New York-Presbyterian Hospital

The clerkship is organized into two halves — Obstetrics and Gynecology. Seven to eight students will rotate through each service at a time and you will switch at the halfway point in the clerkship. During the Orientation session, you should decide amongst yourselves which student will be assigned to each schedule-A, B, C, D, etc.

Course Requirements

The course requirements are as follows:

1. Attendance is mandatory at all Thursday didactic sessions and preceptor sessions.
2. At the end of the clerkship each student must turn in one copy of an H&P from a GYN patient encounter at the 21 Audubon Clinic and the L&D Portfolio sheet from one patient encounter on Labor & Delivery.
3. At the end of the clerkship each student must have completed the log of patient encounters (Clinical Skills Attainment Document,) in the New Innovation Procedure Logger as required by the Dean’s office. This is a mandatory requirement of the course and students will not be able to receive their final grades until completed.
4. Each student must prepare a Patient Education handout/ pamphlet on the obstetrical or gynecologic topic of his/ her choice. The final product should be written in language that is easily understandable by a lay person and should contain factual, relevant information. At least three sources must be used in researching and preparing the material, with proper acknowledgement of sources. These pamphlets may be presented to the Resident Education Committee and other faculty members in the department, and stellar projects may be chosen for general distribution to our patients in the Audubon clinic.
5. Other informal presentations may be assigned by the Preceptor or by the Chief Resident on either the OB or GYN services.
6. Each student must complete the web-based tutorial on genetic counseling by the end of the clerkship. Please print the certificate at the end of the tutorial and submit it to the clerkship coordinator on the penultimate day of the rotation.
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7. The NBME shelf written examination and an OSCE, or objective structured clinical skills examination, will be given to all students on the last day of the clerkship.

Mid-Clerkship Feedback

The clerkship director will meet with each student for a brief feedback session around the mid-point of the clerkship.

Evaluation Policy

Your final evaluation will be based on questionnaires submitted to the house staff as well as direct observation by the clerkship director and preceptor and review of the materials submitted in your student portfolio. Taken into consideration will be your fund of knowledge, data gathering ability, diagnostic problem solving ability, communication skills (oral and written presentations), attitude towards learning, relationship with patients, peers, residents, attending physicians and staff, professionalism and performance on the written shelf examination and OSCE. These elements are weighted as follows:

NBME Shelf Examination

We use a minimum passing score recommended by the NBME; students usually need to score above the 6th percentile nationally to pass the exam. We usually limit Honors for those students who attain at least the national mean score with the idea being that students who receive an Honors score demonstrate excellence in every arena of the clerkship. We feel that the shelf exam is very well aligned with the educational objectives of the clerkship and is a fair and representative examination.

Honors

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. She/he should read in preparation for lectures and procedures and after seeing a patient with a specific problem. He/she should be able to integrate information from readings and lectures with clinical problems and be able to organize and prioritize information and focus on the important clinical problems. The student should be especially independent in learning on his/her own. A score of 70 or above on the final written examination 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 focuses. 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. He/she 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 actively seek out feedback and use criticism in a constructive way. He/she 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. He/she should be able to be trusted. Above all, the student should show that he/she 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 clinical year v. the 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.

Didactic Sessions

Every Thursday you will be excused from your clinical duties to attend group didactic sessions. The schedule on Thursdays will be (roughly) as follows:

Preceptorship

Each rotation will have a faculty member who has volunteered to serve as a Preceptor for the group. Information about your group’s Preceptor should be enclosed in your handbook or will be distributed at the initial orientation meeting of your rotation. Each Preceptor will determine the content, format and meeting times for your group sessions. You will be excused from your clinical duties (in most situations) to attend these sessions with your Preceptor. This is a valuable opportunity for you to have close contact with faculty mentors who are truly dedicated to teaching, and most students have found it to be a very rewarding experience.

Obstetrics

The OB team should contact the third year resident covering the Antepartum service after your Orientation session. The resident will advise you when to come in for rounds the following morning. Usually, you will be assigned one or two patients on the Antepartum service to round on each morning. You should be prepared to present your patients to the team each morning. Sometimes morning rounds are not as formal and you may not be called upon to present, but you should be ready to present nonetheless.

The entire team should report to morning Board Turnover rounds in the physician’s lounge on L&D – CHONY 10 Tower promptly at 7:30AM. On Wednesdays and Thursdays, Board Turnover occurs at 7:00AM. On Wednesdays, a Prenatal Pediatrics conference is held at 7:30 AM in the Todd Amphitheatre (P&S 16) which students should attend. After rounds, each student should depart to his or her assigned site for the day. The person assigned to L&D should change into scrubs and join the resident day team in their morning activities. To provide continuity of care, students will take call for 24 hour shifts on Labor & Delivery on a q4 to q5 schedule. The on-call experience is a vital part of your obstetrical rotation, and students will then have their post-call day off. The exception is Wednesday night call, which will be a short call until 10:00PM only. Students are then expected to report for the full day of scheduled didactic sessions on Thursday.

Your responsibilities on L&D might include assisting the resident team in triaging patients, writing admission H&Ps, charting antepartum and intrapartum progress notes on the patients in labor, and assisting with deliveries, both vaginal and caesarean. You should try to become involved in the care of a wide variety of patients. Your best resources will be the junior resident “running the board” and the chief resident on L&D. They will help identify the best patients for you to become involved with.

Every student has been assigned to one “L&D Sections” day on the labor floor. On this day, you should receive first priority to participate in as many scheduled caesarean deliveries and/or obstetrical procedures such as cerclages, external cephalic versions, etc. as possible to maximize your breadth of exposure. When you are not on L&D, you will be assigned to a variety of other sessions, including attendance in the Ultrasound suite and perinatal clinics as well as the general OB/GYN clinic at 21 Audubon Street. Your participation in these settings may range from shadowing the technicians, residents and attending physicians to more active involvement in the evaluation of patients, if deemed appropriate by the supervising team.

The Ultrasound CPP/ Center for Prenatal Pediatrics suite is located on the twelve floor of Babies Hospital, 12 Central. There is also an Ultrasound suite is located on PH-12, located along a long corridor with one main ultrasound reading room. The Perinatal Clinic is located on the second floor of the 21 Audubon Clinic. Just ask someone in the vicinity or one of the residents where to go and they’ll help direct you to the right place!

Gynecology

Students on the GYN team will spend time on either the Benign or GYN Oncology service. You may divide evenly into groups yourself and contact the chief residents covering both services after your Orientation session. The residents will advise you when and where to come in for rounds the following morning. Usually, you will be assigned to one or two inpatients on the GYN service to round on each morning. Most often these will be your post-operative patients or patients you admitted from the ER. You should be prepared to present your patients to the team each morning.

After rounds, each student should depart to his or her assigned site for the day. The people assigned to the OR should be dressed in scrubs and ready to assist in surgery with the residents. Those students who are not scheduled to be in the OR will be assigned to a variety of other sessions, including attendance in several of the ambulatory clinics as well as the general OB/GYN clinic at 21 Audubon Street. On occasion you may be asked to go to the OR instead of your assigned clinic if additional assistants are needed.

In addition, you have each been assigned to at least one colposcopy clinic, regardless of whether or not you are on the Gyn Oncology service. There is also a Wednesday tumor board clinic, which you may attend if your schedule permits. Both are valuable opportunities to learn more about gynecologic oncology. The clinic is located in the Irving Pavilion (a.k.a. Atchley Building) on the 8th floor and begins around 8:45 – 9:00 AM. The Irving Pavilion is next to the Milstein Building, on Fort Washington Avenue.

Students will take call for Gynecology on a q4 to q5 schedule. After evening rounds have been completed, the student on call should page the ER Consult Resident. GYN call will be short call until 10:00PM only. On the weekend, the student on call should come in to round with the GYN team in the morning and accompany the resident if there is a patient to be seen in the ER or on the consult service. The student can help with any floor work that needs to be done, and during downtime, may study independently.

21 Audubon Clinic

Each student is assigned to several sessions over the course of the rotation in the general OB/GYN clinic at 21 Audubon Street. This clinic will provide the best opportunity for you to see a wide spectrum of obstetric and gynecologic patients on your own, take their H&Ps, and perform breast and pelvic examinations with the residents and/or attending physicians in the clinic. The patients are wonderful and usually very receptive to student involvement in their care. It is a great experience – enjoy!

The clinic is located at 21 Audubon Street on the 2nd floor. If you exit the hospital from the main Babies’ Hospital entrance or by the Energy Court on Broadway, cross the street and continue for two blocks. It is at the intersection of Audubon and 165th Streets.

Family Planning

Each student has been allotted one session with the Family Planning service. This is an optional session designed to provide you with the opportunity to learn more about the counseling and procedures involved with voluntary termination of pregnancy, contraceptive options and female sterilization. For philosophical and ethical reasons there may be some students who do not feel comfortable attending this session, which is fine. Please let the clerkship administrator know if you do not plan to attend this session, so that we may inform the Family Planning division of the student schedule for the rotation. The current sessions are held on Saturdays in the Irving Pavilion, Room 440. You will be assigned either the morning session, beginning at 8am or the afternoon session, beginning at 12 noon.

Allen Hospital Obstetrics

Each student will spend one day on the Labor & Delivery at the Allen Hospital. The Allen has a low-risk obstetrics unit which has a distinct flavor from the labor and delivery floor at CHONY, and a benign gyn service. Students will have the opportunity to work one-on-one with attending and resident physicians and to participate directly in the management of labor, the performance of vaginal and caesarean deliveries, and the delivery of inpatient antepartum and postpartum care. On their assigned day students should report to the on call physician at 7:30am in the board sign out room of the Labor and Delivery suite, located at 1 River West in the Allen Hospital. There is a shuttle to the Allen Hospital, which departs from the circle in front of the Milstein Hospital Building at 6:45am and 7:15am. The shift will end at 6pm.

Teaching Resident

Each rotation will have a senior resident who will serve as the “Teaching Resident” for the group. All of the residents in the department will be involved in your teaching on the wards, but the “Teaching Resident” will function as an additional point person among the residents, with whom you will have the opportunity to interact regularly about a variety of clinical topics. Information about your group’s first session with the Teaching Resident will be distributed at the initial orientation meeting of your rotation. Each Teaching Resident will determine the content, format and meeting times for your group sessions – in general you will meet for four group sessions over the course of your five-week clerkship. You will be excused from your clinical duties (in most situations) to attend these sessions with your Teaching Resident. This is a valuable opportunity for you to have close contact with residents during time that is “protected” for them to dedicate to teaching.

Electives

Each student is assigned to several Elective sessions during the clerkship. This will allow you to explore other areas of OB/GYN that interest you. For example, you may choose to go back and spend some extra time in the Ultrasound suite or helping out with the floor work on the Antepartum Service. Some other experiences which students have found useful in the past include:

Reproductive Endocrinology
This clinic is held Monday 1-4 PM, Wednesday 1-4 PM, and Friday 9-12 AM at 21 Audubon Street on the 2nd floor. The clinic is run by the reproductive endocrinology attendings and fellows and provides useful exposure to patients with endocrinologic and infertility issues.

Faculty Office Hours
Many clinical faculty members welcome students to shadow them during their office hours. This is a great way to experience “a day in the life of” a practicing obstetrician/ gynecologist, particularly if you are considering a future career in OB/GYN. It is wise to telephone the office the day before to confirm the location and time and to check with the physician that it is a good day for you to attend.