OBGU-4024 - A/I in Gynecologic Oncology

OBGU-4024 - A/I in Gynecologic Oncology

Elective Title: A/I in Gynecologic Oncology
Course Number: OBGU-4024
Elective Type: clinical Duration/Weeks: 4 Max Enrollment: 1
Prerequisites: Successful completion of Year 2
Additional Requirements: Successful completion of Ob/Gyn clerkship; All visiting students must seek prior approval. All students being enrolled within 3 weeks of the start date must seek prior approval.
Responsible Faculty Director: Gwyn Richardson, MD Periods Offered: 1-7, 9-13 excluding holiday period 8 
Coordinator: Brandie Denton Other Faculty:
Location to Report on First Day:
Clinical Science Building 3.316

Goals
1. Will act as the primary physician (house officer): admit, develop management and diagnostic plan for the gynecologic oncology patient and have plan for initial orders.
2. Follow up on patient's status and develops new management and diagnostic plans for the gyn/onc patient.
3. Will be the primary physician for procedures as level of training allows.
4. Will take ward call in house every fourth day and work up patients with the Ward Call residents and faculty including taking part in surgical procedures performed during this time.
5. Will manage a sufficient number of gyn/onc patients as an intern to gain skills, attitudes, and knowledge necessary to function as the primary physician.


Objectives
Demonstrate a level of skill in-patient care of both gynecologic oncology in-patients and out-patients comparable to an intern completing his/her first gynecologic rotation.
Student will demonstrate knowledge of responsibilities of an intern by completing all intern related administrative tasks under supervision of chief resident, fellow and assigned faculty

Description of course activities
1.The student will work with the Gynecologic Oncology team as it rotates through the OR and Gyn/Oncology private clinic. As skill level allows, the student will:
* Work in clinics evaluating and examining patients and will check out to chief resident, fellow and/or faculty. Clinics include gynecologic oncology private clinics and TDCJ gynecology clinics in Texas City. *Attend all operations and procedures assigned to the team, acting as intern to evaluate and help manage patients.
* Participate as acting intern in all assigned pre-operative and post-operative care and procedures.
2. Participate in Emergency room evaluations as acting intern and be responsible for examining and evaluating gynecologic oncology patients who are admitted or develop problems during his/her time on service (if after-hours only if on call. The student will check out to the OB/GYN resident assigned to ward call or faculty on call.
3. The student will attend all conferences and lectures that the Gyn team intern is required to attend.
4. The student will be responsible for writing clinic and/or ward notes as assigned.
5. There will be a final project that will be expected of the student. Information will be given at the start of the rotation.

Type of students who would benefit from the course
Those students who wish additional background in gynecology and gynecologic oncology and wish to fulfill their acting internship requirement. This course would be most beneficial to those considering training in OB/Gyn, Gynecologic oncology and surgery.

    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 Educational activities, Tumor conference
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: 20
 Call Schedule: no more frequent than every 4th night; compliant with 80 hour work week

Research / Other Course Activities
(estimated schedule)
Activity Hours per Week
Faculty Contact-Time Gwyn Richardson, MD
Self-Directed Study DiSaia textbook
Data-Collection/Analysis N/A
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, fellow and faculty
  B. Frequency / Duration of Presentation(s)?
    daily
  C. Format - What guidelines are set for the student's presentation?
    standard format; similar to small group practices during PGYIII rotation
  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)?
    one written H&P per week
  B. Format - What guidelines are set for the student's written work?
    H&P template based on UTMB standard
  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?
   
  E. Method of content selection - e.g. student-selected, relate to cases, etc.?
    faculty assigned
  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 and division of gynecologic oncology educational sessions and tumor conference on Thursday afternoon from 2 to 5 pm

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 evaluation by the chief resident and Gynecology faculty assigned to the team. Evaluations 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, and overall work ethic. The students ability and willingness to work as an integral part of the team will be assessed

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.
    daily - oral feedback;
endo of rotation: oral and written evaluation
 
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.
    - Colposcopy and biopsy
- cervical conization
- assisting House staff in the operating room depending on their baseline skills and complexity of the procedure
- evaluation of gyn/onc patients with differential diagnosis and treatment planning
 
C.
How specifically will this AI build on developing skills from the clerkship year to prepare students for internship?
    1. Surgical staging procedures: robotic assisted and open;
2. Radical hysterectomy
3. Radical vulvectomy
4. surgical debulking of ovarian cancer patients
 
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)?
    Since there is no PGY1 resident on gyn/onc service, AI will be given most of the responsibilities of PGY1 and will be reporting to PGY2 and PGY4 residents of the team. AI will not be allowed to place any orders on patient.
 
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?
    The course allows students to understand basic of gynecologic oncology, potential problems, complexity of cancer treatment and surgical procedures; It will allow for the students to recognize when there is a problem with the patient.
This will prepare students to their first year as an OB/Gyn when in ED and on the wards.
 
F.
How is the student demonstrating drawing clinical conclusions and/or developing a management plan and documentation as an intern would do?
    Oral evaluations
Student will be given full feedback after two weeks on service which will give him/her opportunity to improve
If there is no improvement, it will be reflected in their final evaluation
 
G.
How and by whom will midpoint feedback be provided to the student? How will you remediate deficiencies identified at midpoint?
    Two faculty 50% of their rotation; Students are supervised the same manner as PGY1 and PGY2
 
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.