Gynecology

General Information

Gyn Clerkship Roles and Responsibilities

If you are scheduled to be in the OR, you can wear scrubs all day. If you have clinic, you will need to have clothes as well. Scrubs should not be worn outside of the hospital.

The students are divided between the OR and 3030 (consult pager)

Tumor Board and Journal Club alternate Mondays at 7:30a. (All Students attend)

Friday at noon there is a weekly Gyn Conference in the Labor and Delivery Conference Room. Pizza is provided.

Clerkship student Roles on Gyn service

Night Shift student”:
- If you’re on night shift you are expected to work with the on-call resident (who covers #3030) with anything that’s going on whether a consult or regarding patients on the floor. It is expected that the night shift student will assist on any cases that start late in the afternoon or go past 5p. Be sure to let the students know the following morning if something happened to their patients overnight. For all admissions during your call, you are expected to pre-round on them the following morning.

All Gyn students:
- When you are assigned to clinic, you will round with the team before clinic. When you are not in clinic you will be assigned to cases etc per the HAC Chief.

Clerkship Student Responsibilities on Gyn service:

Floor rounds 6:30a M-F:

Students are expected to pre-round on all patients in whose surgeries you were involved in as well as any patients admitted on call or while working with the Consult resident. Most teams assign an early person that rotates daily who comes in to pick up any overnight admissions.

All your notes need to be co-signed by a resident. If one of the residents has already written a note, please do not write another one after him/her. It is expected that you will complete all your notes and place them in the chart by 6:15a, and be prepared to round with the Chief at 6:30am. This time frequently changes depending on the number of patients and will be determined the night before by the team. At this time you will be expected to present your patients in a clear, concise manner. On the weekends there is no pre-rounding. You will see your patients with the resident.

You DO NOT round with the GYN team on Wednesdays. Go directly to your didactics at 7:30AM.

Sit-Down rounds 7:00am

These are sit-down rounds with the Gyn Service attending in the GYN office. All inpatients are presented at these rounds. Students are expected to present the patients they are following.

Operating Room

The operating rooms rarely run more than three concurrent rooms. Schedules are published the week before and updated the day before. It is expected that all surgical cases are covered by at least one student. HAC and ENC cases are written on the GYN office board the week before. You and your colleagues are responsible for dividing up the cases and writing your names on the board next to the cases. If there are enough cases during your rotation, you should each scrub into at least one major (ie TAH, myomectomy, TVH, etc) and a minor case (ie hysteroscopy, Lap TL, etc).

Prior to going into the case, you are expected to know the patient’s medical and surgical history, why she is having the procedure, as well as the basic GYN anatomy pertinent to the case. Most of the H&Ps are on Logician. If they aren’t, the team has usually obtained a hard copy which you can review. You are expected to meet the patients before going into the OR in the pre-op holding area. Be in Pre-op holding 15 minutes before the case to do this. Introduce yourself and let them know that you’ll be assisting in her case AND THAT YOU WILL BE PERFORMING A PELVIC EXAM UNDER ANESTHESIA, remember they signed a consent informing them of this fact already. You are also expected to meet the attending before the case. Again introduce yourself and explain your role. Be prepared to answer questions in the OR by the Attending or Resident, and be prepared to ask questions during the case. READ ABOUT THE PATIENT’S PROBLEM AND SURGERY THE NIGHT BEFORE.

You are expected to follow the patients that you scrub in on throughout their hospitalization. This includes doing a post-op check 4-6h after the case is done, and following up on any labs/tests that are ordered. You are expected to sign out to the gyn student on call any follow-up that will need to be done after evening sign-out.

Floor work and Consults:

The HAC Consult resident service is busier between floor work and consults. Generally one student each day should work with the Consult resident.

Evening sign-outs 5:30p M-F:

In the evening there are informal sign-outs in the Gyn office. The ENC team will often call in their sign-out. However, you should check in on your patient in the afternoon and record their vitals and make sure that the plan developed that morning is carried out. You do not need to write another note in the afternoon. After didactics on Wednesdays, it is your responsibility to update yourself on the day’s events pertinent to your patient(s). You may do this by checking computer labs, orders, and written notes in the chart. Please ask the #3030 resident for sign-out if you have remaining questions.

Presentations:

You are expected to give a short 5-minute presentation (PowerPoint and handouts are not necessary) on a Gyn topic during your rotation. It can be a topic in which you are interested, or something that you saw during your rotation – as long as it’s Gyn related. These are often in the afternoon as the OR winds down.

Down time:

There’s usually a lot of down time on the GYN service, so catch up on all the reading & studying for the exam!! Most students hang out at the on-call rooms in Dowling call rooms (where you can leave your stuff in the morning & throughout the day) or in the Medical School library. If you are not present you are expected to let the residents know where you will be and how to contact you (pager) should anything unexpected arise.

Lahey Students:

Lahey students will be primarily based at Lahey during their Gyn rotation. You will have a combined orientation at the start of the block. You will be at BMC for your continuity clinic, and some other assigned clinics. There is no night call, but you are expected to rotate who stays if a case goes past 5p. Most of you are assigned to come in for weekend rounds with the residents.

This is a brief introduction to your GYN Rotation at Lahey Clinic.
Dress:
You will be in the OR at Lahey every day. You should wear scrubs every day of the week. Wear your white coat over your scrubs if you are not in the Pre-Op Holding, the OR, or PACU. In other words, if you are not doing something associated with the OR or if you are up on the floors, you should wear your white coat. On weekends, some of the residents wear scrubs or professional attire, but all the Attendings wear professional attire. You need to wear your white coat and professional attire for weekend rounds.

DAILY RESPONSIBILITIES:

Expect to arrive at Lahey between 5-5:30am. You are responsible for pre-rounding on your patient(s) and writing a progress note (allocate about 30 min per patient). Your notes should be finished by 6:30AM. You can ask your resident the day before if you should take down the patient’s dressing or remove any packing during pre-rounds. Most patients have dressings removed on POD #2. The nurses and or medical assistants are very consistent about doing vitals before pre-rounds. Lahey has a different type of vitals flow sheet than BMC which can be confusing the first day. The vitals chart is located in a plastic file organizer mounted outside the door of each patient’s room. The temperatures are marked on a graph with little dots, and the BPs are also graphed, but the absolute values are recorded next to each point on the graph.

Do not use the 24h ins and outs on the reverse of the flow sheet! There is a page further along in the binder that gives you 8 hour break downs. Look for today’s date to find the shift totals. Flip back a couple more pages to the day prior and add the totals from shifts #2 and #3 to today’s # to get a 24h value. If the patient has an NG tube, etc calculate those values separately. For pre-rounds, focus on the appropriate post-surgical questions: pain control, flatus, ambulation, nausea, vomiting, chest pain, SOB. Perform a focused surgical physical exam and comment on the wound in the note.

After rounding, you should proceed to the OR. You should know the OR schedule and have already assigned surgeries (the MS3s divide the cases ahead of time). Ask your resident, if they want you to bring the day’s H&Ps down to the OR and then go down to the Pre-Op area on 2 WEST to meet your patient.

When you get to the pre-op holding area, you’ll see a large flat screen monitor where your patient’s name will be listed with which pre-op area the patient is in (eg. “AS11”). Your job is to:

1) Introduce yourself to the patient and let them know that you are a member of the GYN team and will be observing their surgery today.

2) Review/Confirm with the patient:

Allergies and medications. Complete a focused PE and complete PE section on H&P if appropriate.

3) Complete the DISCHARGE paperwork (page 1) for discharge even if the patient is expected to stay for multiple days Do this in the post op area after the case is completed. There is an example discharge note in the 6W cubby room that you can make a copy of at the nurses station.

4) Stay with the patient until it’s time to take the patient to the OR. You are responsible for taking the patient to OR with the anesthesia team and alerting your resident when you are rolling back.

5) Help your resident complete the H&P if an updated version is needed

In the OR, introduce yourself to the scrub nurse and the circulator. Write your name and MS3 on the marker board. (Be sure to do this before they have to ask you). Ask them if you can give them your gloves and get them from the closet. The OR staff at Lahey are particularly nice to med students. From there just do whatever you can to help get the patient positioned and ready; the residents will give you direction. Try to ask to put in the Foley a few times, although sometimes the nurses do this speedily before you can offer. When the patient is positioned the attending and resident will do a pelvic exam under anesthesia. Be ready with gloves on so you can jump in and do the exam after them and they will give you pointers on your pelvic exam which is very helpful for future clinic work.

After the surgery help take your patient to the PACU. At this point you should either go meet your next patient and get ready for the next surgery or go post-op check your earlier patients.

ALWAYS REMEMBER – ask your residents for help or if you have any questions. They want you to have a good experience at Lahey!