ORIENTATION—starts at 12 pm if you are on week #1 or 7:30 am if you are on week #5 of your clerkship in VCU Sch of Med/Inova Fairfax Hosp Campus (phone 703 776 2729) Section I Welcome & Introduction to Inova Fairfax Hospital Womens’ Center 3300 Gallows Road Falls Church VA 22042 Obstetrics/Gynecology 4-week Clerkship OB/GYN Clerkship Director Samantha Buery, MD ph # 703 776 3080 OB/GYN Asst. Clerkship Director Rasha Ebeid, MD ph # 703 776 2174 Residency Coordinator Lolyn Young ph # 703 776 2745 Handouts: 1. IFH Resident rotation schedule 2. IFH Resident on-call schedule 3. IFH Resident weekly schedule 4. GWU/VCU MS3 schedule 5. Mini roster for ID holder 6. Red Book, G Wheel, Suture Kit/Manual 7. IFH Campus Map 8. L&D power point 9. Meal tickets (for GWU M3)
Index for the GWU M3 Orientation Packet Page SECTION 1 WELCOME / INTRODUCTION 1-1 1-2 1-3 1-4
Welcome letter from Dr Buery, OBGYN Clerkship Director Clerkship Expectations Philosophy Evaluation Under Anesthesia Policy
2-1 2-2 2-3 2-4/2-5 2-6
SECTION 2 PORTFOLIO & EVAULATION GWU OBGYN Clerkship Objectives Faculty/Resident Evaluation, RIME Method GWU M3 Evaluation Form for Attendings, Residents to complete GWU M3 Evaluation Form of Clerkship Reminders
3-1 3-2 3.3 3-3 3-4 3-5 3-6
SECTION 3 SCHEDULES, ROTATIONS, LECTURES, CBCs Standing Conferences Teaching Resident Lecture Topics and objectives Benign Gynecology Week Gynecologic Oncology Week Antepartum Week Day Float OB Team Week Night Float OB Team Week SECTION 4 CONTACT INFO
4-1 4-2 4-3
Contact Info Resident Email/Pager Roster IFH OBGYN Attending Roster
5-1 5-2 5-3 5-4 5-5/5-6 5-7 5-8 5-9 5-10 5-11, 5-12 5-13 5-14 5-15,5-16
SECTION 5 MISCELLANEOUS Dress Code at Inova Fairfax Hospital Blood/Body Fluid Exposure Policy at Inova Fairfax Hospital Confidentiality Statement at Inova Fairfax Hospital Commitment to Safety Statement Error Prevention, Red Rules Policy Suture Kit Info, Keeping Costs down in Surgery Items stored on www.gmeone.com Organizations of Interest American College of OBGYN Benefits Abbreviations / Terminology OBGYN Spanish Phrases Basic Perinatal Sonography Terms Medical Student Responsibilities/Orientation Contract
Welcome to your Clinical Clerkship in Obstetrics and Gynecology at Inova Fairfax Hospital Campus! Obstetrics and Gynecology is an extremely rewarding and diverse field of medicine. The obstetrician/gynecologist is not only a specialist of the reproductive tract but also a major provider of the primary and preventative care needs for women. During this 4-week clerkship you will be exposed to normal and pathologic conditions associated with the female reproductive organs. In addition, you will learn about broader health care concerns that face many women today. This will be accomplished by direct patient contact in clinics, wards, operating rooms and labor and delivery suites. Some of the greatest strengths of the Inova Fairfax Hospital Campus are the tremendous cultural diversity and variety of medical conditions seen in our patient population. Our patients will allow you the privilege of sharing in some of the most intimate aspects of their lives including the birth of a child, the vulnerability of undergoing surgery, and pelvic examination. In return for this privilege each patient should be treated with compassion, dignity and respect for their privacy and beliefs. This rotation will require a lot of time and hard work. It is designed to be an enjoyable and educational experience. Your interest and enthusiasm will likely dictate the interest and enthusiasm we take in you. During this clerkship we hope to provide you with a foundation of knowledge and skills to appreciate the health care needs of women. If you have any questions or problems please see me, Dr. Rasha Ebeid or Lolyn. Sincerely,
Samantha D. Buery-Joyner, M.D. Director, OB/GYN Clerkship 703 776 3080, email:
[email protected], pager 84927
Clerkship Expectations 1. 2.
3. 4. 5.
6. 7. 8.
9.
10. 11. 12. 13.
Be professional. Hold yourself and your peers to the highest standards of honesty and integrity. Exhibit dependability and responsibility. As in all services, residents and medical students depend on each other. You are a vital member of the team. Show an exceptional level of interest and compassion for the patient. Reading on your own is expected. You are graduate students and medicine is a life long learning process. You are expected to be present at all formal, scheduled activities as shown in the notebook. Conflicts of time and place will arise and you will need to make choices. You will not be penalized for your choice, but choose the activity that will be best for your education. We want you to have feedback during the rotation. If expectations are unclear, please talk to the appropriate resident or attending. On each rotation give a M3 OB/GYN Clerkship Evaluation form to at least one attending or resident on that service. Informal presentations will be given during several of your rotations. These presentations are informal, lasting approximately five minutes. The topics should be something relevant to a patient you have seen. The chief resident can help you come up with a topic. For your own protection, do not perform breast or pelvic exams without a nurse or aide present. Pelvic exams should always be performed with a resident or attending present. Use universal precautions at all times. Review the evaluation methods for the clerkship. Note that a substantial portion is a clinical evaluation by on-site observation. If you have any problems with anyone at any time, please let me know within 24 hours so that I can address the situation most effectively. At the end of the rotation, you will have the opportunity to make an anonymous evaluation of the clerkship, faculty, and residents. Please complete the evaluation prior to admission to the final exam. We welcome your feedback and use it to improve the rotation. Page 1-1
INOVA FAIRFAX HOSPITAL EDUCATIONAL PHILOSOPHY 3RD YEAR CLERKSHIP IN OBSTETRICS AND GYNECOLOGY 1.
To create an environment that provides opportunities and motivation for students to appreciate the unique medical concerns of women within the context of the general medical education.
2.
To provide students the opportunity to evaluate and manage common gynecologic and obstetric problems.
3.
To provide a setting for the development of motor skills needed for the diagnosis and treatment of common gynecologic and obstetric problems.
4.
To provide students with an understanding of the doctor/female patient relationship and an opportunity to refine communication skills.
5.
To promote effective methods of data collection and record keeping for women’s health in a timely fashion.
INFORMATION CAN BE DIVIDED INTO THREE CATEGORIES: Need to know Nice to know Nuts to know
We will do our best to let you know what is essential
Page 1-2
Exams Under Anesthesia (EUA) Policy 1.
The performance of an Examination Under Anesthesia (EUA) is an integral part of the surgical care provided to patients undergoing gynecologic surgery.
2.
The EUA must be performed with respect for the woman’s modesty and dignity.
3.
Only the members of the surgical team who will participate in the peri-intra-, and/or post-operative care should perform the EUA. These members should meet the patient prior to the exam.
4.
The EUA allows members of the surgical team to select the appropriate incision as well as to correlate the physical findings with the intraoperative surgical findings.
RESOURCES http://www.apgo.org/binary/8th%20edition%20Objectives.pdf A summary of medical student competencies is available on the APGO website. This is a great summary reference by which to study. http://www.acog.com/from_home/departments/category.cfm?recno=22&bulletin=1581 ACOG Student Membership-FREE Student membership provides access to the green journal (The Journal of Obstetrics and Gynecology) and to the Compendium. The compendium offers technical bulletins and practice bulletins for Ob/Gyn conditions.
Page 1-3
Section 2
PORTFOLIO & EVALUATION
George Washington University Washington DC Phone # 202 741 2532 OB/GYN Clerkship Objectives GWU’s Department of OBGYN conducts an 8-week clerkship designed to provide each medical student with information and skills that are essential to medical practice in comtemporary obstetrics and gynecology. Physicians in all aspects of medicine as well as subspecialties regularly have female patients, pregnant or not, and are required to understand the special requirements of female pathophysiology and pregnancy on clinical signs, laboratory tests and therapeutic modalities. Goals and Objectives 1. To be competent in performing gynecology pelvic examination and breast exam 2. To be competent in evaluating pregnant patients 3. Understand disease processes, diagnosis, therapy, and management of gynecology and obstetric diseases 4. Understand management of medical and surgical conditions in the pregnant patient 5. Understand, diagnose, treat common primary care conditions of the female patient 6. Understand diagnosis and treatment of hormone disorders throughout life in the female patient 7. Understand the psychosexual issues that arise in the field of OB/GYN 8. Understand the ethical controversies of reproductive health and medicine 9. Attain exposure to breadth and depth of OB/GYN 10.Enjoy your learning experience Requirements Attend all designated lectures, conferences, grand round, teaching sessions, weekly preceptor meetings. Contact preceptor on 1st day of rotation – priority. Keep log of clinical case experiences: Minimum of 10 surgical cases, 10 outpatient encounters, 10 obstetrical cses Have competency forms completed by senior residents (PGY 3 or 4) or attending on: Pelvic exam OB exam in laboring patient OB/GYN history Acute care assessment in Emergency Room or Labor/Delivery Triage Oral exam with preceptor Written exam Sign off on mid rotation feedback form that are completed by the teaching resident and reviewed together with medical student and teaching resident Page 2-1
INOVA FAIRFAX HOSPITAL
OBSTETRICS/GYNECOLOGY Faculty and Resident Evaluation of Medical Students The RIME Method R – I – M – E Method for evaluation of students • Reporter • Interpreter • Manager • Education
REPORTER—Pass Student • Denotes reliability and competence in collecting and communicating clinical information ¾ Professional qualities ¾ History and Physical ¾ Oral Presentations and Note Writing ¾ Follow Through on assigned tasks
INTERPRETER—additional attributes from ‘reporter’ Pass Student • Functions with independent, critical thinking of clinical data • Can prioritize problem lists and offer differential diagnosis without prodding
MANAGER—additional attributes from ‘interpreter’ – High Pass Student • Describes a high degree of direct involvement in patient care at a level expected of an acting intern or intern • Proposes diagnostic and therapeutic options • Demonstrates judgment in working with patient and family • Reliably implements the treatment plan
EDUCATOR—additional attributes from ‘ manager’ Honors Student • Denotes a pattern of self-directed learning beyond the basics • Frequently contributes to the education of fellow students, residents, even faculty • Can frame important questions that are posed by complicated cases • Can resolve these questions through independent and efficient literature research
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MS-3 OB/GYN ROTATION GWU M3 STUDENT INFORMAL EVALAUTION FORM BY OB/GYN ATTENDING or RESIDENT Return to Lolyn Young Coordinator 776 2745 or 5034 or whitebox call room Medical Student’s Name Rotation Date Evaluate the medical student’s clinical competency by circling one number for each item below. Keep this sheet as important information to translate onto the end of rotation evaluation form. Rating: Outstanding=5 Excellent=4 Good=3 Needs Attention=2 Unsatisfactory=1 Outstanding 5
Excellent 4
Good 3
Needs Attention 2
Unsatisfactory 1
1. Fund of knowledge assess
Insufficient data to
2. Progress Notes assess
Insufficient data to
3. History taking skills assess
Insufficient data to
4. Physical exam skills assess
Insufficient data to
5. Clinical reasoning assess (analysis, synthesizes & prioritizes patient info, formulates accurate diagnosis & management plan)
Insufficient data to
6.
Insufficient data to
Oral Presentation assess
7. Patient care/relationship assess
Insufficient data to
8. Team Relationships assess
Insufficient data to
9. Attitude, Professionalism assess
Insufficient data to
10. Progress during month assess
Insufficient data to
Additional comments:
Print name: Resident/Attending Signature: just retype your name if submitting electronically Date: Page 2-3
INOVA FAIRFAX HOSPITAL/ George Washington University M3 OBGYN CLERKSHIP EVALUATION Excellent
Satis-factory
Needs Improvement
1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14.
I learned USEFUL/APPLICABLE information on this rotation My PERSONAL EDUCATIONAL OBJECTIVES were The LEVEL OF RESPONSIBILITY placed on me was The NUMBER OF PATIENTS with whom I interacted was Amount of service obligations (“scut”) COMPARED to other rotations The amount of service and “SCUT” work was APPROPRIATE for the amount of education provided The IFH OB/GYN ORIENTATION was adequate/helpful I had an opportunity to develop a plan of care and manage patients to a degree APPROPRIATE TO MY LEVEL I was treated as an important part of the TEAM EXPOSURE to procedures was adequate for this particular training Rotation’s EDUCATIONAL OBJECTIVES were clearly OUTLINED The EDUCATIONAL OBJECTIVES for this rotation were ACHIEVED The MOST valuable learning experience for me was The LEAST valuable learning experience was
COMMENTS ABOUT THE CLERKSHIP:
RESIDENTS Excellent
Satisfactory
Needs Improvement
1. 2. 3.
Residents on my service displayed an INTEREST in TEACHING Residents were EFFECTIVE Teachers I asked and received FEEDBACK FROM RESIDENT(S) on my performance during my rotation
COMMENTS ABOUT RESIDENTS:
Please list the names of effective teaching residents:
Excellent
Satisfactory
Please list the names of ineffective teaching residents:
Needs Improvement
ATTENDING/PRECEPTORS 1. 2. 3. 4. 5. 6. 7. Yes
No
8. 9.
The ATTENDINGS displayed an INTEREST in TEACHING (attitude) I received appropriate MENTORING from attendings The ATTENDINGS were effective teachers (cite literature, lectures) The PRECEPTOR was an effective teacher Attendings shared intraoperative care of patient in meaningful way Ability to challenge my thinking, communicate/answer questions I asked for and RECEIVED FEEDBACK from attendings on my performance DURING my rotation I RECEIVED PERFOMANCE FEEDBACK at END of rotation I had an opportunity to RESPOND TO FEEDBACK I received
ATTENDING/PRECEPTOR COMMENTS:
Please list the names of effective teaching attendings:
Please list the names of ineffective teaching attendings:
INOVA FAIRFAX HOSPITAL-GWU M3 OBGYN CLERKSHIP EVALUATION 2 Excellent
Satisfactory
Page 2 of
Needs Improvement
NURSING/HOSPITAL STAFF 1. 2.
NURSING STAFF had a positive ATTITUDE and INTERACTIONS with the medical students. ANCILLARY STAFF (radiology, lab, respiratory, PT/OT, nutrition, speech, social workers) had a positive ATTITUDE and INTERACTIONS with the medical students.
COMMENTS ON NURSING/HOSPITAL STAFF:
ENVIRONMENT Excellent
Satisfactory
Needs Improvement
1. 2. 3. 4.
The medical student CALL ROOM was The LIBRARY, its resources and staff were The CAFETERIA/CAFÉ’ was PARKING availability was
COMMENTS ON THE ENVIRONMENT:
Excellent
Satisfactory
Needs Improvement
LECTURES/CONFERENCES 1. 2. 3. 4. 5. 6.
1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. 17. 18. 19. 20.
The Teaching Resident Lectures were The Monday REI Lectures by Dr. John Gordon were The Monday IFH OBGYN Grand Rounds were The Tuesday REI Lectures by Dr. Suheil Muasher were The Wednesday GWU OBGYN Grand Rounds were The Wednesday Maternal Fetal Medicine Lectures by Drs. Khoury, Nies, Bronsky or AlKouatly were 7. The Journal Club lectures w/ Dr. Sheridan were 8. The Thursday GYN/ONC/Case Presentation Conferences were 9. The (i.e. Suture workshop, HIV Transmission, other) lecture(s) were 10. CONFERENCES: quality was 11. CONFERENCES: taught at an appropriate level 12. CONFERENCES: rooms were 13. CONFERENCES: number should be 14. Academic Dept Registration/Orientation Process 15. Your computer accounts set up (patient database, internet, etc.) Best points about this clerkship: Areas that need improvement: 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. 17. 18. 19. 20. Return evaluation to: Lolyn Young OB/GYN Residency/Academic Coordinator Ofc 703 776 2745, Fax 776 6078 Email:
[email protected] Pager 703 764 7310, pager #73496
Inova Fairfax Hospital OBGYN Faculty Evaluation Form NAME OF FACULTY: SERVICE:
OB
DATE:
ANTEPARTUM
# OF INTERACTIONS:
1-5
GYN
6-10
UROGYN 10-20
GYN ONC
CLINIC
LECTURE/PRESENTATION
OVER 20 patient encounters/cases during a clerkship (GWU=4 weeks, VCU=6 weeks)
PATIENT CARE: 1.
The attending demonstrates commitment to carrying out professional responsibilities, ethical principles, sensitivity to diverse patient population
excellent
satisfactory
needs improvement
2.
The attending provides compassionate care that is effective for the promotion of health, prevention, treatment and care at the end of life
excellent
satisfactory
needs improvement
3.
The attending demonstrates interpersonal and communication skills that result in effective information exchange with patient/family/professional associates.
excellent
satisfactory
needs improvement
4.
The attending calls on system’s healthcare resources to provide optimal patient care
excellent
satisfactory
needs improvement
PRACTICE-BASED LEARNING/IMPROVEMENT 1.
The attending assimilate evidence from scientific studies related to their patient’s healthcare
excellent
satisfactory
needs improvement
2.
Rounds with medical students on post-partum and sign-out patients (documentation, signature, leads sign-out patient rounds)
excellent
satisfactory
needs improvement
3.
The attending displays interest in teaching (attitude)
excellent
satisfactory
needs improvement
4.
The attending is an effective teacher (cited literature, lectures)
excellent
satisfactory
needs improvement
1.
The attending discusses investigatory/analytic approach to clinical situations
excellent
satisfactory
needs improvement
2.
The attending challenges my thinking
excellent
satisfactory
needs improvement
MEDICAL KNOWLEDGE
INTERPERSONAL & COMMUNICATION SKILLS 1.
The attending discusses intraoperative patient care, decisions, resources
excellent
satisfactory
needs improvement
2.
Availability/Accessibility (easily, consistently available)
excellent
satisfactory
needs improvement
3.
Interaction with hospital staff (nursing, techs, etc)
excellent
satisfactory
needs improvement
1.
The attending’s integrity, role model traits are:
excellent
satisfactory
needs improvement
2.
The attending demonstrates commitment to excellence, on-going professional development
excellent
satisfactory
needs improvement
3.
The attending demonstrates sensitivity and responsiveness to patients’ culture, age, gender, disabilities
excellent
satisfactory
needs improvement
4.
The attending demonstrates ethical principles pertaining to clinical care, confidentiality, informed consent, business practices
excellent
satisfactory
needs improvement
1.
The attending demonstrates to student how to effectively utilize system resources to provide patient care of optimal value
excellent
satisfactory
needs improvement
2.
The attending discusses partnering with healthcare organizations and other professionals to assess/coordinate/improve healthcare
excellent
satisfactory
needs improvement
3.
The attending discusses methods of cost effectiveness and resource allocation
excellent
satisfactory
needs improvement
4.
The attending promotes the quality of care through the effective use of the system resources (cost effective, resource allocation)
excellent
satisfactory
needs improvement
5.
The attending demonstrates an advocacy for quality patient care/patient safety
excellent
satisfactory
needs improvement
PROFESSIONALISM
SYSTEM-BASED PRACTICE
FEEDBACK 1.
I asked for and received feedback from the attending on my performance during my rotation
excellent
satisfactory
needs improvement
2.
I received performance feedback at the end of the rotation
excellent
satisfactory
needs improvement
3.
I had an opportunity to respond to the feedback I received
excellent
satisfactory
needs improvement
excellent
satisfactory
needs improvement
OVERALL 1. 2.
Overall teaching ability/effectiveness: provides feedback; offers suggestions for improvement; motivated learner. Do you feel that this teaching attending contributed to your education/training?
COMMENTS:
Yes—state reasons
No—state reasons
REMINDER: YOU MUST COMPLETE AND TURN IN: 1. IFH LOANER PAGER 2. IFH NAME BADGE, $5 WILL BE RETURNED 3. PARKING PLACARD 4. IFH CLERKSHIP EVALUATION 5. Complete your electronic GWU case log
Survival Tips
read your emails daily keep new batteries in your pagers ask questions call any of us if you have questions
Page 2-6
Section 3
Schedules, Rotations, Lectures
STANDING CONFERENCES / LECTURES AT IFH OBGYN SIGN IN Attendance Sheet MONDAYS Weekly 7:15 am REI Kaiser Rm, 2nd floor PCC with Dr Gordon
TUESDAYS weekly 7:05 REI Kaiser Rm, 2nd floor PCC (sometimes 7th flr) with Dr. Muasher
8:00 am IFH OBGYN Grand Rounds, 1st floor PCC
on 2nd Tuesdays Sept-June PGY3 GWU OBGYN Resident and Visiting Professor Series at 3 pm at GWU, HC or IFH (email will be sent)
WEDNESDAYS weekly Starting 9.5.07 7:15 am GWU OBGYN Grand Rounds or Visiting Professor (on 2nd Wednesdays SeptJune), Telecast at IFH in ASTEC Rm, VCU Lecture Hall or PCC (email will be sent) (Night float student attends)
THURSDAYS weekly 7:15 am GYN Rounds, Conference Rm D, Ground Floor/Green Elevators, Original Bldg, above Cafeteria
FRIDAYS 1st and 3rd 7:15 am 7th Flr rm # W7331 Journal Club with Drs. Mecklenburg, Sheridan Article copies in the resident call room, left top wall pocket (if you do not have a TR lecture) Every Friday Teaching Resident Lectures 7:15 in 7th Flr Conf #W7120 code 1/3/5 across from Med Student Call Rm
GWU OBGYN Resident School Sessions 2007-08 August 2007
September 2007
October 2007
November 2007
December 2007
Friday Aug 3rd Hospital auditorium Friday Aug 10th Friday Aug 17th Hospital auditorium Friday Aug 24th Friday Aug 31stth Friday Sept 7th Friday Sept 14th Friday Sept 21st Friday Sept 28th Friday Oct 5th Friday Oct 12th, Location TBD Friday Oct 19th Friday Oct 26th, Location TBD Friday Nov 2nd Friday Nov 9th, Location TBD Friday Nov 16th Friday Nov 23rd Friday Nov 30th Fridays Dec 7th and 14th
Lactation Workshop
Gaba/Clark
Professional Development Self Study #2 Evidence Based Medicine Workshop Keller/Macri/Gaba Professional Development Self Study #3 Professional Development Self Study #4 Workshop TBD Professional Development Self Study #5 Professional Development Self Study #6 OSCE on Vulvar Disorders Hospital CLASS Center Professional Development Self Study #7 Hysteroscopy Workshop #1 Chahine/Janakiraman REI Workshop-Male Factor Infertility Drs Dubey Hysteroscopy Workshop #2 Chahine/Janakiraman Professional Development Self Study #8 Ultrasound Workshop Macri/Marfori Professional Development Self Study #9 Thanksgiving Holiday Workshop TBD Residency Interviews--NO RESDENT SCHOOL Winter holidays NO RESIDENT SCHOOL Page 3-1
APGO – Medical Student Education Cases/Teaching Resident Cases OBSTETRIC CASES GYNECOLOGIC CASES 1. Preeclampsia – 24-year old G1 P0 at 31 weeks’ EGA 1. Cervical dysplasia - 25 yr old with LGSIL on Pap smear with BP 160/100, severe headache, scotomata and a. Bethesda system epigastric pain b. Colposcopy a. Chronic vs Acute hypertension Definition b. Risk factors History c. Diagnosis Equipment required i. PIH c. HPV & role in dysplasia–viral integration into human ii. Severe preeclampsia genome Sub-types of HPV including high-risk subiii. HELLP syndrome types 1. laboratory findings Immune response to HPV and eradication of virus 2. management Vaccine development 3. steroids d. Treatment for dysplasia d. Management e. Follow-up for dysplasia i. Delivery? f. Risk factors for dysplasia ii. Magnesium sulfate – dose and administration 2. PPROM and PTL – 32-yo G3 P2 pt w/ prior preterm 2. Breast disease – 40-yr old with “lump in right breast” delivery at 27 wk EGA after ROM now presenting with a. Family history and risk factors for BRCA1 & BRCA2 PPROM at 30 weeks’ EGA b. Characteristics of benign breast disease a. Definitions c. Characteristics of malignant breast disease b. Use of steroids d. Work-up and evaluation of breast mass – US, c. Etiology Mammogram, Biopsy, Pathology evaluation d. Tocolytics – what types are used, contraindications, mechanisms of action, dosing and route of administration e. Diagnosis f. Definition of Viability g. Neonatal morbidity and mortality 3. Diabetes mellitus – 33-year old Hispanic female with 7 3. No Menses for 6 months – 26-year old with no menses year history of IDDM requiring insulin therapy who now Primary vs secondary amenorrhea presents for new OB visit Differential diagnosis a. Whites’ classification Testing to distinguish main causes b. Screening for GDM and IDDM Management c. Who do we screen? Therapy d. What screening test do we use? e. Define the values for 1 hr glucola & 3 hr GTT? f. Management – How do you manage a pregnant diabetic? g. What do you screen for? EKG, Eye examination, 24-hr urine for total protein and creatinine clearance h. How do you decide on insulin dosing? i. What types of insulin are there? j. Complications 4. Genetic test/screen – 38-yo G3 P0 status post IVF who 4. 27-yr old with asymptomatic 5 cm right adnexal mass presents for New OB visit and who asks you about what testing is available. a. Differential diagnosis First trimester NT screening – What is the NT measurement? b. Work-up and laboratory evaluation What is this test useful for? d. Treatment What biologic markers are used with the NT? e. Ovarian neoplasm PAPPA and serum B-hCG f. Cancer of ovary Second trimester Multiple marker screening – g. State and Grade What markers are used? h. Biomarkers for disease including AFP, hCG and others How are the markers measured? What is the pattern for DS? Trisomy 18? Open NTD? Amniocentesis and CVS – Prenatal diagnosis by invasive techniques Population screening and at-risk groups (sickle cell anemia, thalassemias (alpha and beta thalassemia, Ashkenazi Jewish panel, Cystic Fibrosis screening, Fragile X MR) Page 3-2
DEPARTMENT OF OB/GYN MS3 Information BENIGN GYNECOLOGY SERVICE How This Rotation Works: What You Can Expect From Us/ What We Expect of You
Inova Fairfax Hospital has an extremely busy gynecologic surgery service and you will have the opportunity to operate with a variety of gynecologists. Take advantage of every opportunity to perform a pelvic examination under anesthesia prior to each surgery. This is the single greatest opportunity to learn the art of the pelvic exam. You will see most major gynecological operations, including hysterectomies, laparoscopy, etc. as well as other gynecological conditions requiring hospitalization, e.g., pelvic inflammatory disease. Our goal is to expose you to common gynecologic procedures, the indications for them, and following with postoperative care.
The Benign Gynecology Team: 1. Chief resident 2. 3rd year resident 3. Military resident 4. Two second year residents 5. Attending Rounding: Usually, you will be assigned two or three inpatients to round on each morning. Most often these will be your post- operative patients. Any new patients that get admitted overnight should be picked up first thing in the morning. In the morning you should pre-round on your patients. Get their vitals, talk with them, ask appropriate questions (pain? flatus? Nausea?), get results of all new labs and/or radiological reports, then write your progress notes in a SOAP format. NOTES SHOULD BE WRITTEN BY 6:30 AM. At 6:30 am you will usually meet your resident on the gyn floor, shadow them on rounds and get feedback on your presentations and notes. During the day you should follow up on any plans from morning rounds (consults/labs/studies) and check on your patients. Attend educational conferences as indicated on the Clerkship Calendar. Surgery: The teaching resident will assign surgical cases to you for the following day. Make sure that you have read about the case and appropriate anatomy in preparation for the surgery. Cases take place in the GYN Operating Suite on the 3rd floor, blue elevators. Dress in scrubs. Introduce yourself to the patient in the Pre-op holding area. Familiarize yourself with the patient history. Immediately after surgery the resident can assist you in writing a postoperative note and orders. Approximately 2-4 hours after your case, you should write a post –op note on your patient and the resident will cosign it. Ask about incision pain, nausea, chest pain, and shortness of breath, check urine output and vital signs, examine the patient and write a note.
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DEPARTMENT OF OB/GYN MS3 Student Information GYNECOLOGIC ONCOLOGY SERVICE How This Rotation Works: What You Can Expect From Us/ What We Expect of You Traditionally, this can be a tough service. The patients have various gynecologic malignancies in all stages and can be medically complex. Often, you will be doing surgery on non-scheduled days for other problems, i.e. small bowel obstruction. You will learn how to screen for cervical, uterine, vulvar and ovarian cancer, as well as, learn basic staging and treatment when cancer is diagnosed. The Gyn Oncology Team: 1. Chief Resident 2. 3rd year resident 3. Attending: Drs. Annette Bicher, Fred Helmkamp, Hans Krebs, John Elkas Rounding: Some ONC cases are in the Tower Main OR, ground floor/orange elevators. These post surgical patients will be located in the Tower 2nd floor/grey elevators. Usually, you will be assigned three or four inpatients to round on each morning. Most often these will be your post- operative patients. In the morning you should pre-round on your patients. Get their vitals, talk with them, ask appropriate questions (pain? flatus? Nausea?), get results of all new labs and/or radiological reports, then write your progress notes in a SOAP format. NOTES SHOULD BE WRITTEN BY 6:00 AM. At 6:30 am you will usually meet your resident on the gyn floor, shadow them on rounds and get feedback on your presentations and notes. During the day you should follow up on any plans from morning rounds (consults/labs/studies) and check on your patients. READ ABOUT YOUR PATIENT’S DISEASE PROCESS TO BE KNOWLEDGEABLE ON ROUNDS. Schedule: Attend Educational Conferences as indicated on the Clerkship Calendar (7:15 am Thursdays, Conference Rm D, GYN Conferences, ) These are operating days. You are expected to scrub for the entire cases that the Mondays, teaching resident has assigned to you. Make sure you have read about the case and appropriate anatomy in preparation for the surgery. Cases take place in the Tuesdays, GYN Operating Suite on the 3rd floor, blue elevators. Dress in scrubs (found in 3rd floor call rooms/right entrance). Introduce yourself to the patient in the Pre-op Thursdays holding area (3rd floor). Familiarize yourself with the patient history. The residents are happy to answer questions or explain cases to you. Approximately 2-4 hours after your case, you should write a post –op note on your patient and the resident will co-sign it. Ask about incision pain, nausea, chest pain, and shortness of breath, check urine output and vital signs, examine the patient and write a note. Wednesdays: The oncology clinic meets in the OB/GYN surgical clinic every first and third Wednesday of the month at 8:30am. When no clinic is scheduled, you will be assigned to either gyn oncology or benign cases for that morning. If there are no gyn oncology cases scheduled you will scrub on benign gyn cases Fridays: assigned by the chief resident. Page 3-4
DEPARTMENT OF OB/GYN MS3 Student Information ANTEPARTUM SERVICE How This Rotation Works: What You Can Expect From Us/ What We Expect of You This service cares for some of the most medically complex obstetrical patients in Northern Virginia, i.e. diabetic women with chronic hypertension, thrombophilias in pregnancy and advanced cervical dilation at pre-viable gestations to name just a few. You will learn how to perform a comprehensive H&P on an antepartum patient, as well as, screen, diagnose and treat many common high-risk conditions. Divide the Antepartum patients amongst yourselves and be prepared for work rounds with the residents then formal rounds with the Attendings. Attending rounds usually end around 10:30am on Monday and 10am Tuesday through Friday. Read about your patient’s disease process to be knowledgeable on rounds. During the day you should followup on any plans from morning rounds and check on your patients. Antepartum Team: 1. Chief resident 2. 3rd year resident 3. Two 2nd year resident 4. 1st year resident 5. Family Practice resident 6. Attending: Drs. Al Khoury, Barbara Nies, George Bronsky, Huda Al-Kouatly, Lorna Rodriguez Schedule Attend Educational Conferences as indicated on the Clerkship Calendar. High Risk Obstetrics Clinic meets on Monday mornings in the Ob/Gyn Surgical Clinic, first floor maroon elevators. Due to the large volume of patients, students will see patients at the same time with the residents. During the week students should alternate between the following duties: 1. Antenatal Testing Unit (ATU) Located on the 6th floor, blue elevators You will see consults with the MFM attending. You will become familiarized with the basics of ultrasound and observe procedures such as amniocentesis. 2. Floorwork Assist the Antepartum resident with follow-up on any plans from morning rounds (consults/labwork/studies) as well as reading non-stress tests. Students on antepartum will take L&D call on the Saturday following their antepartum rotation. You should round on your patients, with the residents, prior to 9 am Board Rounds on Saturday and Sunday. Page 3-5
DEPARTMENT OF OB/GYN MS3 Student Information DAYFLOAT / OBSTETRICS TEAM How This Rotation Works: What You Can Expect From Us/ What We Expect of You Students will be responsible for L&D, emergency room consults, and rounding on the postpartum patients with the residents. Alternate each day which student will cover the labor floor and cover ER consults In 2005, over 11,800 babies were delivered at the Inova Fairfax Hospital Campus. The labor floor student will be exposed to normal and abnormal labor, learn the stages of labor and the Friedman’s curve, learn to triage and admit, as well as assist on cesarean sections and vaginal deliveries. Your best guide for these tasks is the 2nd year resident. The ER medical student will assist in emergency room consults with the ER resident. If there are no consults in the morning the student will shadow the ER resident in the OB/GYN clinic. If there are no ER consults in the afternoon the student will have independent study time. Day Float Team (OB resident on call carries spectralink phone x6882): 1. Chief resident 2. Two 2nd year residents 3. 1st year resident 4. Attending Students on Day float will report to L&D (3rd floor resident call room) at 8:00 am Sunday and 5:30 am Monday through Friday for Board Rounds. The GYN Student on call shadows the GYN resident in the Clinic when there are no or few ER consults Dress in scrubs. All of the clinic patients on the Labor Floor should have a student assigned to them. Triage provides a really great opportunity to practice intravenous insertions. It is recommended that you get to know your patients and know the nurses taking care of your patients. The residents will help you figure out what to do during the day depending on what is going on the labor floor. The day ends when the night team of residents comes in to relieve the day team at 7 pm Sunday through Friday. This can truly be a phenomenal week; your involvement and enthusiasm will be crucial for you to deliver babies. Page 3-6
DEPARTMENT OF OB/GYN MS3 Student Information NIGHT FLOAT / OBSTETRICS TEAM How This Rotation Works: What You Can Expect From Us/ What We Expect of You Students will be responsible for L&D, emergency room consults, and rounding on the postpartum patients with the residents. Alternate each night which student will cover the labor floor and cover ER consults. Night Float Team: 1. Chief resident 2. 3rd year resident 3. 2nd year resident 4. Attending Schedule: Students assigned to night float will report to L&D, resident call room for Board Rounds: Sunday 8:00 PM Monday 7:00 PM Tuesday 7:00 PM Wednesday 7:00 PM Thursday 7:00 PM Friday 7:00 PM Be prepared to work all night. Dress in scrubs but do not wear from home or from hospital (OSHA regulations). All of the clinic patients on the Labor Floor should have a student assigned to them. Triage provides a really great opportunity to practice intravenous insertions. It is recommended that you get to know your patients and the nurses taking care of your patients. The residents will help you figure out what to do during the day depending on what is going on the labor floor. The resident will notify the ER student when he/she is going to see a consult. There will be opportunities to perform pelvic exams, evaluate ectopic pregnancies, admit PID patients, etc. Postpartum rounds are usually done with the residents prior to morning Board Rounds at 7am Monday through Friday. You will learn appropriate post partum care and contraception counseling. An attending will review complicated patients at 8:15 am on the postpartum floors. FOR VCU & GWU MEDICAL STUDENTS NIGHT FLOAT INFORMATION You are expected to work the entire 12 hour shift. New LCME guidelines do not permit the sharing of sleep room between different gender students.
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Section 4
Contact Information
INFORMATION SHEET FOR MS3 CLERKSHIP OBSTETRICS AND GYNECOLOGY
Address:
email: Office: Pager:
Address:
email: Office: Pager:
Samantha Buery-Joyner, M.D. IFH OB/GYN Department Clerkship Director 3300 Gallows Rd, OB Clinic, 1st floor, Original Bldg. Rm #O-1345 Falls Church VA 22042-3300
[email protected] 703 776 3080 Fax: 703 776 2405 703 776 7310 # 84927 Rasha Ebeid, M.D. IFH OB/GYN Department Associate Clerkship Director 3300 Gallows Rd, OB Clinic, 1st floor, Original Bldg. Rm #O-1345 Falls Church VA 22042-3300
[email protected] 703 776 2174 Fax: 703 776 2405 703 776 7310 # 10482
ADMIN CHIEFS 2007 - 08 at IFH
TEACHING RESIDENTS AT IFH
Julie Belcher MD Mar 2008-Jun 2008 Natalya Danilyants MD Sept – Dec 2007 Cindy Kinder MD June-Sept 2007 Abbaa Sarhan MD Dec 2007-Mar 2008
Lesly Warner MD Block ! Roy Khoury MD Block 2 Danielle Dempsey Block 3 Sarah Camp MD Block 4 Wael Khalifa MD Block 5 Pari Ghodsi MD Block 6 Sheetal Sheth MD Block 7 Ramsy Nakad MD Block 8 Sarah Obican MD Block 9 Nadim Hawa MD Block 10
Address: email: Office: Pager:
Lolyn Young, CMSC IFH OB/GYN Dept Residency Coordinator 3300 Gallows Rd, 6th Flr N FCC Rm. W6107, Falls Church VA 22042-3300
[email protected] 703 776 2745 or 5034, Fax: 1 866 291 4915 703 776 7310 # 73469 or 703 705 4028
SCRUBS are located on 3rd floor across from residents’ call rooms, organized by size. Door Codes: 5/2 Resident Call Rm 3rd flr 5/2, 4/2 MS3 Call Rm 7th Flr W7123—phone 53-7923, W3025 Conf Rm 4/2/5—phone 6410, Physician Lounge code 2/5, Male OR lockers 4/3, Female Lockers 5/2
Resource websites www.gmeone.com username=medicalstudent password=inova click on FILESTORE for access to schedules, forms, policies, info www.inova.org Information on Inova Health System and Inova Fairfax Hospital Page 4-1
INOVA FAIRFAX HOSPITAL WOMEN’S CTR OBGYN RESIDENTS (GWU OBG, ED, Military, Inova FPs) as of 10.1.07 Group Page Residents 98922 Group Page Med Students 98930 GROUP Page Perinatologists 98986 EMAIL IFH #703 764 7310 GWU #800 632 5144 CLASS OF 2008 Belcher, Julie MD
[email protected] 11932 741 0091 Danilyants, Natalya MD
[email protected] 12023 741 0092 Gaskins, Sherita MD
[email protected] 12416 741 0246 Gupta Neeru MD
[email protected] 11933 741 0094 Kinder, Cindy MD
[email protected] 11931 741 0095 Sarhan, Abbaa MD
[email protected] 11945 741 0097 Talukder, Saimah MD
[email protected] 11975 741 0098 Walker, Sheneika MD, MPh
[email protected] 12089 741 0099 Zopf, Regina MD
[email protected] 12369 741 0243 Camp, Sarah MD------CLASS OF 2009
[email protected] 12339 741 0251 Dempsey, Danielle MD
[email protected] 12478 741 0254 Friedman, Evan MD
[email protected]. 12413 741 0242 Harper, Cortney MD
[email protected] 12338 741 0252 Khalifa, Wael MD
[email protected] 12520 741 0239 Khoury, Roy MD
[email protected] 12411 741 0250 Puri, Ruchi MD
[email protected] 12883 741 0168 Semaan, Assaad MD
[email protected] 12882 741 0176 Spitzer, Trimble MD
[email protected] 12412 741 0241 Warner, Lesly MD
[email protected] 12320 741 0253 Ba, Xiaomang MD----CLASS OF 2010
[email protected] 12872 741 0180 Evans, Aungel MD
[email protected] 12876 741 0135 Ghodsi, Pari MD
[email protected] 12873 123-2131 Hawa, Nadim MD
[email protected] 12874 123-2155 Iloabachie, Nwamaka MD
[email protected] 12875 164-2627 Lii, Stella MD
[email protected] 12877 741 0139 Nakad, Ramzy MD
[email protected] 12878 741 0141 Obican, Sarah MD
[email protected] 12879 741 0142 Sheth, Sheetal MD
[email protected] 12880 741 0145 Zarek, Shvetha MD
[email protected] 12881 741 0146 Becker, Shannon—Class of 2011
[email protected] 13762 741-2860 Dabling, Heather
[email protected] 13763 741-2810 Kelly, Elizabeth
[email protected] 13764 741-0783 Krapf, Jill
[email protected] 13765 741-2845 Marcus, Charlotte
[email protected]. 13766 741-2823 Moawad, Gaby
[email protected] 13767 741-1288 O'Hern, Candice
[email protected] 13768 741-0378 Semel, Arin
[email protected]. 13769 741-1232 Tabbarah, Rami
[email protected] 13770 741-0369 Toso, Laura
[email protected] 13771 741-0370 IFH OBGYN Dept: Dr. Fred Mecklenburg, OBG Chair 703 776 6040
[email protected] Pgr 86141 Pgr 87712 Dr. Al Khoury, Program Director 703 776 8611
[email protected] Pgr 84927 Dr. Samantha Buery, IFH Clerkship Director 703 776 3080
[email protected] Pgr 10482 Dr. Rasha Ebeid, IFH Assoc Clerkship Director 703 776 2174
[email protected] Lolyn Young, OBGYN Residency Coordinator O: 703 776 2745 F: 6078, Spectralink 5034 Pgr 73469
[email protected] GWU OBGYN Dept Nancy Gaba, MD, GWU Residency Director
[email protected], 202 741 2532 ofc, 741 2550 fax GWU OBGYN Chairman, Jack Larsen, 202 741 2529, 2521,
[email protected] USUHS MILITARY: Chris Zahn MD, OBGYN Residency Director
[email protected] OBGYN Residency Coordinator, Peggy Croyle
[email protected] Ofc 301-295-2048 F:295-1988 Military IFH Pool Pager #6 Mon-Fri day: Thaddeus Mamienski DO, IFH 61528 or 800 759 8888 #108-1316 Saturdays: Jibri Wiggins MD 800 759 8888 #110-9363 UROGYN FELLOW Christine Sears MD IFH Pager #13346
[email protected] FAMILY PRACTICE Rotation Dates Pagers and Emails Inova Fairfax Family Practice Dr. Sam Jones, FP Program Director: Jennifer Neria MD July 1 – Aug 25 2007 pager # 13795
[email protected],
[email protected], Terri Ellen Burd Warner MD July 29 – Sept 22 2007 pager #13797
[email protected] Cheryl Montalvo 703-391-2020 x151; Robin Guthrie Fawcett MD Aug 26 – Oct 27, 2007 pager #13793
[email protected] [email protected], Farah Saeed MD Oct 28 – Dec 29 2007 pager #13796
[email protected] Admin Chief Resident= Emily Crosser FaltimierMD Nov 25 – Jan 26 2008 pager #13792
[email protected] Emily Jones MD # 12329 Molly J White MD Dec 30 – Feb 23, 2008 pager #13798
[email protected] [email protected] Hakima Bouhouch MD Feb 24 – Apri 26 2008 pager #13791
[email protected] Allison Laxton MD Apr 27 – Jun 28 2008 MATERNAL FETAL MEDICINE FELLOW: LORNA RODRIGUEZ, MD 703 776 5689 W-6004 6th Floor at IFH OBGYN Pager # 13741 email
[email protected]
pager #13794
[email protected] GWU EM Program Director: Ray Lucas MD
[email protected] Residency Coordinator 202-741-2914 ofc 2921 fax 202 741 2921 GWU ED (resident 2 wk L&D only IFH pager #68061 Page 4-2
For IFH OB/GYN Attending Roster go to www.gmeone.com, Username = medicalstudent Password = inova Click on Filestore to print or download File name = IFH OB/GYN Attending Roster
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Section 5
Miscellaneous
INOVA HEALTH SYSTEM INOVA FAIRFAX HOSPITAL Undergraduate Medical Education -- Policy No. 004 DRESS CODE Purpose: To outline the standards of personal appearance required of students providing patient care at Inova Fairfax Hospital/Inova Fairfax Hospital for Children, and participating educational facilities. General Statement: Personal appearance is an important component of professional demeanor. Each student shall be expected to dress in a manner that conveys a professional image and inspires confidence in patients and colleagues. The Inova Fairfax Hospital/Inova Fairfax Hospital for Children provides clinical service to a multicultural patient population where clothing choices may convey different meanings for different populations. Apparel should be consistent with each student's duties. Specific Standards: (In accordance with the professional environment in which you are training) 1. A visible ID is required at all times while providing clinical service in a setting which does not require specialized garb. 2. A white coat should be worn at all times on clinical services requiring a white coat. 3. Scrubs may be worn when on a surgical service or during night call hours and on most in-patient clinical units. A white coat should be worn over scrubs if the student steps out of the clinical setting. 4. A tie is required for men when not dressed in scrubs on services requiring a tie. 5. Jeans, sports shirts, T-shirts, excessively short skirts, sandals, tennis shoes (except with scrubs), and provocative buttons or messages or clothing are inconsistent with a professional image. 6. All footwear must be closed-toe. 7. When dresses and skirts are worn, legs must be covered to protect against exposures. 8. Frequent hand washing and high standards of general cleanliness are extremely important. 9. Each student should refer to the individual Department's code of dress that falls outside of the above requirements. Individuals who are in improper attire may be asked to leave immediately to obtain proper dress. Individuals who are asked to leave for the above reason will be required to make up the time for which they are absent from the hospital.
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Undergraduate Medical Education
Policy No. 002 BLOOD AND BODY FLUID EXPOSURE
The clinical Departments at IFH/IFHC are strongly committed to the safety of our medical students. It is the responsibility of each medical student to adhere to standard precautions. When a student has a parenteral needle stick or cut or mucous membrane exposure to blood or body fluids, the guidelines below shall be followed (refer to Inova Fairfax Hospital Administrative Policies Human Resource Policy #7020 “Management of Occupational Exposures to Bloodborne Pathogens—Hepatitis B & C, HIV. For other related protocols, the Inova Fairfax Hospital policies remain the default policies). Guidelines: 1. Bloodborne pathogen exposures are considered urgent medical events. The student is to contact their immediate supervisor and the administrative director upon any of the above-described exposures. 2. The Emergency Room at Inova Fairfax Hospital shall provide evaluation and treatment for students who encounter exposure events that require emergency medical care. The cost of these services will be billed to the student's health insurance. 3. The student will then be referred to their Student Health Services at their own sponsoring institution if that institution is within a reasonable distance from Inova Fairfax Hospital. 4. If students who are rotating at Inova Fairfax Hospital or a site sponsored by an Inova Fairfax Hospital-based teaching program are unable to obtain access reasonable to their home institution, they must contact their home institution to delineate how that institution wishes them to proceed under their health insurance coverage and school policy once #2 has been met. All students, no matter their coverage or home institution, must report any exposures to the Employee Health Department at Inova Fairfax Hospital so that testing of the source patient may be conducted (ext. 3271). 5. In the event that access to care cannot be obtained for any reason, students participating in rotations at, or sponsored through, Inova Fairfax Hospital will be referred to the Emergency Department for any and all immediate treatment. 6. Students who have an exposure at a site affiliated with Inova Fairfax Hospital should report the exposure as above with the only difference being that the report to Employee Health should be to the specific Employee Health office overseeing the site where the exposure occurred. Evening, Weekends, or Holidays: If Employee Health is closed, the medical student should contact Employee Health on the next business day to arrange for appropriate paperwork completion. Wounds/Exposure Assessment: Assess type of injury (examples: puncture wound, laceration) and consult appropriate policy for treatment manuals. Refer to Management of Puncture Wound Policy (#549), or the Management of Lacerations and Abrasions Policy (#460) located in the Employee Health Manual. Health Care Description Quality Improvement Tool: The Health Care Description Tool form must be filled out by the patient, signed by the Department Director or supervisor on duty, and delivered by the Employee Health Department within 24 hours of the occurrence, in accordance with Employee Accident Policy (#815). In all cases, the medical student must report exposure to the Chairman, Program Director, Clerkship Director, and/or Program Coordinator immediately of the injury or incident. The medical student shall complete the Occupational Safety and Health Administration (OSHA) log form, if appropriate. The medical student must have this information reported within 24 hours to their designated medical school. Hepatitis B Vaccination: Hepatitis B vaccination is recommended for medical students if not already immune to Hepatitis B and if not contraindicated. Refer to Employee Health at the time of exposure or on the next business day if the office is closed for a baseline post exposure laboratory study. The medical student must follow up with the appropriate health care professionals as directed by their home institution. OSHA Blood-Borne Pathogen Standard The medical student is also advised to review the Blood-Borne Pathogen Standard for post-exposure evaluation and follow-up. A copy of the standard is available in Employee Health. Patient and/or Employee Testing: Refer to Inova Fairfax Hospital "Management of Potential HIV Exposure, " Policy No. 3-2-1, and "Hepatitis B Vaccination, Hepatitis B and C Post Exposure Follow-Up," Policy No. 3-1-1, both located in the Inova Fairfax Hospital Administrative Manual. Exposure to Blood and/or Body Fluids Quick Reference Monday through Friday, 7:00 a.m.-3:00 p.m. – Call Employee Health at ext. 3271 immediately. During non-business hours 1. Call the administrative director and the student supervisor immediately. 2. Report to the Emergency Room only if necessary at the time of the incident. 3. Voice mail Employee Health at ext. 3271 (or the Employee Health for the training site where exposed) and give your name, Department, and information about the source patient. Report to Employee Health the next business day. 4. Complete the Health Care Description Quality Improvement Tool and Occurrence Report. 5. Obtain the source patient's name, medical record number, and risk status for HIV. 6. Notify the Clerkship Director on the next business day. 7. Notify the patient's physician of the exposure. 8. Notify the home institution of exposure and inquire about the necessary procedures to obtain additional medical follow-up. Name/Signature___________________________________ Date__________________ Page 5-2
ATTACHMENT 1 CONFIDENTIALITY ACKNOWLEDGMENT
I, ________________________________________, will be participating as a Student or Clinical Instructor in a clinical/occupational experience at an Inova Health System facility pursuant to an agreement between Inova Health System (“Inova”) and my college/university, __________________________________________ (“Institution”). In performing my duties at the facility, I understand that I may come in contact with, or be provided with, confidential or proprietary information. Therefore, I hereby agree that I will not now or at any time in the future, without the prior written consent of Inova, either directly or indirectly divulge, disclose, or communicate in any manner whatsoever to any person not employed or affiliated with the facility or Inova: (a) any confidential information, including, but not limited to, patient information and information regarding quality assurance, risk management and peer review activities; and (b) any confidential or proprietary information concerning any matters affecting or relating to the business or operations or future plans of the facility, Inova or any of its affiliates, including, but not limited to, policies, procedures, rules, regulations and protocols of the facility or of Inova. I understand that this prohibition extends to, but is not limited to, divulging such information for the purpose of acting as an expert witness, reviewer or consultant on behalf of a plaintiff or an attorney acting on behalf of a plaintiff, in a claim or action against Inova or any of its affiliates. This acknowledgement, however, shall not prohibit or restrict any such divulgence, disclosure or communication made pursuant to an order of a court of competent jurisdiction or otherwise required by law, including testimony or other sworn statements or activities pursuant to lawful process or subpoena; and furthermore shall not prohibit any such divulgence, disclosure or communication required in connection with the defense of any claim or action against the Institution, its Clinical Instructors, Faculty, Students, employees or agents; provided that Institution notifies Inova of its need to disclose and works with Inova to limit the disclosure to information required for its defense. I further agree that in the event I breach this confidentiality requirement, and without limiting the right of the facility or Inova to seek any other remedy or relief to which it may be entitled under law, I consent to injunctive relief in favor of Inova. My acknowledgments and agreements shall survive termination of the agreement between Institution and Inova. I certify that I have been trained on the privacy and protection of patient information, as required by the Health Insurance Portability and Accountability Act of 1996 (“HIPAA”) and regulations promulgated thereunder, including the Privacy Rule (Standards for Privacy of Individually Identifiable Health Information at 45 C.F.R. part 160 and part 164, subparts A and E). My failure to adhere to the standards of the HIPAA, the Privacy Rule, and Inova policies and procedures may result in termination of my participation in the clinical/occupational experience.
Date________________________
Signature: _________________________
Name: ____________________________
Witness: __________________________ Page 5-3
Inova Fairfax Hospital for Children
Statement of Commitment to Safety
Inova’s Red Rules for Safety #1
Prior to action or procedure, I will verify patient identify using two identifiers
#2
I will confirm the correct action or procedure before I begin.
I understand that Inova Health System is dedicated to providing safe care for its patients wand to safeguarding the work environment for all employees. I have learned about Inova’s Red Rules and why my commitment is needed to ensure a culture of safety. I understand I am contributing to Inova’s error-free culture by complying with the Red Rules and I make a conscious decision to help ensure the safety of patients and fellow employees. My personal commitment to safety and error prevention. 1. 2. 3.
I shall know and follow Inova’s Red Rules. I shall clearly understand the procedures that support the Red Rules. If compliance with an error prevention technique or Red Rule is not possible. I will STOP actions until any uncertainty can be resolved.
I understand that non-compliance with Red Rules shall be managed in accordance with the Inova Progressive Discipline policy.
Print Name:
Inova Fairfax Hospital, OBGYN Dept
Signature:
Date:____________________
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ERROR PREVENTION TECHNIQUE FOR INOVA HEALTH SYSTEM In addition, Inova has established four behavioral safety expectations for all staff, physicians, residents, students. Behavior-Based Expectations: Behavior based or behavioral expectations are the manner of conducting oneself that are considered to be reasonable, due, necessary, bound in duty or obligated. These expectations can be met to utilizing several simple error prevention techniques listed below. Error Prevention Techniques: Error Prevention Techniques are specific actions or methods an individual completes or uses to accomplish or satisfy a desired behavior-based expectation.
Behavior Expectations and Error Prevention Techniques EXPECTATIONS TECHNIQUES 1. Communicate Clearly and Require Repeat-Backs & Read-Backs Completely Encourage Confirmation & Clarification
2. Coordinate Care Effectively
Legible Handwriting & Approved Abbreviations Coordinate Activities with Appropriate People Encourage & Practice a Cooperative Culture
3. Be Aware of High Risk Situations and Mitigate Risk 4. Pay Attention to Detail
Document Information in a Thorough & Timely Manner Adhere to Red Rules, Policies & Procedures Stop, Review, Reassess Options S.T.A.R. (Stop, Think, Act, Review
I understand that I am contributing to Inova’s error-free culture by complying with these behavioral expectations.
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RED RULES FOR INOVA HEALTH SYSTEM Safety of our patients has always been a priority at Inova. Over the past year, we have increased our commitment and focus to patient safety. In order to ensure safety, we have adopted two system-wide Red Rules that apply to staff and physicians across our system. Red Rules are safety stop signs, they are intended to grab our attention and remind us that we are about to take an action that absolutely must be performed in an exact way to ensure safety. If everyone followed our Red Rules every time, we could decrease the number of accidents and injuries to patients and staff by a significant percentage. Following the Red Rules 100% of the time is one way that we can all be personally accountable for safety performance. This document is intended to provide you with effective and simple-to-use techniques to prevent errors that could harm our patients.
INOVA’S RED RULES FOR SAFETY 1. Prior to action or procedure, I will verify patient identify using two identifiers. Indentifiers: Name, MRN, address, armband, ID card, DOB, picture/photo, etc. Room or bed number or diagnosis can never be used. I will confirm the correct action or procedure before I begin. Confirmation of correct action/procedure: Boarding pass, lab slip, physician order, MAR, transport or dietary slip, written instruction, checklist, policy, label, etc.
Red Rules:
Are critical requirements for safety associated with an activity or procedure on a patient that has been known to compromise patient safety
Are not the only activities important to safety
Must be met, require verbatim compliance and must come before any other consideration, including revenue and personal desire
When an individual “stop” a treatment process because a Red Rule has not been satisfied, management and leadership will stand behind that individual and make a point of praising them and their actions. Æ Adhere to Red Rules, Policies, Procedures Æ If you are uncertain, STOP and seek clarification and assistance Æ Raise the Red Flag
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SUTURE KIT FROM THE IFH STERILE PROCESSING DEPARTMENT THIS IS A GIFT FOR YOUR PERSONAL USE ONLY. YOU ARE RESPONSIBLE FOR THE CLEANING OF THESE ITEMS. THEY ARE NOT STERILE. THE INTENTION IS THAT YOU USE IT WHEN PRACTICING SUTURING, TYING, ETC. THESE INSTRUMENTS ARE NOT FOR DIRECT PATIENT CARE (IT IS PROHIBITED). 1. ALL INSTRUMENTS USED IN PATIENT CARE MUST BE INSPECTED AND STERILIZED PRIOR TO USE.
2. 3. 4. 5. 6. 7. 8. 9. 10. 11.
INSTRUMENTS MISPLACED THE MOST 12. #3 KNIFE HANDLE 13. LARGE TOWEL CLIP 14. WEBSTER NEEDLE HOLDER 15. 8” PROBE 16. ST HEMOSTAT 17. CURVED MOSQUITO 18. ST KELLY 19. TISSUE FORCEPTS 20. #10 FRAZIER 21. OPERATING SCISSORS
CURVED HEMOSTAT CURVED KELLY ADSON WITH TEETH ST MAYO SCISSORS CURVED MAYO SCISSORS SHORT ALLIS SMALL TOWEL CLIP 6” NEEDLE HOLDER BLACK HANDLE SCISSORS LONG SPONGE STICK
STERILE PROCESSING SURGICAL CASES/DELIVERIES SUPPORT The Sterile Processing Department at IFH cleans, assembles, and sterilizes procedure trays and instrument sets for all of the patient care areas (Inova Fairfax Hospital, Inova Vascular/Heart Institute, Inova Womens/Childrens Hospital): 1. Tower Operating room 8. EP Lab 2. Outpatient Surgery 9. Special Procedures 3. Cardio Vascular Operating Rooms 10. Emergency Room 4. Labor and Delivery (22 rooms) 11. Radiology 5. C Section Rooms (3 rooms) 12. OB Clinic 6. Surgical Center for Women (5 rooms) 13. Eye Clinic 7. Cardiac Cath Lab 14. All nursing units and other patient care areas TOTAL # OF CASES AT IFH 42685 42084 42270
Year 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006
Annual cost $139,926 $130,001 $149,597 $129,449 $166,642 $192,741 $192,389 $235,637 183,587 206,621
# OF CASES IN WOMENS OR 5633 5483 5693
# OF DELIVERIES 11156 11466 11791
YEAR 2004 2005 2006
Cost of Replacement of Missing Instruments Cost per case $4.31 $4.00 $4.32 $3.63 $4.51 $4.67 $4.40, over 6 million instruments processed, 250,000 sets, 5,699 instruments had to be replaced $5.52 $4.36, $8,000 worth of instruments have been recovered $4.89, over ,840 missing instruments had to be replaced in 2006 YOUR ASSISTANCE IS GREATLY APPECIATED IN MAKING SURE ONLY DISPOSABLES ARE DISCARDED. CHECK DRAPES AFTER CASE, CHECK ROOM AFTER CASE.
HELP US KEEP COSTS DOWN – ASK BEFORE DISCARDING ANY INSTRUMENTS, ITEMS, ETC. Page 5-7
WWW.GMEONE.COM USERNAME=medicalstudent, PASSWORD=inova, Click on filestore to download, print Each resident has his/her own account to document hours at all sites/rotations. Rev 7.1.07
1. 2. 3. 4. 5. 6.
7. 8. 9. 10. 11. 12. 13. 14. 15. 16. 17. 18. 19. 20. 21. 22. 23.
1. 2. 3. 4. 5.
SCHEDULES Residents Weekly Residents Block Oncall Residents Vacation Inova Family Practice Residentsobligations Military Residents Rotation Schedules for: GWU OBGYN, GWU EM, Inova FP, Military, Others Resident Conference/Lectures Visiting Professor Schedule VCU M3 Academic Rotations Suture Workshop VCU M3 Lectures VCU M3 Sch of Med Calendar GWU M3 Sch of Med Calendar Acting Intern Schedule VCU & GWU M3 Clerkship Schedule per block Continuity Clinic Teaching Residents IFH OBGYN Grand Rounds GWU OBGYN Grand Rounds REI Lectures, Dr Muasher IFH 24 hour teaching attending OSCE, POM, Shelf Exam Dates 2006 Womens OR Holidays ORIENTATION OBGYN Residents GWU M3 VCU M3 Inova Family Practice GWU EM Residents OBJECTIVES
1. 2. 3. 4. 5. 6.
1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11.
GWU M3 OBGYN Clerkship at IFH Military Residents Inova FP Rotation Requirements GWU EM Rotation Requirements Orientation contract—residents Orientation contract—med students POLICIES IFH HRP Patients on LDR GYN resident communication for OB Clinic patients Effective Teaching pwr pt slides IFH Escalation Policy IFH Patient Safety Goals IFH Physician Order Denial Avoidance IFH OB Pt Influenza Protocols 2006 Vaccination Policy Vaccine Screening Orders IFH Med Rec Suspension IFH Critical Values Guide
1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. 17. 18. 19. 20. 21. 22. 23.
EVALUATION / FORMS Resident by 24 hr attending eval CREOG eval 24 hr attending by resident eval Rotation by resident eval Graduation by resident eval Journal Club eval Grand Rounds/VP eval GWU M3 informal eval GWU M3 clerkship eva VCU M3 eval by resident/attndg VCU M3 clerkship eval VCU M3 faculty eval Faculty Eval-self eval Time off request-resident Time off request-GWU M3 Time off request-VCU M3 VCU M3 timesheet VCU M3 mid rotation eval Attendance/Sign-in Med Rec Sign in Graduating Residents/Check Out Form GWU EM eval Inova FP eval
1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. 17.
ROSTERS 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11.
Residents’ Pagers, Emails IFH OBGYN Med Staff GWU OBGYN Residents GWU M3 VCU M3 Military Residents GWU EM Residents Inova Family Practice Residents Other Visiting Residents Acting Interns Program Directors, Coordinators
POLICIES 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14.
Informed Consent Medication Ordering Writing Do Not Abbreviate Correct Terms/Charting Requirements Scheduling OB Patients Complete Order Instructions Terbutaline Body Fluid/Blood Exposure Circumcision Perinatal Infection Airborne Perinatal Infection Influenza Perinatal Infection TB Perinatal Infection General Language / Interpreters Services
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RESOURCES IFH GME Registration Instructions IFH GME Red Rules IFH GME Clearance Forms IFH OB Clinic Low Cost Dental Guide IFH OB Clinic Mammogram Guide IFH OB Clinic Delivery Scheudling IFH OB Clinic Female Provider Preference IFH OB Clinic Sample Med Management IFH OBGYN Electronic Library Index Labor/Delivery powerpoint presentation IFH Pager Menu/Maintenance Instructions IFH Med Rec Dictation Instructions JCAHO Prep manual/JCAHO Test HIPAA Compliance Medical Spanish IFH Computer Account Info Samples Notes/Charting (2 pgs)
EDUCATIONAL MATERIAL 1.
IFH OBGYN Residents Rules/Regulations 2. Grieving Family Response Guide 3. NIH Draft Cesarean Study Maternal Requests 4. IFH OBGYN IRB Studies, Dr DeStefano 5. Metformin Study 6. VCU M3 Case Based Conferences 7. ACGME Letter 8. QS Fetal Monitor Info 9. Teaching Resident Duties 10. Admin Chief Duties 11. Fetal Scalp Stimulation Other 1. 2. 3. 4.
Chain of Command at IFH Womens Applying for Step 3 IFH 4411 Telecomm System to Page IFH Pillars of Customer Service
AMERICAN COLLEGE OF OBSTETRICIANS AND GYNECOLOGISTS INTRODUCING ACOG’S MEDICAL STUDENT CATEGORY BENEFITS INCLUDE: ¾ ¾ ¾ ¾ ¾ ¾ ¾ ¾ ¾ ¾ ¾
Access to the ACOG Web site www.acog.org Access to the Resource Center for research documents, etc. Selected ACOG Patient Educational Pamphlets Six issues of the ACOG Clinical per year Free Registration at Annual Clinical Meetings (ACM) ACOG Publications Catalog APGO “Women’s Health Care Competencies” (on request) OB/GYN The Doctors of Women’s Health – Video (on request Member discount on other benefits Check out the publications for download at www.apgo.org ACOG Newsletter “ACOG Today”
ACOG Membership Services 409 12th St SW POB 96920 Washington DC 20090-6920 Office 202 863 2404, Fax 202 479 0054 Email:
[email protected]
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Organizations of Interest 1.
Association of Professors and Gynecology and Obstetrics (APGO) www.apgo.org/home
This APGO site provides information specifically for medical students. Under the members heading, click on “For Medical Student”. You can learn about basic science prerequisites for a clerkship in Ob/Gyn, Women’s Health Care Competencies for medical students, learning objectives and Ob/Gyn interest groups. In addition, there are resources here that will help gear medical students toward the specialty of Ob/Gyn if interested. APGO has created over 50 cases to help students study Ob/Gyn topics. You may reference the site at: http://www.apgo.org/objectives/index.cfm
THE LIST OF WOMEN’S HEALTH CARE COMPETENCIES CAN BE FOUND BY GOING TO http://www.apgo.org/binary/Comp.pdf 2.
American College of Obstetrics and Gynecology Student Membership (ACOG) www.acog.com
The ACOG website is very helpful for patient education as well as education on women’ s issues. Medical students can obtain a FREE membership through ACOG. This allows access to the member website allowing you to review articles from the green journal, technical bulletins, and practice bulletins, This is a very key and useful site that I would highly recommend. ACOG Student Membership Benefits: 1. Free access to website with search engine on all green journals and compendiums-great for references on Ob/Gyn or other rotations. 2. Free ACOG meetings-your meeting fees are waived. 3. Information about the match and applying to residencies on website-stuff from how to write your personal statement to top interview questions, and planning your interview budget. It is easy to join ACOG as a student member-simply go to www.acog.com and look under About ACOG and click on membership-the student membership application can be printed off the web. 3.
MCV Campus Ob/Gyn Interest Group.
4.
Geriatric Self-Instructional Models: http://virginiageriatrics/org/women/index.htm Case Based, interactive, module re: Health of Geriatric Women patients.
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Ab Abd Abx ADW AF AFI AFP AI AODM AP AR AROM ASCUS AV BBT BCP BF BM BPLND bpm BPP BRP BRB BS BSO BTBV BUFA BV c C/O C/S C&S C CIN CIS CKC CMT Cor CST CTA CTSP CVA CVAT CVS ÿ D&C D&E D/C D5 DIC DKA DNKA DOS DR DTR DUB DVT Dx
TERMINOLOGY AND ABBREVIATIONS Abortion EBL Estimated blood loss Abdomen ECC Endocervical curettage Antibiotics EDC Estimated date on confinement (delivery) A.D. Williams Clinic EFM Electronic fetal monitoring Ante flexed (uterus) EFW Electronic fetal monitoring Amniotic fluid index EGA Estimated gestational age, (# wk past LMP) Alpha-fetoprotein EMB Endometrial biopsy Acting Intern EMC Endometrial curetting Adult onset diabetes mellitus EP Ectopic pregnancy Antepartum ER Emergency room Assistant Resident Ext Extremities Artificial rupture of membranes Atypical squamous cells of ff Firm fundus undetermined significance FH Fundal height Anteverted (uterus) FHT’s Fetal heart tones FHx Family history Basal body temperature FM Fetal movement Birth Control Pill FOB Father of baby Black Female FSE Fetal scalp electrode Bowel Movement FT Full term (37-42 completed weeks) Bilateral pelvic lymph node dissection Beats per minute G gravidity (# of conceptions) Biophysical profile (ultrasound) GC Gonorrhea Bathroom privileges (as in bed rest with) GDM Gestational diabetes mellitus Bright red blood GETA General endotracheal anesthesia Bowel sounds Bilateral salpingo-oophorectomy Hb Hemoglobin Beat-to-beat variability HBV Hepatitis B virus Baby up for adoption Hmt Hematocrit Bilateral vaginosis HIV Human immunodeficiency virus HO House office or history of with HPV Human Papilloma Virus Complains of HSV Herpes Simplex Virus Cesarean section HTN Hypertension Culture and sensitivity Complete (completely dilated or I&O Input and output completely effaced on cervical exam) IDDM Insulin dependent diabetes mellitus Cervical intraepithelial neoplasm IUFD Intrauterine fetal demise Carcinoma in situ IUGR Intrauterine growth retardation Cold knife cone IUP Intrauterine pregnancy Cervical motion tenderness IUPC Intrauterine pressure catheter Heart IVDA Intravenous drug abuser Contraction stress test IVF In vitro fertilization or Intra venous fluids Clear to auscultation (lungs) Called to see patient JAR Junior assistant resident (PGY2) Cerebrovascular accident JP Jackson Pratt (Surgical abdominal drain) Costovertebral angle tenderness Chorionic villus sampling L Left Change LBTMI Live born term male infant LBTS Laparoscopic bilateral tubal separation Dilation and curettage LDR Labor delivery recovery room Dilation and evacuation LMP Last menstrual period Discharge (either from hospital or vagina) LN Lymph node 5% detrose solution (IV fluid) LOA Left occiput anterior Disseminated intravascular coagulation LOP Left occiput posterior Diabetic Keto Acidosis LOT Left occiput transverse Did not keep appointment LR Lactated Ringer’s solution (IV fluid) Day of surgery LTCS Low transverse cesarean section Delivery Room Deep tendon reflex MI Myocardial infarction or Membranes intact Dysfunctional uterine bleeding MR Membranes ruptures Deep vein thrombosis MSAFP Maternal serum alpha-fetoprotein Diagnosis Page 5-11
N/D N/V/D N/V NAD NG NKA NSSC NOB NPO NR NT
Not Done Nausea, vomiting or diarrhea Nausea & vomiting No acute distress Nasogastric tube No know allergies Normal size, shape, and consistency (uterus) New OB Nothing by mouth Non reactive (non stress test) Non-tender
OA OB OC OCP’s OCT ONC OOB OP OR
Occiput anterior Obstetrics Oral contraception Oral contraceptive pills Oxytocin challenge test Oncology Out of bed Occiput posterior Operation room
R RF ROA ROM ROP ROT RR RR&R RV
Right Retroflexed (uterus) Right occiput anterior Rupture of membranes Right occiput posterior Right occiput transverse Recovery room Regular rate and rhythm Retroverted (uterus)
S/P SAB SO SP SR SROM SUI Sx
Status post (means following) Spontaneous abortion “miscarriage” Significant other Suprapubic catheter Senior Resident (PGY4) Spontaneous rupture of membranes Stress urinary incontinence Signs
TAB
P Parity (# of births past 20 weeks) PAP Papanicolaou smear (for cytology) PCA Patient controlled analgesia PGY Post graduate year (after medical school) PID Pelvic inflammatory disease PIH Pregnancy induced hypertension PMB Postmenopausal bleeding PMH Past medical history PMP Previous menstrual period PO By mouth POC Products on conception POD Postoperative day PP Postpartum PPD Postpartum day PPROM Preterm premature rupture of membranes PROM Premature rupture of membranes Pt Patient PTL Preterm labor
Therapeutic abortion (elective pregnancy termination ) TAH Total abdominal hysterectomy Tmax Maximum temperature in past 24 hours TOCO Uterine monitor TOL Trial of labor TVH Trans vaginal hysterectomy Tx Treatment U/A U/S UCs UO UPT
Urinalysis Ultrasound Uterine contractions Urine output Urine pregnancy test
VB VBAC VD VSS VTX
Vaginal bleeding Vaginal birth after Cesarean Section Venereal disease or vaginal delivery Vital signs stable Vertex
WDWN Well developed, well nourished WF White female yo
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Year old
OB/GYN H&P en Espanol What is your due date? Cual es la fecha supuesta del parto? What was the first day of your LMP? Cuando fue el primer dia de su ultima regla? Cuando tuvo la ultima regla? Did you have a sonogram? When? Tuvo una sonograma? Cuando? Have you been coming to the clinics? Ha venido a las clinicas? Who is your doctor? Quien es su doctor? Have you had any problems with this pregnancy? Ha tenido algunos problemas con este embarazo? Are you having any pains? Contractions? Tiene ya dolores? Y contractiones? When did they start? How long do they last? Cuando le comezaron? Cuando le dura el dolor o contractiones? Have you had any vaginal bleeding? Ha sangrado de la vagina? Has your water broken? What time? Se le rompio la fuenta (la bolsa de aguas)? What color was it? White or clear? A que hora? Que color fue el laquido? Blanco or claro? Have you felt your baby move today? Like normal? Ha sentido mover el nino este dia? Como normal? Have you had HTN? Ha tenido alta presion de la sangre? Have you had swelling of the hand? Face? Legs? Han hinchado de las manos? La cara? Las piernas? Have you had severe headaches? Ha tenido dolores fo la cabeza? How many times a week? Cuantos veces en una semana? Have you had spots in front of your eyes? Ha tenido manchas enfrente do los ojos? Difficulty breathing? Lying down? After working? Ha tenido dificultad para respirar? Al acostarese?Despues de trabajar? Have you been vomiting? Ha estado vomitando? Have you had diarrhea? Constipation? Ha tenido diarrhea? Estrenimiento? OB History: How many times have you been pregnant? Cuantas veces ha estado embarazada? How many children do you have? Cuantos ninos tiene usted? Have you ever had a miscarriage? Ha tenido un malparto? Abortion? Stillborn? Aborto? Un nino que ha nacido muerto? What year was your child born? A que ano ha nacidosu nino? Number one, two, three…….. La primera? El segundo? El tercero? Were all your pregnancies term? (nine months) Fueron de tiempo (de nueve meses) sus otros ninos? Was the birth from the vagina? Fue el nacimiento de la vagina? Have you ever had a c-section? Ha tenido usted una operacion cesarea? What was the weight of your baby at birth? Cuanto peso el bebe al nacer? Have you had any problems with past pregnancies? Ha tenido algunos problemas con sus embarazos pasados? Like: bleeding, HTN, toxemia? Como sangrando (hemorragia)? Alta presion de la sangre? Toxemia? GYN History At what age did you start menstruation? A que edad empezo su menstruacion? Do you have normal periods? Tiene reglas nomales? Do you ever bleed in between periods? Tiene algun sangramiento despues de pasar la regla? How many days is your period, in general? Cuantos dias es su reglas, en general? Cuantos dias le dura el periodod? How many days in between your periods, in general? Cuantos dias en medio sus reglas, en general? What was your last PAP smear? Was it normal? Cuando fue su ultima prueba de Papanicolaou? (frotis, unto) anormal? Have you ever had an abnormal PAP? Ha tenido alguna vez un prueba de Papanicolaou (frotis, unto) anormal? Are you sexually active? With who? Tiene sexo? Con quien? Do you have pain during intercourse? Tiene dolar durante las relaciones sexuales? Do you use birth control? What type? Usa algun tipo de anticonceptivo? Que tipo? Have you had any infections? STDs? What? Ha tenido algunas infecciones de la vagina? De que? For example….. Por ejemplo….Ha tenido enfermedades verereas? De que? Blood in the urine? Sangre en la orina? Do you have pain or burning when urinating? Tiene dolar o ardor cuando orina? Are you unable to control your urination? No puede controlar la salida de orina? Medical History Have you had any operations? For what? When? Where? Ha tenido algunas operaciones? Para que? En cual hospital? Have you had any major illnesses? Accidents? Fractures? Ha tenido algunas enfermedades graves? Accidentes? Fractures? Do you take medicines? Prenatal vitamins? Tome algunas medicinas? Vitaminas prenatales? Do you have allergies to any medicines? Foods? Tiene alergicas a medcinas? Comidas? What happens? Rash? SOB? Swelling? Que la pasa? A erupcion? Falta de aire? Hinchazon? Family History Any person with cancer in your family? Algunas personas con cancer in su familia? Ovarian? Breast? Cervical? De la ovarios? Pecho? Cervis? Anyone in your family had DM, heart disease,HTN,etc? Alguien en su familia ha tenido DM, enfermedad del corazon? Anyone in your family with MR/BD/twins? Alguien en su familia con retrasado? Defecto de nacimiento? Gemelos? Social History Are you married? Do you work? Do you smoke? Esta casado? Trabaja? Fuma cigarillos? Cuantos paquetes en un dia? How many packs a day? Drink alcohol? How much a week? Bebe alcohol? Cuanto bebe en una semana? Do you use cocaine? MJ, other drugs? Usa cocaine? MJ, otras drogas? ROS: Breathe in and out Respire para adentro y para afuera PPDI Do you want a circumcision for your boy? Quieres un circumcision (excision del prepucio) por su nino? Can you walk? Urinate? Flatus? Puede caminar? Orina? Flatulencia (flato)? Can you eat? Solids? Liquids? Puede comer? Solidos? Liquidos? Do you want to breast feed or bottle feed? Quieres darle del pecho or la botella? Page 5-13
Basic Perinatal Sonography AFI
BPP
CORD DOPPLER
MCA DOPPLER
TVS
LEVEL 2
EFW/S&D
NUCHAL TRANSLUCENCY
AMNIOCENTESIS
To measure the amount of amniotic fluid surrounding the fetus Position is determined/documented Placenta is located/document FHR is document 4 quadrants of amniotic fluid is measured/tabulated For evaluation of fetal well being Includes AFI Observation of fetal movement, tone, fetal breathing activity Two points are given in each of the 4 categories Score determines need for further testing or delivery Determine placental resistance/sufficiency Includes AFI Measurement of fetal arterial resistance determined by ratio of systolic to diastolic flow Normals are gestational age dependent ranging from 2.0-3.5 High dopplers are observed; progression will be to higher numbers to absence of diastolic flow to reversal of diastolic which mandates immediate delivery Determines extent of fetal anemia Usually as a result of Rh sensitization or Parvo virus Includes AFI Doppler used to measure velocity of blood flowing in MCA Normals are gestational age dependent Evaluation for fetal hydrops Transvaginal meausrement of cervical length AFI study Endovaginal probe used to measure cervical length and cerclage placement if indicated Evaluation of fetus for congenital anomalies and size Also referred to as a Genetic Sonogram or Anatomy Survey HEAD: Orbits, Cerebellum, Cisterna Magnum, Nuchal Fold, Lateral Ventricles, Lips, Mandible, Nasal Bone HEART: Orientation in thorax, 4 chamber view, LVOT, RVOT, FHR and rhythm Lungs Kidneys Abdominal cord insertion Bladder 3 vessel cord Gender Spine, including sagittal and transverse views Four limbs and humerus length Basic hand and foot evaluation Placental location and evaluation Placental cord insertion Subjective amniotic fluid evaluation BIOMETRY: biparietal diameter, head circumference, abdominal circumference, femur length To determine an estimate of fetal weight and/or gestational age AFI study Biometry Limited anatomy: 4 chamber, kidneys, addition views as possible, if patient has no previous scan 1st trimester screening for trisomies CRL (44-84 mm window, approx 11-14 weeks BPD Fetal Heart Rate Anatomy: 4 limbs, bladder, stomach, ACI, spine, cranium, nasal bone Measurement of thickness of skin behind fetal neck Blood test for biochemistry For chromosomal analysis or Fetal Lung Maturity AFI study Assist Perinatologist
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INOVA FAIRFAX HOSPITAL OB/GYN Dept MEDICAL STUDENT CONTRACT 1 CONFIDENTIALITY— Maintain confidentiality and professionalism at all times. Be on time, proactive, prepared. Introduce yourself to attendings, residents, hospital staff, patients. This means communicate well (including if you are going to be late or absent—call Lolyn 776 2745) 2 NAME BADGE: Wear at all times. You must return on last day, receive $5 cash deposit. Use at all door/stair card readers (sensitive alarm for code pink)—wait for green light. Take completed MSO name badge form to 2nd flr between M-F 7:30-3:15 pm, bring $5 cash deposit. Discount in cafeteria, café, both gift shops. 3 HIPAA Compliance: you must complete test at GWU 4 PATIENT SAFETY: See National Patient Safety Goals 5 Red Rules/Identifiers/No-Interruption Zones: 1. Use 2 identifiers with a patient 2. Confirm procedure/site before starting 6 ABBREVIATIONS: Comply with abbreviation policies, abbreviation pocket card provided 7 BODY/BLOOD EXPOSURE FORM— Review and sign. Go to ER after hours. Must go to Employee Health in Educational Conf Ctr (Credit Union Bldg), 2nd floor per OSHA regulations to complete form 776 3271. Rapid HIV testing done on source patient if reported within 24 hr of exposure. 8 Utilize www.gmeone.com website for latest schedules, policies, forms, etc., Username=medicalstudent, password=inova A resource manual is stored in each call room. 9 PARKING: All medical students have free parking on the NEW EMPLOYEE GARAGE after you get your ID. Call Safety & Security if you need a ride or have vehicle problems #703 776 3180. 10 Academic Office Registration and IDX Computer Training: ECC Bldg, next to gazebo, across from new parking garage 1st Floor. All students must register and orient with Alyssa Thurman 703 776 2729. 11 You will receive: GWU MS3 only: IFH Pager, Meal Tickets (use in Cafeteria, Café, Coffee Kiosks), Suture Kit & Manual Gestational Wheel Dr. Gordon’s Red Book Abbreviation Pocket Card Maps, Med Staff Directory, Orientation, Evaluations, Objectives/Clerkship assignments, Schedules, Rosters OBJECTIVES/Schedules/ASSIGNMENTS: Ask questions, be sure you understand all your responsibilities. GWU MS3—turn in your supporting documents to Lolyn at end of clerkship VCU MS3—turn in your passport to Lolyn at end of clerkship 12 COMPUTER ACCESS: Complete a SARF (system access request form) & Confidentiality Forms thru the Academic Office. Call 7300 to get username and password, takes 3 days. DOOR CODES: call rm-52, physician lounge 25, med stud call rm-42, OR male lockers—52, OR female lockers--
13
MANAGE YOUR PAGER STATUS EVERY DAY: Call 764 7311, enter your pager number, enter security code 6040. Set up greeting, manage status, know that PBX monitors pages and calls. To page call 7310 or 703 764 7310 and enter ID number and the return phone number, hit #. Group page #s 98922 -Residents, 98930-Students. I understand I am responsible for the IFH pager and will pay $100 to Inova Fairfax Hospital if it is lost, needs to be replaced or repaired while in my possession.
Insert your PAGER #_____________ EVALUATION PROCESS: Please complete the: 14 • Self evaluation (email, fax, drop off office at Lolyn’s office W6107). • Mid-term evaluation by teaching resident/attending • Informal Evaluation by teaching resident / attending • End-Of-Rotation Evaluation by teaching resident/attending • Evaluation by Medical Student on IFH OBGYN Rotation (email, fax, drop off at Lolyn’s office W6107) • Ask the attendings and residents for informal evaluation and feedback 7th Floor Med Student Call Rm W 7123: 15 7th Flr, North, Womens Hosp, thru glass doors, Code 4 & 2, Ph# 53-7923 (internal phone) LECTURES (mandatory attendance): 16 SCHEDULES: Clerkship Assignments Mon 0715 REI, Kaiser Rm, PCC 2nd floor Conferences/Lectures Mon 0800 IFH OBGYN Grand Rounds, PCC Lower Lvl Resident Weekly Schedule Tue 0705 REI w/ Dr. Muasher W7331 or Kaiser Rm Resident On-call Wed 0715 GWU OBGYN Grand Rounds Teaching Residents Schedule teleconference in ASTEC (except 2nd Wed PCC Upper) Resident Vacation Schedule Wed 1600 MFM Conference 3rd Flr W3025 Resident Rotation Schedule Thu 0715 GYN Conf D, Grd Flr, Green Elevators *except rd OR Schedule posted-3 flr call rm & OR Front Fri 0715 Journal Club 7th Flr W-7331 1st/3rd Fridays only Desk Fri Teaching Resident Lectures 24 hour OBGYN Teaching Attendings Fri 2 pm GWU OBGYN Residency School Sessions OB Clinic Lead Attendings UME Policies are provided in orientation and on www.gmeone.com 17 TOUR: 4 hospitals (Womens/Childrens, Main (Med/Surg 12 stories), Inova Vascular/Heart Institute) Med Staff Ofc 1st flr orange elevators & ATM Med Recs, 1st floor, green elevators OB Clinic 1st flr behind Park Café Safety/Security 2nd flr green elevators original bldg st Library, 1 floor, atrium (3 computers) Resident Lounge, 2nd flr Orig Bldg Main cafeteria, basement green elevators Conf Rm D ground flr, green elevators Womens OR-3rd Flr-- code 4-3 Female Call rms, 3rd flr (5 2) & Physician Lounge 3rd flr (2 5) Womens OR--Male lockers code 5-2 ASTEC basement next to Heart Center, GWU Televideo Grd Rds Weds Conf Rms on 6th & 7th Floor Womens Hospital KEY PERSONS at Inova Fairfax Hospital Womens Center: 703 776 4001—Main Hospital Phone 703 776 6040 Fred Mecklenburg, MD, Chairman OBGYN 703 776 8611 Al Khoury, MD,Residency Program Director & Director of Perinatology Associates—Drs. George Bronsky, Barbara Nies, Huda Al-Kouatly, Lorna Rodriguez 703 776 3080 IFH Clerkship Dir, Samantha Buery, MD, W-6000 6th Floor Womens 703-776-2174 IFH Assoc Clerkship Dir, Rasha Ebeid, MD, W-6000 6th Floor Womens OB Clinic Staff: Erika Latchis MD, Al Wolfson MD, Howard Cohn MD, Paul Burka MD 703 776 3561 Toni Ardabell, Hospital Administrator 703 776 3603 Tricia Schmehl, Womens Services Director; Janet Hooper, 6661 703 776-XXXX Patient Care Dir: Rene Zelkin RN—LDR-6461; Cathy Jones RN—Womens OR-6031, Billie Watson RN HRP,ATC & GYN-3142, Cynthia Dingus RN—FCC--6775, 703 776 5034 Lolyn Young, OBGYN Residency/Academic Coordinator— Office 6th floor, W6107—blue elevators, T/L, T/R, 4th door on Left I have reviewed and understand the above items and will fully comply with each item. If I have any questions I will contact the appropriate parties immediately. I understand that less than full compliance can lead to disciplinary action(s).
Name:_______________________________
Date:_________________________________________
