UMMC Medical Student Family Planning Rotation (MS 3 or MS 4)

Welcome to the University of Maryland Family Planning Rotation for Medical Students.

We are excited to have you and please read the course orientation below.

Educational Purpose:

Provide exposure to all aspects of family planning including contraception and pregnancy termination

Rotation Director:

Dr. Jessica Lee

Ryan Family Planning Residency Program Director

University of Maryland School of Medicine

jklee@som.umaryland.edu

Length of Rotation:  4 weeks

****I recommend you watch this video before the start of the rotation, it will help you understand our D&C procedures:

https://vimeo.com/album/3395660/video/127882643
Passcode: outpatientEPL2015 

Below are some additional readings that will set you up for success on this rotation, please read prior to rotation start of in the first half of your first week:

1. Medical evaluation and management Ch 7
2. First trimester aspiration abortion Ch 10
3. Dilation and evacuation Ch 11
4. Values clarification –  I also encourage you to do this values clarification exercise (attached) as this is an abortion elective and I want you to have thought about some of these heavier questions before you begin.
5. An Overview of Maryland Abortion Law – Maryland Abortion and Reproductive Clinical Health Training Program

Extra Reading regarding later abortion that may help you process some of our later abortion care:

1. Thinking about and Processing Later Abortion: Second Trimester Abortion Provision: Breaking the Silence and Changing the Discourse

See below for expectations and objectives for your rotation:

Supervision: 

Medical students work directly with residents, nurse practitioners, and attending physicians in the family planning clinic(s). You will be evalauted by these supervisors.

Educational Objectives:

Patient Care & Medical Knowledge – Abortion

1. Perform a thorough Ob/Gyn history, including menstrual, obstetric, gynecologic, contraceptive and sexual history. Elicit any medical history that may complicate pregnancy or abortion.
2. Counsel patients regarding all options for an unplanned pregnancy
3. Understand indications for 1^st and 2^nd trimester termination of pregnancy.
4. Gain familiarity with medical abortion, including contraindications, medications used, and postoperative management.
5. Gain familiarity with use of conscious sedation in an outpatient setting.
6. Gain familiarity with post-abortion contraceptive options, including intrauterine contraception and subdermal implants.

Patient Care & Medical Knowledge – Contraception

1. Describe the mechanisms of action of hormonal and non-hormonal contraception.
2. Understand the difference between efficacy and effectiveness.
3. Understand and describe the advantages, disadvantages, contraindications, failure rates, complications and appropriate follow-up associated with the following methods of contraception:
   1. Surgical sterilization (trans-abdominal and transcervical)
   2. Combined-oral contraception
   3. Progestin-only oral contraception
   4. Transdermal contraception
   5. Vaginal contraception
   6. Injectable contraception
   7. Intrauterine contraceptives
   8. Subdermal implants
   9. Barrier methods
   10. Natural family planning
4. Appropriately counsel low-risk patients in contraceptive choices.

Interpersonal and Communication skills

1. Demonstrate the ability to create and maintain a therapeutic relationship with patients and families.
2. Communicate effectively and respectfully with other members of the health care team.

Professionalism

1. Demonstrate respect, compassion, integrity, honesty.
2. Teach/role model responsible behavior.
3. Exhibit total commitment to self-assessment.
4. Acknowledge errors.

Practice-based learning improvement

1. Develop and maintain a willingness to learn from errors.
2. Locate, appraise and assimilate evidence from scientific studies related to their patients’ health problems.
3. Use technology to manage information for patient care and self-improvement.
4. Be evaluated by residents, nurse practitioners, and attendings

System-based practice

1. Anticipate problems patients/care givers may face in negotiating the health care system and advocate on the patient’s behalf.
2. Identify and work with other health care professionals and organizations that may assist in a patient’s care.

Medical Student Responsibilities:

1. Complete assigned Innovating Education online curriculum (first 3 weeks, ideally each week module should be done by Wednesday of that week).
2. Complete oral presentation (usually presented on last Wednesday of rotation, 10-15 minutes in length on a contraception or abortion topic, you can check with Dr. Lee, Gracie, or any FP attending on your topic choice)

The team consists of medical student, second or third year resident, attending, and nurse practitioner.

Daily Schedule:

Monday

AM:       work-ups UMRH

PM:       work-ups UMRH

Tuesday

AM:       procedures UMRH

PM:        procedures UMRH

Wednesday

AM:       work-ups UMRH; formal didactics with FP attending

PM:       work-ups UMRH

Thursday

AM:       7:30 GYN conference , then procedures UMRH

PM:        procedures UMRH

Friday

AM:       Protected didactic time with Ob/Gyn residents if applicable

PM:       Research/Reading time, catch up on curriculum

Evaluation:

1. Based on direct observation of clinical care.

(You will be evaluated by the resident you work with, nurse practitioner, AND attendings).

2. Oral presentation
3. Global evaluation – Assessing six competencies: Patient Care; Medical Knowledge; Practice-based Learning and Improvement; Interpersonal and Communication Skills; Professionalism; Systems-based Practice. Completed by attending physicians based on personal contact.

Extra advice from an outstanding prior student:

• Arrival time and place: Clinic is on 7th floor of the North hospital. You can take the central elevators and make a left (away from the MASTRI center) or you can take the north elevators and make a right (the signs say women’s health/reproductive health). You will need to be buzzed in.
• Fridays the clinic is not open, there may be an OR case if one was added on or there might be a learning opportunity, but you’ll be told if there is a Friday thing to do.
• Attire: Scrubs are usually worn by everyone, even on clinic days there might be lam placements/pelvic exams so scrubs are acceptable.
• Patient List: the epic context is OB/GYN CENTER UMH and you can see scheduled patients by going to the schedule and clicking on the OB/GYN CENTER UMH drop down (don’t select any attendings)
• Advice: Know your patients, be ready to present any of the patients on procedure days (there usually are not that many and you will usually have met them beforehand use the templates below to help you). Enjoy this rotation! You get to do SO much and be super involved with the care of these patients. Offer to hold patient’s hand, learn to ultrasound, get good at pelvic exams and cervical blocks!