OBGU-4035 - A/I Minimally Invasive Gynecologic Surgery and Robotic Surgery

OBGU-4035 - A/I Minimally Invasive Gynecologic Surgery and Robotic Surgery

Elective Title: A/I Minimally Invasive Gynecologic Surgery and Robotic Surgery
Course Number: OBGU-4035
Elective Type: clinical Duration/Weeks: 4 Max Enrollment: 1
Prerequisites: Successful completion of Year 3
Additional Requirements: N/A
Responsible Faculty Director: Truong Nguyen, MD Periods Offered: 4-7, 10-13 excluding holiday period 8 
Coordinator: Brandie Denton Other Faculty:
Location to Report on First Day:
MIGS Clinic, 250 Blossom St. Suite 160, Webster, Texas

Goals
1. The student will gain skills and knowledge required to function at the level of a beginning ob/gyn intern.

2. The student will understand the principles of preoperative work of a gyn patient, differential diagnosis of common gyn problems, treatments and surgical options, intraoperative set up for surgery, assistance, surgery, postop care of patient in the hospital and outpatient.

3. The student will consent patient for surgery, writing the preoperative H&P, writing operative note, assist in surgery, placing postoperative orders, and post office care patient in the hospital and in the clinic.

4. The student will become so familiar with many gynecological procedures, using minimally, invasive techniques, such as laparoscopy, robotic surgery, and vaginal surgery.

Objectives
The student will:
1. Personally see patients for consultation in the preoperative clinic.

2. Discuss case with faculty, formulate differential diagnosis and treatment plans.

3. Familiarize with PreOp labs, preop medications management, Surgical site infection protocol, obtain consent with the presence of faculty or residents.

4. Familiarize with pelvic anatomy, common procedures, such as robotic, assisted hysterectomy, vaginal assisted hysterectomy, cystoscopy, treatments of endometriosis, ovarian cyst, ectomy, and hysteroscopy.

5. Will perform positioning of patients for surgery, learn to place laparoscopic trocars, and assist in surgery.

6. Familiarize with docking and undoing of da Vinci Robot for surgery.

7. Familiarize with Surgical instruments, da Vinci robot, laparoscopic equipment, hygroscopic equipment, fluid management equipment, and maintaining sterile field.

Description of course activities
Acting internship in minimum invasive gynecologic surgery will perform history and physical in preop Surgical clinic, evaluate labs and radiological studies, perioperative medical management, consent, patient for surgery, assist in positioning, patient for surgery, assist in surgery, including docking and undocking of robotic instruments, learn postoperative care inpatient and outpatient. Manage of postoperative complications.

Oral presentation of H&P, potential case report of interesting cases. Presents in weekly PreOp conference.

Type of students who would benefit from the course
Fourth year medical students at UTMB or outside institutions that are interested in pursuing a career in obstetrics and gynecology with focus on minimum invasive surgical techniques, including multiport robotic surgery and single port surgery. Focuses on MIGS surgeries and exposing students with interest in a future career in MIGS subspecialty. Student will rotate with our (MIGS faculty) which includes Dr. Nguyen and Dr. Sendukas.

    Weekly Schedule
          Estimated Course Activities (Start-Time/Finish-Time):
Day of Week   AM   PM
Monday 8:00 AM 5:00 PM
Tuesday 6:45 AM 5:00 PM
Wednesday 6:45 AM 5:00 PM
Thursday 6:45 AM 5:00 PM
Friday 8:00 AM 5:00 PM
Saturday
Sunday

 Average number of patients seen per week: 40
 Call Schedule: Available, not required

Research / Other Course Activities
(estimated schedule)
Activity Hours per Week
Faculty Contact-Time 40
Self-Directed Study 5
Data-Collection/Analysis
Other


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?
    Daily
  C. Format - What method(s) are used to document the student's clinical performance?
    Daily oral feedback   End of period oral feedback   Written feedback
Other

2.  Oral Presentation
  A. Audience - To whom does the student present?
    Faculty, 3rd year students, residents
  B. Frequency / Duration of Presentation(s)?
    Daily
  C. Format - What guidelines are set for the student's presentation?
    Clinic and rounding
  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
  B. Format - What guidelines are set for the student's written work?
    H&P EMR
  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 interesting cases
  F. Audience - Who assesses the student's written performance?
    Peer Assessment     Faculty Assessment     Other

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

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)?
    Available

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".
    None

7.  Other Modes of Evaluation
  Please explain below.
    Performance in OR

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.
    Constructive oral feedback
 
B.
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.
    Pelvic exam, suturing, placement of robotic trocars, manipulation of surgical tissue
 
C.
How specifically will this AI build on developing skills from the clerkship year to prepare students for internship?
    They A/I will extend the student’s surgical skills, differential diagnosis, understand risk, and complications of surgical procedures. Enhance understanding of pelvic anatomy.
 
D.
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)?
    Writing case reports of interesting cases or rare, unexpected complications.
 
E.
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?
    Evaluation of PreOp patients, period of management, assist in surgery, postoperative care inpatient, and outpatient.
 
F.
How is the student demonstrating drawing clinical conclusions and/or developing a management plan and documentation as an intern would do?
    Student will obtain H&P in the MIGS preoperative clinic, placement of orders, preoperative and postoperative, assess and manage postoperative complications, such as hemorrhage, cellulitis, pelvic infection, and abnormal postoperative vaginal bleeding.
 
G.
How and by whom will midpoint feedback be provided to the student? How will you remediate deficiencies identified at midpoint?
    Expectation of students' responsibility will be discussed at the beginning of the course, mid-course constructive feedback will be given orally, and final evaluation.
 
H.
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.
    Two faculties MIGS division will work closely with acting intern.