This station is designed to test the student’s knowledge of the issues related to a pregnancy continuing beyond the expected date of delivery. It also tests the student’s ability to document their findings in a note.
The students are given a descriptor page that says:
You have just finished seeing Darla Johnson in the OB Clinic. She is a 24-year-old G-2, P-1 at 41 2/7 weeks gestational age, following an uncomplicated pregnancy.
Her first pregnancy was also uncomplicated, and she delivered at 41 6/7 weeks, a healthy male infant, vaginally, following a spontaneous labor. The baby weighed 6 pounds 14 ounces.
During this pregnancy, she had a 7 week ultrasound scan that confirmed her gestational age. All other testing and evaluation during the pregnancy have been normal.
During your visit today, FHTs were 140 BPM, her fundal height was 39 cm, BP was 110/64, urine neg/neg, and extremities 1+ edema with normal reflexes. Her cervix was 3.0 cm dilated, .5 cm thick, soft, anterior, and the fetal head was presenting at -1 station. She denies vaginal bleeding, loss of fluid, contractions, or pain, and the fetus has been active.
During your visit today, you discussed with Darla the status of her pregnancy and made a number of alternative recommendations to her for further management, describing their risks and benefits. She will think about your recommendations and let you know later on today what she has decided.
Document your discussion in a progress note, and email the progress note to ldr@obgyned.com. Be sure to include your name and title at the end of the note.
(For the purpose of this station, assume that the discussion between you and Darla Johnson took place. Write a progress note that would effectively document that discussion.)
Post-dates Counseling Note – Student
The students would then record their imaginary interaction with the patient. We hoped they would document their imagined discussion of the issue of post date pregnancy and the potential problems. We also hoped they would identify a number of steps that could be taken to minimize the risk. Where choices needed to be made, we hoped the student would outline the risks and benefits of each option.
The student’s performance was measured using this standard form:
Students were assigned “good points” for discussing specific issues in their write-up. They could also receive “bad points” for mistakes. Their final score was the sum of the good and bad points.
Students were also assigned a “gestalt” grade by the faculty evaluator. On a scale of 1-4 (1=fail, 4=honors), how did the faculty feel the student performed. Usually there was good correlation between the numeric scores and the gestalt scores, but no always.
We used this as a paper/pencil exercise (student response via email), although it could be modified to involve a computerized record, a manikin, or a faculty member posing as a patient.
The advantages of it remaining a paper/pencil exercise were:
- We didn’t need faculty (scarce resource)…it could be graded later off the student descriptor sheet.
- We didn’t need a manikin or any setup.
- We didn’t need integration into an EMR.
The disadvantages of it remaining a paper/pencil exercise were:
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- It lacks some of the simulated reality of other clinical stations.
- It requires the students to imagine a conversation they would have had in this clinical scenario, and then document that discussion. Some students handle this fantasy better than others.
- It required a lot of writing in a very short period of time (15 minutes). Many faculty would be challenged by that time limit, and the students usually are not experienced enough to pace their response to the allotted time.
Predictably, some students were critical of the amount of information they needed to convey in too short a period of time. Some were critical that there wasn’t enough explanation of the setup of the station…that they were imagine that the conversation took place, and then write down the imaginary discussion. Some were troubled on a philosophical level…”how can you ask us to document something that didn’t happen? Isn’t that unethical?”