SYLLABUS

University of North Texas Health Science Center at Fort Worth

Department of Obstetrics and Gynecology

Core Clinical Clerkship

Revised 7/1/12

Table of Contents
I. Faculty II. Clerkship Description III. Clerkship Sites IV. Goals and Objectives
1. Approach to the Patient 2. Legal and Ethical Issues in Obstetrics & Gynecology 3. Preventive Care and Health Maintenance 4. Maternal-Fetal Physiology 5. Preconception Care 6. Antepartum Care 7. Intrapartum Care 8. Postpartum Care 9. Identification of the High Risk Patient 10. Abnormal Labor, Intrapartum Fetal Monitoring, Operative Delivery 11. Third Trimester Bleeding 12. Multiple Gestation 13. Preterm Delivery 14. Fetal Growth Abnormalities 15. Hypertension, Preeclampsia, Eclamasia 16. Medical and Surgical Conditions of Pregnancy 17. Isoimmunization 18. Fetal Death 19. Obstetric Procedures 20. Contraception and Sterilization 21. Sexually Transmitted Diseases 22. Vulvar and Vaginal Diseases 23. Pelvic Relaxation and Urinary Incontinence 24. Disorders of the Breast 25. Pelvic Pain 26. Abnormal Vaginal Bleeding 27. Pelvic Mass 28. Gynecologic Procedures 29. Puberty 30. Amenorrhea 31. Hirsutism and Virilization 32. Menopause 33. Infertility 34. Preinvasive Cancer of the Vulva, Vagina and Cervix 35. Gynecologic Cancer 36. Sexuality and Modes of Sexual Expression 37. Violance Against Women 38. Reproductive Pharmacology 39. Reproductive and Breast Imaging 40. Obstetrical and Gynecological Pathology 41. Embryology and Congenital Anomalies 42. Achieving Competency in Osteopathic Manipulative Medicine During Pregnancy

3 4 5 6-31
6-8 8 9 9 9 10 10 11-12 12 13 13 14 14-15 15 16 16 17 17 17-18 18 19 19-20 20 20-21 21 22-23 23-24 24-25 25 25-26 26 26 26-27 27 27-29 29 29-30 30 30 30-31 31 31

V. Basic Principles of Osteopathic Medicine VI. General Competencies VII. Instructional Program VIII.Educational Resources IX. Student Responsibilities X. Student Evaluation XI Disclaimer

32 33 34 35 36 37 37 2

I.FACULTY
Obstetrics and Gynecology Robert Adams, D.O., F.A.C.O.O.G. Melchor Boone, M.D., F.A.C.O.G Steve Buchanan, D.O., F.A.C.O.O.G. John Chapman, D.O., F.A.C.O.G. Khoi Chu, M.D., F.A.C.O.G. Shanna Combs, M.D. Peter Elliott, M.D., F.A.C.O.G. Kollier Hinkle, M.D. Tracy Kobs, M.D., F.A.C.O.G Timothy Kremer, M.D., F.A.C.O.G. G. Sealy Massingill, M.D., F.A.C.O.G. JPS Chairman David Moreland, M.D., F.A.C.O.G. Joseph Pallone, M.D. Clay Perkins, M.D., F.A.C.O.G. Leslie Phillips, M.D., F.A.C.O.G Kathleen Robertson, M.D., F.A.C.O.G. Rose Simani, M.D. Chris Stevens, M.D. G. Douglas Tatum, M.D., F.A.C.O.G Gynecologic Oncology Ralph Anderson, M.D. F.A.C.O.G., F.R.C.S., (C) Department Chairman DeEtte Vasques, D.O., F.A.C.O.O.G. Urogynecology & Pelvic Incontinence Peter Elliott, M.D., F.A.C.O.G. Manhan (Andy) Vu, D.O Maternal-Fetal Medicine David Rindfusz, M.D., F.A.C.O.G Robert Sigman, M.D. F.A.C.O.G Reproductive Endocrinology Frank DeLeon, M.D., F.A.C.O.G. Internal Medicine Kathleen Crowley, M.D. Jennifer Hinkle, M.D. Osteopathic Manipulative Medicine Kendi Hensel, DO, Ph.D. Nurse Midwives Kathleen Donaldson, CNM Gloria Glidewell, CNM Candis Hicks, CNM Lindsay Kragle, CNM Tania Lopez, CNM Summer Okimoto, CNM

II.

CLERKSHIP DESCRIPTION
The Obstetrics and Gynecology Clerkship is a core rotation consisting of six weeks of active participation in patient care with specialists in the field of obstetrics and gynecology. The clerkship is designed to acquaint you with the concepts and practices utilized in the care of obstetrical, gynecological and gynecologic surgical patients. Through this experience you will learn many of the techniques and procedures inherent to the specialty and become familiar with the diagnosis and management of common problems and complications associated with obstetrical and gynecologic patients. At the end of the rotation you should be able to determine which of these techniques and procedures are appropriate for use as a primary care physician and which should be delegated to specialists in the field. The sites of Obstetrics and Gynecology clerkships along with the names of clerkship coordinators are available in the Clinical Affairs Office. Your clerkship responsibilities will be defined by the director at the clerkship site. In addition to responsibilities involving patient care, there should be active attempts to broaden your knowledge of the specialty. To pursue this goal, you will be expected to attend and participate in available structured educational activities and complete reading and/or review assignments that are recommended. You will be immediately supervised by the rotating resident staff and the attending physician. You are expected you to perform consistently as a responsible member of the health care team, displaying a professional demeanor both with your patients and with your colleagues. Your approach to patients should be as a health advocate and partner striving to develop an appropriate rapport, involving their participation and always maintaining a strict sense of confidentiality. One hundred percent attendance is expected of you for all clerkship activities as outlined for your site (daily patient care, daily rounds, available lectures, etc.). You are expected to understand the regulations governing use of controlled substances and realize that their abuse will result in automatic failure of this clerkship. Should the need arise for your absence (i.e. illness or death in the family) you must notify both your immediate supervisor and the clerkship coordinator. When you are on the service, you should make yourself available to assist where needed, using these opportunities to further your learning. You are expected to be punctual and prepared at all times. Dress and appearance should be appropriate for the clinical situation in which you are involved at the time. The nature of the specialty sometimes requires long and varied hours. In addition, there will be call as dictated by the coordinator at your clerkship site. Please make appropriate arrangement to be available during all hours that you have responsibilities.

III. OBSTETRICS AND GYNECOLOGY CLERKSHIP SITES

UNTHSC JPS
Contact Person Faculty Contacts Carolyn Anderson Kollier (Kip) Hinkle, M.D. Ralph Anderson, M.D. 817-735-5455 direct line 817-735-2198 main line 817-735-2198 817-735-2198

JOHN PETER SMITH HOSPITAL

1500 South Main Street Fort Worth, TX 76104 John Peter Smith Switchboard John Peter Smith Department of Ob/Gyn Labor and Delivery JPS HCW Main Street HCW Arlington Clinic HCW Northwest Clinic 817-921-3431 817-927-1065 817-927-1060 817-920-6500 817-852-8250 817-702-8650 817-735-2238 817-250-2000 817-250-2010 817-735-2300

UNIVERSITY CLINIC
PCC 6th Floor Ob/Gyn Clinic

HARRIS METHODIST HOSPITAL

Main Number Labor & Delivery Ob/Gyn Office

BAY AREA CORPUS CHIRSTI MEDICAL CENTER

7101 So. Padre Island Drive Corpus Christi, TX 78412 Contact Person Deborah Wills 361-761-3540

CHRISTUS SPOHN HOSPITAL MEMORIAL

2222 Morgan #114 Corpus Christi, TX 78405 Contact Person 704 Old Montgomery Road Conroe, TX 77301 Contact Person 1441 N. Beckley Ave. Dallas, TX 75203 Contact Person 4301 Garth Rd. Suite 400 Baytown, TX 77521 Contact Person Belinda Bel Flores, RN, BHA 361-888-7523

CONROE MEDICAL EDUCATION FOUNDATION

Jennie Faulkner 936-523-5247

DALLAS METHODIST HOSPITAL

Patrice Williams 214-947-2331

SAN JACINTO METHODIST HOSPITAL

Diane Dougherty, Ph.D. 281-420-8523

LONGVIEW GOOD SHEPHERD MEDICAL CENTER 700 E. Marshal Ave. Longview, TX 75601 Contact Person Cindy Harrison

903-315-5277 5

IV.

GOALS AND OBJECTIVES

Educational Objective 1 - APPROACH TO THE PATIENT A. History Taking Rationale: A gynecological evaluation is an important part of primary health care and preventive medicine for women. A gynecological assessment should be a part of every womans general medical interview and physical examination. Certain questions must be asked of every woman, whereas other questions are specific to particular problems. To accomplish these objectives, optimal communication must be achieved between patient and physician. Objectives: The student will be able to: A. Complete a comprehensive womens medical interview, including: a. Menstrual history b. Obstetrical history c. Gynecologic history d. Contraceptive history e. Sexual history, including sexual orientation and sexual function f. Family history g. Social history B. Assess the risk for unintended pregnancy, sexually transmitted infections, cervical pathology, breast malignancy, gynecologic malignancies and domestic violence C. Assess compliance with recommended screening measures specific to women (e.g. cervical malignancy, gynecologic exam, breast exam, diagnostic breast imaging) in riskappropriate circumstances D. Demonstrate interpersonal and communication skills that build trust by addressing contextual factors (e.g. culture, ethnicity, language/literacy, socioeconomic class, spirituality/religion, age, sexual orientation, disability) E. Communicate the results of the ob/gyn and general medical interview by well-organized written and oral reports B. Physical/Pelvic Examination Rationale: An accurate examination complements the history, provides additional information, and helps determine diagnosis and guide management. It also provides an opportunity to educate and reassure the patient. Objectives: The student will be able to: A. Interact with the patient to gain her confidence and cooperation, and assure her comfort and modesty B. Perform accurate examinations in a sensitive manner, including: a. Breast examination b. Abdominal examination 6

C.

D. E. F.

c. Complete pelvic examination d. Recto-vaginal examination Use accurate terminology to describe the: a. Normal female anatomy across the life span b. Appearance of common pathology of the female urogenital tract c. Appearance of common breast changes and disorders Communicate the relevant results of the examination in well-organized written and oral reports Share results Educate the patient regarding breast self-examination

C. Pap Smear and Cultures Rationale: The Pap smear is one of the most effective screening tests used in medicine today. Proper technique in performing the Pap smear and obtaining specimens for microbiologic culture will improve accuracy. Objectives: The student will be able to: A. Perform an adequate Pap smear B. Obtain specimens to detect sexually transmitted infections C. Handle specimens properly to improve diagnostic accuracy D. Provide an explanation to the patient regarding the purpose of these tests D. Diagnosis and Management Plan Rationale: Accurately identifying problems and selecting the most likely diagnosis leads to effective management plans. Objectives: The student will be able to: A. Generate a problem list. B. Form a diagnostic impression, including differential diagnosis C. Consider economic, psychosocial and ethical issues D. Develop a management plan that includes: a. Laboratory and diagnostic studies b. Treatment c. Patient education d. Continuing care plans E. Personal Interaction and Communication Skills Rationale: The student must have the ability to interact cooperatively with a patient and all members of a health care team. This is a hallmark of professionalism. Objectives: The student will be able to: A. Establish rapport with patients B. Work cooperatively with patients, their social supports and other members of the health care team C. Assess his/her own strengths and weaknesses with regard to personal interactions 7

F. Preventive Care and Health Maintenance Rationale: The student will recognize the value of routine health surveillance as a part of health promotion and disease prevention. Objectives: The student will be able to: A. List age-appropriate screening procedures and recommended time intervals for mammogram, bone density, Pap tests, STI evaluation and other screening tests B. Counsel patient regarding contraception, domestic abuse/violence and prevention of sexually transmitted infections. Reading Suggestions: Obstetrics and Gynecology, Beckman, et al, 6th Ed., Chapter 1, pages 1-13 Obstetrics and Gynecology, Beckman, et al, 6th Ed., Chapter 2, pages 15-21 Educations Objective 2 - LEGAL AND ETHICAL ISSUES IN OBSTETRICS AND GYNECOLOGY Rationale: Legal obligations to protect patients interests are effective only if understood and applied. Recognizing and understanding the basis of ethical conflicts in obstetrics and gynecology will allow better patient care and prevent critical errors in treatment planning. Objectives: The student will be able to: A. Explain the issues involved in informed consent B. Demonstrate the role of confidentiality in clinical activities C. List the local laws requiring the reporting of suspected child abuse and domestic violence D. Discuss the legal and ethical issues in the care of minors E. Describe issues of justice relating to access to obstetric-gynecologic care F. Explain the basis of ethical conflict in maternal-fetal medicine G. Discuss ethical issues raised by induced abortion, contraception and reproductive technology Reading Suggestions: Obstetrics and Gynecology, Beckman, et al, 6th Ed., Chapter 3, pages 23-27

Educational Objective 3 PREVENTIVE CARE AND HEALTH MAINTENANCE Rationale: The student will recognize the value of routine health surveillance as a part of health promotion and disease prevention. Objectives: The student will be able to: A. List age-appropriate screening procedures and recommended time intervals for mammogram, bone density, Pap tests, STI evaluation and other screening tests B. Counsel patient regarding contraception, domestic abuse/violence and prevention of sexually transmitted infections Obstetrics and Gynecology, Beckman, et al, 6th Ed., Chapter 2, pages 15-21 Educational Objective 4 - MATERNAL-FETAL PHYSIOLOGY Rationale: Knowledge of the physiologic adaptations to pregnancy will allow the student to better understand the impact of pregnancy in health and disease. Objectives: The student will be able to: A. Discuss the maternal physiologic anatomic changes associated with pregnancy B. Describe the physiologic functions of the placenta and fetus C. Discuss the effect of pregnancy on common diagnostic studies Reading Suggestions: Obstetrics and Gynecology, Beckman, et al, 6th Ed., Chapter 5, pages 43 - 56 Essentials of Obstetrics and Gynecology, Hacker & Moore, 5th Ed., Chapter 6, pages 56-70 Educational Objective 5 - PRECONCEPTION CARE Rationale: The proven benefits of good health prior to conception include a significant reduction in maternal and fetal morbidity and mortality. Objectives: The student will be able to: A. Describe how certain medical conditions affect pregnancy B. Describe how pregnancy affects certain medical conditions C. Counsel patients regarding history of genetic abnormalities D. Counsel patients regarding advanced maternal age E. Counsel patients regarding substance abuse F. Counsel patients regarding nutrition and exercise G. Counsel patients regarding medications and environmental hazards H. Counsel patients regarding immunizations Reading Suggestions: Obstetrics and Gynecology, Beckman, et al, 6th Ed., Chapter 6, pages 57-76 Essentials of Obstetrics and Gynecology, Hacker & Moore, 5th Ed., Chapter 7, pages 71-90

Educational Objective 6 - ANTEPARTUM CARE Rationale: Antepartum care promotes patient education and provides ongoing risk assessment and development of an individualized management plan. Objectives: The student will be able to: A. Diagnose pregnancy B. Assess gestational age C. Distinguish an at-risk pregnancy D. Assess fetal growth, well-being, maturity and amniotic fluid volume E. Describe appropriate diagnostic studies F. Describe nutritional needs of pregnant woman G. Describe adverse effects of drugs and the environment H. Perform a physical examination on obstetric patients I. Answer commonly-asked questions concerning pregnancy, and labor and delivery J. Counsel a woman with an unintended pregnancy Reading Suggestions: Obstetrics and Gynecology, Beckman, et al, 6th Ed., Chapter 6, pages 57-76 Essentials of Obstetrics and Gynecology, Hacker & Moore, 5th Ed., Chapter 7, pages 71-90 Educational Objective 7 - INTRAPARTUM CARE Rationale: Understanding the process of normal labor and delivery allows optimal care and reassurance for the parturient and timely recognition of abnormal events. Objectives: The student will be able to: A. List the signs and symptoms of labor B. Describe the three stages of labor and recognize common abnormalities C. Describe the steps of a vaginal delivery D. Describe different methods of delivery with the indications and contraindications of each E. Describe the evaluation of common puerperal complications F. Understand principles of obstetrical analgesia and anesthesia G. Understand principles of resuscitation of the newborn Reading Suggestions: Obstetrics and Gynecology, Beckman, et al, 6th Ed., Chapter 8, pages 91-102 Essentials of Obstetrics and Gynecology, Hacker & Moore, 5th Ed, Chapter 8, pages 91-118

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Educational Objective 8 - POSTPARTUM CARE Maternal physiologic changes of the postpartum period Rationale: Knowledge of normal postpartum events allows appropriate care, reassurance of early recognition of abnormal events. Objectives: The student will be able to: A. Discuss the normal maternal physiologic changes of the postpartum period B. Describe the components of normal postpartum care C. Discuss the appropriate postpartum patient counseling Reading Suggestions: Obstetrics and Gynecology, Beckman, et al, 6th Ed., Chapter 11, pages 125-132 Essentials of Obstetrics and Gynecology, Hacker & Moore, 5th Ed., Chapter 8, pages 91-118 Postpartum Hemorrhage Rationale: Postpartum hemorrhage continues to be a major, although often preventable, cause of maternal morbidity and mortality. Objectives: The student will be able to: A. List the risk factors for postpartum hemorrhage B. Formulate a differential diagnosis of postpartum hemorrhage C. Describe the immediate management of the patient with postpartum hemorrhage Reading Suggestions: Obstetrics and Gynecology, Beckman, et al, 6th Ed., Chapter 12, pages 133-140 Essentials of Obstetrics and Gynecology, Hacker & Moore, 5th Ed., Chapter 10, pages 128-138 Postpartum Infections Rationale: Early recognition and treatment of postpartum infection will decrease maternal morbidity and mortality. Objectives: The student will be able to: A. List the risk factors for postpartum infection B. Describe the pathophysiology of postpartum infection C. Identify the organisms involved in postpartum infection. D. Describe the evaluation and management of the patient with postpartum infection Reading Suggestions: Essentials of Obstetrics and Gynecology, Hacker & Moore, 5th Ed., Chapter 8, pages 91-118

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Perinatal and Postpartum Depression and Anxiety Rationale: Pregnancy, as any significant life event, may be accompanied by anxiety and depression. Recognition of psychological disturbance is essential for early intervention. Objectives: The student will be able to: A. Identify risk factors and, diagnose postpartum blues, postpartum depression and postpartum psychosis B. Describe treatment options for postpartum blues postpartum depression and postpartum psychosis C. Identify appropriate treatment options for depression in pregnancy Reading Suggestions: Lecture Obstetrics and Gynecology, Beckman, et al, 6th Ed., Chapter 11, pages 125-132 Educational Objective 9 - IDENTIFICATION OF THE HIGH RISK PATIENT Rationale: For the majority of women pregnancy and childbirth is a normal physiologic process that results in the delivery of a healthy infant. However, certain circumstances may place a mother or infant at risk for increased morbidity or mortality. A pregnancy is defined as high risk when the likelihood of an adverse outcome is greater than in the general pregnant population. Objectives: A. Understand the concepts of maternal mortality and perinatal mortality B. Identify the high risk patient from the a. General history i. Maternal age ii. Presence of substance abuse iii. Presence of environmental risks iv. Presence of domestic violence b. Obstetric history c. Medical history d. Physical examination e. Pelvic examination f. Laboratory studies Reading Suggestions: Essentials of Obstetrics and Gynecology, Hacker & Moore, 5th Ed., Chapter 7, pages 71-90

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Educational Objective 10 - ABNORMAL LABOR, INTRAPARTUM FETAL MONITORING OPERATIVE DELIVERY Cesarean Section Vacuum Delivery Forceps Rationale: Labor is expected to progress in an orderly and predictable manner. Careful observation of the mother and fetus during labor will allow early detection of abnormalities so that management can be directed to optimize outcome. Objectives: The student will be able to: A. List abnormal labor patterns. B. Describe methods of fetal surveillance C. Discuss fetal and maternal complications of abnormal labor D. List indications and contraindications for oxytocin administration E. List indications for VBAC F. Describe indications for and principles of operative delivery G. Discuss strategies for emergency management of breech, shoulder dystocia and cord prolapse H. Perform fetal auscultation I. Interpret fetal heart monitoring Reading Suggestions: Obstetrics and Gynecology, Beckman, et al, 6th Ed., Chapter 9, pages 103-118 Essentials of Obstetrics and Gynecology, Hacker & Moore, 5th Ed., Chapter 11, pages 139-145 Essentials of Obstetrics and Gynecology, Hacker & Moore, 5th Ed., Chapter 9, pages 119-127 Educational Objective 11 - THIRD TRIMESTER BLEEDING Rationale: Bleeding in the third trimester requires immediate patient evaluation. Thoughtful, prompt evaluation and management is necessary to reduce the threat to the lives of the mother and fetus. Objectives: The student will be able to: A. List the causes of third trimester bleeding B. Describe the initial evaluation of a patient with third trimester bleeding C. Differentiate the signs and symptoms of third trimester bleeding D. State the maternal and fetal complications of third trimester bleeding E. Describe the initial management plan for shock secondary to acute blood loss F. List the indications and potential complications of blood products Reading Suggestions: Obstetrics and Gynecology, Beckman, et al, 6th Ed., Chapter 21, pages 207-212 Essentials of Obstetrics and Gynecology, Hacker & Moore, 5th Ed., Chapter 10, pages 128-138

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Education Objective 12 - MULTIPLE GESTATIONS Rationale: When there is more than one fetus, antepartum, intrapartum, and postpartum management must be modified in order to optimize outcome for the mother and fetuses. Objectives: The student will be able to: A. Discuss the etiology of monozygotic, dizygotic and multizygotic gestation B. Describe the altered physiologic state with multifetal gestation C. Discuss the symptoms, physical findings and diagnosis of multifetal gestation D. Discuss the approach to antepartum, intrapartum and postpartum management for multifetal gestation E. Describe the potential complications (maternal and fetal) associated with multi-fetal gestation Reading Suggestions: Obstetrics and Gynecology, Beckman, et al, 6th Ed., Chapter 17, pages 183-188 Essentials of Obstetrics and Gynecology, Hacker & Moore, 5th Ed., Chapter 13, pages 160-172 Educational Objective 13 - PRETERM LABOR Rationale: Prematurity is the most common cause of neonatal mortality and morbidity. The reduction of preterm births remains an important goal in obstetric care. Understanding the causes and recognizing the symptoms of preterm labor provides the basis for management decisions.
Objectives: The student will be able to: A. Cite the risk factors for preterm labor B. Distinguish preterm labor from Braxton Hicks contractions C. Identify the causes of preterm labor D. Counsel the patient regarding the signs and symptoms of preterm labor E. Describe the initial management of preterm labor F. List indications of medications used to treat preterm labor G. Describe the adverse events associated with the management of preterm labor H. Counsel the patient who has experienced prior preterm birth I. Describe cervical incompetence

Reading Suggestions: Obstetrics and Gynecology, Beckman, et al, 6th Ed., Chapter 20, pages 201-206 Essentials of Obstetrics and Gynecology, Hacker & Moore, 5th Ed., Chapter 12, pages 146-159 Premature Rupture of Membranes Rationale: Rupture of the membranes prior to labor is a problem for both term and preterm pregnancies. Careful evaluation of this condition may improve fetal and maternal outcome.
Objectives: The student will be able to: A. Summarize the history, physical findings and diagnostic methods to confirm rupture of the membranes B. Cite the factors predisposing to premature rupture of membranes C. Lists the risks and benefits of expectant management versus immediate delivery

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D. Describe the methods to monitor maternal and fetal status during expectant management E. Counsel the patient with preterm premature rupture of membranes

Reading Suggestions: Obstetrics and Gynecology, Beckman, et al, 6th Ed., Chapter 22, pages 213-218 Essentials of Obstetrics and Gynecology, Hacker & Moore, 5th Ed., Chapter 12, pages 146-159 Post-term Pregnancy Rationale: Perinatal mortality and morbidity may be increased significantly in a prolonged pregnancy. Prevention of complications associated with post-term pregnancy is one of the goals of antepartum and intrapartum management.
Objectives: The student will be able to: A. Identify the normal period of gestation B. Discuss the complications of post-maturity

Reading Suggestions: Obstetrics and Gynecology, Beckman, et al, 6th Ed., Chapter 23, pages 219-222 Essentials of Obstetrics and Gynecology, Hacker & Moore, 5th Ed., Chapter 12, pages 146-159 Educational Objective 14 - FETAL GROWTH ABNORMALITIES Rationale: Abnormalities of fetal growth carry increased risks for morbidity and mortality. Monitoring fetal growth is an important aspect of prenatal care and is performed on a regular basis throughout the antepartum period.
Objectives: The student will be able to: A. Define macrosomia and fetal growth restriction B. Describe etiologies of abnormal growth C. Cite methods of detection of fetal growth abnormalities D. Cite associated morbidity and mortality

Reading Suggestions: Obstetrics and Gynecology, Beckman, et al, 6th Ed., Chapter 18, pages 189-194 Essentials of Obstetrics and Gynecology, Hacker & Moore, 5th Ed., Chapter 13, pages 160-172

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Educational Objective 15 - HYPERTENSION, PREECLAMPSIA, ECLAMPSIA Rationale: Preeclampsia-eclampsia syndrome accounts for significant morbidity and mortality in both the mother and the newborn. Objectives: The student will be able to: A. Define hypertension in pregnancy B. Classify hypertension in pregnancy C. Describe the pathophysiology of preeclampsia-eclampsia syndrome D. Enumerate the symptoms of preeclampsia-eclampsia syndrome E. Summarize the physical findings of preeclampsia-eclampsia syndrome F. Diagnose preeclampsia-eclampsia syndrome G. Manage a patient with preeclampsia/eclampsia syndrome H. Counsel a patient concerning the indications of MgSO4 I. Counsel the patient concerning the maternal and fetal complications associated with preeclapsia/eclampsia syndrome Reading Suggestions: Obstetrics and Gynecology, Beckman, et al, 6th Ed., Chapter 16, pages 175-182 Essentials of Obstetrics and Gynecology, Hacker & Moore, 5th Ed. Chapter 14, pages 173-182 Educational Objective 16 - MEDICAL AND SURGICAL CONDITIONS OF PREGNANCY Rationale: Medical and surgical conditions may alter the course of pregnancy and pregnancy may have an impact on the management of these conditions. Objectives: The student will be able to: A. Recognize the following medical and surgical conditions of pregnancy a. Anemia b. Diabetes mellitus c. Urinary tract disorders d. Infectious diseases, including: i. Herpes ii. Rubella iii. Group B Streptococcus iv. Hepatitis v. Human Immunodeficiency Virus (HIV), Human Papillomavirus (HPV) and other sexually transmitted infections vi. Cytomegalovirus (CMV) vii. Toxoplasmosis viii. Varicella and parvovirus ix. Cardiac disease x. Asthma xi. Alcohol, tobacco and substance abuse xii. Surgical abdomen 16

B. Discuss the potential impact of the above conditions on the gravid patient and the fetus/newborn, as well as the impact of pregnancy on each condition, if any Reading Suggestions: Obstetrics and Gynecology, Beckman, et al, 6th Ed., Chapter 14, pages 151-164 Essentials of Obstetrics and Gynecology, Hacker & Moore, 5th Ed., Chapter 16, pages 191-218 Educational Objective 17 - ISOIMMUNIZATION Rationale: The problem of fetal hemolysis from maternal D isoimmunization has decreased in the past few decades. Awareness of the red cell antigen-antibody system is important to help further reduce the morbidity and mortality from isoimmunizatoin Objectives: The student will be able to: A. Describe the pathophysiology of isoimmunization, including: a. The role of red blood cell antigens b. The clinical circumstances under which D isoimmunization is likely to occur B. Discuss the use of immunoglobin prophylaxis during pregnancy for the prevention of isoimmunization C. Discuss the methods used to identify maternal isoiummunization and the severity of fetal involvement Reading Suggestions: Obstetrics and Gynecology, Beckman, et al, 6th Ed., Chapter 19, pages 195-200 Essentials of Obstetrics and Gynecology, Hacker & Moore, 5th Ed., Chapter 15, pages 183-190 Educational Objective 18 FETAL DEATH Rationale: Early and accurate diagnosis and management will help the patient with emotional adjustments surrounding fetal death and may prevent associated obstetric complications. Objectives: The student will be able to: A. Describe the common causes of fetal death in each trimester B. Describe the symptoms, physical findings and diagnostic methods to confirm the diagnosis of fetal death C. Describe the maternal complications of fetal death, including disseminated intravascular coagulopathy D. Counsel the patient experiencing death of the fetus Educational Objective 19 OBSTETRIC PROCEDURES Rationale: Knowledge of obstetric procedures is basic to management and counseling of the pregnant patient. Objectives: The student will be able to: A. Describe the key components of pre-operative evaluation and planning, including complete medical histories, the informed consent process and working with consultant. 17

B. Describe the common peri-operative prophylactic measures, including steps taken to reduce infection and deep venous thrombosis C. Describe the components of routine post-operative care D. List common post-operative complications. E. Describe each procedure and list the indications and complications of each of the following: a. Ultrasound b. Chorionic villous sampling c. Amniocentesis and cordocentesis d. Antepartum fetal assessment e. Intrapartum fetal surveillance f. Induction and augmentation of labor g. Episiotomy h. Spontaneous vaginal delivery i. Vacuum-assisted delivery j. Forceps delivery k. Breech delivery l. Cesarean delivery m. Vaginal birth after cesarean delivery Reading Suggestions: Essentials of Obstetrics and Gynecology, Hacker & Moore, 5th Ed., Chapter 17, pages 219-230 Educational Objective 20 - CONTRACEPTION AND STERILIZATION Rationale: An understanding of the medical and personal issues involved in decisions regarding contraceptive methods is necessary to adequately advise patients requesting contraception. In the process of deciding whether to have a sterilization procedure, men and women often seek the advice of their physicians. Providing accurate information will allow patients to make an informed decision regarding this elective surgery. Objectives: The student will be able to: A. Describe the physiologic basis of contraception (OCPs, emergency contraception, patches, rings, IUD, sterilization, etc.) B. Describe the effectiveness of each form of contraception C. Understand the benefits and risks for each form of contraception D. Cite the financial considerations of the various forms of contraception E. Describe the methods of male and female surgical sterilization F. List the risks and benefits of procedures, including: a. Potential surgical complications b. Failure rates c. Reversibility (lack of) Reading Suggestions: Obstetrics and Gynecology, Beckman, et al, 6th Ed., Chapter 24, pages 223-234 Obstetrics and Gynecology, Beckman, et al, 6th Ed., Chapter 25, pages 235-240 Essentials of Obstetrics and Gynecology, Hacker & Moore, 5th Ed., Chapter 26, pages 305-314

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Educational Objective 21 - SEXUALLY TRANSMITTED DISEASES Rationale: To prevent sexually transmitted infections and urinary tract infections, the physician should understand their basic epidemiology, diagnosis and management. The potential impact of acute or chronic salpingitis is significant. Early recognition and optimal management may help prevent the long-term sequelae of tubal disease. Objectives: The student will be able to: A. Differentiate the signs and symptoms of the following STIs: Gonorrhea, Chlamydia, Herpes simplex virus, Syphilis, Human papillomavirus infection, Human immunodeficiency virus (HIV) infection, Hepatitis B virus infection B. List the physical and clinical findings in the following STIs: Gonorrhea, Chlamydia, Herpes simplex virus, Syphilis, Human papillomavirus infection, Human immunodeficiency virus (HIV) infection, Hepatitis B virus infection C. Describe the methods of evaluation for the following STIs: Gonorrhea, Chlamydia, Herpes simplex virus, Syphilis, Human papillomavirus infection, Human immunodeficiency virus (HIV) infection, Hepatitis B virus infection D. Describe the management of the following STIs: Gonorrhea, Chlamydia, Herpes simplex virus, Syphilis, Human papillomavirus infection, Human immunodeficiency virus (HIV) infection, Hepatitis B virus infection E. Describe the pathogenesis of salpingitis F. List the signs and symptoms of salpingitis G. Identify the long-term sequelae of salpingitis, including: tubo-ovarian abscess, chronic salpingitis, ectopic pregnancy, infertility H. Counsel the patient about the public health concerns for STIs, including screening programs, costs, prevention and immunizations, and partner evaluation and treatment Reading Suggestions: Obstetrics and Gynecology, Beckman, et al, 6th Ed., Chapter 27, pages 247-258 Educational Objective 22 - VULVAR AND VAGINAL DISEASE Rationale: Vaginal and vulvar symptoms are frequent patient concerns. In order to provide appropriate care, the physician must understand the common etiologies of these problems, as well as appropriate diagnostic and management options. Objectives: The student will be able to: A. Understand the etiology and pathophysiology of vaginitis B. Understand dermatologic disorders of the vulva Infections Vulva Bartholins gland abscess Pediculsis Herpes Granulosa inguinale Lymphogranuloma venereum 19

Condyloma acuminate Syphilis Vagina Trichomoniasis Hemophilus Yeast infection Dystrophies of Vulva Lichen sclerosus Squamous cell hyperplasia Reading Suggestions: Obstetrics and Gynecology, Beckman, et al, 6th Ed., Chapter 26, pages 241-246 Obstetrics and Gynecology, Beckman, et al, 6th Ed., Chapter 42, pages 365-374 Essentials of Obstetrics and Gynecology, Hacker & Moore, 5th Ed., Chapter 18, pages 231-239 Educational Objective 23 - PELVIC RELAXATION AND URINARY INCONTINENCE Rationale: Patients with conditions of pelvic relaxation and urinary incontinence present in a variety of ways. The physician should be familiar with the types of pelvic relaxation and incontinence, and the approach to management of these patients. Objectives: The student will be able to: A. Incorporate screening questions for urinary incontinence when eliciting a patient history B. Discuss the difference between stress, urge and overflow incontinence C. Obtain pertinent history components to differentiate between incontinence types D. Identify the following elements on physical exam: cystocele, rectocele, vaginal vault/uterine prolapse E. List behavioral, medical and surgical methods to appropriately treat incontinence and pelvic organ prolapse Reading Suggestions: Obstetrics and Gynecology, Beckman, et al, 6th Ed., Chapter 28, pages 259-268 Essentials of Obstetrics and Gynecology, Hacker & Moore, 5th Ed., Chapter 23, pages 276-289 Educational Objective 24 - DISORDERS OF THE BREAST Rationale: Every physician should understand the basic approach to evaluating the common symptoms associated with the breast. Objectives: The student will be able to: A. Demonstrate the performance of a comprehensive breast exam. B. Discuss diagnostic approach to a woman with the chief complaint of breast mass, nipple discharge or breast pain C. List history and physical findings that may suggest: a. Mastitis b. Carcinoma 20

c. Fibrocystic changes d. Intraductal papilloma e. Fibroma Reading Suggestions: Obstetrics and Gynecology, Beckman, et al, 6th Ed., Chapter 31, pages 283-294 Essentials of Obstetrics and Gynecology, Hacker & Moore, 5th Ed., Chapter 29, pages 326-331 Educational Objective 25 - PELVIC PAIN Rationale: Pelvic pain occurs in 7-10% of Emergency Room visits. The etiology, diagnosis and the management of patients with pelvic pain varies greatly with the age of the patient. Objectives: The student will be able to: A. Understand the pathophysiology of pelvic pain B. Understand that the etiology and management of pelvic pain depends greatly according to age C. Understand the diagnostic tools available to diagnose pelvic pain D. Formulate a differential diagnosis of pelvic pain E. Understand the principles of management of the various causes of pelvic pain Pelvic Pain Gynecologic Ectopic pregnancy Ruptured ovarian cyst Ovarian torsion Pelvic inflammatory disease Endometriosis Dysmenorrhea Pelvic Adhesions Gastrointestinal Disorders Appendicitis Diverticulitis Regional ileits Ulcerative colitis Urologic Disorders Cystitis Ureteral calculus Reading Suggestions: Obstetrics and Gynecology, Beckman, et al, 6th Ed., Chapter 13, pages 141-150 Obstetrics and Gynecology, Beckman, et al, 6th Ed., Chapter 29, pages 269-276 Obstetrics and Gynecology, Beckman, et al, 6th Ed., Chapter 30, pages 277-282 Essentials of Obstetrics and Gynecology, Hacker & Moore, 5th Ed., Chapter 21, pages 256-264 Essentials of Obstetrics and Gynecology, Hacker & Moore, 5th Ed., Chapter 22, pages 265-275 Essentials of Obstetrics and Gynecology, Hacker & Moore, 5th Ed., Chapter 24, pages 290-297 Essentials of Obstetrics and Gynecology, Hacker & Moore, 5th Ed., Chapter 25, pages 298-304 21

Educational Objective 26 - ABNORMAL VAGINAL BLEEDING Rationale: Abnormal vaginal bleeding in women occurs in all age groups. The etiology, diagnosis and management vary greatly according to age. Objectives: The student will be able to: A. Describe the pathophysiology of menstruation B. Describe terminology in discussing abnormal vaginal bleeding C. Be aware of the causes and pathophysiology of abnormal vaginal bleeding in all age groups D. Describe the principles of management of the various causes of abnormal vaginal bleeding Reading Suggestions: Obstetrics and Gynecology, Beckman, et al, 6th Ed., Chapter 35, pages 315-320 Educational Objective 26 (cont) - Abnormal Vaginal Bleeding Newborn Functional Pre-Pubertal Foreign body Bacterial infections Sexual assault Urethral prolapse Precocious puberty Genital tumors Adolescent Anovulation Coagulative disorders Reproductive Age Groups Accidents of pregnancy Threatened abortion Incomplete abortion Complete abortion Missed abortion Ectopic pregnancy Placenta previa Abruptio placenta Uterine lesion is reproductive age patients who are ovulating, not pregnant and who have menorrhagia Endometrial polyp Uterine fibroids Adenomyosis Endometriosis 22

Perimenopausal Age Group Anovulation Hyperplasia of endometrium Cancer of the uterus Cancer of the cervix Postmenopausal Age Group Exogenous estrogen Atrophic vaginitis or endometrititis Endometrial cancer Endometrial or cervical polyp Endometrial hyperplasia Educational Objective 27 - PELVIC MASS Rationale: Pelvic masses are very common during a womans lifetime. The etiology, diagnosis and management of the pelvic mass vary greatly according to age. Objectives: The student will be able to: A. Describe the anatomy of the pelvic mass and the disease process that can lead to the development of a pelvic mass B. Describe the pathophysiology and differential diagnosis of the pelvic mass in women of all age groups C. To realize the importance of malignancy in the differential diagnosis of the pelvic mass D. Describe the principles of management of the various causes of a pelvic mass Educational Objective 27 (cont) Pelvic Mass - Differential Diagnosis of a Pelvic Mass Ovary and Fallopian Tube Physiologic Follicular cyst Corpus luteum cyst Neoplastic Benign Malignant Epithelial Low Malignant Potential Ovarian Cancer Germ Cell Specialized stromal Endometriosis Pelvic Inflammatory Disease Acute salpingo-oophoritis Chronic salpingo-oophoritis Hydrosalpinx Tuboovarian abscess Ectopic pregnancy Uterus Pregnancy related 23

 Spontaneous abortion Incomplete abortion Missed abortion Gestational trophoblastic disease Leiomyomata (Fibroids) Urinary Distended bladder Pelvic kidney Adrenal-renal tumor Bowel Sigmoid or recum distention with gas Diverticulitis Diverticular abscess Regional ileitis Ulcerative colitis Appendicitis (Abscess) Constipation Cancer of colon Other Pelvic cyst Retroperitoneal neoplasm Abdominal wall hematoma (abscess) Educational Objective 28 GYNECOLOGIC PROCEDURES Rationale: Evaluation and management of gynecologic problems frequently requires performing diagnostic and therapeutic surgical procedures. Understanding the risks and benefits of such procedures is important in counseling patients about their treatment options and reasons for having the procedures performed. Objectives: The student will be able to: A. Describe the key components of pre-operative evaluations and planning, including complete medical histories, the informed consent process and working with consultants. B. Describe the common peri-operative prophylactic measures, including steps taken to reduce infection and deep venous thrombosis C. Describe the components of routine post-operative care D. List common post-operative complications E. Describe each procedure and list the indications and complications of each of the following: a. Colposcopy and cervical biopsy b. Cone biopsy c. Cryotherapy d. Dilation and curettage e. Electrosurgical excision of cervix f. Endometrial biopsy g. Hysterectomy h. Hysterosalpingography i. Hysteroscopy 24

j. k. l. m. n. o. p.

Laparoscopy Laser vaporization Mammography Needle aspiration of breast mass Pelvic ultrasonography Pregnancy termination Vulvar biopsy

Reading Suggestions: Obstetrics and Gynecology, Beckman, et al, 6th Ed., Chapter 32, pages 295-302 Essentials of Obstetrics and Gynecology, Hacker & Moore, 5th Ed. Chapter 30 pages 332-344 Educational Objective 29- PUBERTY Rationale: The maturation of the reproductive system at the time of puberty is accompanied by physical and emotional changes that are part of this normal transition. In order to provide appropriate care and counseling, the physician must have an understanding of the normal sequence of puberty, and recognize deviation from the norm. Objectives: The student will be able to: A. Normal puberty, including: a. Describe the physiologic events that take place in the hypothalamic-pituitaryovarian axis and their target organs at puberty b. Describe the normal sequence of pubertal stages and expected ages at which these changes occur c. Describe the psychological aspects of puberty B. Abnormal puberty, including: a. Define abnormal puberty b. Describe the causes of early or late puberty c. Describe the diagnostic approach to early or delayed pubertal onset C. Describe and review Tanner Stages for breast and pubic hair D. Review common peri-pubertal and adolescent case scenarios of dysmenorrhea, amenorrhea, dysfunctional uterine bleeding, contraception and sexual abuse Reading Suggestions: Obstetrics and Gynecology, Beckman, et al, 6th Ed., Chapter 34, pages 309-314 Essentials of Obstetrics and Gynecology, Hacker & Moore, 5th Ed. Chapter 31, pages 345-354 Educational Objective 30- AMENORRHEA Rationale: The absence of normal menstrual bleeding may represent an anatomic or endocrine problem. A systematic approach to the evaluation of amenorrhea will aid in the diagnosis and treatment of its cause. Objectives: The student will be able to: A. Define amenorrhea and oligomenorrhea B. Describe the etiologies of amenorrhea and oligomenorrhea C. Describe the evaluation methods for amenorrhea and oligomenorrhea 25

D. Describe treatment options for amenorrhea and oligomenorrhea E. Counsel patients who decline therapy Reading Suggestions: Obstetrics and Gynecology, Beckman, et al, 6th Ed., Chapter 35, pages 315-320 Essentials of Obstetrics and Gynecology, Hacker & Moore, 5th Ed. Chapter 32, pages 355-367 Educational Objective 31 - HIRSUTISM AND VIRILIZATION Rationale: The signs and symptoms of androgen excess in a woman may cause anxiety and may represent serious underlying disease. Objectives: The student will be able to: A. Cite normal variations in secondary sexual characteristics B. List definitions of hirsutism and virilization C. List causes, including ovarian, adrenal, pituitary and pharmacological D. Evaluate the patient with hirsutism or virilization Reading Suggestions: Obstetrics and Gynecology, Beckman, et al, 6th Ed., Chapter 36, pages 321-328 Essentials of Obstetrics and Gynecology, Hacker & Moore, 5th Ed. Chapter 32, pages 355-367 Educational Objective 32 - MENOPAUSE Rationale: Women spend as much as one-third of their lives in the postmenopausal years. It is important for all physicians who provide health care to women to understand the physical and emotional changes caused by estrogen depletion. Objectives: The student will be able to: A. Describe physiologic changes in the hypothalamic-pituitary-ovarian axis associated with perimenopause/menopause B. Describe the symptoms and physical findings associated with hypoestrogenism C. Describe appropriate management of menopausal/perimenopausal symptoms D. Counsel patients regarding menopausal issues E. List long term changes associated with menopause, including osteoporosis Reading Suggestions: Obstetrics and Gynecology, Beckman, et al, 6th Ed., Chapter 37, pages 329-336 Essentials of Obstetrics and Gynecology, Hacker & Moore, 5th Ed, Chapter 35, pages 379-387 Educational Objective 33 - INFERTILITY Rationale: The evaluation and management of an infertile couple requires an understanding of the processes of conception and embryogenesis, as well as sensitivity to the emotional stress that can result from the inability to conceive.

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Objectives: The student will be able to: A. Define infertility B. Describe the causes of male and female infertility C. Describe the evaluation of infertility D. List the psychosocial issues associated with infertility Reading Suggestions: Obstetrics and Gynecology, Beckman, et al, 6th Ed., Chapter 38, pages 337-346 Essentials of Obstetrics and Gynecology, Hacker & Moore, 5th Ed, Chapter 34, pages 371-378 Educational Objective 34 - PREINVASIVE CANCER OF THE VULVA, VAGINA AND CERVIX Rationale: Preinvasive cancer of the vulva, vagina and cervix is very prevalent and is a precursor to the development of invasive cancer. Objectives: The student will be able to: A. Describe the pathophysiology of preinvasive cancer of the vulva, vagina and cervix B. Describe the importance of the Pap smear in the diagnosis of preinvasive cancer of the vagina and cervix C. Identify the risk factors for neoplasia of the vagina, vulva and cervix D. Describe the appropriate utilization of new techniques for evaluating vulva, vagina and cervical neoplasia E. Describe the principles of management of preinvasive cancer of the vulva, vagina and cervix Reading Suggestions: Essentials of Obstetrics and Gynecology, Hacker & Moore, 5th Ed, Chapter 38, pages 402-411 Essentials of Obstetrics and Gynecology, Hacker & Moore, 5th Ed, Chapter 40, pages 420-427 Educational Objective 34 - GYNECOLOGIC CANCER GESTATIONAL TROPHOBLASIC NEOPLASIA (GTD) Rationale: Gestational trophoblastic neoplasia is important because of its malignant potential and the associated risks of morbidity and mortality. Objectives: The student will be able to: A. List the symptoms and physical findings of a patient with GTD B. Describe the diagnostic methods utilized for a patient with GTD C. Describe the principles of management of Gestational Trophoblastic Neoplasia Reading Assignment: Obstetrics and Gynecology, Beckman, et al, 6th Ed., Chapter 41, pages 359-364 Essentials of Obstetrics and Gynecology, Hacker & Moore, 5th Ed. Chapter 42, pages 435

27

VULVAR CANCER Rationale: Proper evaluation of vulvar symptoms allows for early recognition and diagnosis of neoplasia, which can improve outcome and may avoid the need for extensive surgery. Objectives: The student will be able to: A. Describe the risk factors for vulvar neoplasms B. List the indications for vulvar biopsy C. Describe the principles of management of cancer of the vulva Reading Suggestions: Obstetrics and Gynecology, Beckman, et al, 6th Ed., Chapter 42, pages 365-374 Essentials of Obstetrics and Gynecology, Hacker & Moore, 5th Ed. Chapter 40, pages 420-427 CANCER OF THE CERVIX Rationale: Detection and treatment of pre-invasive lesion reduces the medical and social costs of, as well as the mortality associated with, carcinoma of the cervix. Objectives: The student will be able to: A. Describe the pathogenesis of cervical cancer B. Identify the risk factors for cervical neoplasia and cancer C. Perform an adequate Pap smear D. Describe the appropriate utilization of new technologies for evaluating cervical neoplsia E. Describe the initial management of a patient with an abnormal Pap smear F. Describe the principles of management of cancer of the cervix Reading Suggestions: Obstetrics and Gynecology, Beckman, et al, 6th Ed., Chapter 43, pages 375-388 Essentials of Obstetrics and Gynecology, Hacker & Moore, 5th Ed. Chapter 38, pages 402-411 CANCER OF THE UTERUS Rationale: Endometrial carcinoma is the most common gynecologic malignancy. Objectives: The student will be able to: A. List the risk factors for endometrial carcinoma B. Describe the symptoms and physical findings of a patient with endometrial cancer C. Outline the differential diagnosis of postmenopausal bleeding D. Discuss the use of diagnostic methods for a patient with endometrial carcinoma E. Describe the principles of management of cancer of the uterus F. Reading Suggestions: Obstetrics and Gynecology, Beckman, et al, 6th Ed., Chapter 45, pages 393-402 Essentials of Obstetrics and Gynecology, Hacker & Moore, 5th Ed. Chapter 41, pages 428-434

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CANCER OF THE OVARY Rationale: Adnexal masses are a common finding in both symptomatic and asymptomatic patients. Management is based on determining the origin and character of these masses. Objectives: The student will be able to: A. List the risk factors for cancer of the ovary B. Describe the histologic classification of cancer of the ovary C. Describe the genetic etiology of cancer of the ovary D. Describe the principles of management of cancer of the ovary Reading Suggestions: Obstetrics and Gynecology, Beckman, et al, 6th Ed., Chapter 46, pages 403-414 Essentials of Obstetrics and Gynecology, Hacker & Moore, 5th Ed. Chapter 39, pages 412-419 Educational Objective 36 - SEXUALITY AND MODES OF SEXUAL EXPRESSION Rationale: All physicians should be able to provide a preliminary assessment of patients with sexual concerns and make referrals when appropriate. Detection and management of a womans health care problems may be affected by her modes of sexual expression. Objectives: The student will be able to: A. Obtain a basic sexual history, including sexual function and sexual orientation B. Describe the physiology of female sexual response C. Discuss female sexuality across the lifespan D. Categorize common patterns of female sexual dysfunction E. Identify physical, psychological and societal contributions to female sexual dysfunction Reading Suggestions: Obstetrics and Gynecology, Beckman, et al, 6th Ed., Chapter 47, pages 415-424 Essentials of Obstetrics and Gynecology, Hacker & Moore, 5th Ed. Chapter 27, pages 315-321 Educational Objective 37 - VIOLENCE AGAINST WOMEN SEXUAL ASSAULT Rationale: Individuals who are the victims of sexual assault often have significant physical and emotional sequelae. Objectives: The student will be able to: A. Identify patients at increased risk for sexual abuse B. List the components of a history on a sexual assault victim (child, adult and acquaintance rape) C. Describe an age-appropriate examination on a sexual assault victim (child, adult, and acquaintance rape) D. Describe age-appropriate counseling on a sexual assault victim (child, adult, and acquaintance rape) 29

Reading Suggestions: Obstetrics and Gynecology, Beckman, et al, 6th Ed., Chapter 48, pages 425-432 Essentials of Obstetrics and Gynecology, Hacker & Moore, Chapter 28, pages 322-325 DOMESTIC VIOLENCE Rationale: Domestic violence affects a significant proportion of the U.S. population in all economic classes and walks of life. All physicians should screen for the presence of domestic violence. Objectives: The student will be able to: A. Cite prevalence and incidence of violence against women, elder abuse, child abuse B. Assess the involvement of any patient in domestic violence situations C. Understand facts important for short-term safety D. Understand support and resources available for long-term management E. Understand resources available to counsel patients who have experienced domestic violence Reading Suggestions: Essentials of Obstetrics and Gynecology, Hacker & Moore, Chapter 28, pages 322-325 Educational Objective 38 REPRODUCTIVE PHARMACOLOGY Rationale: The diagnosis and management of obstetrical and gynecological disorders requires an understanding of the principles of pharmacology and knowledge of the drugs that are utilized in the treatment protocols. Objectives: A. Understand the mechanisms of actions of pharmaceutical agents used B. Understand the side effects of the pharmaceutical agents being used C. Understand the appropriate interactions when multiple drugs are used Educational Objective 39 REPRODUCTIVE AND BREAST IMAGING Rationale: The diagnosis and management of obstetrical and gynecological disorders require and understanding of the imaging techniques that are most appropriate. Objectives: The student will be able to: A. Understand the physiology components for the various imaging techniques plain film, ultrasound, CT scan, MRI scan, PET scan B. Understand the imaging most suitable in various clinical presentations. Educational Objective 40 OBSTETRICAL AND GYNECOLOGICAL PATHOLOGY Rationale: The diagnosis and management of obstetrical and gynecologic disorders requires an understanding of the underlying pathological process.

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Objectives: The student will be able to: A. Describe the patho/physiology of disease processes B. Describe the pathology transition from benign through pre-invasive change to cancer of reproductive organs Educational Objective 41 EMBRYOLOGY AND CONGENITAL ANOMALIES
Objectives: The student will be able to: A. understand the embryologic development of the reproductive system. B. Understand the unique relationship between abnormalities of the genital system and the urinary system. C. Describe the developmental defects in the development of the urinary system, the internal reproductive organs and external genitalia. Reading Suggestions:

Obstetrics and Gynecology, Beckman, et al, 6th Ed., Chapter 4, pages 29-42 Essentials of Obstetrics and Gynecology, Hacker & Moore, 5th. Ed. Chapter 18, pages 231-240 Essentials of Obstetrics and Gynecology, Hacker & Moore, 5th Ed. Chapter 19, pages 240-247 Essentials of Obstetrics and Gynecology, Hacker & Moore, 5th Ed. Chapter 20, pages 248-255 Educational Objective 42 ACHIEVING COMPETENCY IN OSTEOPATHIC MEDICINE DURING PREGNANCY
Rationale:

To assist the students in achieving competency in Osteopathic philosophy principles and practice in Ob/Gyn. Objectives: The student will be able to:
A. Review and be able to identify the key changes in the neuromusculoskeletal system during the changes of pregnancy

B. Demonstrate to the faculty the protocol osteopathic manipulative medicine techniques as mentioned above

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V.

BASIC PRINCIPLES OF OSTEOPATHIC MEDICINE

The Basic Premises The basic premises include: 1. That the human body is an integrated unit in which structure and function are reciprocally and mutually interdependent. 2. That through complex mechanisms and systems the human body is self regulating and self healing in the face of challenges and diseases (this is known as homeostasis). 3. That optimum function of the body systems is dependent upon the unimpeded flow of blood and nerve impulses. 4. That the musculo-skeletal system comprises a major system of the body, and that its importance goes far beyond that of providing a supportive framework. 5. That there are components of disease within the structure of the musculo-skeletal system which are not only the manifestations of disease processes, but which are frequently important contributing, or maintaining, factors in disease processes. These may be local to, or distant from, such disease processes and are usually amenable to appropriate treatment

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VI.

GENERAL COMPETENCIES
a. Osteopathic Principles and Practices 1. Demonstrate an awareness of the basic tenets of osteopathic philosophy and ability in basic manipulative medicine. 2. Understand the interdependence of the musculoskeletal/lymphatic system and other organ systems. 3. Understand that the mind, body and spirit all interact in the promotion of health and wellbeing. 4. Demonstrate the ability to utilize osteopathic manipulative medicine as a part of their patient care regimen. b. Patient Care 1. Caring and respectful behaviors 2. Interviewing 3. Informed decision-making 4. Develop and carry out patient management plans 5. Counsel and educate patients and families 6. Performance of procedures i. Routine physical exam ii. Medical procedures 7. Preventive health services 8. Work within a team 9. Provide osteopathic knowledge, principles and practices into patient care. c. Medical Knowledge 1. Investigatory and analytic thinking 2. Knowledge and application of basic science 3. Must be able to demonstrate the understanding and application of the principles of osteopathic medicine involving clinical, social and behavior sciences. d. Practice-based Learning and Improvement 1. Analyze own practice for needed improvements 2. Use of evidence from scientific studies 3. Application of research and statistical methods 4. Use of information technology 5. Facilitate learning of others 6. Demonstrate ability to integrate evidence based medicine into osteopathic clinical practice. e. Interpersonal and Communication Skills 1. Creation of therapeutic relationship with patients 2. Listening skills 3. Demonstrate interpersonal and communication skills to provide professional relationships related to osteopathic principles and practices. f. Professionalism 1. Respectful, altruistic 2. Ethically sound practice 3. Sensitive to cultural, age, gender, disability issues 4. Demonstrate an understanding that he or she is a reflection of the osteopathic profession. g. Systems-based Practice 1. Understand interaction of their practices within the larger system 2. Knowledge of practice and delivery systems 3. Practice cost effective care 4. Advocate for patients within the health care system

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VII. INSTRUCTIONAL PROGRAM

Orientation at John Peter Smith Hospital Orientation for students assigned to the Health Science Center at Fort Worth/John Peter Smith Hospital is scheduled for 8:00 am on the first day of the rotation. Students should report to the Obstetrics and Gynecology Department Conference Room located on the lower level in the Outpatient Clinic Building at John Peter Smith Hospital. Attendance is mandatory. Lecture Schedule Monday 7:00 am 9:00 am Student Lecture Tuesday 8:00 am 12:00 pm Resident/Student Didactic Session Wednesday 7:00 am 9:00 am Student Lecture Thursday 7:30 am 8:30 am Ob/Gyn Grand Rounds at Harris Methodist Friday 7:30 am 11:00 am Student Lecture Scheduled Faculty Lectures Students are expected to review the topics prior to the lecture to ensure an interactive format. During your night shifts, while you are on your Obstetrics and Gynecology rotation, you must attend lecture. Report back to Labor and Delivery 10 hours after the lecture for that morning is complete. Patient Care Activities AT UNTHSC/JPS students are assigned to a team and will be involved in the clinical activities of that team. Orientation at Bay Area Corpus Christi Medical Center Students rotating at the Bay Area Corpus Christi Medical Center will report to Vicki Rutherford in the Family Practice Residency Program at 7:30 am on the Monday morning at the beginning of the rotation. You will be provided with a copy of Obstetrics and Gynecology, Sixth Edition that will be turned in at the end of the rotation. Orientation at San Jacinto Methodist Hospital Students rotating at San Jacinto Methodist Hospital will report to Diane Dougherty, PhD. You will be provided with a copy of Obstetrics and Gynecology, Sixth Edition that will be turned in at the end of the rotation . Orientation at Conroe Medical Education Foundation Students rotating at Conroe Medical Education Foundation will report to Jennie Faulkner at 7:45 am at Conroe Regional Hospital in the Womens and Newborn Lobby. You will be provided with a copy of Obstetrics and Gynecology, Sixth Edition that will be turned in at the end of the rotation. Orientation at Dallas Methodist Hospital Students rotating at Dallas Methodist Hospital will report to Laura Morris. You will be provided with a copy of Obstetrics and Gynecology, Sixth Edition that will be turned in at the end of the rotation

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VIII. EDUCATIONAL RECOURCES.

REQUIRED RESOURCES
TEXTBOOK(S) Essentials of Obstetrics and Gynecology, N.F. Hacker, J.G. Moore, and J.C. Gambone, Elsevier Saunders, 5th edition, 2010. Robbins and Cotran: Pathologic Basis of Disease, V. Kumar, A. Abbas, and N. Fausto, Elsevier Saunders, 7th edition, 2004. Note: Assignments from Required Resources are testable.

RECOMMENDED RESOURCES
Textbook(s) st Williams Obstetrics, Cunningham, Appleton & Lange, 21 Edition/2001 Clinical Gynecology Endocrinology and Infertility, Speroff, Glass and Kase, Williams and Wilkins, 6th Edition/1999 1 th Comprehensive Gynecology, Droegemuller, et al, CV Mosby, 4 Edition/2002 th Obstetrics and Gynecology, C. Beckmann, et al., Lippincott Williams and Wilkinson, 6 Edition 2010

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IX.

STUDENT RESPONSIBILITY

Equipment The clerk will provide his/her own clinic coat and stethoscope. All other equipment will be provided. Student Examinations The end of rotation examination will be the subject examination of the NBME. This will be administered by the Evaluation Services Department on the last Friday of the rotation (unless advised otherwise). The test will last two (2) hours. A score adjusted from the national mean will be used to calculate the grade. The adjusted grade will count as 25% of the student grade for the course. For this exam or for any board exam, the student will be excused from call at 2100 hours the night before the exam. A grade at or above the 5th percentile is required to pass the test. Two consecutive failures will require an appearance before the student performance committee. Faculty and Site Evaluation All students will be expected to complete an evaluation of their clinical experience and the individual physicians they worked with, as provided by the Office of Clinical Education. Absence from Clerkship Students are expected to follow the attendance policy as set forth in the Uniform Policies and Procedures section of this syllabus. The OB-GYN department, at the discretion of the clerkship director, may require remediation or impose a grade reduction of (3) three points per day for unexcused absence. Excused absences of up to three (3) days will not require remediation. Illness of one day may be excused by filling out the Request for Absence from Clerkship form. Medical leave of two (2) or more days will require a note from the health care provider. Failure to submit the Request for Absence from Clerkship form will result in an unexcused absence. Absence of more than (7) seven days (excused or unexcused) in a six week rotation may result in repeat of the rotation at the UNTHSC/TCOM site.

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X.

STUDENT EVALUATION

Mid-Rotation Evaluation Attempts will be made during the six-week rotation to discuss weaknesses when they become apparent. Constructive criticism will be offered. Serious problems will be dealt with on an individual basis as felt necessary by the faculty or student. At or about mid-rotation a MidRotation Evaluation form will be completed by members of the department or the local preceptor. The results of this evaluation will be discussed with the student and the student advised if he/she is in danger of failing the rotation, or if problems in their performance are identified. Students may request an evaluation of their performance at any time during the rotation. Final Grade 50% of the final grade will be determined by taking into consideration the factors listed on the standard college form Evaluation of Student Performance. These evaluations will be made by various physicians participating in the instruction of the clinical clerk, the chief resident of his/her team, and compiled and completed by the individual course director or site director. A department examination will be given at each site. The exam will comprise 25% of the final grade. Together, the subject exam and the site specific exam will comprise of 50% of the final grade.

XI.

DISCLAIMER

This clinical clerkship is operated in accordance with the policies and procedures of the academic programs of the Texas College of Osteopathic Medicine as presented in the Uniform Policies and Procedures section of this manual, the student handbook and the college catalogue. The provisions contained herein do not constitute a contract between the student and the college. These provisions may be changed at any time for any reason at the discretion of the faculty member. When necessary, in the view of the college, appropriate notices of such changes will be given to the student. Americans with Disabilities Act The University of North Texas Health Science Center does not discriminate on the basis of an individuals disability and complies with Section 504 and Public Law 101-336 (American with Disabilities Act) in its admissions, accessibility, treatment and employment of individuals in its programs and activities. UNTHSC provides academic adjustments and auxiliary aids to individuals with disabilities, as defined under the law, who are otherwise qualified to meet the institution's academic and employment requirements. For assistance contact the Center for Academic Performance at the Health Science Center. Reference Policy 7.105 Americans with Disabilities Act Protocol in the Student Policies .

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