OBGU-4008 - Acting Internship in Maternal-Fetal Medicine

OBGU-4008 - Acting Internship in Maternal-Fetal Medicine

Elective Title: Acting Internship in Maternal-Fetal Medicine
Course Number: OBGU-4008
Elective Type: clinical Duration/Weeks: 4 Max Enrollment: 2
Prerequisites: Successful completion of Year 2
Additional Requirements: Successful completion of Ob/Gyn Clerkship. Visiting students must seek prior approval.
Responsible Faculty Director: Shannon M. Clark, MD Periods Offered: 1-7, 9-13 excluding holiday period 8 
Coordinator: Brandie Denton Other Faculty: n/a
Location to Report on First Day:
Email Mrs. Brandie Denton (bldenton@utmb.edu) and Dr. Clark (shclark@utmb.edu) about 2 weeks prior to starting elective for instructions.

The course is designed to give the students a comprehensive experience in maternal-fetal medicine and broaden their knowledge and skills beyond the core OB/GYN rotation. The goals are listed below:

1. To gain more knowledge of the pathophysiology, diagnosis, and management of common maternal and fetal complications of pregnancy.

2. To learn how to evaluate and triage patients presenting to labor and delivery.

3. To learn the principles of labor management, as well as operative procedures on labor and delivery.

4. To learn management principles of antepartum high-risk patients in the inpatient and outpatient settings.

5. To learn basic ultrasound principles and skills.

6. To learn how to counsel patients with fetal and maternal genetic complications.

7. To participate in the weekly multi-disciplinary MFM conference where we discuss with the highest-risk patients and those with fetal complications, as well as attend MFM fellow lectures.

1. Students will evaluate patients in labor & delivery triage in order to diagnose or exclude labor, ruptured membranes, pre-eclampsia and other common obstetrical problems.

2. Students will be able to follow the progress of a patient in labor and assist in performing a normal spontaneous vaginal delivery, as well as participate in operative procedures like cesarean deliveries.

3. Students will gain basic knowledge of the management of high-risk pregnancy in the inpatient antepartum setting by rounding with the third-year resident and MFM fellow on the antepartum service.

4. Students will gain knowledge in the performance of a basic ultrasound examination by shadowing sonographers in the ultrasound clinic.

5. Students will see patients in the outpatient setting with one of our genetics counselors.

6. Students will see high-risk patients in the outpatient setting with our MFM fellows.

7. Students will learn the multi-disciplinary approach to managing the more complicated high-risk patients by participating on the weekly MFM conference with MFM faculty, MFM fellows, Neonatologists, geneticists, and representative from other disciplines.

8. Students will gain additional knowledge by participating in the weekly MFM fellow lectures.

Description of course activities
An example schedule is below. The schedule is subject to change depending on number of AIs on rotation, resident schedules, AI special requests, etc. Students will also be asked to present a 20 to 30 minute power point lecture on the topic of their choice in the third or fourth week of their rotation. An opportunity to do Thursday night (5:30pm-7:00am) or weekend night call (6pm-8am), or weekend day call is available (8:00am-6:00pm). If call is taken at night, the AI will not be assigned the next day.

Type of students who would benefit from the course
This is available to medical students who have completed satisfactory medical school core rotation in Ob/Gyn. Students interested in postgraduate training in Obstetrics and Gynecology and possibly maternal-fetal medicine are ideal candidates. The course is designed to give the students a rich experience in high-risk obstetrics, broaden their knowledge and skills beyond the core rotation and prepare them to be effective interns should they join an OB/GYN residency. Consent only required for visiting students.

    Weekly Schedule
          Estimated Course Activities (Start-Time/Finish-Time):
Day of Week   AM   PM
Monday Antepartum service (AP), L&D or genetics AP, L&D or genetics
Tuesday AP, sono or high risk NP clinic AP, sono or high risk NP clinic
Wednesday LD MFM fellow conference
Thursday AP, sono or MFM fellow clinic or LD AP, sono or MFM fellow clinic or LD
Friday AP, sono or MFM fellow clinic or LD AP, sono or MFM fellow clinic or LD
Saturday free or optional L&D free or optional L&D
Sunday free or Optional L&D free or optional L&D

 Average number of patients seen per week: 50
 Call Schedule: upon AI request. Optional call shifts: Weekday call is 5:30p-7a (Friday call is 5:30p to 8a). Weekend call can be either 8a-6p or 6p to 8a on Saturday or Sunday

Research / Other Course Activities
(estimated schedule)
Activity Hours per Week
Faculty Contact-Time
Self-Directed Study
Other N/A

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?
  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?
    The AI will be expected to present patients on all services to upper-level residents, MFM fellows, or MFM faculty. The AI will present a PowerPoint Presentation of a medical complication associated of pregnancy. The AI will present background on a specific disease process with will include incidence, manifestation, diagnosis, fetal complications and management. This will be presented during the last week of the elective at the weekly MFM conference, as well as on AP rounds.
  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)?
    Daily on antepartum, LD and MFM fellow clinic.
  B. Format - What guidelines are set for the student's written work?
    EMR progress notes
  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?
  E. Method of content selection - e.g. student-selected, relate to cases, etc.?
    Related to cases
  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)?
    1- Questions on Clinical Rounds. 2- Pertinent literature searches and discussion on cases assigned or seen in Ultrasound or Antepartum Clinics. 3- Attendance to Resident and MFM lectures and to Perinatal Conference.

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.
    You will be evaluated by the residents and fellows on your team and by Dr. Clark and other clinical Faculty that have contact with you.

1. How well student interacts with residents, nursing staff and patients.

2. The strength of students fund of medical knowledge in regards to diagnosis and treatment of women with high-risk pregnancy.

3. Surgical and vaginal delivery, wound closure during cesarean section and bilateral tubal ligation skills will be assessed.

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.
    At mid-rotation, as well as at the end of AI rotation, faculty members and residents whom AI interacted and worked with will be asked to provide feedback evaluation on clinical skills acquired by the AI. Dr. Clark will provide the AI with the summation of the returned evaluations

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.
    Evaluation and assessment obstetric patients presenting at the Labor and Deliver Triage to diagnose or exclude labor, rupture of fetal membranes, preeclampsia, and obstetric bleedings.

Evaluation and management of the labor course and attending spontaneous vaginal deliveries.

Evaluation and daily management of in-patient at the antepartum and postpartum wards.

Evaluate obstetric patients with medical and surgical conditions with the aid of OBGYN residents, MFM fellows, and faculty members.

Learning the basics of ultrasound in determination of fetal presentation, biometry to determine gestational age, and well-delineated fetal anomalies.

Assisting and scrubbing in the scheduled cases of cesarean deliveries.

How specifically will this AI build on developing skills from the clerkship year to prepare students for internship?
    Observing and assisting in operative vaginal deliveries (Forceps and vacuum assisted vaginal deliveries).

Observing prenatal counseling and invasive procedures such as genetic amniocentesis and in-utero fetal interventions.

Observing and participating in management of emergent obstetric bleedings such as contacting blood banks and helping residents in bringing required blood products.

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)?
    Responsibilities similar to PGY1:
-Evaluation and assessment of Obstetric patients in the Triage area
-Evaluation and monitoring progress of labor.
-Attending spontaneous vaginal deliveries.
-Following the directions of the senior OBGYN residents in helping out in management of laboring patients

Responsibilities different to PGY1:
-Assist and scrubbing in the scheduled cesarean deliveries as a second assistant.
-Observing operative vaginal deliveries.

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?
    The course will give the student a real-time exposure to the nature and demands of being an obstetrics provider.

The course will be a practice of the dynamic and unpredictable responsibilities in obstetrical services

The course will expose the students to obstetrical ultrasound in fetal evaluation and assessment.

How is the student demonstrating drawing clinical conclusions and/or developing a management plan and documentation as an intern would do?
    The feedback available at the midpoint of the course will be provided verbally to the students by Dr. Clark. She will also get feedback from the AI.

How and by whom will midpoint feedback be provided to the student? How will you remediate deficiencies identified at midpoint?
    There MFM faculty members (Dr. Olson, Dr. Omere, Dr. Pacheco, Dr. Jain, Dr. Clark, Dr. Saad, Dr. Clifford and Dr. Harirah) the AI is likely to interact with during the course rotation. It is expected that during the 4-week course period, AI is expected to encounter the same individual between 1-4 times depending on the schedule assignment of faculty members. The supervision will be directly by the senior OBGYN residents who are in obstetric service and in charge of supervising other PGY1 residents. Faculty designated in the Labor and Delivery, prenatal ultrasound, and clinics will have the opportunity to supervise AI during different type of clinical skills exposures mentioned earlier.

The supervision will be directly by the senior OBGYN residents who are in obstetric service and in charge of supervising other PGY1 residents. Faculty designated in the Labor and Delivery, prenatal ultrasound, and clinics will have the opportunity to supervise AI during different type of clinical skills exposures mentioned earlier.

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.
    The student will be asked to submit names of residents, fellows and faculty they have worked with the most to Dr. Clark who will contact each individual for feedback. The faculty assignments on respective rotations change daily, but the student will have exposure to multiple faculty. Once feedback is received, Dr. Clark will send to the student mid-rotation, as well as at the end of rotation. This feedback will be used to draft a letter of recommendation if the student asks for one.