OBGYN Clerkship General Information

DIVISION OF REPRODUCTIVE ENDOCRINOLOGY AND INFERTILITY

RESIDENTS Responsibilities

Welcome to the Division of Reproductive Endocrinology and Infertility. Dr. William Kutteh is director of the division and Dr. Raymond Ke directs clinical services. Residents are welcome to all clinical activities in the division, but remember, this is also a private practice. Therefore, all clinical activities and decision making will be under the direct supervision of Drs. Kutteh and Ke. If patients request not to see residents, then these wishes have to be honored. Similarly, while all residents wish to gain more experience with procedures, in some cases, observation and assisting will have to suffice. If you have any concerns, then please discuss this with Dr. Ke or Kutteh.

GENERAL ADMINISTRATIVE ISSUES

1. Vacation or personal leave that occurs during the Reproductive Endocrinology Rotation should be approved by Dr. Kutteh or Ke prior to the rotation.. Medical leave and emergencies should be discussed as they arise.
2. Residents are expected to dress professionally and have clean white coats. Men are expected to have shirt and tie and women will follow our dress code policy. Clean scrubs are acceptable only if the resident had surgery with one of our staff and reported immediately to the clinic.
3. A PGY-2 or PGY-3 resident should be available by beeper every weekend. During this time, residents cannot have other call Responsibilities as they may be needed to see patients at any hospital or assist in emergency surgery. Notify the faculty and nurses on call for the weekend on Friday.
4. Occasionally more than two activities will be occurring at the same time. Please refer to the Resident Assignment instructions to determine resident Responsibilities.
5. If emergencies arise on another service, a resident on RE can only be pulled from this rotation with prior approval of Dr. Ke or Dr. Kutteh.

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CLINICS
New Patients
The Nurse Practitioner (or in some situations the PGY-3) will see new patients. A copy of our patient history form is enclosed. The patients fill out the left hand side of the form themselves and the right side is for notes. Any positive findings on history are fully explored by asking the patient or reviewing the old records. The date of tests and the results available are recorded on the right hand side of the page. Review the history with the attending faculty before proceeding. Ensure that any investigations are communicated to the nurse and see if the patient requires prescriptions or printed information. Ensure that all diagnoses are noted along with their appropriate CPT codes.

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Return Patients
For return patients, first ask your attending physician if it is appropriate for you to see that particular patient. For infertility patients, please document a progress note as noted by the example attached. This is an easy and organized way of ensuring that no facts are missed. Check on lab and pathology results, operative reports and old records. Include date of tests, lab values and units. Quickly review these with the patient and see if there are any other pertinent findings in the history since the last visit. Try not to get into a discussion with the patient on treatment plans, as this will be reviewed with the staff physician. After updating the history, review with Drs. Kutteh or Ke and they will see the patient with you. At that point, complete her updated diagnoses list and treatment plan.

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EXAMPLES OF PROGRESS NOTES

F/U PREGNANCY LOSS PROGRESS NOTE
12/12/03 36 yo G4P0A4 with primary RPL, here for F/U

F/U INFERTILITY PROGRESS NOTE
3/10 33 yo G0 with primary infertility, male factor here for F/U

Post-Op Patients
Post-op clinic is staffed by PGY-2. During this clinic, all patients who were operated on last week are seen and all patients being operated on next week are seen. The purpose of this clinic is to make sure post-op patients are having a normal recovery, that the dictated op note is on the chart, and that the pathology report is reviewed and on the chart.

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POST-OP NOTE

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SURGERY
Surgical schedules vary. Although each staff physician will have designated days to perform most of their surgery, check the weekly schedule for cases and check with the OR Schedule log on the computer at the nurses station every other day or so to look for last minute changes in surgical scheduling. One resident (not both) is expected to attend all surgical procedures. For patients who are admitted, the resident who assisted with the case is expected to round on the patient twice a day and report to the staff. Appropriate discharge summaries should be dictated with a copy sent to our office, prescriptions completed, and discharge orders completed.

Most hospitals (exception is EMSC) will require a pre-operative visit a few days before surgery. The Nurse Practitioner (or in some cases the PGY-3) should review general medical history with the patient and make sure she understands her procedure. Perform a general physical exam, including the cardiovascular and respiratory systems. Document the exam, the planned procedures, and a brief counseling note about risks. Generally, the pelvic exam can wait until the time of surgery to be performed under anesthesia. Our routine pre- and post-op orders are attached.

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PRE-OP ORDERS

POST-OP ORDERS

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LABORATORY PROCEDURES
Residents may observe an oocyte retrieval procedure. You are welcome into the Andrology, Immunology, and Embryology Laboratories to observe laboratory procedure, as long as you change into the appropriate attire and are accompanied. Please schedule these observation times in advance.

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TRANSVAGINAL SONOGRAPHY (TVUS)
TVUS is performed Monday through Friday starting at 7:30 a.m. and on Saturday and Sunday starting at 8 a.m. Based on the schedule below you should be at the office by 9 a.m. to assist with TVUS (mainly early IUPs and some gyn scans). This is an excellent opportunity to improve your sonography. PGY-3 residents are expected to learn and assist with sonohysterography procedures performed on Mon and Wed morning. Each resident should check the Resident Assignment Sheet and attend the designated sessions.

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DIDACTIC TEACHING CONFERENCES
Teaching conferences will be with Drs. Kutteh, Ke and Phillips at a mutually agreeable time. The residents should read entire 6th Edition of Speroff, Glass and Case, Clinical Gynecologic Endocrinology & Infertility, and review the appropriate chapters and be prepared for discussion. Also, read Chapters from 3rd Edition Comprehensive Gynecology and Chapter 9 from Gabbe 3rd Edition Normal & Problem Obstetrics. Topics for discussion will be as follows:

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JOURNAL CLUB
Each month the resident will be expected to present one original article from within the last six months of Fertility and Sterility or Human Reproduction. Case reports and review articles are not appropriate. Each resident will review one paper and give a short (10-15 minute) presentation. He or she will be expected to read methods section and provide some background as to the relevancy of this article. He or she will also be asked their opinion about the quality of the research. See attached guidelines for reviewing a medical report. Faculty will assist in article selection and discussion.

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GUIDELINES FOR REVIEWING A MEDICAL REPORT

A. Objective or Hypothesis

1. 1. What are the study objectives (what are the questions to be answered)?
2. 2. To whom will the findings be applied (what is the population targeted)?

B. Methods

1. What was the study design (i.e., experimental, planned observations, retrospective)?
2. Who were the subjects and the control group (sample population, number, possible selection biases)?
3. What were the inclusion/exclusion criteria for the study group?
4. Who were the controls?
5. What were the descriptive variables of the sample population?
6. What outcome variables were measured and analyzed?

C. Findings/Results

1. Are findings presented clearly, objectively, and in sufficient detail?
2. Is there appropriate use of tables?

D. Analysis

1. Are the data worthy of statistical analysis?
2. What are the methods of analysis?
3. Are analysis methods appropriate?
4. What level of significance will be accepted?

E. Conclusions

1. What conclusions are justified by the findings?
2. Are the conclusions relevant to the hypothesis posed?

F. Comments

1. How does this study contribute to the medical literature?
2. How could this study be improved?
3. Did the study answer the initial question?
4. Will this article impact your medical practice?

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RESIDENT ASSIGNMENTS

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Weekends and Holidays: PGY-2 and PGY-3 will rotate weekend call. At the beginning of the rotation the PGY-3 will provide a copy of the weekend call schedule with pager and home phone numbers.

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