Ob/Gyn Syllabus

Chairs:

Virginia Campus: Cathy Callahan, M.D. (ccallaha@vcom.vt.edu)

Carolinas Campus: Ty B. Robinson, D.O., FACOG (trobinson@carolinas.vcom.edu)

Rotation Credit Hours: 4

Goals

Prior to the completion of the rotation, the student should demonstrate knowledge of the following: (adapted from Association of Professors of Obstetrics and Gynecology Medical Student Objectives, ninth edition)

Develop competence in the medical interview and physical examination of women and incorporate ethical, social, and diverse perspectives to provide culturally competent health care.
Apply recommended prevention strategies to women throughout the life-span.
Recognize his/her role as a leader and advocate for women.
Demonstrate knowledge of preconception care including the impact of genetics, medical conditions and environmental factors on maternal health and fetal development.
Explain the normal physiologic changes of pregnancy including interpretation of common diagnostic studies.
Describe common problems in obstetrics.
Demonstrate knowledge of intrapartum care.
Demonstrate knowledge of postpartum care of the mother and newborn.
Describe menstrual cycle physiology, discuss puberty and menopause and explain normal and abnormal bleeding.
Describe the etiology and evaluation of infertility.
Develop a thorough understanding of contraception, including sterilization and abortion.
Demonstrate knowledge of common benign gynecological conditions.
Formulate a differential diagnosis of the acute abdomen and chronic pelvic pain.
Describe common breast conditions and outline the evaluation of breast complaints.
Demonstrate knowledge of perioperative care and familiarity with gynecological procedures.
Describe gynecological malignancies including risk factors, signs and symptoms and initial evaluation.
Provide a preliminary assessment of patients with sexual concerns.

Rotation Description

Welcome to your OB-GYN rotation!

Obstetrics and gynecology is the medical specialty concerned with the reproductive health and the medical needs of adolescents and women. The specialty encompasses preventive health, reproductive health, maternal care and gynecological surgery for women of all ages. Obstetricians and gynecologists develop enduring relationships with their patients and deliver medical care that may include adolescent gynecology, infertility, endocrinology, health maintenance during pregnancy, treatment of medical problems in pregnancy, operative gynecology and gynecological oncology. The diversity of the specialty is apparent in all practice settings and you will appreciate the challenges and thrill during your third year clerkships.

Regardless of your chosen area of specialty, you will be caring for women. This rotation is designed to best prepare each medical student to develop competence in areas of reproductive and preventive health care for women. The curriculum relies heavily upon the national learning objectives for medical student education outlined by the Association of Professors of Gynecology and Obstetrics. I invite you to learn more about the specialty and providing competent and compassionate care for women! Please let me know if you have any questions regarding the curriculum.

Have fun learning!!

C. Callahan

Clinical Setting in Which Rotation Occurs
The practice of obstetrics and gynecology occurs in the outpatient office setting, labor and delivery unit and in the operating room. Due to the variety of practice opportunities and formats in obstetrics and gynecology, students should review their specific site instructions for a more detailed description of their specific practice setting.

Requirements for Completion

Required Textbooks:

Hacker N, Moore T. Essentials of Obstetrics and Gynecology. Philadelphia: Saunders Elsevier, Fifth edition 2010
Nelson, Kenneth Somatic Dysfunction in Osteopathic Family Medicine, Chapter 9, The Female Patient
The OMS3 curriculum is designed to facilitate the 3rd year student’s continued education in the area of osteopathic manipulative medicine (OMM). Available on the VCOM Electronic Library under Student Consult.

The specific reading assignments in these textbooks have been designed to correspond to the core clinical topics for the rotation and can be found below under the Clinical Modules – Required Curriculum.

Recommended Booklist

Gordon: Obstetrics, Gynecology and Infertility: Handbook for Clinicians 6e 2007
APGO Case book on line.

Requirements for Successful Completion of the OB/GYN Rotation:

1. Attendance according to VCOM and preceptor requirements (student handbook)

2. Understanding of and facility with all Clinical Modules in the Required Curriculum [+]

The goal of the curriculum is to ensure that you have learned the core objectives for medical students in the areas of women’s and reproductive health. The curriculum provides multiple tools including practice questions, reading assignments, cases and videos to assist in your learning. In addition, many of the topics were reviewed in your second year curriculum and a PowerPoint and lecture are available for your review on VCOM TV. You are not required to complete each of the reading assignments, however you are required to have a facility with the material and will be tested on the objectives now and during your clinical board exam. Use the resources for the topics that will be most conducive to your learning and will ensure that you know the material.

3. Completing the uWISE examination question [+]

uWISE is a series of interactive self-exam questions linked to the assigned reading objectives. Each uWISE clinical vignette is a multiple-choice question with five (5) possible answers with immediate explanation and feedback. Some questions are enhanced with images to augment the learning process. The uWISE questions are very similar in format and content to the final examination questions for your clerkship and your medical board exams.
uWISE EXAMINATION - Getting started
Go to: http://www.apgo.org/elearn/uwise/index.cfm?doc=uWISE%20Intr
1. Select the unit you would like to work on as directed from module
2. PASSWORD: Logon to the VCOM Portal to obtain the login and password for uWise.

4. On-line fetal monitoring course [+]

Access: http://ob-efm.com/
East Tennessee State University has created a self-guided Electronic Fetal Monitoring Course. The course should require 2 hours of your time and teaches you the basic interpretation of fetal monitoring strips. Please work through the module. Additionally, you may complete quizzes and case scenarios if you desire.

5. Patient Log [+]

Ob/Gyn Student Patient log
Your patient logs are to be submitted to your Site Coordinator at the end of your rotation and will be part of your evaluation for the clerkship

6. Rotation Evaluations: [+]

Student Site Evaluation. Students must complete and submit at the end of rotation.
Preceptor Evaluation form

It is the student's responsibility to ensure that all clinical evaluation forms are completed and submitted online or turned into the Site Coordinator or the Clinical Affairs Office at the completion of each rotation. Students should inform the Clinical Affairs Office of any difficulty in obtaining an evaluation by the preceptor at the end of that rotation

Mid-Rotation Evaluation Form

7. Successful completion of the end-of-rotation written exam. [+]

The end-of-rotation exam questions will be derived directly from the specific objectives presented in each of the below modules.

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Clinical Modules - Required for Completion

The obstetrics and gynecology curriculum is delivered through the four review topics followed by the 20 following objectives which cover the core topics and clinical conditions most commonly seen in obstetrics and gynecology. Each of the following topics has specific learning objectives and is accompanied by an assigned reading in the text. An on-line case book in addition to videos and/or PowerPoint lectures are available for your review.

Begin by taking the uWISE 100-Question Timed Exam - Practice Shelf Exam by the Association of Professors of Obstetrics and Gynecology. www.apgo.org/student/uwise.html

Many of the learning objectives were initially presented to you during your second year didactic curriculum. Before you begin your clerkship, you should take this examination to identify any areas of weakness. When you complete this examination, you will receive a list of the objectives and questions which you did not answer correctly. Use this self-assessment tool to assist in directing your learning. For any identified areas of weakness, you can then utilize any of the listed materials for each objective including uWISE multiple choice questions, reading assignments, cases and videos. For any objectives initially presented during the second year curriculum, a PowerPoint document and lecture are available for your review on VCOM TV. Use the resources for the topics that will ensure that you know the material. You are not required to complete each of the reading assignments, however you are required to have a facility with the material and will be tested on the objectives now and during your clinical board exam. .

The obstetrics and gynecology end-of-rotation exam questions will be derived directly from the specific objectives presented below

Pre-requisites to a successful clerkship:

(Please ensure that you are familiar with these review topics prior to beginning your obstetrics and gynecology clerkship.)

1. Female Reproductive Physiology [+]

Reading Assignment: Hacker and Moore, pp 34-45
On-line PowerPoint Presentation: Female Reproductive Physiology
Objectives
1. Review female reproductive physiology including:
  1. Hypothalamic-pituitary-ovarian axis
  2. Follicular and luteal phases of menstrual cycle
  3. Proliferative and secretory phases of the endometrium

2. Intrapartum Fetal Surveillance [+]

Reading Assignment: Hacker and Moore, pp 119-127
On-line fetal monitoring course at: http://ob-efm.com/
Tennessee State University has created a self-guided Electronic Fetal Monitoring Course. The course should require 2 hours of your time and teaches you the basic interpretation of fetal monitoring strips. Please work through the module. Additionally, you may complete quizzes and case scenarios if you desire.
uWISE Questions: Obstetrics, Exam 26
Objectives
1. Learn to interpret basic EFM patterns using a systematic approach
2. Learn to use standardized terminology to appropriately document the patterns
3. Learn to properly manage the clinical situations represented by the EFM pattern

3. Obstetrics and Gynecologic History and Exam [+]

Reading Assignment: Hacker and Moore, pp 12-21
On-line PowerPoint Presentation: OB-GYN Medical History
uWISE Questions: Approach to the pateint, Exam 7
Objectives
1. Perform a thorough obstetric-gynecologic history as a portion of a general medical history
2. Interact with the patient to gain her confidence and to develop an appreciation of the effect of her age, racial and cultural background, and economic status on her health
3. Communicate the results of the obstetric-gynecologic and general medical history by well-organized written and oral reports
4. Interact with the patient to gain her confidence and cooperation, and assure her comfort and modesty
5. Perform a painless obstetric-gynecologic examination as part of a woman’s general medical examination
6. Communicate the relevant results of the examination in well-organized written oral reports
7. Educate the patient regarding breast self-examination

4. Embryology and pelvic anatomy [+]

Reading Assignment: Hacker and Moore, pp 22-45
Online PowerPoint Presentation: Comprehensive Review of the Female Reproductive System by Dr. Danielson
Excellent web sites for review: http://anatomy.med.umich.edu/courseinfo/video_index.html
http://www.anatomy.wisc.edu/courses/gross/ (dissections number 9 and 10).
Objectives:
1. Review pelvic anatomy, with a particular focus on surgical pelvic anatomy in preparation for clinical surgical experiences.

Obstetrics

5. Obstetrics and Osteopathy [+]

Reading Assignment: Somatic Dysfunction in Osteopathic Family Medicine, by Kenneth Nelson; Chapter 9 – The Female Patient
VCOM TV Video: Obstetrics and Osteopathy, Palmer
Objectives:
1. Recognize published literature
2. Understand physiological changes in normal pregnancy
3. Define the application of osteopathic manipulation-physiologic models
4. Describe basic female anatomy and the changes that occur in pregnancy
5. Review autonomic nervous system structure and function
6. Review an Osteopathic approach to the obstetric patient

6. Maternal-Fetal Physiology [+]

Reading Assignment: Hacker and Moore, pp 56-70
On-line PowerPoint Presentation: Fetal and Neonatal Circulation, Dr. Danielson and Physiology of Pregnancy, Dr. Reilly
uWISE Questions: Obstetrics, Exam 8
Objectives:
1. Discuss the maternal physiologic anatomic changes associated with pregnancy
2. Describe the physiologic functions of the placenta and fetus
3. Discuss the effect of pregnancy on common diagnostic studies

7. Preconception Care / Antepartum Care [+]

Reading Assignment: Hacker and Moore, pp 71-90, 219-222
uWISE Questions: Obstetrics, Exams 9 and 10
Objectives:
1. Describe how certain medical conditions affect pregnancy
2. Describe how pregnancy affects certain medical conditions
3. Counsel patients regarding a history of genetic abnormalities
4. Counsel patients regarding advanced maternal age
5. Counsel patients regarding nutrition and exercise
6. Counsel patients regarding medications and environmental hazards
7. Counsel patients regarding immunizations

8. Intrapartum Care [+]

Reading Assignment: Hacker and Moore, pp 91-108; 110-118
ACOG Management of Meconium at Delivery
uWISE Questions: Obstetrics, Exam 11, Exam 26
Objectives
1. Describe characteristics of true and false labor
2. Describe initial assessment of the laboring patient
3. Describe stages and mechanism of normal labor and delivery
4. Describe techniques to evaluate the progress of labor
5. Describe pain management during labor
6. Describe methods of monitoring the mother and fetus
7. Describe management of normal delivery
8. Describe vaginal repair
9. Describe indications for operative delivery
10. Describe immediate postpartum care of the mother

9. Postpartum Care [+]

A. Normal Postpartum Physiology and Care

Reading Assignment: Hacker and Moore, pp 108-110
On-line PowerPoint Presentation: Postpartum Care
uWISE Questions: Obstetrics, Exam 13
Objectives:
1. Describe maternal physiologic changes of the postpartum period|
2. Describe normal postpartum care
3. Describe appropriate postpartum patient counseling

B. Postpartum Hemorrhage

Reading Assignment: Hacker and Moore, pp 131-136
On-line PowerPoint Presentation: Postpartum Care
On-line Case: Postpartum Hemorrhage
uWISE Questions: Obstetrics, Exam 27
Objectives:
1. List risk factors for postpartum hemorrhage
2. Describe differential diagnosis of postpartum hemorrhage
3. Describe the immediate management of the patient with postpartum hemorrhage, including:
  1. Inspection for lacerations
  2. Use of uterine contractile agents
  3. Management of volume loss
  4. Management of coagulopathy

C. Postpartum Infection

Reading Assignment: Hacker and Moore, pp 136-138
On-line PowerPoint Presentation: Postpartum Care
u-WISE Questions: Obstetrics, Exam 28
Objectives
1. List the risk factors for postpartum infection
2. Describe differential diagnosis of infectious organisms
3. Describe evaluation and management of the patient with postpartum infection
4. List indications for the use of prophylactic antibiotics

10. Complications of Pregnancy [+]

A. Ectopic Pregnancy

Reading Assignment: Hacker and Moore, pp 290-297
uWISE Questions: Obstetrics, Exam 15
Objectives
1. Develop a differential diagnosis of first trimester bleeding
2. List risk factors predisposing patients to ectopic pregnancy
3. Describe symptoms and physical findings suggestive to ectopic pregnancy
4. Understand methods and tests used to confirm the diagnosis of ectopic pregnancy
5. Explain treatment options

B. Spontaneous Abortion

Reading Assignment: Hacker and Moore, pp 74-77
uWISE Questions: Obstetrics, Exam 16
Objectives
1. Develop a differential diagnosis for first trimester vaginal bleeding
2. Differentiate the types of spontaneous abortion
3. Define recurrent abortion
4. List the complications of spontaneous abortion
5. Identify the causes and complications of septic abortion
6. Counsel a patient following a spontaneous abortion

C. Medical and Surgical Conditions in Pregnancy

Reading Assignment: Hacker and Moore, pp 191-218
uWISE Questions: Obstetrics, Exam 17a and 17b
Objectives
1. Anemia
2. Urinary tract disorders
3. Infectious diseases
4. Cardiac disease
5. Asthma
6. Surgical abdomen
  Gestational Diabetes
7. Describe the incidence and risk factors for gestational diabetes
8. Define gestational and pre-gestational diabetes and describe White’s classification
9. Describe the protocol for screening and diagnosis of gestational diabetes
10. Describe the maternal and fetal complications of gestational and pre-gestational diabetes
11. Describe the management and monitoring of gestational and pre-gestational diabetes in pregnancy

D. Pre-eclampsia-Eclampsia Syndrome

Reading Assignment: Hacker and Moore, pp 173-182
uWISE Questions: Obstetrics, Exam 18
Objectives
1. Definition(s) and classification of hypertension in pregnancy
2. Pathophysiology of pre-eclampsia/eclampsia syndrome
3. Symptoms, physical findings and diagnostic methods
4. Approach to management
5. Maternal and fetal complications

E. Isoimmunization

Reading Assignment: Hacker and Moore, pp 183-190
uWISE Questions: Obstetrics, Exam 19
Objectives
1. Describe the pathophysiology of isoimmunization, including:
2. Role of red blood cell antigens
3. Clinical circumstances under which D isoimmunization is likely to occur
4. Discuss the use of immunoglobulin prophylaxis during pregnancy for the prevention of isoimmunization
5. Discuss the methods used to determine maternal isoimmunization and the severity of fetal involvement

F. Multifetal Gestation and Malpresentation

Reading Assignment: Hacker and Moore, pp 160-1
uWISE Questions: Obstetrics, Exam 20
Objectives
1. Describe the etiology of monozygotic, dizygotic and multizygotic gestation
2. Describe altered physiologic state with multifetal gestation
3. Describe symptoms, physical findings and diagnostic methods
4. Describe approach to antepartum, intrapartum, and postpartum management

G. Fetal Death

Reading Assignment: Hacker and Moore, pp 158-159
uWISE Questions: Obstetrics, Exam 21
Objectives
1. Describe the common causes of fetal death in each trimester
2. Describe the symptoms, physical findings and diagnostic methods to confirm the diagnosis
3. Describe the management of a patient with fetal death
4. Describe the emotional reactions and their effect on management
5. List the maternal complications of fetal death, including disseminated intravascular coagulopathy

H. Abnormal Labor

Reading Assignment: Hacker and Moore, pp 139-145
uWISE Questions: Obstetrics, Exam 22
Objectives
1. List abnormal labor patterns
2. List methods of evaluating fetopelvic disproportion
3. List fetal and maternal complications resulting from abnormal labor\
4. List indications and contraindications for oxytocin administration
5. List strategies for management of abnormal fetal presentations
6. List indications for vaginal birth after cesarean delivery
7. List strategies for emergency management of breech and shoulder dystocia

I. Third-Trimester Bleeding

Reading Assignment: Hacker and Moore, pp 128-133
uWISE Questions: Obstetrics, Exam 23
Objectives
1. Describe the approach to the patient with third-trimester bleeding
2. Compare symptoms, physical findings and diagnostic methods that differentiate patients with placenta previa, abruption placenta and other causes of third-trimester bleeding
3. Describe complications of placenta previa and abruption placenta
4. Describe immediate management of shock secondary to third-trimester bleedinge. Describe components of the various blood products and indications for their use

J. Preterm Labor

Reading Assignment: Hacker and Moore, pp 146-150
On-line PowerPoint Presentation: Preterm labor
uWISE Questions: Obstetrics, Exam 24
Objectives
1. Cite factors predisposing to preterm labor
2. Cite signs and symptoms of premature uterine contractions
3. Cite causes of preterm labor
4. Cite management of preterm labor, including:
  1. Tocolytics
  2. Steroids
  3. Antibiotics

K. Premature Rupture of Membranes

Reading Assignment: Hacker and Moore, pp 150-157
On-line PowerPoint Presentation: Premature Rupture of Membranes
uWISE Questions: Obstetrics, Exam 25
Objectives
1. Describe history, physical findings and diagnostic methods to confirm rupture of the membranes
2. List factors predisposing to premature rupture of membranes
3. Cite risks and benefits of expectant management versus immediate delivery
4. Describe methods to monitor maternal and fetal status during expectant management
5. Describe predicted outcome when premature rupture of membranes occurs at a preterm gestation

L. Post Term Pregnancy

Reading Assignment: Hacker and Moore, pp 157-159
uWISE Questions: Obstetrics, Exam 30
Objectives:
1. Describe normal period of gestation
2. Describe complications of post-maturity
3. Describe management of prolonged gestation

M. Fetal Growth Abnormalities

Reading Assignment: Hacker and Moore, pp 153-157
uWISE Questions: Obstetrics, Exam 31
Objectives:
1. Define macrosomia and fetal growth restriction
2. Describe etiologies of abnormal growth
3. Cite methods of detection of fetal growth abnormalities
4. Cite associated morbidity and mortality

N. Obstetric Procedures

Reading Assignment: Hacker and Moore, pp 219-227
uWISE Questions: Obstetrics, Exam 32
Objectives: Student will be able to describe each procedure and list the indications and complications of each of the following:
1. Ultrasound
2. Chorionic villous sampling
3. Amniocentesis and cordocentesis
4. Antepartum fetal assessment|
5. Intrapartum fetal surveillance
6. Induction and augmentation of labor
7. Episiotomy
8. Spontaneous vaginal delivery
9. Vacuum-assisted delivery
10. Forceps delivery
11. Breech delivery
12. Cesarean delivery
13. Vaginal delivery after Cesarean section
14. Newborn circumcision

Gynecology

11. Menstrual Cycle and Vaginal Bleeding [+]

A. Normal and Abnormal Bleeding

Reading Assignment: Hacker and Moore, pp 34-42; 368-370
on-line PowerPoint Presentation: Female Reproductive Physiology
uWISE Questions: REI, Exam 45
Objectives
1. Abnormal Bleeding
  1. Describe endocrinology and physiology of the normal menstrual cycle
  2. Distinguish abnormal uterine bleeding from dysfunctional uterine bleeding
  3. List causes of abnormal uterine bleeding
  4. Evaluate and diagnose abnormal uterine bleeding
  5. Describe the therapeutic options of abnormal bleeding
2. Leiomyomas
  1. Describe the prevalence of uterine leiomyomas|
  2. Describe the symptoms and physical findings
  3. Describe the methods to confirm the diagnosis
  4. Describe the indications for medical and surgical treatment

B. Amenorrhea

Reading Assignment: Hacker and Moore, pp 355-367
uWISE Questions: REI, Exam 43
Objectives
1. Define:
  1. Primary amenorrhea
  2. Secondary amenorrhea
  3. Oligoamenorrhea
2. List causes of amenorrhea
3. Describe evaluation methods
4. Describe treatment options

C. Premenstrual Syndrome

Reading Assignment: Hacker and Moore, pp 386-389
uWISE Questions: REI, Exam 49
Objectives
1. Define premenstrual syndrome
2. Describe theories of etiology
3. Describe methods of diagnosis
4. Describe management strategies

12. Contraception and Sterilization [+]

Reading Assignment: Hacker and Moore, pp 305-314
uWISE Questions: Gynecology, Exam 33
Objectives
1. Describe physiologic and pharmacologic basis of action
2. Cite effectiveness
3. List benefits and risks
4. Describe financial considerations of the various methods of contraception

13. Vulvar and Vaginal Disease [+]

Reading Assignment: Hacker and Moore, pp 265-269
uWISE Questions: Gynecology, Exam 35; Approach to the patient, Exam 3
Objectives
1. Describe normal vaginal appearance and secretions
2. Evaluation and management of vaginitis due to:
  1. Bacteria
  2. Fungi
  3. Trichomonads
3. Evaluation and management of common vulvar problems, including:
  1. Atrophy
  2. Dermatological conditions of vulva
  3. Bartholin’s gland disease
  4. Vulvodynia
  5. Trauma

14. Sexually Transmitted Infections [+]

A. Sexually transmitted Infections

Reading Assignment: Hacker and Moore pp 269-271
uWISE Questions: Gynecology, Exam 36
Objectives
1. Differentiate the signs and symptoms, the physical and clinical findings, and methods of evaluation of common STI, including:
  1. Syphillis
  2. Herpes Simplex Virus
  3. Gonorrhea
  4. Chlamydia

B. Pelvic Inflammatory Disease

Reading Assignment: Hacker and Moore, pp 271-275
uWISE Questions: Gynecology, Exam 36
Objectives:
1. Describe the pathogenesis of salpingitis
2. List the signs and symptoms of salpingitis
3. Describe the management of salpingitis
4. Counsel the patient about the public health concerns of STI, including screening programs, prevention and immunizations and partner evaluation and treatment
5. Identify the long-term sequelae of salpingitis including tubo-ovarian abscess and chronic salpingitis

15. Cervical Dysplasia [+]

Reading Assignment: Hacker and Moore, pp 270; 402-411
On-line PowerPoint presentation: New Cervical Cancer Screening Recommendations March 2012
uWISE Questions: Neoplasia, Exam 52; Approach to the patient, Exam 3
Objectives:
1. Describe the epidemiology and clinical burden of HPV
2. Identify the risk factors for cervical and vulvar neoplasia and cancer
3. Describe the indications for screening
4. Describe the appropriate utilization of new techniques for evaluating cervical neoplasia
5. Describe the technique for obtaining an adequate Pap smear
6. Describe the management of a patient with an abnormal Pap smear

16. Pelvic Pain [+]

A. Endometriosis and Dysmenorrhea

Reading Assignment: Hacker and Moore, pp 298-304; 256-259
uWISE Questions: Gynecology, Exams 38 and REI, Exam 46
Objectives
1. Define premenstrual syndrome
2. Describe theories of etiology
3. Describe methods of diagnosis
4. Describe management strategies
5. Define primary and secondary dysmenorrhea
6. Cite causes of dysmenorrheal
7. Describe management strategies

B. Chronic Pelvic Pain

Reading Assignment: Hacker and Moore, pp 259-264
uWISE Questions: Gynecology, Exam 39
Objectives
1. Define chronic pelvic apin
2. Cite the incidence and etiologies
3. Cite clinical manifestations
4. Cite diagnostic procedures
5. List management options

17. Breast Disorders [+]

Reading Assignment: Hacker and Moore, pp 326-328
uWISE Questions: Gynecology, Exam 40
Objectives:
1. Describe standards of surveillance of an adult woman, including breast self-examination, physical examination and mammography
2. Diagnose the approach to a woman with the chief complaint of breast mass, nipple discharge or breast pain
3. List history and physical findings that might suggest the following abnormalities
4. Intraductal papilloma
5. Fibrocystic changes
6. Fibroadenoma
7. Carcinoma
8. Mastitis
9. Be able to teach a woman how to perform breast self-examination

18. Infertility [+]

Reading Assignment: Hacker and Moore, pp 371-378
On-line PowerPoint Presentation: Infertility, Dr. Mulligan King College
uWISE Questions: REI, Exam 48
Objectives:
1. Define primary and secondary infertility
2. List the causes of male and female infertility
3. Describe the evaluation and management of infertility
4. Describe the psychosocial issues associated with infertility

19. Pelvic Relaxation and Urinary Incontinence [+]

Reading Assignment: Hacker and Moore, pp 276-289
uWISE Questions: Gynecology, Exam 37
Objectives
1. Identify the following elements on physical exam
2. Cystocele
3. Rectocele
4. Vaginal vault / prolapse
5. List behavioral, medical and surgical methods to appropriately treat incontinence and pelvic organ prolapse
6. Incorporate screening questions for urinary incontinence when eliciting a patient history
7. Discuss the difference between stress, urge, and overflow incontinence
8. Obtain pertinent history components to differentiate between incontinence types

20. Menopause/ Climacteric [+]

Reading Assignment: Hacker and Moore, pp 379-385
uWISE Questions: Gynecology, Exam 47
Objectives:
1. Describe physiologic changes in the hypothalamic-pituitary-ovarian axis associated with perimenopause / menopause
2. Describe appropriate management of menopausal / perimenopausal symptoms
3. Counsel patients regarding menopausal issues
4. List long term changes associated with menopause

21. Abortion [+]

Reading Assignment: Hacker and Moore, pp 362-314
uWISE Questions: REI, Exam 34
Objectives:
1. Describe surgical and non-surgical pregnancy termination methods
2. List potential complications of abortion, such as:
3. Hemorrhage
4. Infection
5. Describe the psychosocial considerations of abortion

22. Hiruitism and Virilization [+]

.Reading Assignment: Hacker and Moore, pp 362-367
On-line PowerPoint Presentation: The menstrual cycle, a problem based tutorial, Dr. Mulligan
uWISE Questions: REI, Exam 44
Objectives:
1. Cite normal variations in secondary sexual characteristics
2. List definitions of hirsuitism and virilization
3. List causes including ovarian, adrenal, pituitary and pharmacological
4. Evaluate the patient with hirsuitism or virilization

23. Gynecology Oncology [+]

A. Vaginal / Vulvar Cancer

Reading Assignment: Hacker and Moore, pp 420-427
uWISE Questions: Neoplasia, Exam 51
Objectives:
1. List risk factors for vulvar neoplasms
2. Describe methods of diagnosis including the indications for vulvar biopsy
3. Review management of vulvar neoplasms

B. Endometrial Carcinoma

Reading Assignment: Hacker and Moore, pp 428-434
uWISE Questions: Neoplasia, Exam 54
Objectives
1. List risk factors for endometrial carcinoma
2. Describe symptoms and physical findings
3. Describe management of the patient with postmenopausal bleeding
4. Describe methods to diagnose endometrial carcinoma
5. Understand impact of staging on management and prognosis
6. Describe management of the patient with endometrial cancer

C. Ovarian Neoplasms

Reading Assignment: Hacker and Moore, pp 412-419
uWISE Questions: Neoplasia, Exam 55
Objectives
1. Evaluation of the patient with an adnexal mass
2. Characteristics of:
  1. Functional cysts
  2. . Benign neoplasms
  3. i. Carcinomas
3. Evaluation and management of carcinomas of the ovary
  1. Symptoms and physical findings
  2. Risk factors
  3. Histologic classification
4. Impact of staging on management and prognosis

D. Gestational Trophoblastic Disease

Reading Assignment: Hacker and Moore, pp 435-442
uWISE Questions: Neoplasia, Exam 50
Objectives:
1. Describe symptoms and physical findings of gestational trophoblastic disease
2. Describe diagnostic methods
3. Describe management and follow-up

24. Sexual Assault / Domestic Violence [+]

Reading Assignment: Hacker and Moore, pp 322-325
uWISE Questions: Domestic Violence, Exams 57 and 58
Objectives
1. Identify patients at increased risk for sexual assault
2. Describe the medical and psychosocial management of a victim of sexual assault
3. Cite prevalence and incidence of violence against women, elder abuse, child abuse
4. Demonstrate screening methods for domestic violence
5. Communicate the available resources for a victim of domestic violence including short-term safety

OMM Objectives for the OB/GYN Rotation

Chapter 9

Objectives:
1. The student will:
  1. Recognize and define causes of pelvic pain in the female patient
  2. Define an effective musculoskeletal treatment for carpal tunnel syndrome in pregnant patients
  3. Recognize the use and mechanism of action of sacral inhibition
  4. Differentiate between viscerosomatic/somatovisceral/somatosomatic/and viscerovisceral reflexes
  5. Define the sympathetic and parasympathetic viscerosomatic reflexes of the female pelvic organs
  6. Recognize and define the sequelae of anterior and posterior sacral dysfunctions
  7. Recognize the causes of primary and secondary somatic dysfunction of the pubic symphysis and pelvis

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Clinical Performance Objectives

While the end-of-rotation exam is derived from the didactic curriculum and objectives described above in the “Clinical Modules – Required Curriculum” section, the end-of-rotation evaluation completed by your preceptor is based on clinical core competencies. These core competencies reflect student performance in 6 key areas: communication, problem solving, clinical skills, medical knowledge, osteopathic medicine and professional and ethical considerations. Your end-of-rotation evaluation from your preceptor will be based directly on your performance in these 6 core competencies as described below.

Communication - the student should demonstrate the following clinical communication skills:
1. Effective listening to patient, family, peers, and healthcare team
2. Demonstrates compassion and respect in patient communications
3. Effective investigation of chief complaint, medical and psychosocial history specific to the rotation
4. Considers whole patient: social, spiritual & cultural concerns
5. Efficiently prioritizes essential from non-essential information
6. Assures patient understands instructions, consents & medications
7. Presents cases in an accurate, concise, well organized manner
Problem Solving – the student should demonstrate the following problem solving skills:
1. Identify important questions and separate data in organized fashion organizing positives & negatives
2. Discern major from minor patient problems
3. Formulate a differential while identifying the most common diagnoses
4. Identify indications for & appliy findings from the most common radiographic and diagnostic tests
5. Identify correct management plan considering contraindications & interaction
Clinical Skills - the student should demonstrate the following problem solving skills:
1. Assesses vital signs & triage patient according to degree of illness
2. Perform good auscultory, palpatory & visual skills
3. Perform a thorough physical exam pertinent to the rotation
Osteopathic Manipulative Medicine - the student should demonstrate the following skills in regards to osteopathic manipulative medicine
1. Apply osteopathic manipulative medicine successfully when appropriate
2. Perform and document a thorough musculoskeletal exam
3. Utilize palpatory skills to accurately discern physical changes that occur with various clinical disorders
4. Apply osteopathic manipulative treatments successfully
Medical Knowledge – the student should demonstrate the following in regards to medical knowledge
1. Identify & correlate anatomy, pathology and pathophysiology related to most disease processes
2. Demonstrate characteristics of a self-motivated learner including demonstrating interest and enthusiasm about patient cases and research of the literature
3. Are thorough & knowledgeable in researching evidence based literature
4. Actively seek feedback from preceptor on areas for improvement
5. Correlate symptoms & signs with most common disease
Professional and Ethical Behaviors - the student should demonstrate the following professional and ethical behaviors and skills:
1. Is dutiful, arrives on time & stays until all tasks are complete
2. Consistently follows through on patient care responsibilities
3. Accepts & readily responds to feedback, is not resistant to advice
4. Assures professionalism in relationships with patients, staff, & peers
5. Displays integrity & honesty in medical ability and documentation
6. Acknowledges errors, seeks to correct errors appropriately
7. Is well prepared for and seeks to provide high quality patient care
8. Identifies the importance to care for underserved populations in a non-judgmental & altruistic manner

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For Students Ob/Gyn Clerkship Requirements (3rd Year)
•	Ob/Gyn Syllabus
•	Required Booklist
•	Evaluation Forms; Clinical encounter log, procedure logs

Ob/Gyn Rotation Sites & Faculty
•	Meet the Ob/Gyn Faculty
•	Ob/Gyn Site-Specific Instructions

Ob/Gyn Residency, Fellowship & Career Information
•	Ob/Gyn Residencies, Fellowships & Careers
•	Ob/Gyn Web Links and Resources

For Faculty
•	Faculty Development and CME Program
•	Useful Faculty Development Links (go to Quick Links)
•	Clinical Faculty Application
•	Preceptor Evaluation of Students

OBSTETRICS and GYNECOLOGY

For Students

For Faculty

Ob/Gyn Syllabus

Chairs:

Rotation Credit Hours: 4

Goals

Rotation Description

Requirements for Completion

Required Textbooks:

Recommended Booklist

Requirements for Successful Completion of the OB/GYN Rotation:

Clinical Modules - Required for Completion

Pre-requisites to a successful clerkship:

Obstetrics

Gynecology

OMM Objectives for the OB/GYN Rotation

Clinical Performance Objectives