Roosevelt Site
http://www.nywomenshealth.com/

• Introduction
• General Guidelines
• Course Requirements
• Evaluation
• Rotation Schedule
• Administration, Divisions and Faculty
• A Brief History

Introduction

Welcome to the Obstetrics and Gynecology Rotation at St. Luke’s-Roosevelt Hospital.

Roosevelt Hospital has a busy Obstetrics and Gynecology service. During the rotation you will be exposed to both normal well-woman care and plenty of pathology. In order to fully expose you to the field, your time will be divided between Obstetrics and Gynecology with 2-3 weeks on Obstetrics and 2-3 weeks of Gynecology and Gyn-Oncology.

Whether on this or any other rotation, the best way to gain the most from any rotation is to picture yourself going into that field. We do not expect all of you to enter this field, but we do expect you to act as though you want to find out what this field and its residency are like. OB/GYN is an extremely rewarding and diverse field of medicine. There will be aspects of the field that are interesting to every student no matter where you primary interests lie. As a student on the rotation, our patients allow you the privilege of sharing in some of the most intimate aspects of their lives – childbirth, pelvic exams, etc. Accordingly, there may be times at which patients choose not to have students involved in their care. It is important that we remain respectful of their wishes.

As in all the services, residents and medical students depend on each other. The residents have a responsibility to incorporate you into the team. Your responsibility is to read, participate, and become an asset to that team. While everyone looks forward to participating in deliveries and surgeries, even the simplest of “scut work” provides an opportunity to learn a new skill and teaches you how to manage your time well. Please do not be offended if a resident asks you to perform these seemingly mundane tasks. If you are enthusiastic and eager to help, you will become a vital part of the team and have many opportunities to be involved in more exciting teaching opportunities. However if you feel that you are being abused in any way by your team members, it is imperative that you inform the clerkship director so that the situation can be properly investigated and appropriate action taken.

1. This is an academic institution—you belong here. Never feel apologetic for being involved. Exceptions will arise, but in general, you have a right to be part of what goes on.
2. Be a team player—apathy and a sense of entitlement go over poorly.
3. Recognize the unique position we in healthcare have and be respectful of all patients.
4. Ask questions.
5. Always have a black pen.
6. Acronyms – ask if you don’t know. There is a fairly comprehensive list in this handbook but there are always more.
7. Realize that “scut” is a part of medicine and will certainly be part of your internship (in any field). Although this is not your primary responsibility, helping with some menial tasks will teach you to manage your time well.
8. Never do a pelvic exam without a resident or attending present.
9. Have a resident sign all of your notes. click here for a sample note)
10. Always tell the team where you are going – if you leave early, have a lecture to attend, etc.
11. Check with the resident before you do anything to/with a patient. Do not discharge patients on your own, discuss diagnoses, discuss fetal heart rate tracings, etc.
12. Do not sleep at night unless the residents ask you to. If you spend too much time on the rotation sleeping, you will surely miss opportunities to take part in patient care. You have the day off after being on call to rest.

1. Attendance is mandatory at all attending lectures (even if you are post-call.)
2. At the end of the clerkship, each student must hand in:
   1. One L&D triage/screening room note from a patient who was evaluated and discharged from the labor floor
   2. One L&D Portfolios for patients whom you followed through their labor and delivery (use the attached Labor & Delivery Portfolio form)
   3. One GYN clinic note for a gynecologic patient seen in the clinic
3. Each student must have one "Observed History and Clinical Examination" form filled out. This can be completed by either an attending or a resident.
4. At the end of the clerkship each student must have completed the PDA log of procedures/patient encounters required by the Dean's office. This is a mandatory requirement and students will not be able to receive their final grades until this is completed.
5. Each student must create a patient hand-out for a condition or problem that they see in the clinic, ER, or in-patient service. This handout must be easy for a patient to understand. It should cover the basic information on the condition. It must be original work (not copied from the internet, etc.)
6. Informal presentations will be given to the resident team during each of your rotations on GYN, GYN/ONC, and OB. These 3 presentations are informal/lasting approximately 5 minutes and handouts are unnecessary. The topics should be something relevant to a patient you have seen. The chief resident can help you come up with a topic.
7. The NBME shelf written examination will be given to all students on the last day of the rotation.
8. An OSCE, or objective structured clinical skills examination, will be given to all students on the last day of the clerkship.

Mid-Clerkship Feedback
The clerkship director will meet with each student for a brief, informal, feedback session around the mid-point of the rotation.

Evaluation Policy
Students are evaluated on a four-tier scale (Outstanding, Good, Satisfactory, Unsatisfactory) by both attendings and residents. Your fund of knowledge, data gathering ability, diagnostic problem-solving skills, communication skills (both oral and written,) attitude towards learning, relationship with patients, peers, residents, attendings, and staff, professionalism, and performance on written exam will all be taken into account when determining your final grade. These evaluations are compiled by the clerkship director.

You will be given a chance to evaluate the housestaff, attendings, and overall experience. You will also complete an entrance and exit questionnaire. This information is very helpful to improve the quality of the clerkship. Please do not hesitate to speak directly with the clerkship director with feedback or suggestions for improvement throughout the clerkship.

This five-week rotation is divided in 2-3 weeks on Obstetrics and 2-3 weeks of Gynecology and Gyn-Oncology.

This service is very much like any other surgical service. We depend on your help seeing patients, writing notes and participating in the operating room. Our goal is to expose you to common gynecologic procedures and the indications for them.

You round with the Gyn team every morning. The team will tell you the night before when to come in the next day. Initially, you will observe the residents seeing patients in the morning and eventually you will be assigned your own patients to follow and write notes on. Make sure you see patients that you were involved with the previous days.

After rounds, your responsibilities will be in the OR, clinic, or the ER. Retracting is not always a glamorous activity, but it is the best way to get close to the action, and is often crucial to the operation itself.

In the OR:

1. Be professional—whether the patient is awake or not.
2. Always perform the exam under anesthesia—this is the single greatest opportunity to learn the art of the pelvic exam.
3. Before each case, read about the procedure in a surgical atlas (TeLinde’s, or Wheeless’ Atlas of Pelvic Surgery is recommended.) Some portions are included in this orientation packet. Then, after the procedure, go back to the atlas to review.
4. Ask questions about the proper way to scrub and sterile technique. If you feel out of place, remember that you belong there. Just don’t touch anything blue unless you are sterile.
5. Appreciate the anatomy and ask questions when appropriate.
6. Be ready to field the occasional question yourself. Try to remember the patient’s history and other relevant facts.
7. Know why the patient is having the surgery – ex. why are we taking her ovaries out during the hysterectomy?
8. Ask one of us to teach you surgical knots, and practice—it would be a shame to miss an opportunity to participate in the OR if the moment arose.

If there is nothing going on in the OR, ER, or “floors,” go to the clinic and see patients with the residents who are seeing patients in their continuity clinic. This is the time when you will learn to do pelvic and speculum exams (PAP smears) so make sure that you spend some time in the clinic. There are always residents in the clinic and most afternoons there is someone there from your GYN team ( Mon- the 4^th year, Tues- booking clinic, Wed- 2^nd year, Thur- urogyn clinic, Fri- 3^rd year)

Thursdays: You must attend Dr. Neuwirth’s rounds at 8am on Thursday in the 10^th floor conference room.

Meet Dr. Keltz promptly at 9am in the OR. Stay in the OR until Dr. Keltz finishes his cases on Thursday. (He likes to teach medical students.) After he’s done in the OR, go to urogyn clinic.

Labor and delivery is a world like no other. In general, you want to learn what labor and its complications entail. You will be exposed to normal and abnormal labor. We also plan to familiarize you with the basics of ultrasound and fetal heart monitoring. You will learn to triage, admit, and assist on cesarean sections. Your best guide for these tasks is the intern. Shadow the intern for an example and turn to the chief for questions. Don’t lie down or sit down to eat while the rest of your team is working on the floor. We will make every effort for you to be involved in deliveries. However, remember that we have to take our residents’ education and the patient’s situation into account.

Every morning you will round with the OB team on postpartum and post-op patients. You should come in around 6am to begin rounding. Initially you will observe the residents seeing patients in the morning and eventually you will be assigned your own patients to follow. Try to see patients that you were involved with the previous days on L&D.

During the day you will be on the labor floor. Do not leave without telling the residents when you leave. If the residents don’t know where you are or have a sense that you are around on the labor floor, they will not find you for deliveries, etc. The residents will help you figure out what to do during the day depending on what is going on on the labor floor.

The day ends when the night team of residents comes in to relieve the day team. If you are on call, then you stay with the night team until the morning. In the morning, you round with the intern and go home after board sign out.

Click here for a full list of extensions and important phone numbers.

Administration
Oded Langer, MD, Chairman
Joseph T. Chambers, PhD, MD, Vice Chairman for Education
Lois E. Brustman, MD, Residency Program Director
Jacques Moritz, MD, Director of Medical Student Education
Barbara Deli, MD, Co-Director of Medical Student Education

Division of Obstetrics and Maternal-Fetal Medicine
Barak M. Rosenn, MD, Director
Lois E. Brustman, MD
Robert J. Soper, MD
Oded Langer, MD
Richard Jaffe, MD

Gynecologic Ultrasound and Fetal Evaluation Section, Division of MFM
Richard Jaffe, MD, Director

Institute for Genetics and Fetal Medicine
Mark I. Evans, MD, Director
Kwame Anyane-Yeboa, MD

Division of Urogynecology
Anne Hardart, MD
Lisa Dabney, MD

Division of Reproductive Endocrinology and Infertility
Martin Keltz, MD, Director
Daniel E. Stein, MD

Division of Gynecologic Oncology
Joseph T. Chambers, PhD, MD, Director
Lisa Anderson, MD
Kevin Holcomb, MD

Obstetrics and Gynecology Department, St. Luke’s Hospital
Edward Jew, MD, Director

Hysteroscopy Section, Division of Gynecology
Jacques Moritz, MD, Director
Robert M. Neuwirth, MD

Division of Gynecology (General Obstetrician/Gynecologists)