Medical Student Education: Phase 3

Kathy Stewart, MD, MS
Professor
IAI Director, Maternal-Fetal Medicine

Course Location

UnityPoint Health-Meriter Hospital

Course Description

The Maternal-Fetal Medicine Inpatient Acting Internship will provide medical students with an in-depth exposure to the inpatient care of high-risk obstetrical patients. The student will work under the direct supervision of the senior and junior resident on service as well as the maternal-fetal medicine fellows and faculty. This rotation will provide the student with the opportunity to function at the intern level and play an active role in the antepartum, intrapartum and postpartum care of high-risk obstetrical patients. Additionally, clinical opportunities in the genetic counseling unit, prenatal diagnosis/ultrasound unit and diabetes clinic can be added. 

Learning Activities

• Learning will be facilitated via direct patient care activities of high risk obstetrical patient presenting to the Perinatal Clinic for consultation and for admission, as well as patients presenting to triage, labor and delivery and the antepartum floor for inpatient care.
  
• Working in conjunction with the OB Chief, and the PGY-2, attend scheduled deliveries and other operative cases on UW High Risk service patients.
  
• Participate in multidisciplinary case management of complicated maternal and fetal patients.
  
• Select and interpret appropriate diagnostic tests and propose a treatment plan for patients with common medical complications of pregnancy such as chronic hypertension, pregestational diabetes, antiphospholipid syndrome, and advanced maternal age.
  
• Select and interpret appropriate diagnostic tests and propose a treatment plan for patients with common obstetric complications such as intrauterine growth restriction, preterm contractions, chronic hypertension and preterm premature rupture of membranes.
  
• Attend and lead history portion of Maternal-Fetal Medicine consultations after reviewing the patient’s chart and assessing pertinent literature.
  
• Participate in multidisciplinary case management conferences of complex maternal-fetal medicine patients.
  
• Observe the antenatal diagnosis and management of fetuses with suspected aneuploidy and congenital anomalies.
  
• Participate in and observe fetal antenatal testing such as amniotic fluid assessment, basic ultrasound, biophysical profile and fetal heart rate monitoring.
  
• Participate in the delivery of UW high risk service patients, including completion of documentation in the medical record.
  
• Write labor progress notes as well as detailed preoperative assessments with consideration given to both the fetal and maternal patients.
  
• Perform appropriate pre-rounding assessment of patients including assessments of labs, vital signs and fetal wellbeing.
  
• Present patients to healthcare team in a well-organized manner during morning board report, highlighting pertinent positives and negatives. Include interim overnight care.
  
• Demonstrate advancement in basic clinical and surgical skills, including knot tying and simple suturing.

Maternal-Fetal Medicine IAI Team

The clinical team on the Maternal-Fetal Medicine Inpatient Acting Internship may include one Phase 2 student, one PGY-2 resident, one MFM fellow, and one MFM attending physician. Additionally, an APP may be present for part of the week.

Margaret Wilkes, MD
Assistant Professor
IAI Director, Urogynecology and Reconstructive Pelvic Surgery

Welcome to Urogynecology & Reconstructive Pelvic Surgery (URPS) at the University of Wisconsin! URPS is a subspecialty within Obstetrics and Gynecology dedicated to the evaluation and management of complex pelvic floor disorders, including but not limited to: pelvic organ prolapse; lower urinary tract dysfunction (such as urinary incontinence and bladder pain syndrome); fecal incontinence; fistulas; and pelvic pain. Our team offers a comprehensive range of nonsurgical and surgical treatment options to patients throughout the region. Our division's faculty physicians and advanced practice providers are committed to improving patients’ quality of life by addressing often distressing symptoms through individualized, evidence-based care. We look forward to introducing you to this specialty and the important role it plays in helping patients restore function and improve their well-being.

Course Location

UW Health Eastpark Medical Center

UnityPoint Health-Meriter Hospital

UW Health East Madison Hospital

Course Description

This acting internship will provide medical students with an in-depth exposure to Urogynecology & Reconstructive Pelvic Surgery (URPS). The student will work under the direct supervision of faculty members, fellows, and a senior resident. This rotation will provide the student with the opportunity to function at the intern level and play an active role in the pre-operative, intra-operative, and postoperative management of complex urogynecologic surgical patients.  

Learning Activities

Learning will be facilitated via direct patient care activities of gynecologic patients presenting to the Urogynecology Clinic for consultation and peri-operative planning, inpatient and outpatient peri-operative care, and hospital and ED consultations.

• Perform new patient evaluations and preoperative histories and physical examinations, and document findings accurately and appropriately in the medical record.
• Evaluate patients requiring consultation for pelvic floor disorders, formulate a differential diagnosis, develop an appropriate diagnostic and therapeutic plan, and present clinical assessments and recommendations to the healthcare team.
• Conduct comprehensive preoperative assessments, incorporating individualized risk stratification and consideration of the needs of special patient populations, including geriatric adults and patients with significant medical comorbidities.
• Present one to two patients at the weekly case conference, incorporating an evidence-based discussion of a relevant clinical question or learning point related to each case.
• Participate in the preoperative evaluation and perioperative management of surgical patients and actively assist in urogynecologic and reconstructive pelvic surgery (URPS) procedures, including vaginal and laparoscopic surgeries, under appropriate supervision. Students are expected to prepare ahead of time for all attending surgeries, including being familiar with the patient’s history and presentation, understanding procedural indications, and considering most common complications. 
• Demonstrate progressive proficiency in foundational surgical skills, including knot tying, simple suturing, and assisting with surgical procedures, with appropriate supervision and feedback.
• Evaluate postoperative patients for common postoperative concerns and complications, develop appropriate management plans, and present findings and recommendations to the healthcare team.
• Participate in inpatient rounds and ongoing management of postoperative patients requiring hospitalization or continued monitoring.
• Interpret patient vital signs, laboratory results, and other relevant clinical data to assess clinical status, identify abnormalities, and guide management decisions.
• Present patients to the healthcare team in a concise, organized manner, emphasizing pertinent positive and negative findings, clinical reasoning, and proposed diagnostic and therapeutic plans.
• Compose inpatient progress notes that accurately reflect interval events, clinical assessments and management plans, and collaborate with the healthcare team to coordinate patient care.
• In collaboration with the healthcare team, assess patients’ readiness for discharge and identify indications for transition to an alternative level of care, including intensive care, inpatient rehabilitation, or outpatient rehabilitation.
• Respond promptly to nursing calls regarding acute postoperative concerns in patients on the URPS service, perform an initial assessment, recognize findings requiring urgent intervention, and communicate management recommendations to the supervising resident or attending physician.

URPS IAI Clinical Team

The clinical team on the Urogynecology and Reconstructive Pelvic Surgery Inpatient Acting Internship team will include one PGY-3 resident, one URPS fellow, and one URPS attending physician.

Laura Huffman, MD
Assistant Professor
IAI Director, Gynecologic Oncology

Welcome to the Gynecologic Oncology Inpatient Acting Internship. This rotation is designed to provide medical students with an immersive experience in the multidisciplinary care of patients with gynecologic malignancies while preparing students for the responsibilities of an Obstetrics and Gynecology intern. As an acting intern, you will become an integral member of the gynecologic oncology team and participate actively in the evaluation and management of hospitalized patients, perioperative care, and complex surgical cases under the supervision of residents, fellows, and faculty. Through direct patient care, operating room experience, tumor board participation, team-based didactics, and structured laparoscopic skills training, you will have opportunities to strengthen your clinical reasoning, communication, surgical skills, and ability to function effectively within a multidisciplinary team. We encourage you to approach the rotation with curiosity, initiative, and increasing ownership of your patients while taking advantage of the many opportunities for teaching, feedback, and professional growth.

Course Location

UW Health University Hospital

Course Description

The Gynecologic Oncology Inpatient Acting Internship provides medical students with an immersive experience in the comprehensive inpatient and surgical care of patients with gynecologic malignancies. Working under the direct supervision of residents, gynecologic oncology fellows, and faculty, students will function as integral members of the inpatient care team with responsibilities designed to approximate those of an Obstetrics and Gynecology intern. Students will develop increasing ownership of their patients and actively participate in clinical decision-making, multidisciplinary care, perioperative management, and the surgical care of patients with both common and complex gynecologic cancers.

Learning Activities

Learning is centered on active participation in the clinical care of gynecologic oncology patients across the emergency department, inpatient setting, and operating room. The primary responsibility of the Phase 3 student is the evaluation and management of patients admitted to the Gynecologic Oncology service. Students will participate in daily rounds, develop and communicate patient care plans, follow patients throughout their hospitalization, and assist with coordination of multidisciplinary care.

Students will also participate in the surgical care of gynecologic oncology patients, including preoperative evaluation, operative procedures, and postoperative management. This experience provides opportunities to develop familiarity with pelvic and abdominal anatomy, surgical decision-making, perioperative care, and fundamental operative skills.

Additional educational activities include weekly team didactics, Gynecologic Oncology Tumor Board, and journal club when scheduled during the rotation. Students will also complete a structured laparoscopic skills curriculum using a laparoscopic trainer. The curriculum focuses on mastery of three assigned technical skills selected to build foundational abilities important for Obstetrics and Gynecology residency and future surgical training.

Gynecologic Oncology IAI Clinical Team

The Gynecologic Oncology Inpatient Acting Internship is a multidisciplinary, teamb-based experience. The inpatient clinical team typically includes three ob-gyn residents (PGY-1, PGY-2 and PGY-3), one Gynecologic Oncology fellow, inpatient advanced practice providers (APPs), and one Gynecologic Oncology attending physician. The acting intern works closely with each member of the team and is expected to participate actively in patient care, communication, and clinical decision-making appropriate to their level of training.

Ryan Luellwitz, DO
Associate Professor
IAI Director, Obstetric Hospitalist

Course Location

UnityPoint Health-Meriter Hospital

Course Description

The Obstetrics Hospitalist Inpatient Acting Internship will provide students with an in-depth exposure to inpatient care of patients on Labor and Delivery. The student will work under the direct supervision of the Obstetrics Hospitalist whose primary role is the general medical care of hospitalized patients. The student will help manage laboring patients, see patients in labor and delivery, triage, and assist with cesarean sections. They will round on all patients for whom they were involved in care for once they are post-partum. Additionally, they will function as the residents do at night and assist with cross coverage of inpatient gynecology patients as well as see patients who arrive in the emergency department with obstetric or gynecologic concerns. They may assist in the operating room if the patients who present to the emergency room require immediate surgery.

Learning Activities

Obstetrics

• Describe the 3 stages of labor and be able to diagnosis protracted and arrested labor.
  
• Describe pain management strategies/options during labor.
  
• Describe indications and contraindications to labor induction agents (e.g. misoprostol, oxytocin, cervidil, intrauterine balloon).
  
• Describe the risks and benefits and contraindications for a trial of labor after cesarean section.
  
• Describe indications for cesarean section.
  
• Describe basic anatomy and surgical steps of a cesarean section. 
  
• Describe the various skin incisions that can be used to perform a cesarean section and describe clinical scenarios for which each may be used.
  
• Describe types of operative vaginal delivery as well as indications/contraindications for operative vaginal delivery.
  
• Describe the anatomy and surgical steps of vaginal laceration.
  
• Generate a differential diagnosis, evaluation and management strategy for common obstetrical triage complaints (abdominal pain, dysuria, contractions, third trimester vaginal bleeding, etc.)
  
• Demonstrate an ability to care for patients in the immediate postpartum period after vaginal delivery or cesarean section.
  
• Engage Phase 2 medical students in patient management plans, decision making regarding tests, orders, and procedures, and review of current literature.
  

 Gynecology

• Develop a differential diagnosis for vaginal bleeding and abdominal pain in the first trimester. 
  
• Perform a physical exam to assess for acute abdomen. 
  
• List risk factors for ectopic pregnancy.
  
• Discuss diagnostic protocols for ectopic pregnancy.
  
• Describe treatment options for patients with ectopic pregnancy.
  
• Develop a differential diagnosis for first trimester vaginal bleeding.
  
• Differentiate the types of spontaneous abortion (missed, complete, incomplete, threatened, septic).
  
• List the causes of spontaneous abortion.
  
• List the complications of spontaneous abortion.
  
• Discuss treatments options for spontaneous abortion.
  
• Describe the pathophysiology of salpingitis and pelvic inflammatory disease.
  
• Describe the evaluation, diagnostic criteria, and initial management of salpingitis/pelvic inflammatory disease.
  
• Identify possible long-term sequelae of salpingitis/pelvic inflammatory disease.
  
• Describe the initial management of a patient with an adnexal mass
  
• Describe the evaluation, diagnostic criteria and initial management of ovarian torsion.
  

Obstetric Hospitalist IAI Clinical Team

The clinical team on the Obstetric Hospitalist Inpatient Acting Internship will include three residents (PGY-1, PGY-2 and PGY-3 or 4), and one Obstetric Hospitalist attending physician.