Teacher-Learner Contract: Gynecology Block

Teacher-Learner Contract: Gynecology Block

MAHEC 3rd year Ob-Gyn Clerkship – Department of Obstetrics and Gynecology, Asheville, NC

Student Name: ______Rotation: ______

Instructions: The student should review this document with each resident-teacher on the team. Any changes to this document must be agreed to by all.

Gynecology: Wards

CURRENT GOAL: Students assigned to the Gynecology Block should attend daily work rounds with the benign Gynecology team. Students should contribute to the care of their assigned patients by performing daily rounds, writing progress notes in the medical record, interpreting laboratory and imaging studies, and presenting those patients at team rounds.

1. Where and when should the students report?

The student should contact the benign Gynecology chief resident to determine the morning meeting time. This will be 6 am unless otherwise notified. The student should then meet with the benign Gynecology team at the predetermined time on the Women’s surgery floor, A7, left side bank of computers.

1. Who should the students report to- who assigns patients to the students?

The student should report to the chief resident on the first day. Every evening the chief resident will assign patients for the student to follow. The student should check in with the chief resident at the end of each work day to obtain this information.

1. Should the tudent initially see the patients by themselves during morning rounds and hen present them to the resident, or should the student wait for a resident to accompany him/her to see the patients?

The student should first evaluate assigned patients independently. The student should obtain a pertinent history and perform a focused physical exam (excluding pelvic). The student should then report this data to the supervising resident who will then evaluate the patient with the student and confirm the history and physical exam findings, and also perform a pelvic exam if indicated. The student may assist the resident in removing bandages and/or drains only if specifically advised to do so.

1. Should the student write a progress note? If yes, who will review the student’s notes, co-sign them and provide feedback to the student?

The student should write progress notes on assigned patients in the chart. The supervising resident will review the note and provide immediate feedback.

1. What are the specific tasks that the students should complete in the care of the patients in whose cases they participate?

The student should follow only resident gynecology patients post-operatively. Patients from private physicians should not be seen post-operatively. For resident gynecology patients, the student should perform post-operative or inpatient assessment, evaluate the patient daily prior to team rounds, make sure all post-op or clinical care goals are being met, and follow-up and document all labs and imaging studies in a standard SOAP note format.

1. Should the students complete any tasks on patients if they do not participate in their cases? If yes, what?

The student’s first priority is his/her assigned patients. Once finished providing care for the assigned patients or when other learning opportunities are lacking, the student may assist in following up with laboratory and imaging studies for any gynecology patient.

1. Are there any general tasks that the students can help the team with?

When other learning opportunities are lacking, the student may be asked to assist in preparation of discharge items such as discharge instructions, prescriptions, etc.

1. When do rounds with the Attending occur? What should be the student’s role during rounds?

Attending rounds are typically at 7am. This may vary slightly according to the daily operating schedule; the student should check with the chief resident daily. When attending rounds are taking place, the student is expected to present his/her assigned patient to the attending.

1. When and where is the weekly Surgery Conference? What is the student’s role during Surgery Conference?

The Surgery Conference takes place on Mondays at 12:30 in the outpatient clinic. The student will participate in the weekly review of abnormal Pap charts by taking turns with the residents presenting a patient and proposing a plan for their follow up based on the NCCN guidelines. The student will then participate in Surgery Conference by listening and participating in any discussion about the pre-operative evaluation and management of issues that arise with patients preparing for surgery the subsequent week.

Gynecology: OR

CURRENT GOAL: Students will have the opportunity to participate in the perioperative care of patients from the benign gynecology service. In general, the student should expect to participate in as great a number and variety of cases as possible.

1. Who assigns the cases to the students? When should case assignment occur?

The chief resident will assign cases to the student the day prior to surgery.

1. What kinds of cases should the students expect to see (e.g. Resident, Private, Uro)?

The goal is for the student to see the breadth of surgical problems, procedures and techniques. Therefore, the student may be assigned to cases from any of the operating surgeons.

1. What role should the student have in the pre-op care of the patients? Who will review the student’s evaluations and provide feedback to the student? Can this be consistently done?

The student should accompany the resident to the Pre-op area. They will assist in preparing the patient for surgery, counselling the patient, and expediting the transfer of the patient to the OR.

1. What role should the student have in the immediate post-op care of the patients? Who will review the student’s evaluations and provide feedback to the student? Can this be consistently done?

The student should follow only resident patients post-operatively. Patients from private physicians should not be seen post-operatively. For benign gynecology resident patients, the student should perform post-operative assessment and follow-up and document all perioperative labs and imaging studies.

1. What are the specific tasks that the students should complete on the patients when they are in the operating room?

The student may be asked to assist in tasks such as transferring the patient to the operating table, positioning the patient, and placing a urinary catheter. In addition, the student may be provided the opportunity to perform an exam under anesthesia. Depending on the type of surgery and potential for learning, the student may be asked to scrub in for the case. The student should assure that a gown and surgical gloves are available for them by asking the scrub tech or circulator nurse prior to the procedure. Appropriate intraoperative tasks include holding retractors, cutting suture and driving the uterine manipulator. For the surgically advanced student, appropriate tasks include sewing peritoneum, sewing fascia, and sewing skin. The supervising resident or faculty member will decide if a student is prepared for these tasks. Students should be familiar with the patient’s history, diagnosis and indication for surgery if the case is assigned in advance.

1. What should the students do when there are no cases in which to participate?

The student should see hospital consults with the gynecology team or assist with the care of other admitted patients. If there are no cases or consults and all floor work is completed, the student may use this time for self-study. The student should discuss with the resident whether there should be a time or place to meet or whether they should plan to meet in the afternoon clinic.

Gynecology: Clinic

1. Where and when should the student report?

The student will participate in gynecology clinic every afternoon at the resident outpatient clinic. Clinic begins at 1pm. The student should be dressed professionally (scrubs are acceptable for procedure clinic on Friday afternoons).

1. Who assigns patients to the students?

On procedure clinic days, the chief resident will assign the student to observe LEEP procedures and colposcopy. The supervising resident will decide on the level of participation of the student in colposcopy procedures. On continuity clinic afternoons, the student will be assigned to work with a resident by the clerkship director. That resident will assign patients as appropriate to the student, with a goal of providing exposure to a breadth of gynecologic issues.

1. Should the student initially see patients by themselves and then present them to the resident or should the student wait for a resident to accompany him/her to see the patients?

The student should discuss the expectation with the resident at the beginning of the clinic. Depending on the flow of the clinic, those expectations may be changed, and flexibility should be expected. In some cases, the student will be expected to present to the attending and join the resident and attending in examining the patient and formulating a plan of care.

1. Should the student write a progress note? If yes, who will review the student’s notes, co-sign them and provide feedback to the student?

The student should write progress notes on each patient they see in SOAP format in the chart. The supervising resident will review the note, co-sign and provide immediate feedback.

1. What are the specific tasks that the students should complete in the care of the patients?

The student should obtain a focused history, perform a physical exam (excluding breast or pelvic), write a note in the chart, and present to the resident.

General Guidelines

1. What should the students do when there are no learning opportunities in which they can participate (i.e. “downtime”)?

The student should use this time for self-study, but remain available.

1. Where should the students spend down time?

In the clinic, they may spend their down time in the nurse’s station or in the resident work room. In the hospital, the surgeon’s lounge or the 7th floor resident’s area are acceptable alternatives. In all cases, the student should remain available by pager. The student should remember to communicate with the chief resident regarding his/her whereabouts, other assigned duties, scheduled didactics, excused absences (as pre-arranged with the clerkship director) and any other obligations.