OBGU-4061 - Enriching Gyn Ultrasound Knowledge and Skill for entering to Residency

OBGU-4061 - Enriching Gyn Ultrasound Knowledge and Skill for entering to Residency

Elective Type: clinical
    
Title
Enriching Gyn Ultrasound Knowledge and Skill for entering to Residency		 Course Number
OBGU-4061		 Duration/Weeks
1
Prerequisites: Successful completion of Year 3 
      Additional Requirements: C-form Required and successful completion of OB Gyn Clerkship. Please contact Brandie Denton @ bldenton@utmb.edu
Responsible Faculty Director:
Ivette F. Gordon, MD & Amjad Hossain, Ph.D.
Other Faculty:
Kathleen Vincent, MD & Ultrasound Techs		 Location to Report on First Day
Gyn Suite (335 CSB 3rd floor; contact 2-2610) or 		Periods Offered
2AB, 3AB ,6AB-9AB, 12AB, 13AB
excluding holiday period 8
 Maximum Enrollment
2

Goals
Ultrasound is integral to OB/Gyn practices. It allows comprehensive anatomic and physiologic evaluation of female pelvic organs. This course is designed to introduce and/ or enhance the understanding of gynecologic sonography of 4th year medical students by helping them to supersede the minimum threshold required for gynecologic ultrasound skills for entering residency program. Therefore, the goal of the elective is to enrich OB/Gyn-specific and first trimester ultrasound knowledge to learners interested in residency in OB/Gyn, Radiology, Family Medicine, and Internal Medicine with an interest in women's health.

Objectives
To familiarize the learner with the contemporary gynecologic sonographic resource for promoting their self-learning of the topic
To introduce the learner to real-time experiences with routine ultrasound undertakings in a typical OB Gyn clinic for allowing them to apply their knowledge to patient care
To teach the learner how to use AIUM/ACOG endorsed ultrasound learning tools to assess and hone their ultrasound competency

Description of course activities
The elective is rich by its carefully selected resources and literature support (Appendices 1&2). The course activities will be accomplished in two ways. The relevant study materials (Appendix 2&3) will be supplied to learner which will notify them with what they should had learned at UME and what they anticipate learning in first year in residency particularly in OB/Gyn residency. Most importantly the study materials will refresh and/or upgrade their understandings of the fundamentals of gynecologic sonography.

Concurrently the learner will participate in ultrasound activities of UTMB OB/Gyn clinics and analysis of the ultrasound images of image bank developed by AIUM/ACOG for teaching purposes (Appendix 1). Both types of learning will occur side by side during the entire week. In OB/Gyn clinics the learner will expect to face patients requiring sonographic examinations for some of the following clinical scenarios: postmenopausal bleeding; abnormal uterine bleeding in reproductive age women; adnexal masses; pelvic pain; infertility issue; uterine fibroids; first trimester gestation; early pregnancy loss; etc. The AIUM/ACOG endorsed gynecologic ultrasound image bank (Appendix 1) has plenty of learning materials that covers more than above indicated clinical scenarios. Thus, in case the UTMB clinic in that week when the student is scheduled does not have enough patients representing diverse clinical issues, the image bank can be either an effective alternate or complimentary learning method.

Teaching as well as evaluation will involve MCQ (knowledge acquired from assigned reading), real-time scanning, still ultrasound image analysis or combination of methods as applicable. In real-time scanning the learners will be asked to prepare notes on select sonographic tasks. Where applicable the notes prepared by the learners will be compared with the notes that were prepared by the clinic staff for the same patient. The comparison will allow to have a better understanding of the learning accomplished by the learner. The responsible faculty will monitor the progress of learnings and consult with Dr. Patel for appropriate action in timely manner.

From the above-mentioned triple approaches of teaching the learner is expected to accomplish the following learning objectives: 1. Orient to a transvaginal ultrasound, 2. Identify uterus in longitudinal and transverse views on the ultrasound, 3. Take uterine measurements, 4. Measure the endometrial stripe, 5. Find the adnexa and get measurements, 6. Ultrasound identification of tissue architectures of pelvic organs, 7. Prepare note on ultrasound findings for patient’s chart.
Appendix 1. Course Resources
A. Ultrasound cases in a regular week at UTMB gyn clinics including specialty clinics. Usually outpatients but inpatients may be included when appropriate

B. Obstetric and Gynecologic Ultrasound Curriculum and Competency Assessment in Residency Training Programs: Consensus Report Abuhamad A et al. 2018. Journal of Ultrasound in Medicine; Vol 37(1). https://doi.org/10.1002/jum.14519

C. The OB/GYN ULTRASOUND LECTURE SERIES developed by the American Institute of Ultrasound in Medicine (AIUM) with input from several collaborating organizations that include ACOG, CREOG, ACR, SMFM and SRU. https://www.aium.org/uls/index.htm

Appendix 2. Literature Reference (reading materials)

1. Hoppmann RA et al. 2015 The evolution of an integrated ultrasound curriculum for medical students: 9-year experience. Critical Ultrasound Journal., 2015; 7:1-15.

2. Tarique et al. Ultrasound Curricula in Undergraduate Medical Education. J Ultrasound Med 2018; 37(1): 69-82.

Type of students who would benefit from the course
Medical students who have interest in developing career in OB Gyn or aiming primary care and internal medicine practices but have interest in women health issues will be benefited from the course.

Weekly Schedule
  Clinical Activities (estimated schedule)
  Day of Week AM PM
  Monday 8:00 5:00
  Tuesday 8:00 5:00
  Wednesday 9:00 5:00
  Thursday 8:00 5:00
  Friday 8:00 5:00
  Saturday
  Sunday
   Average number of patients seen per week: 30  
   Call Schedule:   N/A  

Research Activities (estimated schedule)
Activity Hours per Week
Faculty Contact-Time
Self-Directed Study
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?
    The student will be engaged in ultrasound related activities in clinic and/or in electronic resource 8:00 am to 5:00 pm on Monday, Tuesday, Thursday, and Friday and 9:00 am to 5:00 pm on Wednesday of the 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
Other

2.  Oral Presentation
  A. Audience - To whom does the student present?
    Dr. Patel or her designee
  B. Frequency / Duration of Presentation(s)?
    once
  C. Format - What guidelines are set for the student's presentation?
    written as ultrasound result prepared for patient's chart
  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)?
    one time
  B. Format - What guidelines are set for the student's written work?
    As if prepared for patient chart.
  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.?
    Faculty selected and relate to 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)?
    N/A

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.
    The student will be challenged with the AIUM/ ACOG endorsed select ultrasound images (course resource # B and C). The students will be asked to answer (orally or written as applicable) some specific questions which will require critical analysis of those sonographic images.

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.
   
 
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.
   
 
C.
How specifically will this AI build on developing skills from the clerkship year to prepare students for internship?
   
 
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)?
   
 
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?
   
 
F.
How is the student demonstrating drawing clinical conclusions and/or developing a management plan and documentation as an intern would do?
   
 
G.
How and by whom will midpoint feedback be provided to the student? How will you remediate deficiencies identified at midpoint?
   
 
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.