MDP 30408 Obstetrics and Gynaecology Student Guide Book

INTRODUCTION

We are pleased that you will be with us for 8 weeks

of Obstetrics and Gynaecology posting.
Female reproductive health is an important compo-
nent of medical education and you need to have a basic
knowledge and skills pertinent to care of a female patients
as a medical student.
We will try our best to fulfil your needs during post-
ing and please do not hesitate to contact us if there is any
query and we will welcome your feedbacks and suggestions
at end of posting.
We hope you will enjoy your stay during posting.

Posting Coordinators

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MDP 30408 Obstetrics and Gynaecology Student Guide Book

Dean of the faculty Professor Dr.Hj Ahmad Hata Rasit

Deputy Dean Professor Dr.Lela Hj Suut

Post graduate and Research

Deputy Dean Professor Dr.Hj Kamarudin Kana

Academic and Undergraduate
Deputy Dean Professor Dr. Mohammad Zulkarnaen bin Ahmad
Development and Clinical Services Narihan
Phase II coordinator Dr Nariman Singmamae

Head of the department Dr. Mardiana Binti Kipli

Posting coordinator Dr.Yee Yee Kyaing

Deputy Posting coordinator Dr.Mi Mi Khaing

CONSULTANTS/ LECTURERS (SARAWAK GENERAL HOSPITAL)

1 Professor Dr.Haris Njoo Suharjono
2 Dr.Rafaie Amin
3 Dr.Sim Wee Wee
4 Dr.Christine Lee Mui Fong
5 Dr.Gerald Teh Beng Hock
6 Dr.Edawati Dahrawi Edrus

LECTURERS (UNIMAS)
1 Professor Dr.Awi Anak Idi
2 Associate Professor Dr.Soe Lwin
3 Dr.Mardiana Binti Kipli
4 Dr.Yee Yee Kyaing
5 Dr.Myat San Yi
6 Dr.Thidar Soe
7 Dr.Mi Mi Khaing
8 Dr. Andy Bong Cheong Shin - Trainee
9 Dr. Sharifah Nor Fatimah bt Wan Mohamad Su'ut - Trainee
10 Dr.Abigail Rembui Ak Jerip - Trainee

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MDP 30408 Obstetrics and Gynaecology Student Guide Book

A. OBJECTIVES

General Objectives
At the end of clinical posting the students should improve in working knowledge on
history taking, physical examination and principles of management regarding:
1. normal pregnancy, normal labour and normal puerperium
2. abnormal pregnancy, abnormal labour and abnormal puerperium
3. common gynaecological problems.

Specific Objectives
Knowledge
At the end of the clinical posting the students should improve in:
1. apply basic sciences to clinical practice
2. demonstrate knowledge of underlying patho-physiology in obstetrics and gynae-
cology
3. define common clinical conditions (obstetrics and gynaecology)
4. interpret clinical symptoms and signs
5. interpret relevant investigation results
6. establish differential diagnoses
7. plan management and
8. assess outcome

Attitude
At the end of the clinical posting the students should have the attitude of:
1. caring for patients in conformity with medical ethics
2. respecting the customs and religion of the patient and community
3. respecting women's place in a family and society and the importance of the social
aspect of obstetrics and gynaecology
4. being vigilant throughout the course of pregnancy and labour
5. as pregnancy though a physiological process can turn pathological at any stage and
6. good obstetric care is preventive gynaecology
7. adopting the habit of continuing self education and scientific investigations.

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MDP 30408 Obstetrics and Gynaecology Student Guide Book

Skill
At the end of the clinical posting the students should be able to develop:
1. communication skill by acquiring the ability of taking proper obstetric and gynae-
cological history
2. clinical skill by performing physical examination systematically
3. managing normal pregnancy and labour (witness 10 cases and conduct 1 case)
4. recognizing abnormal pregnancy and labour
5. recognizing common gynaecological disorders
6. recognizing and managing cases of obstetric and gynaecological emergencies
7. prioritizing common obstetric and gynaecological problems in the country
8. data analyzing skill by understanding the basic principles underlying the investiga-
tions, diagnosis and treatment options for common obstetric problems and gynaeco-
logical diseases
9. counseling skill for common obstetric problems and gynaecological diseases

B. TRAINING PERIOD (Clinical Posting)

Duration : 8 weeks (Rotation)
Time : 7.30 AM to 5 PM (Teaching Activities)
Venue : Lot 77 UNIMAS/Sarawak General Hospital

Ward Maternity Labour Ward Gynaecology

Posting Ward
27/02/2017 - 05/03/2017 Lectures - Lot 77 UNIMAS
06/03/2017 - 19/03/2017 Group A Group B Group C
20/03/2017 - 02/04/2017 Group C Group A Group B
03/04/2017 - 16/04/2017 Group B Group C Group A
17/04/2017 - 23/042017 End of posting Examination

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MDP 30408 Obstetrics and Gynaecology Student Guide Book

Weekly Teaching Learning Schedule

Monday Tuesday Wednesday Thursday Friday

Seminar/Lecture/Tutorial/Problem based learnings/Ward work/Bedside

8.00-10.00
Teaching
Seminar/Lecture/Tutorial/Problem based learnings/Ward work/Bedside
10.00 - 12.00
Teaching

12.00 - 14.00 LUNCH

Seminar/Lecture/Tutorial/Problem based learnings/Ward work/Bedside

14.00 - 17.00
Teaching /Self directed learning

18.00 - 22.00 On-call Duty

Total Teaching /Learning Hours in posting

Lectures 35 Hours per student per posting

Seminars 24 hours per student per posting

Tutorial 18 hours per student per posting

Problem based learning 18 hours per student per posting

36 hours per student per posting

Bed side teaching
6 hour per students per weeks

Out patient Clinic sessions

Jawa Clinic 8 hours per student per posting

Gynaecology Clinic 8 hours per student per posting

Major OT sessions 8 hours per student per posting

Ward procedures clerkships and physical examinations 48 hours per student per posting

On-call 24 hours per student per posting

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MDP 30408 Obstetrics and Gynaecology Student Guide Book

RESPONSIBILITIES OF GROUP LEADER

Responsible
Responsibilities
Student
Allocate students to Ward, Labour Room, OPD, OTH, and
1 Group leader
daily on-call
2 Students bed allotment Sub-group leader

3 Daily attendance of students Sub-group leader

4 Submission of case reports Individual

Group leader/Sub -
5 Contact lecturers whenever necessary
group leaders
6 Arrange appropriate audio-visual aids Group leader

7 Communicate teaching / learning problems, students' needs Group leader

C. TEACHING / LEARNING STRATEGIES

Students posted in Obstetrics and Gynaecology will be divided into three groups.
All teachings will be performed on group basis except lecture, seminar, tutorial, problem
based learnings.

Teaching / Learning
Venue Remarks
Strategies
Maternity Ward, Labour
Bedside Teaching Presentation by stu-
1 Ward, Postnatal Ward,
(BST) dent
Gynae: Ward
Out-Patient Department Jawa Clinic
2 Group basis
(OPD) SGH Gynaecological Clinic

Operating Session
3 Operation Theatre Group basis
(OTH)
Lectures/seminars/
4 tutorial/Problem based Lot 77,UNIMAS All students of posting
learnings

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MDP 30408 Obstetrics and Gynaecology Student Guide Book

1. BEDSIDE TEACHING (BST)

Every student must perform history taking and physical examination on
those patients allotted to them and present their case when asked by their supervisor or
consultant or lecturer for bedside teaching.
Students are NOT allowed to do perineal examination / vaginal examina-
tion / digital rectal examination in the absence of supervisor or consultant or lecturer.
Evaluation of the presentation should be done by the lecturer after bedside
teaching .
2. OUTPATIENT DEPARTMENT (OPD)
Three times per week (Monday, Wednesday and Friday). Students can learn
from consultants and specialists from Sarawak General Hospital about the common
obstetric and gynaecological problem cases. Students posted to OPD will have to note
the cases seen, in their Log Book and ask the supervisor (medical officer) or consultant
concerned to sign it.

LABOUR ROOM
In the labour room, third year students must observe the labour room setup and
follow the labour room procedures, witness 10 normal labour cases and deliver one
normal labour case under the guidance of labour ward staffs of Sarawak General Hos-
pital. Records have to be put in log books and signed by staffs on duty in labour ward.

3. OPERATING THEATRE SESSION

In the operating theatre, students must witness on obstetric and gynaecologi-
cal operations.

Procedures Procedures
1 Scrubbing 8 Sterilization procedures
2 Gowning 9 Skin incision
3 Gloving 10 Closure of surgical wound
4 Preoperative skin preparation 11 Instruments used for C-section
Instruments used for Gynaecological
5 Positioning 12
Surgery
6 Draping 13 Instruments used for D & C
7 Catheterization 14 Anesthesia used for C-section

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MDP 30408 Obstetrics and Gynaecology Student Guide Book

4. LECTURES/SEMINARS/TUTORIAL/PROBLEM BASED LEARNINGS

Lectures will be given by the lecture assigned during first week of posting to
understand basic knowledge skills concerning obstetrics and gynaecology.
Seminars will be prepared and presented by students allocated. The allocated
students has the responsibility to discuss with lecturer on the contents which should be
based on the prescribed textbooks or journals. The lecturer conducting the seminar has
to assess the presentation and performance and sign the logbook of the presenter
(student). All students will be assessed 20 responses of MCQs at the end of seminar
presentation with minus score system. It will be counted continuous assessment in end
of posting assessment.
Tutorials also will be prepared by students allocated. Students presentation and
performance will be signed in the logbook of presenters.
Problem based learnings will be presented by the students allocated based on
trigger given by lecturer. Students have to request the lecturer to give the trigger earlier
to prepare.
5. MEETING WITH SUPERVISORS
Students can meet the supervisors at convenient time and discusses about the
case write ups as well as topics.
6. CASE WRITE UPS
Student must submit
1.One normal partograph
2.One abnormal partograph
3.One Obstetrics case write-up
4.One Gynaecology case write-up

D. POSTING ACTIVITIES

Students are requested to comply with the learning activities as listed

OBSTETRICS
Clerk and follow through antenatal ward patients
Attend ward round by Specialists / Consultants
Learn the principles of managing the common conditions associated
with pregnant mothers
Maternity Ward
Learn and observe the process of induction of labour
Learn regarding the postnatal care
Learn the conditions associated with maternal morbidity and mortality
On-call duty
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MDP 30408 Obstetrics and Gynaecology Student Guide Book

OBSTETRICS

Clerking patients
Following through labour
Observe and learn the care of mother and baby during labour
Observe and learn the conduct of a normal delivery
To conduct delivery under supervision
Labour Ward Chart/Enter Partogram recordings
Learn how to recognize and manage complications of the 3 rd stage of
labour
Observe forceps and ventouse deliveries
Observe elective/emergency LSCS
On-call duty

GYNAECOLOGY

Clerking ward patients and follow them up

Attend ward round by Specialist / Consultants
Case presentation
Attend the operating theatre sessions
Gynaecology
Learn the management of common gynaecological conditions
Ward
Observing ward procedures
Attend gynaecology clinic
On-call duty

E. POSTING ASSIGNMENTS.
Every student is requested to comply with the posting assignment as listed below.
1. OBSTETRIC AND GYNAECOLOGICAL CASES RECORD:
Keep records of every case clerked and assist (help) in its management (by them)
during the entire period of posting. Students can discuss with their supervisor /
lecturer / specialist as necessary.
2. CLINICAL WORK:
Each medical student must conduct (10) normal deliveries with or without repair
episiotomies during the posting period.

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MDP 30408 Obstetrics and Gynaecology Student Guide Book

3.ON CALL DUTY:

Student will take on-call duty in hospital (labour ward, maternity ward and gynae-
cology ward) during the clerkship rotation. On-call duty will be begin at 6.00 pm
until 10.00 pm. The student group leader and subgroup leaders will arrange and
allocate the students on-duty for on-call session. If there is any emergency obstetric
and gynaecological case, they should be documented.
4. ACTIVE PARTICIPATION:
Every student is encouraged to participate actively in clinical teaching, ward rounds,
operation session and other teaching activities. You will be evaluated on your active
participation.

5. LOG BOOK:
Complete the tasks and procedures that are required in logbook. The logbook must
be submitted (need to be handed over) to the supervisor for evaluation before end of
posting examination and supervisor will sign and assessed. Scoring of log book will
be counted to continuous assessment of posting.

Logbook Remarks

Normal labour 10 To observe and record in log book

Normal labour 1 To perform under supervision.

6. OBSTETRIC AND GYNAECOLOGICAL CASE WRITE-UP

It consists of ONE Obstetric case and ONE Gynaecological case. Only those cases
that had been personally clerked and follow-up can be written by the student. No
duplication of cases is allowed. Students are encouraged to discuss with their re-
spective supervisor before writing the case write-up. This O & G CASE WRITE
UP should be submitted (handed) to your supervisor for evaluation latest by 7 th
week of clinical posting.

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MDP 30408 Obstetrics and Gynaecology Student Guide Book

Requirement of posting Remarks

Recorded with signature of medical

Normal Labour Observe 10
staff performing the procedure

Recorded with signature of medical

Normal Labour Perform 1
staff supervised the procedure
Presentation
Bedside Teaching /Seminar/Tutorial/Problem 5 Recorded with lecturers signature
based learning

Obstetric examination 20 Recorded with lecturers signature

Gynaecological examination 20 Recorded with lecturers signature

Case write-up for obstetrics and gynaecology should be in accordance with the follow-
ing format:-
(1) History
(2) Physical Examination General and local
(3) Vaginal Examination (Speculum and Bimanual Examination) and Per Rectal
Examination are NOT ALLOWED to perform by the students. But, the
students are advised to include the possible findings of vaginal examination
and per rectal examination.
(4) Provisional Diagnosis
(5) Relevant Investigations
(6) Discussion should be based on anatomy, physiology and pathology of
that particular condition and its clinical presentation.

The student can ask any supervisor / lecturer / consultant if he/she do not know how to
arrange or what to be included in the case write-up.

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MDP 30408 Obstetrics and Gynaecology Student Guide Book

8.End of posting Assessment

Theory Clinical Total
MCQ (20) 12.5 % OSCE (10) 15 %

BAQ (10) 12.5 % Long case 20 %

(1)
MEQ (2) 12.5 % Short case 15 %
(1)
SAQ (4) 12.5 %
End of posting examination 50 % 50 % 100 %

End of posting Assessment 100 %

End of posting examination 70 %

Weekly post seminar Assessment 20 %

(continuous assessment)
Log book nd case write ups 10%

F. REQUIREMENTS DURING POSTING

1. ATTENDANCES:
Attendances are compulsory for all teaching activities throughout the posting.
Attendances will be evaluated at the end of seven weeks. WARNING will be
given by the coordinator to those students whose attendances are poor. Any
students whose attendances are less than 90% WILL NOT BE ALLOWED
TO SIT FOR THE EXAMINATION.
2. DRESS CODE:
Student should wear identification tag and white-coat all time dur ing their
clerkship. Neatly pressed clean clothes are required and a necktie for male stu-
dent. It is the student's responsibility to make sure that their attire is maintained
in a professional manner. Dress codes are sensitive areas; it is the philosophy of
the medical ethics to maintain a high degree of professionalism.

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MDP 30408 Obstetrics and Gynaecology Student Guide Book

3. PUNCTUALITY:
You are required to be punctual in all teaching activities. Late comers will be
considered as absent.
4. MEETING REGULARLY WITH YOUR SUPERVISOR:
You are advised to meet your supervisor regularly to discuss your progress during
the clinical posting. Your supervisor will help you during your posting and to
ensure that you have met the objectives of the clinical posting.
5. HONESTY
Throughout your posting you must be honest. Disciplinary action will be taken if
any student is found cheating during posting.
6. TAKING CARE OF PATIENT CONFIDENTIALITY
At all means you must ensure the patient records remain strict confidential
information.
7. ETHICS
Always practices good medical ethics at all times.

G. PRE-REQUISITES TO SIT FOR THE POSTING EXAMINATION

Each student must fulfill the following pre-requisites to ensure their eligibility to sit for
the posting examination in the 7th week.
1. Complete conduct of 1 deliveries under supervision.
2. Achieved attendances NOT LESS THAN 90%.
3. Submission of log book.
4.Submitted all case write-ups.
5.Have done SATISFACTORY Clinical Examination on patients.
20 Abdominal palpation for obstetric patients.
20 Abdominal palpation for gynaecological patients.

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MDP 30408 Obstetrics and Gynaecology Student Guide Book

H. LIST OF TEXTBOOKS
Prescribed textbooks
1. Obstetrics by Ten Teachers (19th Edition), Edited by Philip N.Baker and Louise C
Kenny (2011) Hodder Arnold (Publishers) Ltd.
2. Gynecology by Ten Teachers (19h Edition), Edited by Ash Monga and Stephen
Dobbs (2011) Hodder Arnold (Publishers) Ltd.
3. Essentials of Obstetrics (2nd Edition) by Sabaratnam Arulkumaran, V Siva-
nesaratnam, Alokendu Chatterjee and Pratapb Kumar (2010) published by Jaypee
Brothers Medical Publishers (P) Ltd

References
1. Labour Ward manual 2016 published by Department of Obstetrics and Gynaecol-
ogy Sarawak General Hospital
2. Web site of Department of Obstetrics and Gynaecology Sarawak General Hospital
O&G@SGH
3. Dewhurt's text book of Obstetrics and Gynaecology D. Keith Edmonds, 7 thed,
Blackwell Publishing, 2007
4. High Risk Pregnancy-Management Options(4th edition), edited by David K
James, Philip J Steer, Carl P Weiner, Bernard Gonik, (2011) Elservier
5. History Taking and physical examination in Obstetrics and Gynaecology
by Professor Dr.Awi Idi and Professor DatoDr.Nik Mohd Nasri Nik Ismil (2011)
published by University Malaysia Sarawak

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