Welcome to the Gynecology Rotation
Welcome to your rotation with an intense focus on topics in Gynecology! During this rotation, you will learn about and care for patients in a variety of clinical and community settings. It is expected that you will arrive at those locations well-read and prepared to contribute to the care of patients in that practice setting. All rotations which include additional time for gynecology procedures must be approved in advance by Michelle Zamudio or Dr Montiel Rosenthal. Please confirm prior to beginning the elective that have you have obtained all necessary approvals. Required readings and references are available on the Residency website. These readings are strongly encouraged and will prepare you for your experiences in the clinical setting.
This rotation is designed to address 12 areas of content focus in the care of women. Health promotion and management of common problems are addressed. Objectives are constructed to meet the learning needs of Family Medicine resident physicians and meet RRC requirements. You must forward to M. Zamudio 2 self-directed learning objectives before completing the first week. Identification of community resources is woven throughout the rotation. You must also be prepared to present a 25 minute case study at the next OB M&M. (Odd numbered months) See M. Zamudio, CNM or Dr Montiel Rosenthal for details. Ideally, your case study presentation will assist in meeting your self-directed learning objectives.
Lead faculty for this rotation are available and happy to assist as you engage in this dynamic course of study. An end-of-rotation evaluation will be reviewed and all recommendations for future changes are taken very seriously. We hope that you find this rotation to be insightful!
The best way to get feedback is to ask for it! It is helpful to your attendings for you to bring the feedback form (pulled up on your phone/tablet or printed out). Do this on 1 of the last days of the rotation. The link can be found here.
Helpful Numbers:
Dr. Molley Carey 513-382-2247
Michelle Zamudio, CNM 513-225-1709 / mjzmidwife1@aol.com
Jessie Betsch, CNM 859-802-8174
Jackie Martin, DPN 513-535-1815
Dr Bruce Allen, OB/GYN 513-871-0290 ( Lisa is office manager)
Dr David Barrere 513-784-1201
Dr Aparna Shah 513-585-3474
Schedule
Colpo Clinic
Getting there:
The clinic has moved! It is now located at the Barrett Center, 3rd Floor. The building is in front of the main UCMC entrance. (Updated 8/16/19)
Epic:
Context: UH OBGYN CENTER HOX
Select “Community Health Dysplasia” to see the schedule for the day
Ask the OBGYN residents to share with you the dot phrases for the note and consent form.
General Information
Prior to your first day, be sure to review the colposcopy PowerPoint.
On your first day, they should share a prep sheet with you that has all the patients info for that day in clinic and questions to ask.
The staff will room the patients and when they’re ready to be seen, a white paper will be placed on the table and you need to write your name on the back of the sheet to “claim” that patient.
Review the patient chart
Prior pap smears (check the ASCCP guidelines and make sure the patient actually needs a Colpo!)
Prior procedures (Colpo, LEEP, etc)
Fill out the consent form for Colpo and discuss the procedure with the patient. Sign the consent
Get a little more info from the patient
Confirm their last pap and prior procedures
Ask about current birth control method
Ask about smoking – if currently smoking counsel them on why quitting may help them clear the HPV virus and prevent cervical changes
Counsel the patient on each step of the procedure and what to expect during and after the procedure
Ex: Monsel’s will go in looking like peanut butter but comes out looking like coffee grounds. This is normal. You will have spotting for a few days. Nothing in the vagina until the spotting has stopped. You’ll get a call with results in the next 2 weeks. Etc.
Order a urine pregnancy test if any chance they may be pregnant (anyone who hasn’t had tubal, basically) – the order is LAB3468. They collect urine on everyone when they arrive so you don't have to ask for it again. Note: Most of the time the order is already completed and you do not need to add it.
Go present the patient to the attending
Brief, pap history, why guideline says they need colpo, prior procedures
When the urine pregnancy results come back negative, you can get started
Colpo:
Ask your MA to join you to assist
Use speculum to get cervix into view
Swab with vinegar
Observe with scope using white light and green light, but also change the magnitude to look at things closer.
Determine which areas you’d like to biopsy then ask the MA to get the attending to double check
Take your biopsies (helpful hint, get the low ones first as gravity will cause blood to obscure your view if you pick a top one first)
Do the endocervical sampling
Stop bleeding with Monsel’s
Remove speculum and give patient a pad
Patient can get dressed at this time but stays in the room
Document the visit in a progress note (use the template for Colposcopy and add any information you gathered from your interview).
Place the surgical path order. (NOTE: Most attendings want to do this themselves so the results come directly to their inbasket – so just ask them ahead of time)
Go to orders
Search “surg path”
Pager # - ask attending what they want put in
Choose University hospital
Put your name in provider name
Choose “routine/permanent”
Put the diagnosis in clinical hx (ex: ASCUS +HPV)
Document your biopsy sites under “specimens submitted” in the order your took them as separate lines (ex: 6 o’clock cervical biopsy, *new line*, endocervical biopsy)
Enter the date and time
Put your name as person completing requisition
Choose “sidedness does not apply”
When you are done, take the white paper you wrote your name on the back and mark what you did (ex 1 bx at 4 o’clock + ECC) and there’s a specific nurse who collects that and enters it all in.
Ask your attending if you want to do LEEPs or other procedures how you should go about that.
Topic Areas
Prior to the start of your month, it is strongly recommended you review the normal physiology of the menstrual cycle.
Abnormal Uterine Bleeding
Fertility and Fertility Disorders
Sexually Transmitted Infections and Vaginitis
STI Diagnosis and Management Update (Handout from Michelle's Noon Conference)
Pelvic Floor Dysfunction
Menopause
Breast Disorders
Pelvic Pain
Sexual Dysfunction
Adnexal Masses
Preventive Health Screening
Cervical Dysplasia
PCOS
Contraceptive Care
Management of Unplanned Pregnancy
Vulnerable Populations