Goals and Objectives
During the third year of the MD Program curriculum, medical students at the University of Wisconsin School of Medicine and Public Health in Madison will complete a rotation with the Department of Obstetrics and Gynecology.
Students are expected to meet the following goals and objectives.
- Knowledge for Practice
- Problem Solving and Clinical Skills / Patient Care
- Lifelong Learning / Practice Based Learning and Improvement
- Systems Based Practice
- Interpersonal and Communication Skills
Knowledge for Practice
- Demonstrate knowledge of the physiology of the female pelvic anatomy with an emphasis on reproductive development and changes in endocrinology across a woman’s lifespan.
- Acquire a comprehensive understanding of primary and preventive care for women across the lifespan with appropriate screening tests, exams, and treatments at each stage.
- Develop an evidenced-based understanding of the pathophysiology of conditions and common disorders that affect women, tests to diagnose, and the appropriate management options for these conditions.
- Describe the course of a normal pregnancy and effective health care during pregnancy to ensure the health of the mother and fetus.
- Discuss the proper management of labor and delivery and the management of common medical complications that occur during and after pregnancy.
- Recognize common obstetric and gynecological surgical procedures in terms of patient selection, pre-operative concerns, and the risks and benefits for each procedure.
Problem Solving and Clinical Skills/Patient Care
- Take an effective history and physical, develop a differential diagnosis, and develop a management plan for common disorders and conditions.
- Provide appropriate assistance in the operating room for gynecological surgeries and C-sections.
- Evaluate surgical patients pre-operatively and post-operatively in terms of common complications and explain proper management of these complications.
- Discuss how to provide non-directive counseling to patients regarding pregnancy options and various methods of contraception with their benefits and risks.
- Assess the health of the mother and fetus health during pregnancy and labor and demonstrate the proper technique for delivering the baby.
Lifelong Learning/Practice Based Learning and Improvement
- Use evidence-based resources to better understand the condition and treatment of patients under your care.
- Improve performance based on instructional feedback from the faculty, residents and health care.
- Reflect on your performance as a medical student and identify individual learning goals to accelerate your development as a physician.
Systems Based Practice
- Know and utilize hospital and community resources to support quality patient care.
- Describe how multiple systems – hospitals, insurance carriers, government agencies - intersect in the clinical setting to impact patient care.
- Identify the major public health issues impacting women's health care today.
- Recognize the effect social and cultural factors have on the provision of quality patient care.
- Demonstrate the ability to be an effective team member by assuming an appropriate role in any clinical situation in order to support quality patient care.
Interpersonal and Communication Skills
- Contribute to effective teamwork by communicating with the health care team in a timely, thorough and accurate manner.
- Document patient information with logically organized, concise, accurate written notes.
- Develop patient-centered communication skills to effectively convey health care information to patients.
- Use a respectful non-aggressive manner in counseling patients regarding lifestyle choices that contribute to optimal health.
- Accomplish tasks in a way that demonstrates that patient well-being is always paramount.
- Demonstrate professionalism by interacting respectfully with the health care team, patients and families regardless of differing beliefs, culture or status.
- In developing management plans for patients consider the physical, emotional, social and financial costs that the condition and its treatment impose on the patient.
- Take responsibility for accomplishing assigned tasks in an effective and punctual manner.
- Demonstrate trustworthiness by maintaining patient confidentiality at all times.
Learning Activity Objectives
Well-Woman Care (Routine Preventive Health Care)
- Elicit a comprehensive history (menstrual, obstetric, gynecologic, contraceptive, sexual, family and social), perform a well woman exam (with pelvic and breast exam), and recommend screening adhering to the primary preventative care standards established by ACOG.
- List and describe age-appropriate screening procedures and appropriate time intervals for these tests:
- Bone density
- Pap tests
- Sexually transmitted infections
- Demonstrate the ability to counsel patients in a non-directive manner on the following methods of contraception, their mechanism of action, and the risk associated with each:
- Natural family planning
- Barrier methods
- Oral contraceptives
- Emergency contraception
- LARC methods
- Permanent contraception
- Unintended pregnancy
- Cervical pathology
- Breast malignancy
- Gynecologic malignancies
- Domestic violence
- Participate in a first prenatal visit observing the taking of a history, physical exam, pelvic exam, determination of due date and lifestyle counseling
- Analyze prenatal patient vitals and laboratory assessments
- Describe how to diagnose a pregnancy and assess gestational age
- Demonstrate appropriate counseling for pregnant patients or those considering pregnancy regarding the effects of the following on pregnancy:
- Substance abuse
- Environmental hazards
- Second-trimester loss
- Preterm labor
- Third-trimester bleeding
- Multiple gestation
- Post-term pregnancy
- Fetal death
- Intermittent auscultation
- Electronic monitoring
- Fetal scalp stimulation
- Vibroacoustic stimulation
- Non stress test
- Biophysical profile
- Diabetes mellitus
- Chronic hypertension
- Urinary tract disorders
- TORCH infections
- Group B streptococcus
- Alcohol, tobacco, drugs
- Participate/observe in a pertinent history, a focused physical examination, select and interpret diagnostic tests and establish an initial treatment plan for some/all of the following conditions:
- Sexually transmitted infections
- Pelvic pain
- Breast mass
- Abnormal uterine bleeding
- Uterine fibroids
- Herpes simplex virus
- Lichen planus
- Lichen sclerosis
- Vulvar neoplasia
- Vaginal pH
- Saline and potassium
- Hydroxide microscopy
- Bacterial and viral culture
- First trimester screen
- Free fetal DNA analysis
- Quadruple screening versus definitive testing via chorionic villus sampling
- List the signs and symptoms of pre-labor contractions and labor contractions.
- Describe the cardinal movements of labor and the steps of performing a vaginal delivery.
- Describe the stages of labor and recognize common abnormalities including:
- Prolonged latent phase
- Arrest of dilation
- Protracted descent
- Arrest of descent
- Labor concerns
- Vaginal bleeding
- Decreased fetal movement
- Perineal discomfort
- Wound infection
- Postpartum depression
- Perform a pertinent history, assist in a focused physical examination, the selection and interpretation of diagnostic tests and the initial treatment plan for common presenting patient complaints including:
- Abdominal pain
- Vaginal bleeding
- Pelvic mass
- Urologic/gynecologic infections
- Vulvar/vaginal symptoms
- Dilatation and sharp/suction curettage
- Diagnostic and simple operative hysteroscopy
- Diagnostic and simple operative laparoscopy
- Open versus vaginal hysterectomy
- Excision of vulvar lesions
- Sterilization procedures
- Arterial blood supply
- Venous and lymphatic drainage
- Neurologic innervation
- Anatomic relationship between reproductive organs and the non-gynecologic abdominal viscera
- Pain control
- Wound complications
- Cardiovascular symptoms
- Change in mental status
- Renal/fluid balance issues
- Respiratory symptoms
Obstetrics and Gynecology Clerkship Mid-Rotation Feedback
- Reflect on your clinical performance as a medical student for the first 3-4 weeks of your clerkship and complete the student self-assessment portion of the clerkship mid-rotation feedback form.
- Meet with the clerkship director and/or faculty member to discuss your performance and identify areas for improvement.
- Perform appropriate pre-rounding assessment of patients.
- Analyze patient vitals and laboratory assessments.
- Present patients to health care team in a well-organized manner during morning board report, highlighting pertinent positives and negatives.
- Present and appropriately prioritize differential diagnosis for patients and develop a postpartum or post-surgery management plan.
- Faculty Directed Case-Based Instruction (assigned relevant to current case)
- Student Led Case-Based Instruction
Faculty Directed Case-Based Instruction (assigned relevant to current case)
- Describe an understanding of the patient condition and case context by explaining appropriate management options.
- Discuss the pathophysiology, diagnosis, management and public health implications by leading an evidence-based discussion of the assigned case.
- Present findings and management plan with evidenced based support from the literature.
Student Led Case-Based Instruction
- Cite respected sources of evidenced-based information in the field of obstetrics and gynecology.
- Discuss the pathophysiology in the presented case and describe the proper diagnosis, management, and treatment options for the patient.
- Capture the essential elements of a patient management plan and communicate the plan clearly, concisely, and thoroughly to the healthcare team.
- Respond effectively to follow up questions by fellow students and the supervising faculty member.
M&M and Grand Rounds
- Identify important evidence-based resources in obstetrics and gynecology.
- Analyze factors contributing to clinical and surgical errors and poor patient outcomes.
- Describe systems-based factors that lead to sub-optimal patient care and note successful interventions.
Clerkship Orientation: Lectures
Basics of Labor and Delivery
- Define the medical student’s role at a delivery and a C-section.
- Describe the basics of labor evaluation and how to complete a cervical assessment.
- Explain the stages of normal labor.
- Explain the proper delivery technique in a standard birth.
Introduction to Gynecology
- List the four age categories of women patients and explain the major health concerns for each category.
- Describe the process of proper breast cancer screening.
- Discuss the etiology and treatment of abnormal uterine bleeding.
- Discuss the diagnosis and treatment of patients with the human papilloma virus.
Basics of Fetal Heart Tracings
- Explain the ACOG categories for fetal heart tracings.
- Discuss the normal parameters of the fetal heart strip and how the readings relate to labor.
- Identify accelerations and decelerations on the fetal heart strip and explain their significance relating to fetal health and the labor process.
Clerkship Orientation: Simulation Stations
Labor and Delivery Simulation
- Explain the medical student’s role in the labor and delivery room.
- Describe the 7 cardinal movements of labor.
- Demonstrate proper delivery technique, traction, and handling of infant after delivery.
- Discuss cultural sensitivity to family preferences regarding the post-delivery handling of the infant and care for the mother.
Pelvic Exam Simulation
- Demonstrate proper positioning and draping of the patient.
- Demonstrate proper technique of an effective pelvic exam.
- Explain how to reposition the patient and handle the equipment after the exam.
- Describe a proper explanation of exam results to the patient.
Core Case Discussions
- Ectopic Pregnancy
- Spontaneous Abortion
- Third Trimester Bleeding
- Sexually Transmitted Infections and Urinary Tract Infections
- Disorders of the Breast
- Normal and Abnormal Uterine Bleeding
- Uterine Leiomyoma
- Sexual Assault
- Intimate Partner Violence
- Pregnancy Termination
- Pelvic Floor Disorders
- Endometrial Hyperplasia and Carcinoma
- Ovarian Neoplasm
- Gestational Trophoblastic Neoplasia
- Vulvar Neoplasms
- Vulvar and Vaginal Diseases
- Chronic Pelvic Pain
- Hirsutism and Virilization
- Premature Rupture of Membranes
- Premature Labor
- Preeclampsia-Eclampsia Syndrome
- Postpartum Hemorrhage
- Develop a differential diagnosis for vaginal bleeding and abdominal pain in the first trimester.
- Perform a physical exam to assess for acute abdomen.
- List risk factors for ectopic pregnancy.
- Discuss diagnostic protocols for ectopic pregnancy.
- Describe treatment options for patients with ectopic pregnancy.
- Develop a differential diagnosis for first trimester vaginal bleeding.
- Differentiate the types of spontaneous abortion (missed, complete, incomplete, threatened, septic).
- List the causes of spontaneous abortion.
- List the complications of spontaneous abortion.
- Discuss treatment options for spontaneous abortion.
Third Trimester Bleeding
- List the causes of third trimester bleeding.
- Describe the initial evaluation of a patient with third trimester bleeding.
- Differentiate the signs and symptoms of third trimester bleeding.
- List the maternal and fetal complications of placental previa and abruption placenta.
- Describe the initial evaluation and management plan for acute blood loss.
- List the indications and potential complications of blood product transfusion.
Sexually Transmitted Infections and Urinary Tract Infections
- Describe the guidelines for STI screening and partner notification/treatment.
- Describe STI prevention strategies, including immunization.
- Describe the symptoms and physical exam findings associated with common STIs.
- Discuss the steps in the evaluation and management of common STIs including appropriate referral.
- Describe the pathophysiology of salpingitis and pelvic inflammatory disease.
- Describe the evaluation, diagnostic criteria and initial management of salpingitis/pelvic inflammatory disease.
- Identify possible long-term sequelae of salpingitis/pelvic inflammatory disease.
- Describe the diagnosis and management of UTIs.
- Describe theories of the pathogenesis of endometriosis.
- List the most common sites of endometriosis.
- Describe the symptoms and physical examination findings in a patient with endometriosis.
- Describe the diagnosis and management options of endometriosis.
Disorders of the Breast
- List factors that place individuals at risk for breast disorders.
- Describe symptoms and physical examination finding of benign or malignant conditions of the breast.
- Demonstrate the performance of a clinical breast examination.
- Discuss the steps in the evaluation of common breast complaints: mastalgia, mass, nipple discharge.
- Discuss initial management options for benign and malignant conditions of the breast.
- Define amenorrhea and oligomenorrhea.
- Explain the pathophysiology and identify the etiologies of amenorrhea and oligomenorrhea, including possible nutritional causes.
- Describe associated symptoms and physical examination findings of amenorrhea.
- Discuss the steps in the evaluation and initial management of amenorrhea and oligomenorrhea.
- Describe the consequences of untreated amenorrhea and oligomenorrhea.
Normal and Abnormal Uterine Bleeding
- Define the normal menstrual cycle and describe its endocrinology and physiology.
- Define abnormal uterine bleeding.
- Describe the pathophysiology and identify etiologies of abnormal uterine bleeding.
- Describe the steps in the evaluation and initial management of abnormal uterine bleeding.
- Summarize medical and surgical management options for patients with abnormal uterine bleeding.
- Define menopause and describe changes in the hypothalamic-pituitary-ovarian axis associated with perimenopause/menopause.
- Describe symptoms and physical exam findings related to perimenopause/menopause.
- Discuss management options for patients with perimenopause/menopausal symptoms.
- Counsel patients regarding the menopausal transition.
- Discuss long-term changes associated with menopause.
- Cite the prevalence of uterine leiomyoma.
- Identify symptoms and physical findings in patients with uterine leiomyoma.
- Describe the diagnostic methods to confirm uterine leiomyomas.
- Describe the management options for the treatment of uterine leiomyomas.
- Identify patients at increased risk for sexual assault.
- Describe the medical and psychosocial management of a victim of sexual assault.
Intimate Partner Violence
- Cite prevalence and incidence of violence against women, elder abuse, and child abuse.
- Screen a patient for intimate partner violence.
- Summarize the available resources for a victim of intimate partner violence including short-term safety.
- Describe the mechanism of action and effectiveness of contraceptive methods.
- Counsel the patient regarding the benefits, risks and use for each contraceptive method including emergency contraception.
- Describe barriers to effective contraceptive use and to reduction of unintended pregnancy.
- Describe the methods of male and female surgical sterilization.
- Explain the risks and benefits of female surgical sterilization procedures.
- Provide non-directive counseling to patients surrounding pregnancy including unintended pregnancy.
- List surgical and non-surgical methods of pregnancy termination.
- Identify potential complications of pregnancy termination.
- Describe the public health impact of the legal status of abortion.
Pelvic Floor Disorders
- Describe normal pelvic anatomy and pelvic support
- List risk factors for pelvic floor disorders
- Describe signs and symptoms of pelvic floor disorders
- Differentiate the types of urinary incontinence
- Discuss the steps in evaluation of pelvic floor disorders
- Describe the anatomic changes associated with pelvic floor disorders
- Describe non-surgical and surgical management options for pelvic floor disorders
Endometrial Hyperplasia and Carcinoma
- List the risk factors for endometrial hyperplasia/cancer
- Describe the symptoms and physical findings with endometrial hyperplasia/cancer
- Outline the causes, diagnosis and management of postmenopausal bleeding
- Describe the initial management of a patient with an adnexal mass
- Compare the characteristics of functional cysts, benign ovarian neoplasms and ovarian cancers
- List the risk factors and protective factors for ovarian cancer
- Describe the symptoms and physical findings associated with ovarian cancer
- Describe the three histological categories of ovarian neoplasms
Gestational Trophoblastic Neoplasia
- Describe the symptoms and physical examination findings of a patient with GTN including molar pregnancy
- Describe the diagnostic methods, treatment options and follow-up for GTN including molar pregnancy
- Recognize the difference between molar pregnancy and malignant GTN
- List the risk factors for vulvar neoplasms
- Describe symptoms and physical examination findings of a patient with vulvar neoplasms
- List the indications for vulvar biopsy
Vulvar and Vaginal Diseases
- Formulate a differential diagnosis for vulvovaginitis
- Interpret a wet mount microscopic examination
- Describe the variety of dermatologic disorders of the vulva
- Discuss the steps in the evaluation and management of a patient with vulvovaginal symptoms
Chronic Pelvic Pain
- Define chronic pelvic pain
- Define the prevalence and common etiologies of chronic pelvic pain
- Describe the symptoms and physical exam findings in a patient with chronic pelvic painï? Discuss evaluation and management options for chronic pelvic pain
- Discuss the psychosocial issues associated with chronic pelvic pain
Hirsutism and Virilization
- Recognize normal variations and abnormalities in secondary sexual characteristics
- Define hirsutism and virilization
- Describe pathophysiology and identify etiologies of hirsutism
- Describe the steps in the evaluation and initial management options for hirsutism and virilization
- Describe how hirsutism and virilization are manifested in other medical disorders
- Define infertility
- List the causes of male and female infertility
- Describe the evaluation and initial management of an infertile couple
- Describe the psychosocial issues associated with infertility
- Describe management options for infertility
- Describe ethical issues confronted by patients with infertility
- Identify the impact of genetic screening and testing on infertility associated treatments
Premature Rupture of Membranes
- List the history, physical findings and diagnostic methods to confirm rupture of the membranes
- Identify risk factors for premature rupture of the membranes
- Describe the risks and benefits of expectant management versus immediate delivery based on gestational age
- Describe the methods to monitor maternal and fetal status during expectant management
- Identify the modifiable and non-modifiable risk factors and causes for preterm labor
- Describe the signs and symptoms of preterm labor
- Describe the initial management of preterm labor
- List indications and contraindications of medications used in preterm labor
- List the adverse outcomes associated with preterm birth
- Describe the counseling for reducing preterm birth risk
- Define the types of hypertension in pregnancy
- Describe the pathophysiology of preeclampsia-eclampsia
- List risk factors for preeclampsia
- Recognize the signs and symptoms to diagnose preeclampsia-eclampsia
- Explain the management of a patient with preeclampsia-eclampsia
- List the maternal and fetal complications associated with preeclampsia-eclampsia
- List the risk factors for postpartum hemorrhage
- Construct a differential diagnosis for immediate and delayed postpartum hemorrhage
- Develop an evaluation and management plan for the patient with postpartum hemorrhage including consideration of various resource settings