Brigham and Women's Hospital Harvard Medical School

Curriculum

The clerkship is divided into 3 weeks on obstetrics and 3 weeks on gynecology. Within each service, students spend time in the ambulatory, inpatient and operating room settings. Daily rounds occur on all services as well as teaching conferences. Students choose electives while on the rotation including gynecologic oncology, genetic counseling, ultrasound, family planning, fertility clinic and in-vitro fertilization. Specialty electives are also available on request including urogynecology, ob neurology clinic, embryology lab and adolescent clinic.

O.B. Simulation

Students have patient exposure in the operating room, inpatient setting, labor and delivery, ob triage and ambulatory settings (resident and faculty practices for ob and gyn). During the ob assignment, time is divided between labor and delivery and the ambulatory practices. While on labor and delivery, students are assigned to triage, the labor floor and assisting with Cesarean deliveries. Students will be able to spend quality time with residents, faculty and midwives for normal vaginal deliveries. During gyn, students are assigned to the Operating Room and ambulatory practices. In addition, all students attend one colposcopy clinic during their gynecology block.

Obstetrics

Students assigned to OB will spend approximately 2 weeks on Labor & Delivery (BWH resident OB service or HVMA service), and one week in the BWH ambulatory Ob clinics with attendings and residents. Students on resident OB L&D and in clinics are expected to attend morning Ob rounds at in the Residents Work Room on the 5th floor in CWN-582. At Ob Board Rounds, L&D patients are reviewed with the faculty attending of the day. Morning rounds begin at 7:30am except on Wednesdays when they begin at 7:00am (students & residents attend Grand Rounds on Wednesdays from 7:30-8:30am in the Duncan Reid Conference Room located in the Ambulatory 1 Bldg., 2nd floor behind the elevators). On select mornings (check with the OB clinic chief), BWH & HVMA L&D students are expected to attend AM Teaching Rounds led by the OB clinic chief resident in CWN-582 before their respective board rounds. Tuesday mornings, following morning board rounds at 7:55 AM, Dr. David Acker, Chief of Obstetrics, when available, treats students to breakfast in the BWH cafeteria at “shadow rounds”. BWH Students assigned to L&D or a midwife will attend 6:15PM evening rounds. To create a more team-oriented experience for students, assignments are made with the goal of maintaining student/resident/attending teams. All students are expected to attend one breastfeeding class held daily from 12-1 pm on CWN 9 in the back nursery led by a lactation consultant. Students should round on postpartum patients if involved in their delivery prior to OB Board rounds, check with residents regarding time for postpartum rounds.

HVMA L&D Students. Students assigned to the Harvard Vanguard service on Labor & Delivery round at 7:15am and 7:15pm in the CWN-5 Triage office. Plan to attend OB chief resident Teaching Rounds on select mornings in CWN-582 (check with OB clinic chief for days/times) and also attend Dr. Acker’s Tuesday 7:55AM Shadow Rounds in the cafeteria. Students should round on postpartum patients daily, coordinating with the physician and midwife “rounders” to see patients before or after rounds.

Students on OB are encouraged to attend Tuesday 12:00-1:00PM Gyn Resident Teaching Rounds with Dr. Robert Barbieri, BWH Ob/Gyn Chairman, in Kistner Conference Room, Connors Bldg., 4th floor (lunch is included) & Wednesday 12:00-1:00PM OB MEC Rounds in the Swift Library, Ambulatory 1 building, 3rd floor or the Anesthesia Conference Room on CWN-L1(check resident website www.partnersobgynres.org for location). Also encouraged is Thursday Perinatal conference from 12:00-1:00PM in the Swift Library.

OB Call Schedule

Students on L&D will be assigned two 12-hour calls consisting of one weekend day and one weekend night 12 hour shift, allowing for up to 30 min for transfer of care and sign-out rounds. The shift for the L&D student on 12-hour weekend day call on the resident service will be 7:30 am-7:30 pm and for the 12-hour weekend night call will be 7:30 pm-7:30am. The Ob team consists of the Chief resident, PGY 2 & PGY 3residents, interns, the L&D students and the faculty attending of the day/night. On HVMA, the team will be an attending, midwife and student. HVMA rounds on the weekend are the same as during the week, starting at 7:15am, thus weekend day shifts are 7:15 am to 7:15 pm and night shifts are 7:15pm-7:15am with up to 30 min allowed for transfer of care and sign-out rounds. Call rooms are available for students.

Midwifery Service

Students on the Resident OB service will be assigned one session with the BWH midwives during the day. When assigned to a midwife, be sure to attend morning midwifery rounds at 6:45AM. Morning rounds are held on the 4th floor in CWN-405. If no student has elected to work with a midwife on a particular day, you may follow a BWH midwife if the resident service is quiet. Students may follow BWH midwives nights and weekends when on call as well. On HVMA, students may participate with both midwife and attending OB patients at any time.

Gynecology

The BWH Gynecology block is composed of an operating room and ambulatory experience. Students are part of the resident gyn team except when on the gyn oncology elective. The student/resident teams have been designed to provide both the students and residents with the most productive experience. The teams should enhance each student’s sense of belonging and responsibility. The teams also enable the residents to assess each student’s level of knowledge and skill and work appropriately with them. The ambulatory sessions will be with residents and faculty and depending on the core preceptor’s practice location, may be at BWH or at an off-campus practice site. All students will also be scheduled to attend one Colposcopy Clinic in the GYN Oncology practice or General Gynecology practice. Students are expected to perform at least 5 pelvic exams (including exam under anesthesia) during the rotation which are kept track of on a pocket procedure card.

All students who are in the Gynecology block will meet daily with the team (Attending, Gyn Chief Residents, Senior and Junior Residents, intern) for clinical morning rounds. Students are expected to follow any operative or nonoperative patients that they were involved with their care and may also be assigned to gyn inpatients or consults to follow while in the hospital. Morning rounds are at 6:45 am, except on Wednesday and Friday morning rounds start at 7:00 AM. During rounds, the team reviews patients seen in the Emergency Room and inpatients and makes operating room assignments (the students will be assigned with a resident to a gyn surgical case). Students will follow their assigned resident either to the operating room or go to their assigned clinic after morning rounds. To promote continuity, attempts are made to pair students with the same resident. This is not always feasible because of limited time on gyn and an effort to provide as much exposure in each of the many areas in gyn surgery. Time is set aside for students’ self-directed learning and for electives.

All students are assigned one week as “consult” gyn student. During this week, the student will be paged for any inpatient or ED consults and, depending upon the student’s availability, the student will evaluate the patient along with the intern. The student should also choose a patient from the “Ectopic List” to follow along with gyn resident team during this week.

All gyn students are expected to attend Tuesday 12:00-1:00PM Gyn Teaching Rounds with the residents and Dr. Robert Barbieri, BWH Ob/Gyn Chairman, in the Kistner Conference Room, Connors Center for Women & Newborns, 4th floor (lunch is included) & Wednesday 12:00-1:00PM OB Chiefs Rounds (also referred to as MEC Rounds) in the Swift Library, Ambulatory 1 building, 3rd floor, or the Anesthesia Conference Room on CWN-L1 (check resident website www.partnersobgynres.org for location).

All gyn students should attend evening gyn rounds at 4:30pm in Abramson Library (Monday, Wednesday, and Thursday). On Tuesdays, OR committee is held in place of PM team rounds in which resident gyn clinic patients needing surgery are presented and discussed. At 5:30 pm, during the week, only the student who is on Gyn Call attends 5:30 Sign Out rounds to “sign out” OR cases and to review the inpatient service.

Gyn Call Schedule

Students on gyn will be assigned one overnight call Monday through Friday. Students will be off the next day following a 24 hour call. The gyn student on 24-hour call will be assigned to the gyn second year resident who serves as gyn consult to the ED and inpatient floors. Students are encouraged to present any patients seen during the call night (consults, admissions, surgical patients) the following morning at rounds. Call rooms are available for students.

Student Responsibilities on Ob and Gyn services

Morning rounds

  • Present patients at morning rounds on both gyn and OB services
  • Prepare teaching topics if asked on gyn service
  • Round daily on patients that they admitted or for whom they participated in deliveries or surgery. Students are expected to round on at least 2 postpartum patients each morning (coordinate with faculty, midwives and residents). All notes should be done in the morning prior to team rounds so that faculty/midwife/resident can review the patient issues and cosign notes.
  • Know and follow up on the laboratory and imaging results on their patients.

Evening sign out

  • Students are expected to present their patients to the night team on both gyn and OB services

Operating Room

  • Know the indication, procedure, and anatomy that is involved in the case in which they are participating
  • Write operative notes, helping with patient positioning, preparation for surgery, transport, discharge paperwork, prescription writing (all supervised by resident or faculty)

Labor and Delivery

  • Perform history and physical examinations on patients, present cases to either a resident, faculty or midwife, and elicit feedback and co-signature.
  • Write progress notes approximately every 2 hours on labor and delivery patients (once an hour when patient is pushing); show these to a resident, faculty or midwife, elicit feedback and co-signature.
  • Evaluate patients in OB triage, present cases to either a resident or faculty member, and elicit feedback and co-signature.
  • Attend postpartum tubal ligations, planned and unplanned Cesarean sections and circumcisions as schedule permits.

Ambulatory OB and Gyn Clinics

  • Prepare for clinics by looking up patient histories, prior evaluations and emailing provider ahead of time to confirm time of clinic, location and any advance preparation required.
  • Perform histories and supervised physical examinations with faculty or resident
  • Present cases, write notes, elicit feedback and co-signature

General Comments

Students on the clerkship are encouraged to actively participate in patient care activities and learning opportunities, be self-motivated, open-minded and be aware of the sensitive nature of some aspects of Obstetrics and Gynecology. Students who come to the clerkship prepared, have a positive attitude and willingness to learn, participate and contribute to the patient care team should easily succeed.