2a. Obstetrics and Gynecology Curriculum

OBSTETRICS AND GYNECOLOGY

TABLE OF CONTENTS

 

1. Course Overview 
2. Course Description 
3. Course Objectives
4. Clinical skills training – Guidelines by AAMC 
5. Linkage with XUSOM educational objectives
6. Overall curriculum
7. Learning resources

 

CLINICAL CHAIR: DR. ISHA MEHTA

1. COURSE OVERVIEW:

COURSE	Obstetrics and Gynecology Core Rotation
LENGTH	6 weeks
SUPERVISING FACULTY	Dr. Isha Mehta, Chair of Obstetrics and Gynecology Dr. Richard Pestell, Dean of Clinical Sciences
MAJOR HOSPITAL SITES	Jackson Park Hospital, Chicago, IL
METHODS OF EVALUATION	Attendance Attitude, professional behavior, Patient evaluation, case presentation and summaries [written and oral] Knowledge of differential diagnosis, initial and ongoing therapies Technical skills, where required Oral and written quizzes NBME Clinical clerkship examination Mid-course [three week] formal feedback session [not part of final grade]
GRADING	75% - Preceptor Evaluation 10% - Final Examination [NBME] 10% - Clinical Logs 5% - Attendance Notes: A minimum passing grade on each area listed above is required to receive a final grade. No grade will be given until complete clinical logs and multimedia assignments have been completed and submitted
On-call	No more than two times per week

 

2. COURSE DESCRIPTION:

The Obstetric and Gynecologic Core Clerkship is designed to provide clinical experience in both obstetrics and gynecology. This didactic and clinical experience will be in an academic atmosphere which includes residents, house officers, and attending faculty. This curriculum is intended to provide objectives for the medical student who may enter any discipline and is divided into units and sections with specific objectives.

This course will be taught through a series of lectures, group discussions, observation, Grand Rounds, clinical/hospital interaction, assignments, and case studies under the direction of the doctors and/or senior residents at the hospital, clinic, or private office. Students will further demonstrate knowledge of the core through completion of case studies and assignments as determined by the doctors and/or senior residents. Students will be expected to observe minor and major surgical procedures and learn basic surgical techniques.
 

3. COURSE OBJECTIVES:

Upon successful completion of this course the student will be able to:

• Demonstrate competency in taking a history and performing a physical examinations of women throughout their lifetime;
• Develop the skills needed to effectively communicate with patients and their families;
• Assess a woman’s overall condition with or without a medical complaint, including the importance of age, menstrual status, sexual and contraceptive history;
• Describe the physiology and processes of normal and abnormal pregnancy and delivery, including standards of care for both normal and high risk pregnancies;
• Understand the importance of selection, use and interpretation of history, physical and laboratory findings and other test data for common obstetric & gynecologic conditions;
• Describe common obstetric, gynecologic and breast diseases; delivery and surgical procedures; and show the initial technical skills [e.g. proper sterile procedures, suturing utilized] to undertake them;
• Understand the importance of a professional and compassionate doctor/patient relationship and continue to develop the necessary skills to achieve this;
• Present an initial differential diagnosis from among the common obstetric and gynecologic diseases based on the information gathered, and relate these to the overall medical history of the patient;
• Develop an initial plan to advise and educate the patient and families about the disease process, diagnostic tests, initial therapy and expected outcome;
• Understand the influence of the family, community and society on a woman, during both health and illness.

 

4. OBJECTIVES OF CLINICAL SKILLS TRAINING (MODIFIED AND ADOPTED FROM ASSOCIATION OF AMERICAN MEDICAL COLLEGE (AAMC) GUIDELINES FOR UNDERGRADUATE MEDICAL EDUCATION (UME):

 

1. The ability to understand the nature of, and demonstrate professional and ethical behavior in, the act of medical care. This includes respect, responsibility and accountability, excellence and scholarship, honor and integrity, altruism, leadership, cultural competency, caring and compassion, and confidentiality.
2. The ability to engage and communicate with a patient, develops a student-patient relationship, and communicate with others in the professional setting, using interpersonal skills to build relationships
3. For the purpose of information gathering, guidance, education, support and collaboration.
4. The ability to apply scientific knowledge and method to clinical problem solving.
5. The ability to take a clinical history, both focused and comprehensive.
6. The ability to perform a mental and physical examination;
7. The ability to select, justify and interpret selected clinical tests and imaging;
8. The ability to understand and perform a variety of basic clinical procedures;
9. The ability to record, present, research, critique and manage clinical information.
10. The ability to diagnose and explain clinical problems in terms of pathogenesis, to develop basic differential diagnosis, and to learn and demonstrate clinical reasoning and problem identification;
11. The ability to understand and select clinical interventions in the natural history of disease, including basic preventive, curative and palliative strategies
12. The ability to understand and to formulate a prognosis about the future events of an individual’s health and illness based upon an understanding of the patient, the natural history of disease, and upon known intervention alternatives.
     

5. LINKAGE WITH THE EDUCATIONAL OBJECTIVES OF XUSOM:

XUSOM Educational objective	Course objectives	Learning methods	Assessment methods
The Science and Practice Of Medicine Apply scientific principles and a multidisciplinary body of scientific knowledge to the diagnosis, management, and prevention of clinical, epidemiologic, social and behavioral problems in patient care and related disciplines. Understand the variation in the expression of health and disease through critical evaluation of both patients and the scientific literature. Apply knowledge of study design and statistical methods to the appraisal of clinical studies and other information on diagnostic and therapeutic effectiveness	Describe the physiology and processes of normal and abnormal pregnancy and delivery, including standards of care for both normal and high risk pregnancies; Understand the importance of selection, use and interpretation of history, physical and laboratory findings and other test data for common obstetric & gynecologic conditions	Lectures Group discussions Observation Grand rounds Clinical/ hospital interaction, Assignments Case studies	Preceptor Evaluation Log books Multimedia assignments On-call evaluation
Clinical Competence Obtain a sufficient level of medical knowledge to understand the basic facts, concepts, and principles essential to competent medical practice. Exhibit the highest level of effective and efficient performance in data gathering, organization, interpretation and clinical decision making in the prevention, diagnosis, and management of disease. Communicate effectively using caring and respectful behaviors when interacting with patients, families and members of the health care team. Perform all technical procedures accurately and completely, to the extent considered essential for the area of practice and level of education Understand and appropriately use medically related information technology Effectively use the resources of the entire health care team in treating disease, preventing future health problems and maintaining the health of individuals	Describe common obstetric, gynecologic and breast diseases; delivery and surgical procedures; and show the initial technical skills [e.g. proper sterile procedures, suturing utilized] to undertake them;	Lectures Group discussions Observation Grand rounds Clinical/ hospital interaction, Assignments Case studies	Preceptor Evaluation Log books Multimedia assignments On-call evaluation
The Social Context Of Medicine Understand and respond to factors that influence the social, behavioral, and economical factors in health, disease and medical care working to be able to provide care that is of optimal value. Advocate for quality patient care and assist patients in dealing with system complexities Begin to understand the complexities of the entire health care practice and delivery system, managers, payers, providers, organizations and bureaucracy in defining access, cost, value and outcomes	Assess a woman’s overall condition with or without a medical complaint, including the importance of age, menstrual status, sexual and contraceptive history;	Lectures Group discussions Observation Grand rounds Clinical/ hospital interaction, Assignments Case studies	Preceptor Evaluation Log books Multimedia assignments On-call evaluation
Communication Demonstrate effective and compassionate interpersonal communication skills toward patients and families necessary to form and sustain effective medical care. Present information and ideas in an organized and clear manner to educate or inform patients, families, colleagues and community. Understand the complexity of communication including non-verbal, explanatory, questioning and writing in a culturally appropriate context	Develop the skills needed to effectively communicate with patients and their families; Present an initial differential diagnosis from among the common obstetric and gynecologic diseases based on the information gathered, and relate these to the overall medical history of the patient; Develop an initial plan to advise and educate the patient and families about the disease process, diagnostic tests, initial therapy and	Lectures Group discussions Observation Grand rounds Clinical/ hospital interaction, Assignments Case studies	Preceptor Evaluation Log books Multimedia assignments On-call evaluation
Professionalism Display the personal attributes of compassion, honesty and integrity in relationship with patients, families, and the medical community. Adhere to the highest ethical standards of judgment, conduct and accountability as each applies to the health care milieu. Demonstrate a critical self-appraisal in his/her knowledge and practice of medicine, as well as received and give constructive appraisal to/from patients, families, colleagues and other healthcare professionals. Demonstrate a commitment to ethical principles pertaining to provision or withholding of clinical care, confidentiality of patient information, informed consent, and business practices Demonstrate sensitivity and responsiveness to patients’ culture, age, gender and disabilities	Understand the importance of a professional and compassionate doctor/patient relationship and continue to develop the necessary skills to achieve this;	Lectures Group discussions Observation Grand rounds Clinical/ hospital interaction, Assignments Case studies	Preceptor Evaluation Log books Multimedia assignments On-call evaluation
Lifelong Learning Understand the limits of personal knowledge and experience and demonstrate the intellectual curiosity to actively pursue the acquisition of new scientific and clinical knowledge and skills necessary to refine and improve his/her medical practice, assure excellent care of patients, or to contribute to the scientific body of medical knowledge throughout a career. Understand the concepts of analyzing practice experience and perform practice-based improvement activities using a systematic methodology Understand methods to obtain and use information about their own population of patients and the larger population from which their patients are drawn	Demonstrate competency in taking a history and performing a physical examinations of women throughout their lifetime;	Lectures Group discussions Observation Grand rounds Clinical/ hospital interaction, Assignments Case studies	Preceptor Evaluation Log books Multimedia assignments On-call evaluation

 

6. OVERALL CURRICULUM:

Note to the student:

• This is a suggested weekly curriculum undertaking a minimum of two modules or topics per week.
• By the end of the rotation, the student should have covered all topics listed.
• The individual preceptor, based on scheduling, patient population and other factors may alter the order of the topics or assignments.
• In addition, the student should complete all Skills Modules
• At the end of week 3, the student should request a formal feedback session from the preceptor on their progress.
• At the end of week 4, or beginning of week 5, the student should ensure that Comprehensive Examination has been scheduled.

Week 1:

• Physiology and Endocrinology of Normal Pregnancy.
  • Conception and Implantation.
  • Fetal Development.
  • Fetal Circulation.
  • Maternal Physiology throughout pregnancy.
  • Endocrinology of Normal Pregnancy.
• Human Genetics, Review of Common Syndromes.
• Teratology review of Common Syndromes.
• Prenatal Care.
  • Prenatal Visits.
  • Prenatal Nutrition.
  • Prenatal Diagnosis including Amniocentesis.
• Medical Complications of Pregnancy.
  • Hyperemesis Gravidarum.
  • Gestational Diabetes mellitus.
  • Preeclampsia.
  • Gestational Hypertension.
  • Chronic Hypertension.
  • Urinary Tract Infections in Pregnancy.
  • Genital Herpes.
  • Group B Streptococcal Infection.
  • Gestational Trophoblastic Disease.
  • Hydatidiform Moles.
  • Gestational Choriocarcinoma.

Week 1 Assignments

Beckman Section 1, General Obstetrics & Gynecology - all
Beckman, Section 2, Obstetrics – 5, 6, 7, 8
Beckman, Section 3, Med/Surg Disorders – all
Access Medicine OB Case Files - #39, #27, #16, #9, #28, #23, #7, #29

Week 2: 

 

• Obstetric Complications of Pregnancy.
  • Ectopic Pregnancy.
  • Therapeutic Abortion.
  • Septic Abortion.
  • Intrauterine Fetal Death.
  • Rhesus Isoimmunization.
  • Oligohydramnios.
  • Polyhydramnios.
  • Multiple Gestation.
  • Preterm Labor.
  • Premature Rupture of Membranes.
  • Third-trimester Bleeding.
  • Abruptio Placenta.
  • Placenta Previa.
  • Cesarean Section - Indications for; Statistics and Complications of- Labor and delivery.
  • Stages of Normal Labor and Delivery.
  • Fetal Heart Rate Monitoring.
  • Intrapartum Fetal Stress.
  • Assisted Delivery. Anesthesia and Analgesia in Labor and Delivery.
  • Abnormal Labor.
  • Induction of Labor.
  • Prolonged Latent Phase.
  • Prolonged Active Phase.
  • Cephalopelvic Disproportion.
  • Fetal Malpresentations.

Week 2 Assignments

Beckman, Section 2, Obstetrics – 9, 13, 14, 15, 16, 17, 18, 19
Access Medicine OB Case Files - #13, #45, #42, #43, #5, #18, #1, #12, #10, #11, #17, #4, #41, #8, #19, #15, #22, #2

Week 3:

• Postpartum Hemorrhage.
• Puerperium.
  • Immediate Care of the Newborn.
  • Physiology of the Normal Puerperium.
  • Lactation and Breast-feeding.
  • Nipple Fissures.
  • Breast-feeding Mastitis.
  • Postpartum Sepsis.
  • Postpartum "Blues" and Postpartum Depression.
  • Postpartum Psychosis.
• Contraception.
  • Behavioral Methods.
  • Barrier Methods.
  • Hormonal Methods.
  • Sterilization

Week 3 Assignments

Beckman, Section 2, Obstetrics – 10, 11, 12
Beckman, Section 4, Gynecology – 26, 33
Access Medicine OB Case Files - #6, #14, #26, #44, #25, #24, #33, #31

Week 4: 

• Physiology and Endocrinology.
  • Menstruation and Ovulation.
  • Spermatogenesis.
  • Ovigenesis
  • Intercourse
  • Orgasm and Ejaculation
  • Menopause
• Sexually Transmitted Diseases.
  • Gonorrhea.
  • Chlamydia.
  • Pelvic Inflammatory Disease.
  • Herpes Genitalis
  • Condyloma Acuminata,
  • Trichomonas Vaginitis.
  • Syphilis.
  • Chancroid.
  • HIV
  • Molluscum Contagiosum
• Other Infections.
  • Candida Vulvovaginitis.
  • Bacterial Vaginosis.
  • Urinary Tract Infections.
  • Bartholin's Gland Abscess.
• Domestic violence.

Week 4 Assignments

Beckman, Section 4, Gynecology - 28, 29, 35, 36
Access Medicine OB Case Files - #37, #20, #35, #30, #54, #36, #38

Week 5:

• Toxic Shock Syndrome. Disorders of Pelvic Support. Pelvic Relaxation.
• Urinary Incontinence. Gynecologic Neoplasms.
  • Vulvar Neoplasms
  • Cervical Dysplasia
  • Cervical Cancer
  • Uterine Myoma
  • Endometrial Cancer
  • Ovarian Neoplasms

Week 5 Assignments

Beckman Section 4, Gynecology – 30 Beckman, Section 6 – Oncology - all
Access Medicine OB Case Files - #58, #60, #59, #32, #34, #3, #40

Week 6: 

• Disorders of the Breast.
  • Breast Cysts.
  • Fibrocystic Change of the Breast.
  • Abscess of the Breast.
  • Fibroadenoma.
  • Breast Cancer.
  • Paget's disease of the Breast.
• Menstrual and Endocrinological Disorders.
  • Primary Amenorrhea.
  • Secondary Amenorrhea.
  • Premenstrual Syndrome.
  • Primary Dysmenorrhea.
  • Secondary Dysmenorrhea.
  • Abnormal Uterine Bleeding.
  • Endometriosis.
  • Hirsutism and Virilization.
  • Polycystic Ovary Syndrome.
  • Postmenopausal Bleeding
• Infertility and In Vitro Fertilization.

Week 6 Assignments

Beckman Section 5, all
Access Medicine OB Case Files - #5, #46, #47, #48, #49, #50, #51, #52, #53, #55, #56, #21

 

 

7. LEARNING RESOURCES:

REQUIRED READING

1. Obstetrics/Gynecology for the Medical Student – 7th edition – 2013 - C. Beckman - William and Wilkins. URL to purchase book http://www.amazon.com/Obstetrics-Gynecology-Charles-Beckmann- MHPE/dp/1451144318

2. APGO uWISE Self Assessment Quizzes and Comprehensive tests [when available]

https://www.apgo.org/student/uwise2/320-uwise-index.html

SUPPLEMENTAL OR ALTERNATIVE READING

3. General Textbooks

1. Fundamentals of Obstetrics and Gynecology - Llewellyn-Jones
2. Essentials of Obstetrics and Gynecology - Holker and Moore
3. A Pocket Obstetrics and Gynecology - Clayton and Newton
4. Obstetrics and Gynecology - Wilson - Carrington – Mosley
5. Handbook of Obstetrics and Gynecology - R. Benson - Lange Medical publications

4. Gynecology

1. Novak’s Gynecology - ed. Jones, Wentz and Burnett
2. Jeffcoate’s principle of Gynecology - ed. Tindall
3. Gynecology Illustrated - Garney, Gowan, Hodge, and Callander - Churchill Livingstone
4. A Pocket Gynecology - S.G. Clayton - Churchill- Livingstone
5. Essentials of Obstetrics and Gynecology - Hacker and Moore

 

5. Obstetrics

1. William’s Obstetrics - ed. Cunningham, et al
2. Available through AccessMedicine
3. Obstetrics - ed. Turnbull and Chamberlain
4. Obstetrics: Essentials of clinical practice - Niswander - Little, Brown and co.
5. Practical Obstetric problems - I. Donald – Lippincott
6. Obstetrics and Gynecology - Wilson - Carrington – Mosley
7. Human reproduction and Obstetrics - Page, Villie, and Villie – Saunders
8. Lecture notes on Obstetrics - F. Musgrove - Blackwell scientific publications
9. Obstetrics illustrated - Garney, Gowen, Hodge, and Callander - Churchill - Livingstone