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Fourth Year Obstetrics Rotation

Course outline for the eight week fourth year Obstetrics rotation

The fourth year Obstetrics block is probably the teaching programme that the Department of Obstetrics and Gynaecology could be most proud of within the medical undergraduate programme. For many students, Obstetrics in fourth year is a baptism into the coal-face of clinical practice. They are exposed to women and babies at their most vulnerable in a health system (Peninsula Maternal & Neonatal Services) that could be described as one of the most successful on the continent. Obstetrics in year four also presents the opportunity for students to become part of the health care team in serving women and babies within our maternity services.

The block runs for eight weeks, five times a year. Each block has approximately 40 students who rotate through the Obstetrics and Gynaecology department. The block has an introductory week during which students receive lectures on core topics, 6 weeks of clinical attachments (one of which is the Academic Units week, where students are exposed to tertiary care medicine) and an assessment week. The clinical attachments are within the primary care, community-based Midwife Obstetrics Units (MOU) and include a three week attachment at one of the 2 secondary level hospitals; either Mowbray Maternity or New Somerset Hospital.

We pride ourselves on fostering inter-disciplinary teaching, and incorporating the Faculty 'golden threads' such as compassion for patients, the upholding of patients' rights, professionalism and communication skills, examples of which follow.

The majority of South Africa's population are black people who speak Xhosa. Many rural patients cannot speak English, and many medical students do not speak Xhosa. We have Xhosa language teachers who teach and assess basic, essential 'medical' Xhosa. Another essential issue which was identified some years back is the difficulties students experience when births have bad outcomes. They are thus now coached by a sister with an interest in 'compassion training'. We also have midwives who teach about breastfeeding, and who play a large part in supervising students when they 'catch' babies. Students also have an innovative Health and Human Rights workshop, the students' evaluations of which have been published

What? Where? When? Who?
47 formal lectures and 7 Zhosa Department of O&G Intro week and every Monday Convenors, lecturers (Obstetrics and Neonatology)
School of languages Tutorials MMH and NSH Daily during three week residence Clinical and sessional staff
Clinical skills MMH Skills Lab Intro week and weekly thereafter Convenors, Registrars, MO's, Midwives
Academic Units MMH Vanguard community clinic [Student Learning Centre], GSH Weekly from week two until seven Convenors, Lecturers
Compassion session MMH/GSH/NSH Weekly from week two until seven Sr Robyn Sheldon
Academic Units MMH Vanguard community clinic, GSH Weekly from week two until seven Convenors, Lecturers
Health and Human Rights Department of O&G Once in intro week and once in assessment week Veronica Mitchell

Besides the formal teaching as shown above, students attend ward rounds and do calls within the secondary hospitals. A logbook is used for students to document their clinical learning activities. This serves as a record of their clinical involvement and is used to determine their Duly Performed requirements (DP) for entry into the final examinations for the year.

The student assessments are shown in the following table:

What? Where? When? Who? Weight (%)
In-course assessment MMH and NSH During three week residence Consultants, registrars and midwives DP
Case presentations MMH and NSH During three week residence External consultants DP
OSCE MJ maternity Centre Assessment week, End of block Convenors, lecturers, sessional staff, language staff, lactation consultant 50%
MCQ New Learning Centre, medical school End of block Convenors and support staff 50%

In the OSCE, students are asked to complete an evaluation of the teaching activities and the facilitators during the block. The response has largely been positive, where the majority of the students recorded that they were satisfied with all of these.

The programme provides a solid theoretical and practical base in obstetrics for students. This is mainly due to the range of topics covered within the programme and the students' immersion into the practice of obstetrics. The clinical learning placements provide the students with ample opportunity to immerse themselves in perinatal care at primary and secondary level facilities within the health care services.

The fourth year Obstetrics programme has evolved into a well -managed one and is planned a year ahead. Lectures and block rotations are completed before the start of each year so that all facilitators are able to plan their year well in advance.

We have the great challenge of dwindling funding, which is primarily used to pay for non-specialist sessional clinical tutors. As with our other courses, this is a threat to our excellent teaching and can be very uncomfortable for patients who are seen by larger student groups.

In summary, the course is evolving on a yearly basis and continuous to grow. The current convening and administration team has developed a well-oiled machine which has seen it strengthen over the last few years. If the current momentum and commitment to the programme can be maintained, one can be sure that the fourth year Obstetrics course will remain the flagship programme in the Department of Obstetrics and Gynaecology.