, or review the involved areas of the anatomy for a patient) are the ones asking the key question, or give a suggestion that leads to the appropriate diagnosis and subsequent treatment.
You don’t have to wait for graduation to feel you are already acting and performing exactly as an aspiring doctor should whenever you explore, think on your own, and reason your way towards a healing solution!
Guiding Principles (how to achieve student mastery)
Ob-Gyn can be hard work and long hours, and we expect you to work hard. Period.
At the end of these six weeks, the only good way to get a solid win is to dedicate yourself mind and heart to this process!
However, dedicated and proactive students gain a measure of professional growth, making the most of this opportunity for hands-on learning and understanding women healthcare needs. The many students who have experienced a win-win outcome in these six defining weeks will tell you that the hard work, the long hours, along with the necessary mini-avalanche of new information, have all added to their experience, and certainly have enhanced the quality and worth of their performance.
Clinical learning demands of us a willingness to get involved, and will build up our situational awareness! So, get involved in every team interaction! See where you can step up, and volunteer for any task helping your team to care for your patients. Especially when you understood, or anticipate what needs to be done. This steadily increases you knowledge and skills that will later assist your ability to perform like a doctor.
Volunteer to be in the next delivery or surgery. Ask for guidance to do Gyn exams and office procedures, and placentas and babies deliveries (with the resident staff guiding your hands) also ask if you can stitch, cut tissue in a supervised, safe manner (as circumstances allow it) during the cases you are involved in.
Expect also that each of these moments of assertive curiosity and desire to learn, you made apparent to your educators, may trigger questions (e.g. about the anatomy or pathophysiology of your patients, about disease mechanisms and more!). Its how your understanding and skills will grow! It is what makes it fun!
FINALLY READ, READ, READ! EVERY DAY!
First and foremost, feel compelled to know and understand the anatomy, the physiology and all the underlying pathogenic mechanisms, along with each of the diverse elements that underlie, or determine each of the clinical pictures you will follow and treat.
Every detail is, or maybe a clue, possibly affecting patient outcome, aiding, or maybe challenging all of our prevention, or healing strategies!
Your residents are your main partners and educators, often willing to teach and appreciate the interested, assertive student! Please be on time, every time, and a team player! (No one likes to be there that early!)
Please be courteous, respectful and professional with our wonderful nurses, staff, and auxiliary personnel.
Again, Welcome to Your Kern Medical Department of OB/GYN Clerkship and Good Luck!
Scholastic Goals and Objectives
The primary learning goals and objectives for the rotation will help prepare students for Step 2 of the National Medical Licensing Exam and the Objective Structured Clinical Examination (OSCE) through the following Must-Know Topics:
Must-Know Topics in Obstetrics
- Obstetric History and Physical
- OB prenatal visit, prenatal care, postpartum care
- First trimester Pregnancy Complications/Embryonic Abortion/Ectopic Pregnancy
- Diabetes in Pregnancy
- Domestic violence
- Hypertensive Disorders in Pregnancy
- Preterm Premature Rupture of Membranes (PPROM)
- Intrauterine Growth Restriction (IUGR)
- Normal and Abnormal Labor
- Fetal Monitoring/Antenatal Surveillance
- Third Trimester Bleeding
- Obstetric hemorrhage/Antepartum-Intrapartum-Postpartum
- Abnormal Placentation
- Gestational Trophoblastic Disease (GTD)
- Breast-feeding
Must-Know Topics in Gynecology
- Age-specific gynecology History and Physical
- Annual pelvic examination
- Age-specific preventive care and cancer screening
- Pap smear screening and management
- Endometrial hyperplasia
- Abnormal uterine bleeding and amenorrhea
- Menopause and hormone replacement therapy
- Contraceptive options and counseling
- Abortion
- Infertility
- Breast masses and diseases
- Prolapse/Incontinence
- Pelvic masses and gynecological malignancies
- Pelvic pain
- Sexually transmitted diseases/Pelvic Inflammatory Disease/Vaginal Discharge
Check also and follow your specific school’s objectives.
(Suggestion for a Planned Sequence of Weekly Assignments)
First Week
Annual Exam/Breast/Pelvic Bimanual/Speculum/Pap
Contraception Counseling
Family Planning
First Trimester Bleeding
Ectopic gestation
Maternal-fetal Physiology
Antepartum care/Fetal Assessment/NST/BPP
Second Week
Sexually Transmitted Infections/Vaginitis/UTI
Cervical dysplasia and Neoplasia
Intrapartum Care/Normal labor/Fetal Surveillance
Abnormal Labor/Fetal Heart Patterns
Third week
Normal and Abnormal Uterine Bleeding
Amenorrhea
Breast disorders
Third Trimester Bleeding/Postpartum Hemorrhage
Postpartum Care/Postpartum Infection
Fourth Week
Endometrial Hyperplasia/Neoplasia and Endometrial Cancer
Preterm labor
Preterm Premature Rupture of Membranes
Hypertensive Disorders in Pregnancy/Ch HTN/Gest. HTN/Preeclampsia-Eclampsia/HELLP Sy
Fifth Week
Infertility
Endometriosis/Ch Pelvic Pain
Menopause
Multifetal Gestation/Twin Gestation Management
Sixth Week
Pelvic Floor Disorders/Organ Prolapse/Stress and Urge Incontinence
Pelvic Masses/Ovarian Neoplasms
Diabetes in Pregnancy
Fetal Growth Abnormalities.
Scheduling
Core Clerkship Duration: Six weeks
Medical Student Typical Duty Hours:
- Daily: Weekdays, 5 am-5 pm
- Weekends – Off unless on you are on call (see below)
- Pre-rounds: Daily starting at 5:30 a.m. while on a team
Have the list ready by 6 a.m., then round on the patients. Be ready to present patients by 6:30 a.m.
Rounds (Morning Conference): Daily at 7:30 a.m. (except Accreditation Council for Graduate Medical Education (ACGME) Conference days*). All faculty, residents and students must attend.
- Monday-Thursday: OB Conference Room 4025
- Fridays (Didactics): Main Conference Room 1058
Labor and Delivery/Operating Room: 8 a.m.-sign-out
OB-GYN Resident and Faculty Clinics: 9 a.m.-5 p.m., unless otherwise posted
Rotations: See posted schedule for your assignments.
- Teams: A, B, C, D resident teams designated to different fields within OB-GYN. You will see the spectrum of Clinic, L&D, and OR on this service.
- Sagebrush Clinic and Faculty: See posted schedule. You will work house staff and directly with an attending in the Kern Medical faculty clinics.
- Stockdale Clinic and Faculty: See posted schedule. You will work house staff and directly with an attending in the Kern Medical faculty clinics.
- Community Attending (one-on-one) Faculty: You will rotate with various community OB-GYN providers in their private offices. See posted schedule for address/contact information.
- Night Shift: 7 p.m.-8 a.m. Monday, Tuesday, Thursday, Friday. Meet in Labor and Delivery or find residents on call.
- Weekend Call: 7:30 a.m.-7 p.m. Meet in OB Conference Room (4025).
Conferences:
OB-GYN Didactics and Grand Rounds: Fridays 7:30 a.m. – variable depending on didactic activities
Student Didactics & Feedback: Thursdays at 1 p.m. in 4025 followed by weekly, or mid-clerkship individual sessions for evaluations and feedback (other additional one-on-one feedback sessions can be scheduled as needed with and by the clerkship director to assist your rotation needs)
Attendance
Attendance
Monday through Friday each week ALL students are expected to participate in the 07:30 AM morning rounds and when due in the outpatient clinics be there as requested by the leaders of the teams you are assigned to.
Students are expected to be present all day unless excused.
Students are excused for shelf exams and school-specific meetings or duties.
Notify your team for sick calls or planned absences. All absences must be cleared by Dr. Motiu.
Dress Code:
Clinic: Professional attire
Labor and Delivery/Operating Room/Call: Kern Medical scrubs (See Medical Education for scrub card)
Policy for Medical Student Notes in EMR:
All inpatient and clinic notes are to be written by residents, SUB-Is and co-signed by an attending. If a student MS III sees the patient with an attending, the attending writes the note.
Didactics
Didactic time is protected for all medical students for two-three hours per week, Thursday beginning at 1 p.m. in the OB-GYN Conference Room in 4025, unless otherwise specified.
Students are excused from other responsibilities so they can participate in didactics.
OB/GYN H&P skills: All students are required to do a week 3 OB H&P and week 5 GYN H&P and use it as topic of clinical group discussion of the significance of findings and effectiveness of methods to diagnose and treat. Also whenever possible engender, or prepare questions for the rest of the students in the study group.
READING MATERIALS: The new Ob/Gyn assigned reading will be the 7th edition of Beckman
Assessment
Students will be evaluated by their assigned team residents and faculty. Written evaluations, with the student’s participation in the weekly didactics, will account for 70 percent of the student’s grade. Students will be evaluated based on their knowledge base, clinical and analytic skills, enthusiasm, and professional demeanor.
The remaining 25 percent of the grade will be derived from the student’s performance on the national shelf exam. This computerized 40-question exam is given over one hour at the Sagebrush Technology Learning Center on the last Thursday of each rotation. A passing grade is a minimum of 70 percent correct on the exam.
APGO Resources
APGO Resources (Association of Professors of Gynecology and Obstetrics)
Links to APGO Topics
Topic 1: History
Topic 2:Abnormal Placentation
Topic 3: Pap Test and DNA Probes/Culture
Topic 4: Alloimmunization
Topic 5: Aneuploidy Screening
Topic 6: CONTRACEPTION
Topic 7: Preventative Care and Health Maintenance
Topic 8: MATERNAL-FETAL PHYSIOLOGY
Topic 9: Preconception care
Topic 10: ANTEPARTUM CARE
Topic 11: Gestational Diabetes
Topic 12: *
Topic 13: Postpartum Care
*Topic 14: Hypertensive Disease in Pregnancy
*Topic 14: Lactation
Topic 15: Ectopic Pregnancy
Topic 16: Spontaneous Abortion
Topic 17: *
Topic 18: Preeclampsia-Eclampsia
Topic 19: Gestational Trophoblastic Disease
Topic 20: Multifetal Gestation
Topic 21: Multifetal Gestation Pregnancies
Topic 22: Abnormal Labor
Topic 23: Third trimester bleeding
*Topic 24: Pelvic Organ Prolapse
*Topic 24: Preterm Labor
*Topic 25: Physiology of Labor
*Topic 25: Premature Rupture of Membranes
Topic 26: Intrapartum Fetal Surveillance
*Topic 27: Postpartum Hemorrhage
*Topic 27: Sexually transmitted Infections
Topic 28: Postpartum Infection
*Topic 29: Urinary incontinence
*Topic 29: Anxiety and Depression
*Topic 30: Postterm Pregnancy
*Topic 30: Uterine Atony
Topic 31: Fetal Growth Abnormalities
Topic 32: *
Topic 33: FAMILY PLANNING
Topic 34: Pregnancy termination
Topic 35: Vulvar and Vaginal Disease
Topic 36: Sexually Transmitted Infections (STI) and Urinary Tract Infections (UTI)
Topic 37: Pelvic Floor Disorders*
Topic 38: Endometriosis
Topic 39: Chronic Pelvic Pain
Topic 40: Disorders of the BREAST
Topic 41: *
Topic 42: Puberty
Topic 43: Amenorrhea
Topic 44: Hirsutism and Virilization
Topic 45: Normal and Abnormal Uterine Bleeding
Topic 46: Dysmenorrhea
Topic 47: Menopause
Topic 48: Infertility
Topic 49: Premenstrual Syndrome (PMS) and Premenstrual Dysphoric Disorder (PMDD)
Topic 50: Gestational Trophoblastic Neoplasia
Topic 51: Vulvar Neoplasms
Topic 52: Cervical Disease and Neoplasia
Topic 53: Uterine Leiomyoma
Topic 54: Endometrial Hyperplasia and Carcinoma
Topic 55: Ovaria Neoplasms
Topic 56: *
Topic 57: *
Topic 58: *
Topic 59: Introduction to Osteopathic Principles in OB-GYN (Parts I & II)
Part I: https://youtu.be/acErMZYxF78 Part II: https://youtu.be/cVl__YVc4l0
* – Video not available on YouTube