OBGYN Clerkship General Information

Clerkship Information

Rotations and Responsibilities

OB (MED)

I. Call

1. Call is on the Day/Night float system.  Students are assigned to one of 4 Teams (A, B, C, or D). One team is on 10½ hour call (7:30 AM to 6:00 PM and one team is on call (6:00 PM to 7:30 AM) for 5 consecutive week days or week nights.  Of the remaining two teams, one will be on 24-hour call on Saturday (7:30 a.m. to 7:30 a.m.), and the other will be on 24-hour call on Sunday (except for the Sunday before a new block starts when the team will only have 10½ hour call (7:30 AM to 6:00 PM). 
   There is no sleeping on the day or night call; only on the 24-hour call. You must complete your pre-call and post-call duties.  The on call night team needs to stay in L&D from 5 a.m. to 7:30 a.m. (no rounding during this time).  The on call night float team does not have to stay for Turnover.
2. Introduce yourself to each of your residents and attendings. There will be three residents who are specifically assigned to each of the four call teams, A, B, C and D in addition to two residents who serve on the high risk obstetrics service. Each team has an additional member who has different Responsibilities during the day but who takes call with that team at night. The attendings change from day to day.
3. On call, you will be stationed in the Labor & Delivery area which includes the triage area called Evaluations (Eval). This is an Emergency Room for pregnant patients. Your Responsibilities here include:
   1. Assessing patients when they arrive and then checking out to the resident or staff in Eval. Because you are the first “physician-type” person to assess a patient, let your resident know immediately if you believe a patient is unstable or needs immediate attention. Be ready to present your patient to the resident or staff.
   2. Students will be assigned to follow particular patients who have been determined to be in labor. All efforts should be made by the assigned students to be present for the delivery.
   3. Attend and assist on OB surgery. This includes a wide variety of cases, especially at night on call, including Cesarean sections and tubal ligations. This should be planned in advance with your team of residents.
   1. You should attend all lectures even if you are on call, but let your residents know.
   2. If you leave the L&D suite, let your resident know.
   3. During call, you should be keeping a list of your patients. Any patient who is delivered on your call belongs to your service.
   4. Since you have most of the post-call day off and since L&D can be very busy, there will not necessarily be time for sleep during call. If there is time to sleep during the night, rotate among students. Check out with your resident prior to sleep so they know where to find you and so you can be sure all Responsibilities have been completed.

II. Post call

1. After turnover rounds, you should complete your floor rounds. During the call, you can see floor patients if it is not busy in L&D in the early morning. This will ensure that your post-call work is completed earlier and that your departure time is earlier.
2. You are expected to assist on circumcisions. Ask your residents when to meet them in the nursery.
3. Check out with your resident prior to leaving. Compare your rounding lists and make plans for the next morning.
4. When all the AM work is complete, you may leave. Drive safely please.
5. Again, all lectures are required…yes, even when you are post-call.

III. Morning duties

1. Each morning, no matter if you are on call or post-call or if it is a weekday or weekend, you must round on all your patients.
2. Prior to leaving, check out with your resident or the cross-cover resident and make sure that no additional help is needed.
3. Arrive early enough to see all your patients and to have your notes written prior to the arrival of the resident. Refer to progress note templates for correct format.
4. You may rotate rounding duties among your immediate teammates, especially on weekends, if the census is low and if your residents approve your plan. This is not be done between teams. This allows you to have some days off; however, if patients are missed, or rounding is not completed in a timely fashion, this privilege will be removed.
5. You are expected to have your work completed and to be on time for formal and informal rounds each morning. Formal rounds start at 7:00 AM on M/W/F and consist of a morning conference sponsored by the MFM Division. This is followed by turnover rounds at 7:30 AM on M/T/W/Th/F and at 8:00 AM on Sat/Sun. Informal rounds are held with your team. On weekends, if you are not rounding, you are not expected to attend. Be on time! Again, if you are post-call, you can complete rounding after turnover rounds.
6. After turnover rounds, check in with your residents, report to call, clinic, lecture or home, depending on your assignment.

IV. Clinic

1. You should be in clinic each weekday morning and afternoon that you are not on call and not post-call.
2. The clinics to which you will be assigned are all located on the third floor of 880 Madison, formerly known as the Medplex. They include NST (non-stress test), USG (ultrasound), COCC (continuity of care clinic), OB or faculty Private Office. Again be flexible with the assignments. If you are assigned to USG, but they need extra help in NST at a given moment, please go help. The goal is to get all the work done together and to get a wide range of educational opportunities.
3. You should see patients when they arrive, take a history, perform a basic and relevant physical exam. Again, do not perform a breast or pelvic exam without a physician present. Check your patients out with the resident or the attending.

GYN B (MED)

GYN B at the Med is an inpatient service, a consult service, a surgical service and a clinic service. Needless to say, there is a lot of work to be done, but a lot of learning happens in the process. You will be assigned certain clinics, please attend accordingly. The rest of the team who is not in clinic needs to cover the remaining Responsibilities.

I. Call

1. At the end of the workday, the student on call should report to the L&D senior resident and introduce him/herself. Discover if there is anything happening or anything pending. Write your name and phone number on the turnover board in the back hall. Leave your pager on. It is up to the discretion of the L&D senior resident whether you can go home or not.
2. You are responsible for doing any late post-op notes. When these are complete, call the Gyn pager and check out your patient to the resident, reporting any relevant findings.
3. In the morning, you should call the Gyn pager to find out if there were any new admissions. Only one student needs to call the pager in the morning!
4. You may be paged to help with a consult or a surgery. Please make yourself available in a timely fashion.

II. Clinic

1. Each weekday students will be assigned clinics at 880 Madison, third floor. These include your Gyn residents’ COCC’s (continuity of care clinic), faculty Private Office, Colposcopy clinics or Urogynecology clinic. Again, be flexible with the assignments. If you are assigned to a COCC, but they need extra help in Private Office at a given moment, please go help. The goal is to get all the work done together while getting chances to learn the clinical medium.
2. You should see patients when they arrive, take a history, perform a basic and relevant physical exam. Again, do not perform a breast or pelvic exam without a physician present. Check your patients out with the resident or the attending.

III. Morning Duties

1. This is the busiest time of the day so be sure to have all the work completed early. In the morning, you will be responsible for rounding and for assessing the surgical patients: Floor rounding Responsibilities include:
   1. Arrive early enough to complete notes. Refer to progress note templates for progress note format.
   2. Alert your resident if the patient is in distress of if you are concerned about the patient’s status.
   3. Stay updated on the floor patients including late night admissions and new consults. Help the residents organize and maintain a list of the patients.
   4. Surgical duties include:
   1. Assess patient;
   2. Be sure chart is complete and labs are resulted;
   3. Write pre-op note;
   4. If there is no H&P, call the resident with the Gyn records or compose one by interviewing and examining the patient.
   5. Help get patients to surgery on time and avoid paperwork mishaps, lab error or other types of delays.
   6. Scrub and assist for every case (at least one student). Other students can observe, stand by, and help with prepping, draping, filling in paperwork and other OR tasks. All aspects of the OR can be educational. Rotate these duties.
   7. Write a post-op note for each patient who stays through the night. The student on call can be responsible for notes written in the late evening. Patients with surgery early in the day can be post-op’d prior to 5:00 PM.

IV. Consults

1. Accompany your resident to assist on consults. If the residents are really busy, you may be sent ahead to assess a patient and then to report your findings. Take a complete history and do a complete physical minus the pelvic/breast/rectal exam.
2. Try to assess what instruments will be needed to complete the pelvic exam (endometrial biopsy, formalin, speculum, ring forceps, specimen cup, Pap supplies, etc.). Assemble these for your residents.

GYN (Baptist)

GYN at Baptist are surgical and inpatient services. You will have additional clinic duties, and there is an occasional consult. Your primary Responsibilities include rounding, assisting on surgeries and attending clinic.

I. In general, keep in mind the following:

1. The patients are private patients, and some of them may not be expecting a medical student. You should introduce yourself as one.
2. Introduce yourself to the attendings. They want to know who you are.
3. Get to know your residents. It is very easy to go the whole month and never work with a particular resident because of scheduling.
4. If you are scheduled for clinic, but there is a case that needs covering as well, your priority is to attend surgery and then proceed immediately to clinic. Call ahead to the clinic to let them know because they will be expecting you.
5. The student on call should accompany the resident who is holding the pager and take direction from that resident. The resident might be performing surgery, seeing a consult or managing the labor hall.
6. You must attend lecture. Please check out with your resident when you leave for lecture and check back in after lecture is over.
7. Organization is important in these two rotations because there are multiple sites (Baptist East and Women’s Hospital) and multiple Responsibilities. Designate one student, preferably the on-call student, to obtain the surgery schedule and list of in-house patients each night from the on-call resident and distribute that information to the other students.
8. At Baptist, surgery and the inpatient service are assigned at either the Women’s Hospital or the original Baptist East site.

II. Morning duties

1. This is the busiest time of the day so be sure to have all the work completed early. In the morning, you will be responsible for rounding and for assessing the surgical patients: Floor rounds Responsibilities include:
   1. Arrive early enough to complete notes. Refer to progress note templates for progress note format.
   2. Alert your resident if the patient is in distress of if you are concerned about the patient’s status.
   3. Stay updated on the floor patients including late night admissions and new consults. Help the residents organize and maintain a list of the patients.
   4. Surgical duties include:
      1. Assess patient;
      2. Be sure chart is complete and labs are resulted;
      3. Write pre-op note;
      4. If there is no H&P, call the resident with the Gyn records or compose one by interviewing and examining the patient.
      5. Help get patients to surgery on time and avoid paperwork mishaps, lab error or other types of delays.
      6. Scrub and assist for every case (at least one student). Other students can observe, stand by, and help with prepping, draping, filling in paperwork and other OR tasks. All aspects of the OR can be educational. Rotate these duties.
      7. Write a post-op note for each patient who stays through the night. The student on call can be responsible for notes written in the late evening. Patients with surgery early in the day can be post-op’d prior to 5:00 PM.

III. Clinic

1. Clinic assignments are as follows:
   1. Baptist students are assigned to clinics at the Frayser site, the Guthrie site or the Wolf River site.
   2. At some of these sites, you will be working alone with a faculty member. There may be no resident.
   3. Check with each faculty member individually about the extent of your duties. In these different clinics you will have a different level of responsibility. Sometimes you will only observe and sometimes the full extent of patient care is your responsibility. You should see patients when they arrive, take a history, perform a basic and relevant physical exam. Again, do not perform a breast or pelvic exam without a physician present.

IV. Call

1. Be available to assist the on-call resident. It is up to his/her discretion whether you may leave early or not.
2. Be sure all surgical patients received a post-op assessment.
3. Collect the surgery schedule and inpatient list from the resident prior to departure and inform the other students regarding the activities of the next day.