Immersive Selectives: A New Approach for the OBGYN Clerkship

Clerkship Director: Dr. Julia MacCallum Education Specialist: Dr. Kyan Lynch

At many academic medical centers, medical students on third year OBGYN clerkships rotate through multiple services and clinical environments in a compressed time period, often including time spent in ambulatory clinics, inpatient obstetrics, inpatient gynecology and gynecologic surgery, gynecologic oncology, and overnight with night float care teams. This breadth of experience has advantages, such as offering students a comprehensive view of the OBGYN profession, and exposing students to a wide range of pathology. There are downsides to rotating through multiple services in a short time period, however. At the University of Rochester, clerkship students spend five weeks with the OBGYN specialty. Once orientation, didactic sessions, the NBME subject exam, and work hour restrictions are taken into account, the time window remaining for student immersion in clinical OBGYN shrinks substantially. Students and health care teams find it challenging to have students frequently transitioning from one service to the next, which in many clerkships happens on a weekly basis. Students can feel excluded from their clinical teams due to their abbreviated experiences.

Educators and students both report the difficulty in students longitudinally growing their clinical skills in any one environment, and opportunities for high-quality student feedback become less robust with frequent transitions. This lack of depth in OBGYN exposure may significantly hamper the learning experience for clerkship students. In response to these limitations, we implemented a new selective-based structure for the OBGYN clerkship. In this new model, students are given a guide with information on a wide range of clinical environments and subspecialty services to their clerkship. Each student must then rank their choices for both a gynecology-focused selective and an obstetrics-focused selective. Once the choice rank order lists are submitted, an algorithm assigns each student to one 14-day gynecology-focused selective and one 14-day obstetrics-focused selective, optimizing the process to match all students in a clerkship cohort to their highest possible selective choices. The selectives offered each block differ slightly based upon faculty availability but generally represent the full breadth and scope of obstetrics, gynecology, and subspecialty OBGYN care.

Students in the Driver's Seat

Using the Selective System, students read about the available service lines and subspecialties, and use a ChatBot-based tool to determine which selectives they are most interested in before putting them in ranked order of preference.

OBGYN Selectives Guide

Students receive a PDF Guide with a brief overview of each Selective, including the clinical context, key activities, and learning highlights

Sample Selectives

This Table of Contents lists the Selectives available during a typical block

"Selexa"

ChatBot-based tool that walks students through the process of exploring their options and submitting their ranked lists.

The Selective Design Process

In order to offer these selectives to our students, we designed and then implemented a selective creation process. We started by seeking and receiving support from our departmental leadership. Next, we reached out to medical education champions in all divisions within our department, as well as those in community-based and affiliated practices. The clerkship director, department education specialist, and, when feasible, the resident undergraduate medical education liaisons then met with each interested group or division.

These meetings followed a thoughtful and predictable pattern, designed to generate buy-in from participating faculty, identify the strengths of each proposed clinical learning environment, preemptively discuss potential barriers, and develop unique goals and expectations for each nascent selective. The selective creation meetings were well-received by participating faculty. Several faculty members admitted initial hesitation to accept clerkship students but ultimately found themselves

excited to participate as selective champions, dubbed clerkship selective directors, by the end of the meeting. Though the selective structure has only been in place for 7 months, the preliminary findings from clerkship feedback indicate that the change has largely been very successful. Students, residents, fellows, and faculty alike report an increased desire to engage in the educational process, as well as a greater understanding of the role of a medical student within the health care team.

Changing the Didactic Experience

In order to maximize the benefit of clinical immersion, we also made significant changes to the formal didactic schedule. Rather than dispersing classroom-based teaching sessions throughout the Clerkship, potentially pulling students away from meaningful clinical encounters, we set aside three days for synchronous learning.

Following orientation, the first two days of the clerkship are dedicated to Introduction to Clinical Obstetrics and Introduction to Clinical Gynecology, respectively. These days have two primary objectives: 1) Teach the fundamentals of OBGYN 2) Orient students to the unique world of OBGYN One particularly exciting aspect of these front-loaded didactic days is the role that other learners played in developing and delivering the curricula.

The Introduction to Obstetrics day was designed and continues to be taught by second-year MFM Fellows as part of their Fellows as Teachers curriculum. The Introduction to Clinical Gynecology didactic day was designed in collaboration with Dr. Adam Evans, a fourth-year OBGYN resident serving as the senior Undergraduate Medical Education Liaison. While both days are long and packed with material, they also feature a mixture of teaching modalities, including case-based discussions, small group work, independent study, gamification, and flipped-classroom.

two individuals turn a gear as they change directions

The third didactic day is known as "Transition Day". As the name implies, this day occurs at the midpoint of the clerkship, when students are leaving one Selective and preparing to start the next. Transition Day is a full-day educational experience employing multiple learning modalities. The day involves protected time for:

Formative feedback meetings between clerkship students and faculty

Students to watch pre-recorded topic presentations prepared by their peers and uploaded to a shared media library

Students to develop multiple choice questions (MCQs) based upon content in peers’ recorded videos

An interactive videoconference session with the clerkship director during which students review, submit answers to, and discuss all MCQs.

Feedback

Though the evaluation process is ongoing, the preliminary findings from clerkship feedback indicate that the changes have largely been very successful. Students, residents, fellows, and faculty alike report an increased desire to engage in the educational process, as well as a greater understanding of the role of a medical student within the health care team.