Logbook: Obstetrics & Gynaecology
UNIVERSITY OF MALTA
FACULTY OF MEDICINE & SURGERY
DEPARTMENT OF OBSTETRICS & GYNAECOLOGY
CLINICAL PLACEMENTS
LOG BOOK
Student’s Name: ___________________________
Year of Studies: 5th Year
□: 201_
Kindly attach a
passport-sized
photograph to
enable
identification
during
assessments
Revised 2015/16
1
Logbook: 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 component is spread over two years with two three-week
attachments during the fourth year of studies and one three-week attachment
during the fifth year. 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 case-based 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.
Logbook: The student is required to keep a clinical log-book 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 IVth 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.
Present the booklet to the Department Secretary within two weeks of ending your
clerkship so that your work is signed up. The overall Logbook assessment will be
integrated towards the final examination assessment of the student.
FORGING OF SIGNATURES AND PLAGIARISM IS CONSIDERED A VERY SERIOUS
MATTER RELATING TO PROFESSIONAL CONDUCT AND WILL JEOPARDISE YOUR
FUTURE QUALIFICATION.
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
Revised 2015/16
2
Logbook: Obstetrics & Gynaecology
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
Logbook: Obstetrics & Gynaecology
TIMETABLE
It is important to look up the weekly timetable of the lead tutor [consultant tutor]
your group has been attached to. This overall clinical timetable of the department
is detailed in the Course Instruction Booklet. 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.
Weekly timetable
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.
THE RELEVANT TIMETABLES & DATES CAN BE OBTAINED FROM
SECRETARIES IN THE CLINICAL DEPARTMENT AT MATER DEI HOSPITAL.
THE
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
Logbook: 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. The student should also strive to attend the subspecialist
sessions in order that a broad experience in the speciality is attained.
Period of assigned Clinical Attachment:
d
m
y
-
d
m
y
Assigned 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
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.
Sessions attended
week 1
week 2
week 3
# Health Centre session/s
[optional]
Signature
# Ultrasound session/s
[at least 1 session per attachment]
Signature
# Antenatal cardiotocography
[at least 1 session per attachment]
Signature
# Urodynamics Session/s
[at least 1 session per attachment]
Signature
# Bone density Session/s
Session
[at least 1 session per attachment]
attendance
Signature
Mark
# Emergency on-call Session/s
[at least 1 session per attachment]
Signature
Students are welcome to attend and sign-off obstetric experience during
the previous summer months.
Revised 2015/16
5
Logbook: Obstetrics & Gynaecology
Intrapartum experience
To get supervisor’s signature
1st
2nd
3rd
# Normal deliveries observed
[at least two deliveries]
Signature
# Abnormal deliveries observed
Intrapartum
[any number]
experience
Signature
Mark
# Caesarean Sections observed
[at least two operations]
Signature
Students are welcome to attend and signoff obstetric experience during
the previous summer months.
Teaching sessions
To get tutor’s signature
1st
2nd
3rd
# Case based teaching
# Tutorials
# Workshops
Case Summaries presented
The student should present the Case Summaries with a critical appraisal of the
case of at least two obstetric cases and two gynaecological cases. 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 FOLLOW-UP ON THEIR OWN INITIATVE.
No.
Obs.1
CASE TITLE
Obs.2
Gyn.1
Gyn.2
Revised 2015/16
6
Logbook: Obstetrics & Gynaecology
OUTPATIENTS CASES NOTED
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 at least one
interesting obstetric and one gynaecological case per clinic.
Case
Date
INTERESTING CASES SEEN
[note at least two cases per session attended]
1
2
3
4
5
6
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. 3 This will help
broaden the students’ experience.
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.
3
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.
Revised 2015/16
7
Logbook: Obstetrics & Gynaecology
OPERATIONS OBSERVED
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.
Case
Date
INTERESTING CASES SEEN
[note at least two cases per session attended]
1
MINOR
1
MAJOR
2
MINOR
2
MAJOR
3
MINOR
3
MAJOR
Revised 2015/16
8
Logbook: Obstetrics & Gynaecology
DELIVERIES
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
two deliveries 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.4 The student should also strive to observe at least
two deliveries by Caesarean section to enable him/her understand the principles
of the procedure.5 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
SUMMARY OF CASES SEEN
[normal, abnormal, caesarean deliveries]
1
2
3
4
4
Not more than one medical student should attend an individual patient during
delivery. Attendance is at the discretion of the attending midwife & patient.
5
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
9
Logbook: Obstetrics & Gynaecology
FORMAL TEACHING SESSIONS ATTENDED
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.
Simulation Workshop for abdominal/vaginal examination. Please do care
for the models since these do represent a financial investment.
DATE
EXAMINATION TECHNIQUES
Attendance to be
confirmed by
assigned tutor
1.
2.
Case–based learning schedule during clinical attachment period [generally
delivered by lead consultant tutor]
DATE
SUBJECT DISCUSSED
Attendance to be
confirmed by
assigned tutor
1.
2.
3.
4.
5.
6.
Revised 2015/16
10
Logbook: Obstetrics & Gynaecology
Tutorials schedule during clinical attachment period [generally delivered by
assistant tutors]
DATE
SUBJECT DISCUSSED
Attendance to be
confirmed by
assigned tutor
1.
2.
3.
4.
5.
6.
Revised 2015/16
11
Logbook: Obstetrics & Gynaecology
CASE SUMMARIES
During the fifth-year attachment the student should strive to clerk fully at least
two obstetric and two gynaecological patients per week; i.e. at least a total of
four 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 Course Instruction Booklet].
CASE WRITEUPS TO FOLLOW THIS PAGE
Revised 2015/16
12
Logbook: Obstetrics & Gynaecology
5th YEAR STUDENT’S CONFIDENTIAL AND ANONYMOUS COMMENTS
The Department of Obstetrics & Gynaecology would like feedback from all the students
about their experience during the study units. Your comments are very helpful to us in
looking to ways of improving the programme. You need not sign your name, but please do
take the trouble to return this sheet back. Your contribution would help us improve the
teaching programme for future students. PLEASE DO RETURN THIS QUESTIONNAIRE
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
13
Logbook: Obstetrics & Gynaecology
Revised 2015/16
14