Stamford

Clerkship at Stamford Hospital

Welcome to Stamford Hospital. We hope you have an enjoyable and educational rotation with us. The OB/GYN rotation is a very short clerkship and there is a tremendous amount of material you need to be exposed to in only four and a half weeks. As such, we understand that it is difficult for you, the students, to know exactly what is expected of you and where you should be at various times of the day. We have prepared this brief overview of our department, our expectations of you, and your responsibilities to the “team”. You will also receive a more formal schedule.

Full-Time Faculty of Stamford Hospital Department of OB/GYN

Dr. Lance Bruck, Chairman of Dept OB/GYN
Dr. Sareeta Bjerke, Director of Ambulatory Services and Med Edu Liaison
Dr. Fran Ginsburg, Residency Program Director
Dr. Brian Hines, Director of Urogynecology
Dr. Tracy Shevell, Division of MFM
Dr. Iris Wertheim, Director of Gyn Oncology
Dr. Paul Bobby, Director of MFM
Dr. Shefali Pathy, Associate Residency Program Director

Course Requirements

At the end of your rotation (last Thursday of the rotation), you will be expected to prepare a formal case presentation for the residents and faculty of the OB/GYN department. Any interesting case that you may have seen on your rotation (or any OB/GYN case you wish you had seen) should be presented along with a brief (5-10 minute) summary of the most recent evidence based literature.

At the end of the clerkship you must turn in Dr. Bjerke’s obstetric labor and delivery summary and one copy of a gynecologic note (e.g. clinic annual gyn exam, complete preop H&P, gyn admit note, ER eval). Please submit these summaries by the last Tuesday of the rotation so that they may be returned to you with constructive feedback.

At the end of the clerkship each student must complete the PDA log (patient encounter tracking system) of procedures and patient encounters as required by the Dean’s Office. This PDA log is a mandatory requirement for completion of the course and students will not receive their final grade until the PDA is submitted to Dr. Ratan’s office at Columbia.

As there are some “glitches” in the PDA system, we encourage you to keep index cards on all of your patient encounters throughout the rotation so that we may prove to the Dean’s office that you have a balanced experience that represents the breadth and depth of our OB GYN specialty.

Other informal presentations may be required by the faculty or chief residents, such as an OB/GYN “patient education handout”.

Evaluations

If you have problems or concerns, please make an appointment to speak with Dr. Pathy at any time. Approximately half way through your rotation, you are encouraged to meet with Dr. Pathy to discuss your strengths and weaknesses, to focus on ways to improve your performance, and to address ways to expose you to particular areas of the field you might be missing out on. You are also welcome to speak with any of the other faculty members at any time should any issues of concern arise.

We will be evaluating your fund of knowledge, data gathering ability, diagnostic problem solving ability, communication skills (oral and written presentations), attitude towards learning, relationships with peers, residents, staff and patients, and your professionalism. Evaluations are compiled by Dr. Pathy from questionnaires completed by the chief residents, PA/NP’s, full time faculty, and attendings. This clinical evaluation will comprise 70% of your final grade.

Performance on the written NBME Shelf exam is also considered. This 2 hour exam will be given to all students on the last day of the clerkship. You must pass this exam in order to pass the clerkship. You must score a minimum 70% in order to receive “honors” in the course. This Shelf score will comprise 10% of your final grade.

Performance on the OSCE exam will comprise another 10% of your final grade. This 2 hour objective structured clinical skills exam will also be given to all students on the last day of the clerkship and will consist of 8 – 10 proctored stations, which are designed to assess the clinical obstetric and gynecologic skills you should have achieved on this rotation.

The remaining 10% of your final grade consists of your final case presentation, the H&P and LDR summaries you submit, and any patient handouts that you may have been asked to prepare.

Of note, the following are specific standards set forth by the Dean’s office that should be met for a student to receive a passing grade with Honors in this clinical clerkship:

Knowledge
The student should show exceptional curiosity and interest. (S)he should read in preparation for lectures and procedures and after seeing a patient with a specific problem. (S)he should be able to integrate information from readings and lectures with clinical problems, be able to organize and prioritize information, and be able to focus on the important clinical problems. The student should be especially independent in learning on his/her own. A score of 75 or above on the final written exam is recommended for the student to receive honors.

Skills
The student’s H&Ps and oral or written presentations should be complete, accurate, organized, and focused. There should be little room for improvement by the resident or attending. The problem list and differential diagnoses should be complete and prioritized by likelihood and importance. Pelvic exams should be complete, as accurate as can be expected from a student and not unnecessarily painful. Orders and notes should be very accurate and complete, with no inappropriate comments or orders. During surgery the student should remain involved, know what is being done, demonstrate understanding of appropriate actions and not merely follow instructions. When following patients in labor the student should be aware of whether monitoring data are normal or abnormal, while remaining aware of the woman in labor.

Attitude
The student should show an exceptional level of interest and compassion for the patient. (S)he should be a part of the health care team and interact appropriately and positively with all members of the team, including nurses and other students. The student should show exceptional ability to organize and prioritize. The student should seek out feedback and use criticism in a constructive way. (S)he should be active, not passive and take an interest in teaching others. The student should strike a balance between independent thought and action and the need to seek assistance and supervision. (S)he should be able to be trusted. Above all, the student should know that (s)he has the capacity to learn and improve.

These are general guidelines, which are subject to modification. The stage of the student’s training (i.e. beginning of the 3rd year v. end) should be kept in mind, but the Honors student is one who should stand out from the rest regardless of the time of year. Overall excellence is required. If there is a significant deficit in one area, such as poor interaction with others, Honors should not be given. Honors are given because of excellence, not in spite of a problem. Conversely, a student who excels amazingly in one area, but is only average in another does not deserve Honors.

You will also be given the opportunity to confidentially evaluate the residents, the faculty, the private attendings, and the overall clerkship experience at the end of the rotation. This information will be very helpful for us in improving the quality of the clerkship.

Make the most of this all too short rotation by staying busy with the myriad of learning opportunities noted above. Most of all: be enthusiastic, even if this is not your chosen field! Your educators will be much more willing to teach you and allow you to participate in the care of their patients if you are eager and motivated! Enjoy!

Responsibilities as Part of the “Team”

You are expected to learn appropriate history taking and physical exams. You will be asked to help admit labor patients and pre-op patients, keeping in mind that it is more important to understand why a procedure is being done than how it is done. You are expected to present the patients in an organized and concise way on rounds, and sign-off your patients to your colleagues and junior residents at the end of the day/ call. You will learn so much more if you make every effort to follow a patient each day throughout their hospital stay.

You are here to learn and a there is a lot of learning to be had with even the simplest of “scutwork”, such as phlebotomy, insertion of IV’s, Foley catheters, pulling CT scans, etc. Don’t be offended if the resident asks you to do these seemingly mundane tasks, in fact be eager and make yourself available to help out. The residents are extremely grateful for any and all help and will then be freed up to do more teaching. If, however, you feel like you are being “abused”, please talk to Dr. Bjerke.

If you are enthusiastic and demonstrate a thorough interest in and knowledge of your patient’s history and progress, you will surely invite more learning opportunities from the residents and attendings (like all the exciting deliveries, episiotomy repairs, suturing, abdominal closures, etc.).

On Call

Because of the very nature of OB/GYN, the on-call experience is a vital part of your learning experience. A tremendous amount of activity occurs at night and on the weekends, times when you will have a unique opportunity to be a critical part of the on-call team. “Stick like glue” to the junior residents because they will always be where all the action is — if you are up and around and enthusiastic when interesting things occur, then you will see interesting things. You are expected to stay awake and active with the residents whether it is on the labor floor, in the OR, or in the ER. Please do not expect the residents to wake you or find you when something is going on. The residents are far too busy to “page you for a delivery”.

Your responsibilities might include admission H&P’s, intrapartum progress notes, delivery notes, postop notes, orders, fever work-ups, and any other follow-up deemed appropriate relative to the care of patients you follow on the labor floor, ER, or OR.

You should make up an every fourth night call schedule with you colleagues, including an equitable number of weekday and weekend calls (on average 7 calls). In order to maximize your learning opportunities, the chief residents have also asked that you avoid, if at all possible, being on-call the nights that the family practice resident is on-call. At the request of some of your colleagues, the Dean of Columbia has recently changed your call requirements to a maximum “24 hour shift”. In order to accommodate the new regulations and still continue to provide you with all of the lectures, we have modified your call schedule so that you can go home Sunday through Thursday nights at 11pm, but you are expected to stay overnight on Friday and Saturday.

Work Schedule

You will divide yourselves into 3 groups, and rotate on 3 services, obstetrics, gynecology and outpatient. You will spend only about 1 1/2 weeks on each service.

We expect you to report to SH for morning sign-in rounds as per the chief residents, typically at 6:15 AM. At that time the prior evening’s call team will update you on any significant overnight events and then you will be expected to round on (and write progress notes on) all in-house OB and/or GYN patients (depending on which team you are on). If you are in your clinic week, you can round with the OB team on the antepartum and postpartum patients.

You are expected to stay through afternoon sign-out rounds, typically at 4:30 PM. At that time you will be expected to sign out the significant events of the day and any evening follow-up that might be necessary for all the OB and/or GYN in-house patients. It should go without saying that you should not leave prior to sign-out unless you have made special arrangements with your chief resident.

Lectures & Reading Materials

Your lecture schedule takes precedence over all other responsibilities. To maximize your clinical experience, please notify your resident of your lecture schedule or any changes/cancellations so they can help you prioritize your activities for the day.

You are expected to attend the resident didactic lectures on Thursday mornings from 7:30 – 10:30 AM. You will also have tutorials designed only for the students to go over basic OB/GYN concepts as outlined by Columbia objectives. A schedule for didactics will be given to you at the start of the rotation. Please also call Dr. Wertheim at the beginning of the rotation (327-6755) to schedule 2 gyn onc lectures with her at her convenience. Please call the above attendings the day prior to your scheduled lecture to confirm that they can meet with you at the scheduled time.

We expect you to take every quiet moment to read. As your preceptors we are terribly conflicted by providing you with a balance of actual hands-on clinical experience and didactic sessions. Even with all the lectures we cram into your 4 1/2 week clerkship, we cannot (and should not) be your only source of OB/GYN information. There is a huge amount of material we cannot share with you or you will not experience in the clinical setting. As such, we encourage you to read Hacker and Moore, a great, easy-to-read, comprehensive textbook, from cover to cover. But remember, it is your responsibility to check in periodically with the residents, as they may inadvertently forget to call you for a delivery or a trip to the ER.

Ambulatory Clinic

The clinic is where you will be expected to learn how to evaluate the routine obstetric and gynecologic patients. You are expected to learn appropriate history taking and physical exams, including breast and pelvic exams. This rotation is perhaps your only opportunity to become really comfortable with asking “sensitive” questions about sexuality, menstruation, abortion, incontinence, etc. of women ages 15 to 95 years old. You will be amazed about how forthcoming our patients are if you truly endear yourselves to them. Be kind, be considerate, be compassionate, and most of all, be professional.

Take the initiative to pick up a chart and start seeing a patient. Obtain the relevant history and perform the basic physical exam. Then present the patient to the resident who will assist you with the appropriate breast and pelvic exam. You must always have a nurse chaperone for this part of the exam. At the conclusion of the patient’s visit, you should write up and present the patient to the clinic attending in an organized and concise way.

We have some type of OB/GYN clinic happening nearly every day, so if you are on the OB or GYN team and absolutely nothing is going on in the OR, ER, or labor floor, you are expected to go to the clinic. When you are on the “clinic” service, you are expected to go to continuity clinics each morning after completing OB rounds and morning report with Dr. Ginsburg, approximately 8:30am. Monday afternoon is general gyn clinic (starting approx. 1:15pm), which should be attended by the clinic and gyn students. Tuesday afternoon is the only afternoon we don’t have clinic and the “clinic” student should arrange on his/her own to spend the afternoon with either Dr. Ginsburg (7559), Hines (7269), perinatal (7060) or Wertheim (327-6755) in his/her private office. Wednesday afternoon is new OB clinic, which should be attended by the clinic and OB students. Thursday afternoon is colposcopy clinic, which should be attended by the clinic or gyn students. Friday afternoon is a contraceptive clinic, which should be attended by the clinic student.

Other Learning Opportunities

Other gold mines of learning opportunities frequently forgotten by the students… If there are no patients in labor, ER or OR, no clinics, or no lectures, students should consider the following experiences:

Perinatal Unit in the Whittingham Pavilion (7060)

The obstetric students should try and spend time in the perinatal unit learning about antepartum monitoring, obstetric ultrasound, genetic counseling, and high-risk consultation.

REI Office with Dr. Ginsburg in Main Bldg, main floor (7559)
Urogyn Office with Dr. Hines in Physician Office Bldg, terrace level (7269)
Gyn Onc Office with Dr. Wertheim at the Tully Health Center (276-6755)

Departmental Conferences

You are expected to attend all departmental conferences including:

Morning Report, Monday – Friday at 7:00 AM
Grand Rounds, every Friday at 8:15 AM
Journal Club, every Friday at 7:30 AM
Tumor Board, second Thursday of the month at 7:30 AM

Whom to Contact

Dr. Shefali Pathy is the medical education liaison between Columbia and SH and Michelle Tomczyk is the medical education coordinator. If you have practical day-to-day questions about the lecture schedule, beepers, meal cards, etc. please contact Michelle Tomczyk at (203) 276-7581. If you have substantive questions or problems, please contact Dr. Pathy at spathy@stamhealth.org (or Dr. Ginsburg in her absence at 276-7133/7559)

Meals

You have been allotted a meal card, which works both in the cafeteria and the cafe. Most days, residents and students have ample time to eat breakfast and lunch, however, patient care always comes first. That means, of course, that you may miss a meal on a particularly crazy day. If you have trouble missing meals, eat breakfast before you come to rounds or keep a snack in your pocket.

Related Links
http://www.stamhealth.org/Services/WomensHealth/default.aspx