OBGU-4013 - Acting Internship in Gynecology

OBGU-4013 - Acting Internship in Gynecology

Elective Title: Acting Internship in Gynecology
Course Number: OBGU-4013
Elective Type: clinical Duration/Weeks: 4 Max Enrollment: 1
Prerequisites: Successful completion of Year 2
Additional Requirements: Successful Completion of an OB Gyn Clerkship. Visiting students must seek prior approval. All students being enrolled within 3 weeks of the start date must seek prior approval.
Responsible Faculty Director: Karren Lewis, MD Periods Offered: 1-7, 9-13 excluding holiday period 8 
Coordinator: Brandie Denton Other Faculty: n/a
Location to Report on First Day:
Email will be sent out to meet Gynecology team

Goals
Will act as the primary physician, i.e., admit, write orders, develop management and diagnostic plan for the gynecologic patient.
2. Follow up on patients' status and develops new management and diagnostic plans for the gynecologic patient.
3. Will be the primary physician for procedures as level of training dictates.
4. Will serve as the first line for health care team, i.e., nurses, respiratory therapists, etc.
5. Will manage similar number of gynecologic patients as an intern to gain skills, attitudes, and knowledge necessary to function as the primary physician.


Objectives
1. Demonstrate a level of skill in patient care of both gynecologic inpatients and outpatients comparable to an intern completing his/her first gynecologic rotation.
2. Student will demonstrate knowledge of responsibilities of an intern by completing all intern related administrative tasks.

Description of course activities
1. The student will work with the General Gynecology team as it rotates through the OR and Gyn clinic. As skill level allows, the student will work in clinics evaluating, examining, and writing clinic notes for patients and will check out to chief resident and/or faculty.
2. Students will attend all operations and procedures assigned to the team, acting as intern to evaluate and help manage patients. Students will participate as acting intern in all assigned pre-operative and post-operative care and procedures.
3. Cover the Emergency room every 4th day as acting intern and be responsible for examining and evaluating gynecologic patients who are admitted or develop problems during this shift including surgical cases. The student will check out to the OB/GYN resident assigned to ward call or faculty on call.
4. The student will attend all conferences and lectures that the Gyn team intern is required to attend.

Type of students who would benefit from the course
Ideal for students desiring to increase knowledge of gynecology management and surgery. This course would be most beneficial to those considering training in OB/Gyn, Family Medicine or any Women's Health focused training. It will fulfill their acting internship requirement. Consent only for visiting students.

    Weekly Schedule
          Estimated Course Activities (Start-Time/Finish-Time):
Day of Week   AM   PM
Monday Clinic or OR Clinic or OR
Tuesday Clinic or OR Clinic or OR
Wednesday TDCJ clinics TDCJ clinics
Thursday Clinic or OR Clinic or OR
Friday Clinic or OR Clinic or OR
Saturday Round with team if on call Round with team if on call
Sunday Round with team if on call Round with team if on call

 Average number of patients seen per week: 25
 Call Schedule: No

Research / Other Course Activities
(estimated schedule)
Activity Hours per Week
Faculty Contact-Time
Self-Directed Study
Data-Collection/Analysis
Other


Method of Student Evaluation
1.  Clinical Observation
  A. Where are students observed on this elective?
    Inpatient Service   Ambulatory   Surgery   Standardized patients
Patients simulators   Other
  B. Frequency - How often are students observed clinically?
    Daily
  C. Format - What method(s) are used to document the student's clinical performance?
    Daily oral feedback   End of period oral feedback   Written feedback
Other

2.  Oral Presentation
  A. Audience - To whom does the student present?
    Residents and faculty.
  B. Frequency / Duration of Presentation(s)?
    Daily
  C. Format - What guidelines are set for the student's presentation?
    Standard patient presentation for chief complaint, history, exam and plan.
  D. Assessment - Who assesses the student's presentation performance?
    Self-assessment   Peer assessment   Faculty assessment
  E. Method of content selection
    Current cases  Student-selected topic   Assigned topic

3.  Written Assignment (H&P's, notes, papers, abstracts, etc.)
  A. Frequency of written assignment(s)?
    N/A
  B. Format - What guidelines are set for the student's written work?
    N/A
  C. Length of written assignment(s)?
    Abstract   Annotated bibliography   1 - 2 page paper   3+ page paper
  D. Are recent references required?   No    If yes, how are they selected?
    N/A
  E. Method of content selection - e.g. student-selected, relate to cases, etc.?
    N/A
  F. Audience - Who assesses the student's written performance?
    Peer Assessment     Faculty Assessment     Other

4.  Examination
  Format
    Oral   Written multiple choice   Written essay / short answer   OSCE
Other

5.  Extra Course Activities
  What expectations do you have for the student to demonstrate participation in the elective (e.g. small group activities, seminars, thoughtful questions, providing resources, journal club, resident lecture attendance)?
    The student will attend the weekly resident conferences on Wednesday mornings from 7-10 am.

6.  Additional Costs
  Please list any additional costs and/or purchases (books, materials, movies to watch, etc.) that are required for this course. Include an estimated total cost. If there are no additional costs, please enter "None".
    None

7.  Other Modes of Evaluation
  Please explain below.
    Written evaluations by the chief resident and Gynecology faculty assigned to the team. Evaluation will be based on clinical performance in the role as acting intern to include assessment of charting skills, clinical diagnostic skills, ability to formulate differential diagnoses, oral presentation skills, ability and willingness to work as an integral part of the team and overall work ethic.

8.  If this course is an Acting Internship, please complete the following:
  A. Objectives for the AI should relate directly to the Entrustable Professional Activities (EPAs). Each AI should describe how the four key Year-4 EPAs that our school has identified as being Year-4 skills are assessed. The Year-4 objectives are:
1. Entering and discussing orders/prescriptions.
2. Give or receive patient handover to transition care responsibility.
3. Recognizing a patient requiring urgent or emergent care and initiating management.
4. Obtaining informed consent for tests and procedures.
Specify how the student will be given formative feedback on their clinical skills.
    At the end of the AI rotation, the student will be given written feedback from the Director, other faculty members and residents who interacted with the student.
 
B.
Year-4 students should demonstrate mastery of EPAs they developed in the clerkship year, including recommending and interpreting common diagnostic and screening tests, and performing general procedures of a physician. They should be able to demonstrate masterfully and independently skills they mastered in Years 2-3, including efficiently performing comprehensive admission-notes and succinct daily progress notes and perform accurate, concise, and hypothesis-driven clinical presentations, form clinical questions and retrieve evidence to advance patient care. They should be able to demonstrate basic understanding of and beginning mastery of collaborate as a member of the interprofessional team and identify system failures and contribute to a culture of safety improvement.

List advanced clinical skills that a student will be assured an opportunity to practice.
    Student will be able to assist with GYN procedures in OR (i.e. hysterectomy, exploratory laparotomy, laparoscopic surgery), based on their skills and the complexity of the procedure. The student will learn the basics of 1st trimester ultrasounds. Patient will assess ED patients and practice examination in various clinical settings.
 
C.
How specifically will this AI build on developing skills from the clerkship year to prepare students for internship?
    Robotic surgery/procedures
Advanced laparoscopic surgery
Gynecologic ultrasound
 
D.
What opportunities will typically be available to all students who take this AI (procedures, required presentations, etc.)? What opportunities may be available based on patient load/presentation or student initiative (ie. Writing a case report)?
    Responsibilities similar to PGY1:
- Evaluation and assessment of Gynecological patients in the ER, inpatient and clinic areas
- Following the directions of the senior OBGYN residents in helping out in management of inpatient and surgical patients
Responsibilities different to PGY1:
- Assist and scrubbing into surgeries as a second assistant.
- No night calls.
 
E.
An AI should have expectation of a minimum of 32 hours per week of clinical responsibilities. Duty hours should be capped at ACGME limits for an intern, thus up to 24 hours followed by 4 hours of activities related to patient safety, education, and handoff. Students cannot work more than 80 hours per week averaged over 4 weeks. They can only have 1 day off in a 7-day work week with 8 hours off between shifts.

Clinical responsibilities will vary depending on specialty, but how is the student functioning with work commensurate to a PGY1 with an appropriate level of training?
    AI student will develop the basic skills to evaluate, assess and treat the most common gynecologic complaints. The elective will provide exposure needed to continue further training in OBGYN or Women's Health Specialties
 
F.
How is the student demonstrating drawing clinical conclusions and/or developing a management plan and documentation as an intern would do?
    Patients will be responsible for individual patients including both verbal and written feedback. Their assessment will be based on the completeness of oral presentations and clinic note writing.
 
G.
How and by whom will midpoint feedback be provided to the student? How will you remediate deficiencies identified at midpoint?
    A midterm evaluation will be done with AI Director to assess any deficiencies or lack of certain topics based on student experience thus far in the rotation. It is expected that during the 4-week course period, AI is expected to encounter same gynecology faculty between 1-4 times depending on the schedule assignment of faculty members. The supervision will be directly by the senior OBGYN residents who are on the gynecology service. Faculty designated on the gynecology clinics, OR and rounds will have the opportunity to supervise AI during different type of clinical skills exposures mentioned earlier.
 
H.
Acting Internship students often seek letters of recommendation following their experience. How many different Faculty will work directly with the student and have knowledge of the student's abilities to detail in a written evaluation? Describe the degree of supervision and interaction with faculty vs. residents or other providers and how feedback will be obtained if more direct work is with residents or other providers.
    The student will work directly with multiple faculty members in the various clinic settings. She/He/They will have ample opportunities to earn a quality letter of recommendation from departmental faculty. OB/Gyn residents will work closely with the student and be asked to give a detailed explanation of how they experienced the student as an acting intern to assist with writing the OBGYN SLOE letter.