OBGU-4011 - Outpatient Gynecology

OBGU-4011 - Outpatient Gynecology

Elective Title: Outpatient Gynecology
Course Number: OBGU-4011
Elective Type: clinical Duration/Weeks: 4 Max Enrollment: 1
Prerequisites: Successful completion of Year 2
Additional Requirements: Successful completion of Ob/Gyn clerkship; students may ONLY enroll for OBGU-4011 if no student enrolled in OBGU-4013. Students enrolled within 4 weeks of the start date must seek prior approval. C-form required & go to Brandie Denton (bldenton@utmb.edu)
Responsible Faculty Director: Elisha Jackson, MD Periods Offered: 1-7, 9-13 excluding holiday period 8 
Coordinator: Brandie Denton Other Faculty: n/a
Location to Report on First Day:
Clinical Science Bldg rm 335

The student will encounter patients with a wide variety of gynecologic complaints in an outpatient setting. The student will learn the methods of investigation for diagnosis of these complaints and the treatment options. They will also participate in planning pre-operative evaluations for gynecologic procedures and participate in post-operative outpatient care of patients who have undergone these procedures.

The student should be able to outline the initial work-up of common gynecologic complaints and explain the rationale used in determining the diagnosis. The student should also begin to integrate the gynecologic ramifications of treating many medical conditions into a more comprehensive treatment perspective.

Description of course activities
1. The student will be assigned to work in the outpatient gynecology clinics on Monday through Friday. They will be under the supervision of the faculty and Gynecology Team residents who are assigned to clinic. 2. The student will directly participate in obtaining historical information and performing physical exams on patients with appointments to the clinic and patients who have been referred from the Emergency Department. 3. The student will develop algorithms for three common gynecologic complaints and present references, which validate the rationale used in the algorithms. 4. The student will be responsible for creating clinic notes in the EMR as allowed by institutional policy.

Type of students who would benefit from the course
Students who are planning careers in specialties in which they will be providing primary care for women such as Internal Medicine, and Family Medicine. This will also be available for students considering Ob/Gyn although the acting internship would be preferable for those individuals. Consent only for visiting students.

Weekly Schedule
  Clinical Activities (estimated schedule)  
Day of Week   AM   PM
Monday 1st trimester/Gyn Clinic - 8:00 Urogyn Bay Colony - 5:00
Tuesday Bay Colony Gyn USG - 8:00 Gynecology Clinic - 5:00
Wednesday TDCJ Texas City/Gatesville - 8:00 TDCJ Texas City/Gatesville - 5:00
Thursday 1st trimester/Gyn Clinic - 8:00 TDC Galveston Clinic - 5:00
Friday 1st trimester/Gyn Clinic - 8:00 Urogyn Galveston UHC - 5:00
Saturday N/A N/A
Sunday N/A N/A

 Average number of patients seen per week: 20
 Call Schedule: none

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?
  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?
    Faculty and OB/GYN residents
  B. Frequency / Duration of Presentation(s)?
    Daily/with each patient.
  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)?
  B. Format - What guidelines are set for the student's written work?
    Students develop written algorithms for the diagnostic evaluation of three common gynecologic complaints.
  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.?
    Student selected, may relate to cases seen in clinic
  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)?
    Student will demonstrate participation by seeing patients in the clinic and presenting the patients to faculty and residents.

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.
    Students will be evaluated by the PGL III and IV residents and faculty. The evaluation is based on their attendance, enthusiasm, initiative, evidence of outside reading, and the quality of algorithms.

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.