The schedule is complicated. The goal of these seemingly uninterpretable schedules is to give each student 2 weeks on an ob team, 2 weeks on a gyn team, one week on night-call, and a half-day each week with a generalist preceptor in clinic.
Two thirds of the students rotate at OHSU. The OHSU rotation consists of three weeks of obstetrics and two weeks of gynecology, either benign or oncology. Two of the students will rotate at Legacy Emanuel Hospital (LEH), and Good Samaritan Hospital (GSH). Four of the students will rotate at St. Vincent's. Two students will rotate in Eugene and one student will rotate every other rotation in Salem. All Portland students work on on labor and delivery (L&D) every fourth or fifth night depending upon number of students enrolled in the rotation. The OHSU students work on L&D nights at OHSU and the LEH/GSH students work on L&D nights at LEH. Students at each hospital are allowed to make call switches.
Each student has half a day per week assigned with a generalist preceptor. The preceptor clinic remains the same throughout the five-week clerkship. Please e-mail or page your preceptor to confirm time and places for clinic. This clinic preempts any other team duties that you have. However, if you have a conflict it is fine to ask your preceptor to change the time or day of the clinic that you attend.
The students on OB at OHSU are divided so that two students spend their time on L & D, and two students go to high-risk clinic every morning. The students on L & D may spend AM time doing newborn exams with the pediatrics team. Those students on clinic do rounds in the afternoon. Halfway through the first three weeks, the two teams switch jobs.
OB at LEH is less structured, although each student spends a half-day with one of the perinatologists in clinic. You may do newborn exams, however you must request this.
OB runs more like an ED than a ward service. The labor unit is covered in shifts, both by attendings and by residents. You do not take call as a team, nor do the residents. This can be a difficult system at first, as there is no one resident to identify as being in charge. One way to deal with this is to identify first with the patients, then identify which resident will help you accomplish your goals in caring for your patients. The L&D nurses are very knowledgeable about how to get things done, and can be infinitely helpful to you as long as they perceive that you have the patients' best interests at heart.
At both OHSU and LEH there is a brief orientation to L&D held on the first day of the clerkship, after your orientation to prenatal and antepartum care. All students attend at the L&D location where you will work at night, even if you start on the GYN service.
Students are welcome to approach the midwives, and ask to follow their patients. If they do not already have a midwife student, they will gladly have you. At OHSU, the midwifes expect you to function like a midwife student for the day or night that you are with them, seeing their exam patients and following and supporting their labor patients as your first duty and taking on patients with the resident service only if time permits.
GYN teams are teams in the traditional sense, and your schedule reflects two days in the OR, a half-day in pre-op clinic, and a half-day in GYN clinic (or colpo clinic) with your team. Again, GSH has less structure but the same goals.
Team schedules are templates and have approximate times. The time that AM rounds begin depends on the census. Ask your team each night. PM rounds usually occur when the physicians have time.
Orientation to Call
On the first Monday of each clerkship, Dr. O'Reilly meets with students to go over a problem-based learning exercise that is designed to get you ready for your first night shift on L&D. The written materials for this session are in your packet, labeled “quiz”. Please read about normal intrapartum and work through this exercise before coming to orientation.
For the OHSU students, in your binder will be guides to how the teams function on Ob and Gyn. These guides also were prepared by former residents.
Required text is Obstetrics & Gynecology, 6th ed., publisher: Lippincott, Williams & Wilkins.
Friday Lectures and Presentations
Lectures are scheduled every Friday. You will do AM rounds, then come to OHSU for lectures, which begin between at 9:00a.m. OB/GYN Grand Rounds is every Friday, September through June, 7:30-8:30 a.m. in UHS 8B60 and you are required to attend these.
After two weeks, you have an opportunity to review your progress on the clerkship. You will be emailed a Midterm Evaluation that you will give to the person who you feel has the best idea of your progress. Please hand this in the following Friday at lectures.
Please page your team if you need to be absent for any reason. If you must miss any of the clerkship, you need to let Dr. O'Reilly know and she will make arrangements for make-up time.
If you feel you are having a personality conflict or other sort of problems with your team or preceptor, please bring this to Dr. O'Reilly as early as possible. Five weeks goes by very quickly!
Included in your binder is a clinic opportunity for which students are welcome but not routinely assigned. If such an opportunity appeals to you and fits your schedule, you are welcome to attend. I try to keep the information, but because of changes in residents on service or vacations, it may sometimes be inaccurate.
Students are expected to wear a white coat and name tag. Men should wear ties to clinic and women wear equivalent attire. Scrubs are for L&D and the OR. Please do not wear scrubs to clinic and if you must, don't wear the ones you slept in!
OBGYN Policy: Exams under Anesthesia
Students do pelvic exams on anesthetized patients when they are scrubbed as part of the surgical team. If more that one student is involved in a case, only the student who is going to scrub should do the exam under anesthesia, unless there is special permission from the patient for another student to do an exam. Most patients are open to allowing this, but the surgical consent for exam only applies to the scrubbed team.
There is a shelf exam that reflects your course objectives and counts 25% towards your final grade.
The grade breakdown is as follows:
OB team evaluation (residents and faculty): 30%
GYN team evaluation (residents and faculty): 30% Preceptor evaluation: 15%
Shelf Exam: 25% (no minimum score for passing the course)
The median grade is NH in this course.
Your final grade is submitted to the dean's office on a summary form. The summary comments represent a distillation of the various evaluators, and are meant to be transcribed directly onto your Dean's letter. Formative comments are transcribed straight off the evaluations and are not meant for the Dean's letter. If you want to review your grade packet, make an appointment with Dr. O'Reilly.
If you feel your grade is unfair or does not contain complete material, you can contact her by e-mail or phone to discuss this.