DEPARTMENT OF OBSTETRICS & GYNAECOLOGY · DEPARTMENT OF OBSTETRICS & GYNAECOLOGY ... The...

Portfolio: Obstetrics & Gynaecology

Revised 2015/16 1

UNIVERSITY OF MALTA FACULTY OF MEDICINE & SURGERY

DEPARTMENT OF OBSTETRICS & GYNAECOLOGY

CLINICAL PLACEMENTS PORTFOLIO

Student’s Name: ___________________________

Year of Studies: 4th Year □: 201_

Year of Studies: 5th Year □: 201_

Kindly attach a

passport-sized

photograph to

enable

identification

during

assessments

TO BE HANDED IN

WITHOUR FAIL UP

TO ONE WEEK

AFTER THE END OF

THE FIFTH YEAR

CLINICAL

ATTACHMENT.


Revised 2015/16 2

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 three-

week 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 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.

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 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.

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 3

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 Clinical Competency Professional Skills & Attitudes

Be able to take a reproductive health

history (Obstetrics and Gynaecology) including a sexual history.

Be able to take & analyse an obstetric and

gynaecological history in a succinct and logical manner.

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.

Be able to elicit Physical signs. 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

Respect to patients’ dignity and confidentiality.

Develop communication skills.

Develop communication skills. Develop listening and interviewing skills. Develop and understanding of effective

communication; be this verbal and non- verbal.

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 role of U/S in fetal wellbeing assessment.

Be familiar with the use of appropriate

protocols and guidelines.

Be familiar with the mechanisms of normal

and abnormal labour and delivery.

Be familiar with a normal Vaginal Delivery.

Be able to interpret at CTG.

Develop a realistic recognition of own

competence level.

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 able to give clear information and

feedback, and share information with patients.

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 4

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 5

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 WEDNESDAY THURSDAY FRIDAY SATURDAY

8.00 -

9.00 LECTURE LECTURE LECTURE LECTURE LECTURE

CLINICAL

TEACHING

9.00 -

10.00

CLINICAL

TEACHING

CASE

DISCUSSION *

CLINICAL

TEACHING

CLINICAL

TEACHING

CLINICAL

TEACHING

CLINICAL

TEACHING

10.00 -

11.00

CLINICAL

TEACHING

CASE

DISCUSSION *

CLINICAL

TEACHING

CLINICAL

TEACHING

CLINICAL

TEACHING

SELF-DIRECTED

LEARNING

11.00 -


SELF-DIRECTED

LEARNING

12.00 -


1.00 -

2.00 TUTORIAL *

SURGICAL

DEPARTMENT

SEMINAR

MEDICAL

DEPARTMENT

SEMINAR

SELF-

DIRECTED

LEARNING

SELF-DIRECTED

LEARNING

2.00 -

3.00

SELF-DIRECTED

LEARNING **

SELF-DIRECTED

LEARNING

SELF-DIRECTED

LEARNING

SELF-

DIRECTED

LEARNING

SELF-DIRECTED

LEARNING

3.00 -

4.00

SELF-DIRECTED

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.

Monday Tuesday Wednesday Thursday Friday Saturday

CSV Minor OT Ward Round Major OT Outpatients Ward Round

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 Centre

Mosta Floriana Paola Gzira Qormi & B’Kara

Cospicua

CSV: Prof. C. Savona-Ventura MPB: Prof. M.P. Brincat GGB: Mr. G.G. Buttigieg MF: Mr. M. Formosa AS: Mr. A.P. Scerri YMB: Prof. Y. Muscat Baron JT: Mr. J. Thake AV: Mr. A. Vella JM: Mr. J. Mamo IS: Ms I. Saliba MS: Mr. M. Sant CP: Ms. C. Portelli


Revised 2015/16 6

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 M y - D M Y

Assigned lead tutor: ______________________________________

Sessions attended week 1 week 2 week 3

# Outpatients

[1 session a week]

Signature

Date

# Major Operating Theatre

[1 session a week]

Signature

Date

# Minor Operating Theatre

[1 session a week]

Signature

Session attendance

mark

Date

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Period of Second assigned Clinical Attachment: D M y - D M Y



# Outpatients

[1 session a week]

Signature

Date


[1 session a week]

Signature

Date


[1 session a week]

Signature

Session attendance

mark

Date

Period of Third assigned Clinical Attachment: D M y - D M Y



# Outpatients

[1 session a week]

Signature

Date


[1 session a week]

Signature

Date


[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.

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Revised 2015/16 8

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



# Urodynamics Session/s



# Bone density Session/s



Session attendance

Mark

# Emergency on-call Session/s



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 1 2 3 4

# Normal deliveries observed

[at least four deliveries over the

9-week attachment]

Signature

# Abnormal deliveries observed

[any number]

Signature

Intrapartum experience

Mark

# Caesarean Sections observed

[at least four operations over the

9-week attachment]

Signature

Students are welcome to attend and signoff obstetric experience during

the holidays.

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Revised 2015/16 9

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 FOLLOW-

UP ON THEIR OWN INITIATVE.

No. CASE TITLE

Obs.1

Obs.2

Obs.3

Obs.4

Obs.5

Gyn.1

Gyn.2

Gyn.3

Gyn.4

Gyn.5


Revised 2015/16 10

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 11

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.




WEEK 1

MINOR

WEEK 1

MAJOR

WEEK 2

MINOR

WEEK 2

MAJOR

WEEK 3

MINOR

WEEK 3

MAJOR


Revised 2015/16 12




WEEK 4

MINOR

WEEK 4

MAJOR

WEEK 5

MINOR

WEEK 5

MAJOR

WEEK 6

MINOR

WEEK 6

MAJOR




WEEK 4

MINOR

WEEK 4

MAJOR

WEEK 5

MINOR

WEEK 5

MAJOR

WEEK 6

MINOR

WEEK 6

MAJOR


Revised 2015/16 13

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 14

FORMAL TEACHING SESSIONS ATTENDED


Teaching sessions

To get tutor’s signature 1st 2nd 3rd

# Case based teaching

# Tutorials

# Workshops


Teaching sessions

To get tutor’s signature 4th 5th 6th


# Tutorials

# Workshops


Teaching sessions

To get tutor’s signature 7th 8th 9th


# 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.

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Revised 2015/16 15

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.


DATE EXAMINATION TECHNIQUES TUTOR’s NAME

1.

2.


Revised 2015/16 16

Case–based learning schedule during clinical attachment period [generally

delivered by lead consultant tutor]


DATE SUBJECT DISCUSSED TUTOR’s NAME

1.

2.

3.



1.

2.

3.



1.

2.

3.


Revised 2015/16 17

Tutorials schedule during clinical attachment period [generally delivered by

assistant tutors]



1.

2.

3.



1.

2.

3.



1.

2.

3.


Revised 2015/16 18

OVERALL REFLECTIONS – Strengths & weanesses


OVERALL REFLECTIONS

Strengths What have you particularly learned of relevance to the

specialty during this assignment?

Weaknesses What aspect will you concentrate upon in your next assignment

to improve your knowledge & skills in the specialty?


OVERALL REFLECTIONS



Weaknesses What aspect will you concentrate upon in your next assignment

to improve your knowledge & skills in the specialty?


OVERALL REFLECTIONS



Weaknesses What aspect will you concentrate upon in the furure to improve

your knowledge & skills in the specialty?


Revised 2015/16 19

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 20

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 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]

Strong

agreement

Some

agreement

Little

agreement

No

agreement 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]

Strong

agreement

Some

agreement

Little

agreement

No

agreement 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]

Strong

agreement

Some

agreement

Little

agreement

No

agreement 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 21

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