Gynecology

General Information

Gyn Clerkship Roles and Responsibilities

The Gyn Service covers both the HAC and ENC campuses. The Gyn Consult Resident #3030 covers both sides. The chief resident is responsible for distributing cases on both sides of campus.

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

  • East Newton Student:
    • Before starting the rotation, decide amongst yourselves which student will go to ENC.  This student will be at ENC for the entire rotation, and will be working primarily with the ENC Chief. When you are in clinic, one of your colleagues will cover the cases at ENC.
  • Harrison Avenue Campus students:
    • All other students will be with the HAC gyn team. Each of you have clinic some days (see your schedules). When the ENC student is in clinic one of you will be assigned to cases at East Newton .
  • “On Call student”:
    • Gyn call is until 10p all nights. The on call student will follow the Night gyn resident (who covers #3030). It is expected that the on call student will assist on any cases that start late in the afternoon or go past 5p.  Weekend call starts at 7:00a.  You are not expected to pre-round.
  • All Gyn students:
    • The following expectations apply to both the ENC student and the HAC students except for the rounding times, which are at the discretion of the ENC resident. 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. If you have greater than 4 patients ask a chief to help you decide who to continue to follow and who to pass to other students. An example of a Gyn note can be found under Course Documents – Useful Information. 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 by 6:15a, and be prepared to round with the Chief at 6:30a. At this time you will be expected to present your patients in a clear concise manner. An example of a Gyn presentation can be found on course info under Course Documents –Useful Information. On the weekends there are no floor rounds. The off-going team rounds on all the patients.
Sit-Down rounds 7:00a M-F; 8:00a weekends and holidays:
These are sit-down rounds at HAC with the Gyn Service attending. All inpatients are presented at these rounds. Students are expected to present the patients they are following.
Operating Room 8:30a M; 7:30a T, TH. F; 10:30a W:
The operating rooms on both sides of campus usually never 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 can write your name next to the case on the board. 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. Introduce yourself and let them know that you’ll be assisting in her case. 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.

You are expected to follow the patients that you scrub in on throughout their hospitalization. This includes doing a postop 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 chief resident is responsible for organizing rounds for the junior residents and medical students on gyn.On ENC the chief resident manages the patients and sees consults through the day, often from the OR or between cases. You are expected to participate in this process. The HAC Consult resident service is busier between floor work and consults. Generally one student each day should work with the Consult resident. You can determine who should work with the Consult resident based on clinic assignments and equitable OR distribution.

There are usually informal afternoon rounds with the Chief and/or the Attending, depending on how busy the OR is. However, you should check in on your patient in the afternoon to make sure that the plan developed that morning is carried out. You do not need to write another note in the afternoon.

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. On Wednesdays you should return from didactics in time to round on your patients and attend sign-outs.
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.

RESIDENT GYN TEAM
Fellow
BMC R3 and BMC R2
TUFTS R3
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.

Parking:
All students are instructed to park at the Verizon lot in areas #2 and #3 on 51 South Bedford Street

Computer Access:
Dr. Dick will give you a ticket number at orientation. Your first morning, call the computer help desk (she’ll give you the number) and ask for a sign-on and password for the Lahey Mainframe. The best thing to do is call while sitting at a computer on the floor (7 West or 6 West is where most of the Gyn patients are) and attempt to sign on while you’re on the phone with the help desk. There are inevitably glitches with this process, and if you have them on the line they can remotely connect to whatever computer you’re on and help make sure you get access. The passwords they’ll give you are 1) to sign onto Windows and 2) the Mainframe program. The Mainframe is where you check labs each day; it is an old school Dos program, so you don’t use a mouse for it. It has a tendency to crash if you hit the wrong button, and you often have to restart the program. One trick is when you hit Enter, use the Enter button on the far right of the keyboard, next to the number pad. For some reason the program likes to crash more when we use the normal Enter button.

Signing onto the Lahey Mainframe:
When you sign onto the mainframe, enter your logon name and password; if a blank screen shows up after you log on type “lcmc” and hit the right-hand enter button. This will take you to the main menu. Sometimes you try to log onto the Mainframe and the screen where you type your password doesn’t show up. This always happens on the computer in the residents’ room. For this situation, type this series of commands:
1) sign (enter)
2) hit the Pause/Break button it’s on the upper right line of the keyboard
3) cesn (enter)
4) the logon screen will appear-type your logon name and password
5) lcmc (enter)
This sounds like a joke, but it isn’t. Ask the residents. BMC spoils us! There is a piece of paper next to the residents’ computer with these same instructions on it.

Checking Labs:
When you get to the main menu, Type 74, enter, then 15, enter to get a list of all the Gyn inpatients. You can then select individual patients by typing the letter next to the patient’s name, then enter. Theoretically it should be self-explanatory from there. The easiest way to access labs that we’ve found is to select a patient, then hit 47, enter to select “results by date range” and type in the dates you’re interested in. The residents may have other tricks for getting this info. If the patient in question is not an inpatient hit 16 at the main menu for outpatient results. If you make a mistake when typing a date or any command, don’t try to use the delete button. This often crashes the program. Use the arrow buttons to move the cursor to what you want to delete and hit the spacebar to delete it. Again, this is not a joke! Knowing this in advance will save you time and decrease your level of frustration.

Pre-op H&Ps:
This is the main piece of paperwork that students take responsibility for and is greatly appreciated by the residents. The H&Ps are done several days in advance of the scheduled OR cases.

H&Ps are located in the first of a series of plastic wall mounted file organizers in the GYN residents’ office on 6 West. This is located on your right when you enter the office. There is a manila file folder marked “Blank H & Ps” and another manila file folder marked “H & Ps for tomorrow.”

Before each patient goes to the OR, the GYN team is responsible for completing an H&P and placing it in the patient chart on the day of surgery.

The Medical Students are responsible for filling out the following in the H&P:

  1. Date of Surgery
  2. HPI
  3. Allergies
  4. Current medications
  5. Family History – in regards to h/o breast, colon or gyn malignancy
  6. Social history – in regards to tobacco/etoh/drug history
  7. Assessment/Plan
  8. The medical students are responsible for completing a brief Physical Exam in the Pre-op holding area prior to the patient being taken to the OR (more about this below).

DAILY RESPONSIBILITIES:
Expect to arrive at Lahey between 6:00 – 6:15AM . You are responsible for pre-rounding on your patient and writing a progress note. 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.

On the reverse of the flow sheet are the 24-hour Ins and Outs, which are very nicely totaled for you in advance. Ask the RN or your resident where to find shift totals. 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 dry-erase white board where all the patients are listed with the attending’s name next to them. There will be a number next to the patient’s name which indicates which pre-op area the patient is in. 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. You should pretty much stick with the patient, at the pre-op desk or in the small office across from the Pre-Op main desk until it’s time to take the patient to the OR. Prior to surgery the patient must be seen by anesthesia, the OR nurses, the GYN resident and the GYN attending, so there is usually a lot of activity around the patient. At some point you should fill out the rest of the H&P form that you’ve prepared in advance.

The most important questions to review with the patient: review/confirm allergies and medications Fill out the physical exam with these categories:
General
CV
Resp
Abd
Pelvic exam: write “deferred to OR”
Ext: i.e. no LE edema/pain b/l

Sometimes the resident will take the H&P form from the folder in the office and do the PE themselves; that’s fine and resident-dependent, but you can offer to do this and they’re usually glad to let you. You are responsible for helping anesthesia bring the patient to the OR.

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, which makes the whole Lahey experience extremely pleasant. 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, fill out the Operative Note in the chart in the Progress Notes section, and help take your patient to the PACU. You can then add to the patient to the list in the residents’ office (it is always open on the computer). Sometimes the residents will do this before you have a chance to, but again it’s good to offer. 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!