Portfolio: Obstetrics & Gynaecology UNIVERSITY OF MALTA FACULTY OF MEDICINE & SURGERY DEPARTMENT OF OBSTETRICS & GYNAECOLOGY CLINICAL PLACEMENTS PORTFOLIO Student’s Name: ___________________________ □: 201_ Year of Studies: 5th Year □: 201_ Year of Studies: 4th Year Kindly attach a passport-sized photograph to enable identification during assessments Revised 2015/16 TO BE HANDED IN WITHOUR FAIL UP TO ONE WEEK AFTER THE END OF THE FIFTH YEAR CLINICAL ATTACHMENT. 1 Portfolio: Obstetrics & Gynaecology INTRODUCTION The Obstetrician-Gynaecologist provides primary and preventive care for women’s health care needs, with an emphasis on reproductive lifecycle needs. During these Study Units, the student will be provided with a solid foundation of knowledge and skills to address these gender-specific health care needs. The principles of reproductive health care learned on in these Study Units will be integral in whatever area of medicine the individual will ultimately practice. The teaching of the subject is based on Theoretical and Clinical components of learning and training. The Clinical skills teaching component is spread over two years with two threeweek attachments during the fourth year of studies and one three-week attachment during the fifth year – a total of nine weeks. The Clinical teaching aims to give the student Core Clinical Skills and Competences related to women’s health care needs. The teaching component will include opportunities for casebased learning and formal tutorials. Regular attendance to the clinical attachments, including emergency on-call duties [x1 during the fourth year of studies; x1 during the fifth year of studies] is mandatory. During the emergency on-call session, the students should strive to attend emergency admission patients and follow-up labouring women. Students may augment their clinical experience by voluntary attendance to the clinical department outside the period of their clinical attachment. They should however be sensitive to other students – in their year of studies or otherwise – who may be formally attached to the department. Students with formally designated attachments should be given priority. This voluntary attendance does NOT replace in any way the need to attend the formal clinical attachment. STUDENTS WHO DO NOT ATTEND A SUITABLE PROPORTION OF THEIR ASSIGNED ATTACHMENT MAY NOT BE ALLOWED TO SIT FOR THEIR FINAL OBSTETRICS & GYNAECOLOGY EXAMINATION. Portfolio: The student is required to keep a clinical portfolio that includes a series of clinical cases with a dedicated discussion to each one - a minimum of six cases [three obstetric and three gynaecological] is expected during the IV th year of studies and a minimum of four cases [two obstetrics and two gynaecological] during the Vth year of studies. For your own sake, try to choose cases with varied pathology. This booklet is intended as a guide for augmenting and recording the practical experience that you should strive to gain during your attachment. The cliché that “the patient should be your textbook” is very true and only regular contact with patients will enable you to truly assimilate and make your own the knowledge obtained from books and lectures. The overall Portfolio assessment will be integrated towards the final examination assessment of the student. Present the booklet to the Department Secretary within one week of ending your fifth year of studies clerkship so that your work is assessed in time for inclusion in the final mark of the MDS4026 study unit assessment in January – Failure to do so will mean a lesser mark in that assessment. FORGING OF SIGNATURES AND PLAGIARISM IS CONSIDERED A VERY SERIOUS MATTER RELATING TO PROFESSIONAL CONDUCT AND WILL JEOPARDISE YOUR FUTURE QUALIFICATION. Revised 2015/16 2 Portfolio: Obstetrics & Gynaecology Adult learning: As a medical student, you are an adult learner. You are no longer a Secondary School student spoon-fed information to be regurgitated during the examination. Becoming a doctor requires you to attain definite defined goals and objectives. These are clearly detailed in the Course Instruction Booklet that has been made available to you. Students learn differently; but reading about, discussing and seeing patients with different clinical problems reinforces and consolidates your knowledge base. Seek out opportunities whenever possible to practice your history taking, physical examination and technical skills. More importantly, you should learn to prioritize patient problems and report on your patients in a clear, organized fashion, whether orally or in writing. You should also learn to utilise the clinical data obtained from the history and examination of the patient to build up a differential diagnosis and management plan. Link your reading to the patient problems you encounter in the wards, outpatients, etc. Much of the time spent on your clerkship will involve being a member of a care team who include your peers. You should collaborate with your fellow medical students – they are not in competition with you for marks. If you have had the opportunity to experience a certain procedure while your student colleague has not, then you should stand back and allow your colleague to gain that experience. Please inform early the Departmental Secretary if the assigned lead tutor [Consultant tutor] is not available for any reason for part of the clinical attachment. This will allow that student group to be reassigned to other tutors. Core Clinical Skills and Competences: A series of core skills and competencies have to be attained throughout your attachment. These are outlined in the table below. Knowledge Criteria Be able to take a reproductive health history (Obstetrics and Gynaecology) including a sexual history. Be able to elicit Physical signs. Clinical Competency Be able to take & analyse an obstetric and gynaecological history in a succinct and logical manner. Develop communication skills. Be able to perform a basic obstetric and gynaecological examination specifically: a. Abdominal palpation of a pregnant and non-pregnant abdomen; b. Pelvic examination including inspection, speculum and bimanual; c. Performance of a cervical smear/swab Develop listening and interviewing skills. Be able to assess maternal & foetal wellbeing and compromise. Be able to manage routine antenatal care and be able to identify high risk situations. Be familiar with the mechanisms of normal and abnormal labour and delivery. Develop Counselling Skills - especially in relation to: a. contraception and reproductive choice; b. safer sex and STD prevention; c. pre-conceptional health; d. menopausal health; e. postnatal care f. choice of surgery g. postoperative care Be familiar with the role of U/S in fetal wellbeing assessment. Be familiar with a normal Vaginal Delivery. Be able to interpret at CTG. Be able to give clear information and feedback, and share information with patients. Professional Skills & Attitudes Be able to show empathy and develop rapport with patients. Be able to appreciate the psychological and social impact of disease on patients and their relatives. Respect to patients’ dignity and confidentiality. Develop communication skills. Develop and understanding of effective communication; be this verbal and nonverbal. Be familiar with the use of appropriate protocols and guidelines. Develop a realistic recognition of own competence level. Be familiar in the selection of operative procedure with due regard to degree of urgency, likely pathology and anticipated prognosis. Recognition that decision making is a collaborative process between doctor and patient. Professional behaviour: Specific professional behaviours are expected of medical students during their clinical attachment. Empathy, sensitivity and compliance with the patient’s wishes are essential. Asking patients if you can observe or participate in their care is common courtesy. Most patients gladly accept students as part of their health care team, but it must be remembered that this is always the patient’s choice. Graciously comply with patients’ wishes regarding student involvement in their care. Revised 2015/16 3 Portfolio: Obstetrics & Gynaecology TIMETABLE It is important to look up the weekly timetable of the lead tutor [consultant tutor] your group has been attached to. You should also identify the Firm’s “emergency on-call days” for you to be able to attend. Please note that you are expected to devote a significant amount of time in self-directed learning [Ward work] where you strive to have a maximum amount of contact time with patients taking histories, examining, and following the progress of their medical condition. MAKE SURE THAT YOU DO NOT FOR ANY REASON MISS OUT ON THE OPPORTUNITIES OFFERED FOR CLINICAL TEACHING BY SCHEDULING ANYTHING ELSE DURING THE TIME ALLOTED FOR YOUR ATTACHMENT, IN PARTICULAR DO NOT MISS OUT ON OUTPATIENTS AND OPERATING THEATRE SESSIONS. Do not accept to schedule tutorials from other departments during the morning which will impinge on your clinical experience in obstetrics & gynaecology. Your stay in obstetrics & gynaecology has already been foreshortened to a bare total of nine weeks. Weekly timetable Consultant X3 weeks Consultant X3 weeks Consultant X3 weeks Consultant’s name Monday Tuesday Wednesday Thursday Friday Saturday 1 Emergency on-call duty days The group should split up into small groups of two-three students and arrange a timetable between themselves to enable them to target attendance to at least one emergency on-call days during their attachment. You should only attend the emergency on-call assignment when your lead tutor’s firm is actually on duty. That way you will not impinge of other student groups’ opportunities. 1 The clinical working week at Mater Dei University Hospital is spread out over six days of the week including Saturday. It is in the students’ interests to attend all sessions, particularly when these involve outpatients and theatre sessions. It is advised that the students should follow their patients daily from admission to discharge from the hospital. DO FIND TIME FOR SELF-DIRECTED LEARNING IN THE FORM OF WARD WORK. Revised 2015/16 4 Portfolio: Obstetrics & Gynaecology The following is the proposed weekly schedule defining student teaching opportunities during the attachment in the Department. It takes into consideration the teaching scheduled by the Faculty. MONDAY TUESDAY LECTURE LECTURE LECTURE 9.00 10.00 10.00 11.00 CLINICAL TEACHING CLINICAL TEACHING CASE DISCUSSION * CASE DISCUSSION * 11.00 12.00 LECTURE 12.00 1.00 LECTURE 8.00 9.00 1.00 2.00 TUTORIAL * WEDNESDAY THURSDAY FRIDAY SATURDAY LECTURE LECTURE CLINICAL TEACHING CLINICAL TEACHING CLINICAL TEACHING CLINICAL TEACHING CLINICAL TEACHING CLINICAL TEACHING CLINICAL TEACHING CLINICAL TEACHING SELF-DIRECTED LEARNING LECTURE LECTURE LECTURE LECTURE SELF-DIRECTED LEARNING LECTURE SURGICAL DEPARTMENT SEMINAR LECTURE MEDICAL DEPARTMENT SEMINAR LECTURE SELFDIRECTED LEARNING SELFDIRECTED LEARNING SELFDIRECTED LEARNING LECTURE 2.00 3.00 SELF-DIRECTED SELF-DIRECTED LEARNING ** LEARNING SELF-DIRECTED LEARNING 3.00 4.00 SELF-DIRECTED SELF-DIRECTED LEARNING LEARNING SELF-DIRECTED LEARNING SELF-DIRECTED LEARNING SELF-DIRECTED LEARNING SELF-DIRECTED LEARNING * the days these teaching assignments will be carried out will vary according to the student group and tutor convenience. ** SELF-DIRECTED LEARNING includes “Ward Work” which will enable students to take histories, examine patients and generally follow-up patients during their admission-discharge interval. The overall timetable of the work carried out within the department is outlined below. Each Consultant generally has a Resident Specialist, Specialist Trainees, and House Physician-Surgeon. These professionals are very well suited to impart basic clinical skills when the tutor is unavailable. CSV Monday Minor OT Tuesday Ward Round Wednesday Major OT Thursday Outpatients Friday Ward Round Saturday Ward Round MPB Outpatients Major OT Ward Round Ward Round Minor OT Minor OT GGB Major OT Outpatients Ward Round Minor OT Ward Round Ward Round MF Ward Round Ward Round Minor OT Outpatients Major OT Ward Round APS Ward Round Minor OT Ward Round Major OT Outpatients Ward Round YMB Major OT Ward Round Outpatients Ward Round Minor OT Major OT JT Ward Round Major OT Minor OT Ward Round Outpatients Ward Round AV Minor OT Ward Round Outpatients Ward Round Ward Round Major OT JM Ward Round Outpatients Major OT Minor OT Ward Round Minor OT IS Ward Round Minor OT Ward Round Major OT Outpatients Major OT MS Outpatients Ward Round Ward Round Minor OT Major OT Ward Round CP Major OT Outpatients Ward Round Minor OT Ward Round Ward Round Health Mosta Floriana Paola Centre CSV: Prof. C. Savona-Ventura MPB: Prof. M.P. Brincat MF: Mr. M. Formosa AS: Mr. A.P. Scerri JT: Mr. J. Thake AV: Mr. A. Vella IS: Ms I. Saliba MS: Mr. M. Sant Revised 2015/16 Gzira Qormi & Cospicua B’Kara GGB: Mr. G.G. Buttigieg YMB: Prof. Y. Muscat Baron JM: Mr. J. Mamo CP: Ms. C. Portelli 5 Portfolio: Obstetrics & Gynaecology ATTENDANCE RECORD It is imperative that the student ensures that his attendance is signed for by the most senior member of the clinical team [consultant – resident specialist – HST/BST] present during that session. Attendance to all clinical sessions – particularly outpatients and theatre – is mandatory, and forms an integral part of the assessment. Period of First assigned Clinical Attachment: D D M y - M Y Assigned lead tutor: ______________________________________ Sessions attended # Outpatients [1 session a week] Signature week 1 week 2 week 3 Date # Major Operating Theatre [1 session a week] Signature Date # Minor Operating Theatre [1 session a week] Signature Session attendance mark Date Revised 2015/16 T U T O R ’ S S I G N A T U R E R E Q U I R E D 6 Portfolio: Obstetrics & Gynaecology Period of Second assigned Clinical Attachment: D D M y - T U T O R ’ S S I G N A T U R E R E Q U I R E D M Y Assigned lead tutor: ______________________________________ Sessions attended # Outpatients [1 session a week] Signature week 4 week 5 week 6 Date # Major Operating Theatre [1 session a week] Signature Date # Minor Operating Theatre [1 session a week] Signature Session attendance mark Date Period of Third assigned Clinical Attachment: D D M y - M Y Assigned lead tutor: ______________________________________ Sessions attended # Outpatients [1 session a week] Signature week 4 week 5 week 6 Date # Major Operating Theatre [1 session a week] Signature Date # Minor Operating Theatre [1 session a week] Signature Session attendance mark Date Any attendance to these sessions signed outside the formally assigned “clinical attachment period” will NOT be considered. Identify any Public Holidays clashing with assigned session. Revised 2015/16 7 Portfolio: Obstetrics & Gynaecology Sessions attended 1 2 3 4 # Health Centre session/s [optional] Signature # Ultrasound session/s [at least 3 sessions over the 9-week attachment] Signature # Antenatal cardiotocography [at least 3 sessions over the 9-week attachment] Signature # Urodynamics Session/s [at least 2 sessions over the 9-week attachment] Signature # Bone density Session/s [at least 2 sessions over the 9-week attachment] Signature # Emergency on-call Session/s [at least 2 sessions over the 9-week attachment] Signature Session attendance Mark The student should also strive to attend the subspecialist sessions in order that a broad experience in the speciality is attained. Look out for opportunities to experience other related procedures: e.g. Hysterosalpingogram [HSG], paracentesis, amniocentesis, insertion of IUCD, insertion of ring pessary, pipelle endometrial biopsy, hysteroscopy, etc. The student may or may not have an opportunity to view other procedures during the clinical attachment, but should take the opportunity to do so should the opportunity arise. The student should also find time for the opportunity to attend obstetric and gynaecological ultrasound assessments; Doppler studies; cardiotocographic assessments; and any other procedures that may present. This will help broaden the students’ experience. Intrapartum experience To get supervisor’s signature # Normal deliveries observed [at least four deliveries over the 9-week attachment] Signature # Abnormal deliveries observed [any number] Signature # Caesarean Sections observed [at least four operations over the 9-week attachment] Signature 1 2 3 4 Intrapartum experience Mark Students are welcome to attend and signoff obstetric experience during the holidays. Revised 2015/16 8 T U T O R ’ S S I G N A T U R E R E Q U I R E D Portfolio: Obstetrics & Gynaecology Case Summaries presented The student should present the Case Summaries with a critical appraisal of the case of at least five obstetric cases and five gynaecological cases during the overall nine weeks clinical attachment. The cases should reflect the care given and thus adequate follow-up of cases in the wards by the student is mandatory. STUDENTS MUST FIND TIME TO VISIT PATIENTS IN THE WARDS FOR FOLLOWUP ON THEIR OWN INITIATVE. No. Obs.1 CASE TITLE Obs.2 Obs.3 Obs.4 Obs.5 Gyn.1 Gyn.2 Gyn.3 Gyn.4 Gyn.5 Revised 2015/16 9 Portfolio: Obstetrics & Gynaecology OUTPATIENTS CASES NOTED – REFLECTIVE DIARY The Outpatients and the Specialist Clinic at the Health Centre is the ideal place for the student to learn the skills of abdominal and pelvic examination. 2 ATTENDANCE IS MANDATORY. The student should strive to register and reflect on at least one interesting obstetric and one gynaecological case per clinic. First Attachment – Fourth Year Case Date INTERESTING CASES SEEN [note at least two cases per session attended] 1 Week 1 2 3 Week 2 4 5 Week 3 6 Second Attachment – Fourth Year 7 Week 4 8 9 Week 5 10 11 Week 6 12 2 It will be appreciated that it is not in the patients’ interest to have the whole group of students in one consulting room. The students should split up in groups of two-three and disperse in the various consulting rooms in the Clinic. Revised 2015/16 10 Portfolio: Obstetrics & Gynaecology Third Attachment – Fifth Year 13 Week 7 14 15 Week 8 16 17 Week 9 18 OPERATIONS OBSERVED – REFLECTIVE DIARY The student should use the operating theatre sessions to gain an overall view and understanding of the basic principles of the common operating procedures in order that he/she will be capable to explain the overall concept of the procedure to their future patients. Essential procedures that the student should make an effort to see common gynaecological procedures including abdominal hysterectomy, pelvic floor repair, diagnostic laparoscopy, Dilatation & Curettage [D&C], and colposcopy among others. ATTENDACE IS MANDATORY. First Attachment – Fourth Year Case Date INTERESTING CASES SEEN [note at least two cases per session attended] WEEK 1 MINOR WEEK 1 MAJOR WEEK 2 MINOR WEEK 2 MAJOR WEEK 3 MINOR WEEK 3 MAJOR Revised 2015/16 11 Portfolio: Obstetrics & Gynaecology Second Attachment – Fourth Year Case Date INTERESTING CASES SEEN [note at least two cases per session attended] WEEK 4 MINOR WEEK 4 MAJOR WEEK 5 MINOR WEEK 5 MAJOR WEEK 6 MINOR WEEK 6 MAJOR Third Attachment – Fifth Year Case Date INTERESTING CASES SEEN [note at least two cases per session attended] WEEK 4 MINOR WEEK 4 MAJOR WEEK 5 MINOR WEEK 5 MAJOR WEEK 6 MINOR WEEK 6 MAJOR Revised 2015/16 12 Portfolio: Obstetrics & Gynaecology DELIVERIES – REFLECTIVE DIARY The students should strive to follow-up and observe the labour progress of as many patients as possible during the clinical attachment. A target minimum of four deliveries over the nine week clinical attachment period should be aimed at, though it is appreciated that this may not always be possible. At least one of these should be written up as one of the required obstetric case notes. 3 The student should also strive to observe at least four deliveries by Caesarean section over the nine week clinical attachment period to enable him/her understand the principles of the procedure.4 Students should attend the Central Delivery Suite and/or Evening Emergency attendance when the consultant’s team they are assigned to is on duty. This will prevent “crowding” of the Central Delivery Suite and the Emergency Examination Room by too many students. Case Date REFLECTIVE SUMMARY OF CASES SEEN [normal, abnormal, caesarean deliveries] 1 2 3 4 5 6 7 8 3 Not more than one medical student should attend an individual patient during delivery. Attendance is at the discretion of the attending midwife & patient. 4 The number of students attending the Operating Theatre during a Caesarean section should be limited to decrease infection risks. Attendance is at the discretion of the attending physician. The same applies for Gynaecological operations. Revised 2015/16 13 Portfolio: Obstetrics & Gynaecology FORMAL TEACHING SESSIONS ATTENDED First Attachment – Fourth Year Teaching sessions To get tutor’s signature 1st 2nd 3rd th th th T U T O R ’ S # Case based teaching # Tutorials # Workshops Second Attachment – Fourth Year Teaching sessions To get tutor’s signature 4 5 6 7th 8th 9th S I G N A T U R E # Case based teaching # Tutorials # Workshops Third Attachment – Fifth Year Teaching sessions To get tutor’s signature # Case based teaching # Tutorials # Workshops A number of suggested topics for case-based learning and tutorial sessions are listed. However, the tutor and/or students may wish to discuss different topics that may be considered more useful or essential. Revised 2015/16 14 R E Q U I R E D Portfolio: Obstetrics & Gynaecology Simulation Workshop for abdominal/vaginal examination. Please do care for the models since these do represent a financial investment. First/Second Attachment – Fourth Year DATE EXAMINATION TECHNIQUES TUTOR’s NAME 1. 2. Third Attachment – Fifth Year DATE EXAMINATION TECHNIQUES TUTOR’s NAME 1. 2. Revised 2015/16 15 Portfolio: Obstetrics & Gynaecology Case–based learning schedule during clinical attachment period [generally delivered by lead consultant tutor] First Attachment – Fourth Year DATE SUBJECT DISCUSSED TUTOR’s NAME 1. 2. 3. Second Attachment – Fourth Year DATE SUBJECT DISCUSSED TUTOR’s NAME 1. 2. 3. Third Attachment – Fifth Year DATE SUBJECT DISCUSSED TUTOR’s NAME 1. 2. 3. Revised 2015/16 16 Portfolio: Obstetrics & Gynaecology Tutorials schedule during clinical attachment period [generally delivered by assistant tutors] First Attachment – Fourth Year DATE SUBJECT DISCUSSED TUTOR’s NAME 1. 2. 3. Second Attachment – Fourth Year DATE SUBJECT DISCUSSED TUTOR’s NAME 1. 2. 3. Third Attachment – Fifth Year DATE SUBJECT DISCUSSED TUTOR’s NAME 1. 2. 3. Revised 2015/16 17 Portfolio: Obstetrics & Gynaecology OVERALL REFLECTIONS – Strengths & weanesses First Attachment – Fourth Year Strengths Weaknesses OVERALL REFLECTIONS What have you particularly learned of relevance to the specialty during this assignment? What aspect will you concentrate upon in your next assignment to improve your knowledge & skills in the specialty? Second Attachment – Fourth Year Strengths Weaknesses OVERALL REFLECTIONS What have you particularly learned of relevance to the specialty during this assignment? What aspect will you concentrate upon in your next assignment to improve your knowledge & skills in the specialty? Third Attachment – Fifth Year Strengths Weaknesses Revised 2015/16 OVERALL REFLECTIONS What have you particularly learned of relevance to the specialty during this assignment? What aspect will you concentrate upon in the furure to improve your knowledge & skills in the specialty? 18 Portfolio: Obstetrics & Gynaecology CASE SUMMARIES During the nine-week clinical attachment period over the two years the student should strive to clerk fully at least five obstetric and five gynaecological patients per week; i.e. at least a total of ten cases. These cases should be written up fully. At least one obstetric case should be accompanied by a labour progress summary outlined on a partogram. The cases should be accompanied by a dedicated short discussion of the case outlining the differential diagnosis and management options [an example is given in your Guidelines for Medical Students booklet]. CASE WRITEUPS TO FOLLOW THIS PAGE Revised 2015/16 19 Portfolio: Obstetrics & Gynaecology Study Units Audit The Department has an ongoing desire to improve its teaching methods and organisation for the benefit of the students. Students are encouraged to approach the Departmental Secretary with any problems they might encounter within the department during their course of studies. They are further encouraged to complete the anonymous audit assessment form at the end of the study unit. Your contribution would help us improve the teaching programme for future students. Please return this page to: The Department of Obstetrics & Gynaecology, Malta Medical School, Mater Dei University Hospital, Tal-Qroqq, Msida STUDY UNIT – OVERALL VIEWPOINT Strong agreement Some agreement Little agreement No agreement Strong agreement Some agreement Little agreement No agreement Strong agreement Some agreement Little agreement No agreement Strong agreement Some agreement Little agreement No agreement The study unit was interesting. The study unit was well organised. The study unit was helpful to attain the Core Knowledge & Skills in the speciality. FORMAL LECTURE PROGRAMME [generally performed by the Senior staff] The 4th year lecture programme was useful and comprehensive The 5th year revision lecture programme was useful and covered most of the important clinical topics. The lectures were presented clearly and effectively. The lectures were useful to help you to understand the topic. Further comments: FORMAL TUTORIAL PROGRAMME [generally performed by the Junior staff] The 4th year tutorial programme was useful and comprehensive. The 5th year tutorial programme was useful and covered most of the important clinical topics. The Simulation facilities were particularly useful to assist the development of specific examination skills. The junior members of the academic staff were particularly helpful in making the attachment a useful experience. Further comments: CASE-BASED TEACHING [generally performed by Consultant tutor] The consultant regularly availed himself of opportunities to help develop the student’s knowledge and clinical skills. The Outpatients sessions were particularly useful experiences. The Operating theatre sessions were particularly useful experiences. The On-call emergency sessions were particularly useful experiences. The Self-directed opportunities [ward work] were particularly useful experiences. The Logbook helped me to target learning objectives and to develop clinical and reasoning skills. Further comments: Revised 2015/16 20 Portfolio: Obstetrics & Gynaecology Revised 2015/16 21