Department Of OB/GYN

Goals & Objectives

URMC • OB/GYN • Medical Student Education

Third Year Clerkship in Obstetrics and Gynecology

Objectives
Guidelines
Performance Assessment

Objectives

Prior to the completion of the clerkship the student should have DONE the following activities:

Objectives for Obstetrics, Gynecology, and Specialties' Weeks

Obtain a complete OB and Gyn history (including sexual history)
Perform adequate breast, pelvic, and rectal exams
Make an acceptable oral and written presentation that integrates history, clinical data, physical examination, laboratory tests, assessments and plans

Obstetrical Service

Perform vaginal wet prep
Perform microscopic urinanalysis
Obtain Pap smear and genital cultures
Diagnose (via examination and lab tests) and date pregnancy (exam, lab tests, and ultrasound)
Provide routine prenatal care (measure fundus, listen to fetal heart, determine fetal presentation)
Plot labor using Friedman curve
Perform spontaneous vaginal delivery
Assess and examine newborn and assign APGAR score
Provide routine postpartum care
Counsel patient regarding birth control options

Gynecological Service

Perform vaginal wet prep
Perform microscopic urinanalysis
Obtain Pap smear and genital cultures
Counsel patient regarding birth control options

Prior to the completion of the clerkship the student should have OBSERVED and have an understanding of the following procedures:

Gynecological Procedures

Laparoscopy
Elective abortion (optional)
Cone biopsy
Abdominal hysterectomy
Colposcopy
Vaginal hysterectomy
Endometrial biopsy
Urinary incontinence surgery
Dilatation and curettage
Adnexal surgery
Hysteroscopy
Ectopic pregnancy surgery
Tubal ligation

Obstetrical Procedures

Ultrasound (OB/Gyn)
Amniocentesis
Cesarean section
Forceps and vacuum delivery
Circumcision

Guidelines

Prior to the completion of the clerkship the student should demonstrate KNOWLEDGE regarding the following information:

General Topics
- Age appropriate health maintenance screening and immunization recommendations for women of various age groups
- Preventive health information regarding diet, exercise, substance use, seat belt use, and safer sex practices
- Female sexual response and diverse modes of sexual expression
- Differential diagnosis, evaluation, and management of common causes of sexual dysfunction including dyspareunia
- Identification of risk factors, recognition of occurrence, and management methods for the victims of domestic violence / sexual assault
- Familiarity with ethical issues related to reproductive issues, including maternal vs. fetal rights, genetic diagnosis, assisted reproduction, induced abortion and end of life decision making
- Knowledge of issues related to informed consent and patient confidentiality
Obstetrics
1. Physiology
  - Maternal physiologic changes associated with pregnancy
  - Physiologic functions of the placenta and fetus
  - Effect of pregnancy on common diagnostic studies
2. Preconception and Antepartum Care
  - Knowledge of medical and obstetrical conditions that warrant preconceptional counseling (hypertension, diabetes mellitus, genetic abnormalities, substance abuse, etc.)
  - Knowledge of medication, drugs, and environmental exposures which are teratogenic
3. Diagnosis of Pregnancy
  - Indications for pregnancy testing
  - Methods of diagnosing pregnancy and their limitations
4. Antepartum
  - Components and rationale of routine prenatal care
  - Assessment of gestational age
  - Assessment of fetal growth and well being
  - Nutritional needs of pregnant women
  - Ability to answer common questions asked by pregnant women
5. Intrapartum Care
  - Stages and mechanisms of normal and abnormal labor
  - Assessment of fetal and maternal well being during labor
  - Principles of electronic fetal monitoring and management of non reassuring patterns
  - Methods of pain control during labor
  - Methods of evaluating fetopelvic disproportion
  - Indications and contraindications for oxytocin administration
  - Indications and contraindications for vaginal birth after cesarean section (VBAC)
6. Postpartum Care
  - Normal physiologic changes in puerperium
  - Components of routine postpartum care
  - Ability to counsel women regarding breast feeding including nutritional needs of lactating women
  - Signs and symptoms of postpartum depression
7. Immediate Care of Newborn
  - Assessment of newborn
  - Immediate care of normal newborn and need to initiate resuscitation
  - Knowledge of risks and benefits of male circumcision and ability to answer patients questions regarding circumcision
8. Complications of Pregnancy
  - How common medical conditions affect pregnancy and how pregnancy affects these conditions (for example: diabetes, heart disease, renal disease, infectious disease, asthma, substance abuse, anemia, hypertension)
  - Definition, diagnosis, and management of preeclampsia / eclampsia
  - Risk factors, diagnosis, and management of preterm labor and premature rupture of membranes
  - Risk factors, diagnosis and management of abnormal fetal growth
  - Alterations of maternal physiology, diagnosis, and risks associated with multifetal gestation
  - Causes, diagnosis, and management of causes for third trimester bleeding
  - Causes, risk factors, diagnostic, and management approaches for immediate postpartum hemorrhage
  - Causes, risk factors, diagnosis, and management of intra and postpartum infection
9. Spontaneous Abortion / Ectopic Pregnancy / Fetal Death
  - Etiologies, diagnosis, and management of first trimester bleeding including spontaneous abortion and ectopic pregnancy
  - Differential diagnosis of causes of fetal death in each trimester (including risk factors)
  - Symptoms, physical findings, and diagnostic methods to confirm the diagnosis of fetal death
    Management of a patient with fetal death including surgical issues, emotional issues, and medical complications such as DIC
Gynecology
1. Menstrual Cycle and Its Endocrine Disturbances
  - Sequence of events of normal puberty
  - Characteristics, causes, and evaluation of precocious and delayed puberty
  - Knowledge of hypothalamic / pituitary / ovarian / uterine interactions in normal menstrual cycle
  - Knowledge of normal parameters of menstrual cycle
  - Definition, differential diagnosis, evaluation, and management of amenorrhea and oligomenorrhea
  - Diagnosis, evaluation and management of hyperprolactinemia
  - Diagnosis, evaluation, and management of androgen excess
  - Definition, diagnosis and management of premenstrual syndrome
2. Family Planning / Infertility
  - Knowledge of family planing options including contraception, sterilization, and abortion
  - Knowledge of pharmacologic basis of action, risks, benefits, and contraindications for each method of family planning
  - Ability to provide contraceptive counseling and answer common patient questions (including failure rates, cost, and side effects)
  - Knowledge of etiologies, diagnostic tools, and management options for the infertile couple
3. Vaginal Bleeding
  - Differential diagnosis of abnormal vaginal bleeding based on patient age
  - Definition, diagnosis, and management of dysfunctional (anovulatory) uterine bleeding
  - Differential diagnosis, evaluation, and management of common causes of postmenopausal bleeding
4. Pelvic Pain
  - Differential diagnosis and evaluation of acute and chronic pelvic pain
  - Management of causes for acute and chronic pelvic pain (including dysmenorrhea and endometriosis)
5. Sexually Transmitted Diseases
  - Risk factors, symptoms, diagnosis, and management of common STD’s including gonorrhea, chlamydia, syphilis, herpes, Hepatitis B, and HIV
  - Risk factors, diagnosis, and management of PID including indications for hospitalization of patients
  - Long term sequelae of PID
  - Ability to counsel patients on safer sex
6. Vaginitis
  - Risk factors, symptoms, diagnosis, and management of common causes of vaginitis including yeast, trichomonas, bacterial vaginosis, atrophy, etc.
7. Pelvic Mass
  - Differential diagnosis, evaluation, and management of a suspected pelvic mass among adolescent, reproductive age and post menopausal women
  - Definition and characteristics of functional ovarian cysts
  - Diagnosis of uterine fibroids, surgical and nonsurgical management
8. Cervical Dysplasia
  - Risk factors, epidemiology, and role of HPV in cervical dysplasia
  - Classification of dysplastic disease (Bethesda System)
  - Cytologic and tissue pathologic characteristics of dysplastic disease classifications
  - Methods of evaluation to identify dysplasia
  - Treatment modalities (cryotherapy, laser, LLETZ, cold knife cone)
9. Vulvar Disorders
  - Risk factors, symptoms, diagnosis, and management of common benign vulvar disorders
  - Risk factors, symptoms, and management of vulvar intraepithelial neoplasia
10. Menopause
  - Understanding of endocrinological and physiologic changes associated with the climacteric
  - Symptoms and physical findings associated with menopause
  - Short and long term consequences of hyperestrogenic state
  - Risks, benefits, contraindications, and regimes of hormone replacement therapy
11. Pelvic Relaxation / Urinary Incontinence
  - Knowledge of different causes and types of urinary incontinence in women
  - Knowledge of evaluation and management of urinary incontinence in women
  - Knowledge of risk factors, symptoms, surgical and nonsurgical options for management of cystocele, rectocele, entrocele, and uterine prolaps
Oncology

List risk factors, epidemiology, symptoms / physical findings, evaluation, staging, and basic treatment for the following Gyn malignancies:

Cervical cancer
Vulvar / Vaginal cancer
Uterine cancer
Ovarian cancer
Gestational trophoblastic disease

Performance Assessment

Evaluations

• Staff members you have worked with will be asked to evaluate your performance. This will include faculty, private attendings, fellows, nurse midwives, residents, interns, and nurses.
• Clerkship evaluation must be completed on line within 2 weeks of completion of the clinical rotation. Grades will not be distributed until all evaluations have been completed.
Patient Case Log

• Carry it with you and fill it out as you rotate through the clerkship.
Written Exam

• A final NBME shelf examination will be administered on Friday morning of the last week of your 5-week rotation. Everyone must take this examination. There will be NO EXCEPTIONS. Minimum score to pass = 60.
• Please remember to bring your passport.
Final Grade

• Will be calculated as follows:

20% written exam
60% evaluations
10% case presentation
10% patient case log

• The final grade is considered to be final.
• Any student concerns regarding a final grade should be directed to the clerkship director.
• If you wish to review your individual evaluations, please contact the SMH Education Office.
Grade assignment and definition will follow what has been outlined by the Third Year Clinical Instruction Committee (See Policies & Procedures).