Rotation: Ophthalmology/ENT/Gynecology
Elective for Internal Medicine Residents
Site:
- TTUHSC Outpatient Gynecology Clinic: 1400 Coulter Ave
- Northwest Texas Hospital Women's and Children's Clinic 814 Martin Road
- ENT clinic: Dr. William Hale 1400 Coulter Avenue 2 nd Floor
- Ophthalmology: John W. Klein, 1900 Coulter Ave, Suite K Amarillo Texas
Instructors:
- Gynecology: R. Kauffman MD, D. Barclay MD, R. Hodges MD, J. Van Hook MD, C. Van Hook, MD
- ENT: William Hale, MD
- Ophthalmology: John W. Klein, MD
Makeup of team:
- one resident will rotate through the outpatient clinics
Days per week (no night call):
- GYN: 1.5 days per week x 4 weeks
- Otolaryngology: .5 days per week x 4 weeks
- Ophthalmology: 2 days per week x 4 weeks
- *(Days/Times may vary depending on resident didactic sessions/continuity clinic schedules)
Usual time of attending rounds (meeting place):
- Clinic hours as scheduled 8-12pm and 1:00pm-5:00 pm
Types of patients encountered:
- Gynecology: The resident will evaluate post-pubertal female patients. The resident will obtain a familiarity with a wide variety of women's health issues including acute and chronic gynecological processes and preventative screenings such as:
- Health exam
- Perform a comprehensive history and physical.
- Complete age appropriate screening.
- Counseling
- Perform initial evaluation and counseling for alcohol, drug, and tobacco use/ abuse, weight loss, safe sex, contraceptives, domestic violence.
- ENT: The resident will encounter referral patients primarily concerning issues with otitis media, sinusitis, nasal polyps and allergic rhinitis.
- Ophthalmology: The resident will encounter patients for primary ophthalmologic exams and acute issues such as conjunctivitis, episcleritis, conjunctival irritation, and visual changes.
Educational goals/competencies:
Patient care:
The resident will observe patients in the three specialty clinics listed above, while maintaining 2 afternoon Internal Medicine continuity care clinics. If the resident and preceptor are in agreement, the resident may be the initial physician to evaluate the patient. The patient will then be presented to the preceptor who can then guide the resident in evaluation/plan for the patient.
Medical knowledge:
The resident will develop a method for evaluation and treatment of gynecological disease processes and referral patterns for an obstetrician/gynecologist (when to refer a female to an OB/GYN), otolaryngologist, or ophthalmologist.
Gynecology:
The resident will obtain the knowledge and develop a process for formulating a differential diagnosis for common gynecological complaints. The resident will perform "well-woman annual visits". Not all inclusive, but some gynecological areas addressed will include evaluation of perimenopause, vasomotor symptoms relating to menopause, performing a pap smear and reviewing/interpreting the pap result and referral for colposcopy, vulvar biopsy, endometrial biopsy, diagnostic breast evaluation, or gynecological surgery.
Appropriate knowledge of breast care including screening and diagnostic evaluations will be obtained.
The resident will be expected to perform additional reading from appropriate sources to supplement knowledge obtained by direct patient care.
In addition the resident will obtain competence in performing several outpatient procedures such as:
- Perform adequate Pap smear.
- Perform GC / Chlamydia cultures/ vaginal wet prep as indicated.
Otolaryngology:
The resident will obtain skills to adequately perform an ENT exam. The resident will obtain knowledge of when/how to treat sinusitis and acute and chronic otitis media. The resident will obtain an understanding of why it is important to make an appropriate diagnosis.
Interpersonal/communication skills:
Residents will become more comfortable and competent obtaining a medical history relating directly to gynecological and women's health care issues. This rapport will be essential in discussing such sensitive topics as sexual dysfunction, vaginal discharge, dyspareunia and depression, to name a few.
Residents will be required to provide a complete written description of the patients visit, including appropriate documentation and acceptable description of breast exam, genital and pelvic exam. The resident will provide an assessment and plan for each patient encounter and communicate this to the senior gynecology resident or attending.
Otolaryngology/Ophthalmology:
The resident will become better adept at elucidating key points for otolaryngology and ophthalmology patients. The resident will discuss history and physical exam findings with the attending. Written history and exam findings may be required if desired by the preceptor/attending.
Professionalism:
Residents will be expected to dress in business or business casual attire. Residents should not report for clinic wearing "scrubs". Residents should communicate with patients in a respectful and direct manner. Residents should not alter level of professional communication due to differences in ethnic, cultural, religious, or socioeconomic status. Residents should communicate with patients in a comfortable, unbiased manner. Residents should not allow personal opinion to alter level of professionalism toward a patient.
Residents will interact with nursing and support staff in the clinic on a regular basis. Residents should not behave arrogantly to these staff members. All members of the patient care team should be treated with respect. An appropriate level of communication should be used, taking into account that person's baseline knowledge of medical issues.
Residents should become comfortable in discussing referral patients with sub specialists.
Practice-based learning and improvement: Residents are expected to evaluate patients and perform patient presentation to the precepting gynecology attending. Residents will have the learning process enhanced by direct feedback from the attending during patient evaluations. Residents will also learn by observing the senior gynecology resident perform history and physical examination of some patients. The focus of this rotation will be on adequate breast and pelvic exam. Residents will be encouraged to ask questions to aid their understanding of basic gynecology. Further supplementation of knowledge will be obtained through texts and on-line resources listed below.
Systems-based practice:
One of the most difficult areas in outpatient medical care is learning the appropriate documentation level and billing level. Residents will become better informed about costs relating to operating a clinic (supplies, medications, gowns, etc.). Residents will become more adept at prescribing medications within outpatient medication formularies. Residents will become familiar with social services assistance for patients and how to optimize patient care for those with limited resources.
Text/references to be consulted:
- Gynecology: Droegemueler, Obstetrics and Gynecology Text
- Otolaryngology: On-line information: MD Consult, Medline, MicroMedex
Methods of evaluation:
Formal evaluation will be submitted by the attending to the Department of Internal Medicine.