OBGU 4034 - Enriching Knowledge and Skills for Vaginal Delivery

OBGU 4034 - Enriching Knowledge and Skills for Vaginal Delivery

Elective Title: Enriching Knowledge and Skills for Vaginal Delivery
Course Number: OBGU 4034
Elective Type: clinical Duration/Weeks: 2 Max Enrollment: 2
Prerequisites: Successful completion of Year 3
Additional Requirements: C-form required. Please contact the course coordinator, Brandie Denton(bldenton@utmb.edu) and/or course director, Amjad Hossain (amhossai@uttmb.edu).
Responsible Faculty Director: Chasey Omere, MD; Amjad Hossain, PhD Periods Offered: 1,3,5,7,9,11,13 excluding holiday period 8 
Coordinator: Brandie Denton Other Faculty:
Location to Report on First Day:
335 clinical science building (CSB), Conference room in Gyn Suite (3rd floor near CSB auditorium), contact: 409-772-2610 (O) / 281-785-6804 (C)

In preparation for students' transition into Ob/Gyn residency, this elective enriches their knowledge of vaginal delivery - a basic obstetric procedure that all students entering into residency are expected to have sufficient experience. The course consists of 2-weeks of rigorous hands-on experience in labor and delivery (L&D) plus self-directed research and familiarization with American College of Obstetricians and Gynecologists (ACOG) guidelines.

Through the knowledge gathered while working in L&D and from pertinent literature reviews, students will be able to:
1) gain a broader understanding of the procedure including stages and steps of typical and complex delivery,
2) hone their delivery skills,
3) hypothesize basic science explanations of possible pathogenesis during delivery, and appraise options for effective management of such challenges,
4) develop prevention and management of obstetric lacerations, and
5) learn document requirements related to vaginal delivery.

Description of course activities
On the first day of rotation during orientation, the course syllabus, schedule, expectations, and requirements will be discussed. How the course requirements can be achieved will also be explained. Students will get specific information pertaining to their daily roles and responsibilities. They will also be presented with guidelines to follow while working in the L&D unit. Orientation will sufficiently prepare the students performing their tasks in L&D so that all the learning objectives can be achieved.

In week 1, the students take part in vaginal deliveries under the supervision of a course faculty member or his/her designee. In addition, in between deliveries, the students will watch as many videos as possible to expand their familiarity with typical/atypical deliveries.

In week 2, the students will have the option to participate in more vaginal deliveries and/or watch more videos. In addition, students will perform a literature search to increase their knowledge on vaginal delivery. The purpose will be to learn how to face different types of complications that they may encounter in vaginal delivery.

The student will prepare a written report to demonstrate their depth of knowledge reflecting the required learnings that are indicated in the course's goals and learning objectives. The report is due on Friday of week 2; however, students will be allowed to submit their report via email on or before Sunday at midnight of week 2.

Type of students who would benefit from the course
The elective should be of particular interest to students who wish to pursue a career in obstetrics and gynecology. Students interested in women's health issues in other fields such as primary care physician (PCP) and general internal medicine practitioner (GIMP) or related surgical subspecialties would also benefit from this elective.

Weekly Schedule
  Clinical Activities (estimated schedule)  
Day of Week   AM   PM
Monday (Week 1&2, Day 1) 8:00 5:00
Tuesday (Week 1&2, Day 2) 8:00 5:00
Wednesday (Week 1&2, Day 3) 8:00 5:00
Thursday (Week 1&2, Day 4) 8:00 5:00
Friday (Week 1&2, Day 5) 8:00 5:00
Sunday (Week 2) written essay due on or before midnight

 Average number of patients seen per week: More than 50
 Call Schedule: No

Research Activities (estimated schedule)
Activity Hours per Week
Faculty Contact-Time
Self-Directed Study

Method of Student Evaluation
1.  Clinical Observation
  A. Where are students observed on this elective?
    Inpatient Service   Ambulatory   Surgery   Standardized patients
Patients simulators   Other
  B. Frequency - How often are students observed clinically?
    5 times during rotation as students will be required to work 5 days in L&D each week
  C. Format - What method(s) are used to document the student's clinical performance?
    Daily oral feedback   End of period oral feedback   Written feedback

2.  Oral Presentation
  A. Audience - To whom does the student present?
  B. Frequency / Duration of Presentation(s)?
  C. Format - What guidelines are set for the student's presentation?
  D. Assessment - Who assesses the student's presentation performance?
    Self-assessment   Peer assessment   Faculty assessment
  E. Method of content selection
    Current cases  Student-selected topic   Assigned topic

3.  Written Assignment (H&P's, notes, papers, abstracts, etc.)
  A. Frequency of written assignment(s)?
    1 written assignment
  B. Format - What guidelines are set for the student's written work?
    Will be set jointly by the faculty and student upon discussion
  C. Length of written assignment(s)?
    Abstract   Annotated bibliography   1 - 2 page paper   3+ page paper
  D. Are recent references required?   No    If yes, how are they selected?
    The references are selected following instructor's recommendation, but should not exceed 10.
  E. Method of content selection - e.g. student-selected, relate to cases, etc.?
    Student-selected to fulfill the course learning objectives.
  F. Audience - Who assesses the student's written performance?
    Peer Assessment     Faculty Assessment     Other

4.  Examination
    Oral   Written multiple choice   Written essay / short answer   OSCE

5.  Extra Course Activities
  What expectations do you have for the student to demonstrate participation in the elective (e.g. small group activities, seminars, thoughtful questions, providing resources, journal club, resident lecture attendance)?
    In addition to L&D activities and written report, the student is expected to demonstrate professionalism and interpersonal skills reflecting content knowledge during interaction with the faculty.

6.  Additional Costs
  Please list any additional costs and/or purchases (books, materials, movies to watch, etc.) that are required for this course. Include an estimated total cost. If there are no additional costs, please enter "None".

7.  Other Modes of Evaluation
  Please explain below.
    A. Clinical observation: 30% [Fail (score < 75) / Pass (score > or equal to 75)]

B. Written assignment: 70% [Fail (score <75); meet expectation (score 75-84); exceed expectation (score 85-90); Outstanding (score > 91)]

8.  If this course is an Acting Internship, please complete the following:
  A. Objectives for the AI should relate directly to the Entrustable Professional Activities (EPAs). Each AI should describe how the four key Year-4 EPAs that our school has identified as being Year-4 skills are assessed. The Year-4 objectives are:
1. Entering and discussing orders/prescriptions.
2. Give or receive patient handover to transition care responsibility.
3. Recognizing a patient requiring urgent or emergent care and initiating management.
4. Obtaining informed consent for tests and procedures.
Specify how the student will be given formative feedback on their clinical skills.

Year-4 students should demonstrate mastery of EPAs they developed in the clerkship year, including recommending and interpreting common diagnostic and screening tests, and performing general procedures of a physician. They should be able to demonstrate masterfully and independently skills they mastered in Years 2-3, including efficiently performing comprehensive admission-notes and succinct daily progress notes and perform accurate, concise, and hypothesis-driven clinical presentations, form clinical questions and retrieve evidence to advance patient care. They should be able to demonstrate basic understanding of and beginning mastery of collaborate as a member of the interprofessional team and identify system failures and contribute to a culture of safety improvement.

List advanced clinical skills that a student will be assured an opportunity to practice.

How specifically will this AI build on developing skills from the clerkship year to prepare students for internship?

What opportunities will typically be available to all students who take this AI (procedures, required presentations, etc.)? What opportunities may be available based on patient load/presentation or student initiative (ie. Writing a case report)?

An AI should have expectation of a minimum of 32 hours per week of clinical responsibilities. Duty hours should be capped at ACGME limits for an intern, thus up to 24 hours followed by 4 hours of activities related to patient safety, education, and handoff. Students cannot work more than 80 hours per week averaged over 4 weeks. They can only have 1 day off in a 7-day work week with 8 hours off between shifts.

Clinical responsibilities will vary depending on specialty, but how is the student functioning with work commensurate to a PGY1 with an appropriate level of training?

How is the student demonstrating drawing clinical conclusions and/or developing a management plan and documentation as an intern would do?

How and by whom will midpoint feedback be provided to the student? How will you remediate deficiencies identified at midpoint?

Acting Internship students often seek letters of recommendation following their experience. How many different Faculty will work directly with the student and have knowledge of the student's abilities to detail in a written evaluation? Describe the degree of supervision and interaction with faculty vs. residents or other providers and how feedback will be obtained if more direct work is with residents or other providers.