The Core Clerkship in Obstetrics and Gynecology at Stanford is designed as an introduction to the field for medical students. Students spend a total of six weeks rotating through the various specialties in the Department.
Two weeks are spent as part of the labor and delivery team, following laboring and antepartum patients, assisting in deliveries and c-sections and taking night call. During this time, the students spend a few afternoons in the outpatient Obstetrics clinics, where students learn the fundamentals of examination of the pregnant patient, prenatal care and genetic counseling.
Students spend two weeks as part of the Gynecology service. During this time, students assist in the operating room where they see emergency room and in-patient consult patients. A significant portion of this time is also spent in the clinics. The Gynecology clinics at Stanford Medicine introduce the students to both basic and complex gynecologic problems. While at the community clinics, the students can expect to learn the fundamentals of well-woman care, contraceptive counseling and prevention, and management of sexually transmitted diseases. Finally, the students spend two weeks with the Gynecologic Oncology service, during which time the students participate in the care of women diagnosed with gynecologic cancers.
Several advanced clerkships are offered for those students interested in pursuing more training in Obstetrics and Gynecology. These include two to four week rotations in Reproductive Endocrinology and Infertility, Maternal-Fetal Medicine, Gynecologic Oncology and General Gynecology.
Maternal Cardiac Arrest Simulation
Kim Harney, MD, and her team have provided medical students on the OBGYN clerkship with a new capstone simulation case experience that is a joint venture with CISL and the Center for Advanced Pediatric & Perinatal Education (CAPE). As members of a multidisciplinary team, the learners resuscitate a mother in cardiac arrest. With maternal circulation no longer supporting the fetus, rapid delivery of the fetus and advanced neonatal resuscitation are critical and neonatal resuscitation must be accomplished as well. Students work alongside maternity nurses and anesthesia residents to respond to the challenges of the first five minutes to expedite the delivery. In the simulation suite, students have the unique opportunity to perform this cesarean delivery.
In this rare but critical event, the patient’s outcome may depend on providers from various disciplines utilizing the American Heart Association (AHA) modifications for Advanced Cardiac Life Support (ACLS) in pregnancy. These recommendations come from the Scientific Statement on Cardiac Arrest in Pregnancy, that was authored in part by several colleagues at Stanford. Following a return of the mother’s spontaneous circulation (ROSC)--which happens in a large proportion of such cases--managing her critical situation will need all available information, including bedside echocardiography, an additional aspect of the training experience. Communication to the medical code team will be more complex than in nonpregnant adults as a large proportion of arrested mothers experience Return of Spontaneous Circulation (ROSC).
Students may not have had any exposure to ACLS prior to this experience; it may be their first introduction to analyzing cardiac rhythms and assessing the various possible causes of PEA/Asystole. They practice positive pressure ventilation and receive feedback on their chest compressions from the electronic patient simulator. This simulation often also provides their first experience working within a multidisciplinary team. They appreciate and comment on the realism of this kind of immersive learning compared to having only students playing these roles. It is a significant logistical challenge to schedule these varied groups of participants: medical students, RNS, MDs (OBGYN, Anes, Neo) at the same time, and to ensure that content experts from several of the disciplines are available to jointly prepare and then debrief this new and challenging scenario. The simulation also requires content experts from several disciplines whose contributions are invaluable to the preparation and debrief of the new scenario.