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.
Overarching Goals
Upon completion of the Obstetrics and Gynecology Clerkship, students will:
1. Learn the female anatomy and physiology, including reproductive growth and development, and endocrinologic changes across the lifespan.
2. Understand the pathophysiology of common disorders and conditions that specifically affect women, affect women disproportionately, or present differently in women, including:
- Sexually transmitted infections (STIs)
- Fibroids
- Incontinence
- Abnormal PAP smears
- Acute abdomen
- Urinary tract infections (UTIs)
- Breast disease
- Vaginal/vulvar disorders
- Infertility
- Abnormal uterine bleeding
- Reproductive cancers
3. Begin development of the clinical skills required for the routine health maintenance for women, including interviewing, screening and counseling approaches, as well as diagnosis and management of common disorders and conditions.
4. Be aware of common gynecologic surgeries, including abdominal procedures, laparoscopic procedures and vaginal procedures.
5. Know the pathophysiology and management of normal pregnancy, labor and delivery, and pregnancy associated complications.
6. Be aware of the important cultural and public health issues associated with providing women's health care.
7. Understand appropriate professional behavior for the Ob-Gyn setting.
Educational Objectives
Patient Care (Problem Solving and Clinical Skills)
Students are expected to provide patient care that is compassionate, appropriate and effective for the treatment of health problems and the promotion of health.
Ob/Gyn Primary Care
- Complete a comprehensive women's medical interview, including menstrual, obstetric, gynecologic, contraceptive, sexual (including orientation and function), family and social histories
- Assess risk for unintended pregnancy, STIs, cervical pathology, breast malignancy, gynecologic malignancies and domestic violence
- Perform a thorough pelvic exam
- Perform pap smear
- Perform a thorough breast exam
- Discuss self breast exam with patient
Contraceptive Technology
- Demonstrate an effective presentation on preconceptual counseling
- Demonstrate the ability to counsel patients on various methods of contraception and the risks associated with each of these methods:
- OCPs
- Emergency contraception
- Patches
- Rings
- IUD
Population Health
- Demonstrate to an attending and classmates the ability to counsel patient domestic abuse/violence and prevention of sexually transmitted infections
- Demonstrate the ability to provide non-directive counseling to patients surrounding pregnancy options
Obstetrics
- Conduct a low-risk OB prenatal visit
- Diagnose pregnancy and assess gestational age
Breast Health and Pregnancy
- Recognize and treat common postpartum abnormalities of the breast
- Demonstrate the performance of a comprehensive breast exam
- Discuss diagnostic approach to a woman with the chief complaint of breast mass, nipple discharge or breast pain
Labor and Delivery
- Perform the following:
- Obtain cervical cultures
- NSVD (with minimal intervention)
- Fern and Nitrazine test
- Labor cervical exam
- Observe the following:
- Clinical course of labor
- Operative vaginal delivery
- Perineal laceration repair
- Cesarean delivery
- Post-partum bilateral tubal ligation
- Obtain the Hx, PE, E and M with supervising clinician and observe treatment in the following cases:
- Pre-natal: Diabetes and pregnancy, preeclampsia/eclampsia, preterm labor, PROM, first trimester bleeding, third trimester bleeding
- Post-partum: post-partum care/lactation, post-partum hemorrhage
Gynecology
- Collect and interpret a cervical cytology
- Perform an effective Pap smear
- Demonstrate the ability to provide an explanation to the patient regarding the purpose and need for the test
- Diagnose a patient with vaginitis
- Perform wet prep and KOH exams
Screening for Reproductive Cancers
- Perform an abnormal Pap smear
- Outline the approach to a patient with an adnexal mass
- Obtain the Hx, PE, E and M with supervising clinician and observe treatment in the following cases:
- Abnormal uterine bleeding
- Abnormal Pap smear
- Adnexal mass/cyst
- Dysmenorrhea
- Endometriosis
Gynecology Surgery
- Insert Foley catheters
- Demonstrate knot tying of common surgical knots
- Perform surgical field prep (abdominal or vaginal)
- Observe the following abdominal procedures after obtaining the Hx, PE, E and M with supervising clinician:
- Total abdominal hysterectomy
- Unilateral/bilateral salpingo-oophorectomy
- Ovarian cystectomy
- Ectopic pregnancy surgery (list procedure)
- Incontinence/prolapse surgery (abdominal)
- Observe the following laparoscopic procedures after obtaining the Hx, PE, E and M with supervising clinician:
- Diagnostic laparoscopy
- Laparoscopic tubal ligation
- Laparoscopic cyctectomy/oophorectomy
- Laparoscopic hysterectomy
- Observe the following vaginal procedures after obtaining the Hx, PE, E and M with supervising clinician:
- Total vaginal hysterectomy
- Cystoscopy
- Diagnostic or operative hysteroscopy
- Endmetrial biopsy (office procedure)
- Dilation and curettage
Medical Knowledge
Students are expected to demonstrate knowledge of established and evolving biomedical, clinical and social sciences.
OB/Gyn Primary Care
Acute Abdomen
- Develop a differential diagnosis of pelvic infection, ectopic pregnancy, adnexal torsion, appendicitis, diverticulitis and nephrolithiasis
- Develop a differential for bleeding and abdominal pain in the first trimester
- Identify risk factors and discuss management for ectopic pregnancy
- Describe the clinical presentation, diagnosis and management of the following STIs:
- Gonorrhea
- Chlamydia
- Herpes simplex virus
- Human papilloma virus
- Human immunodeficiency virus infection
- Hepatitis B virus infection
Contraceptive Technology
- Describe the methods of male and female surgical sterilization and the risks associated with each of these methods
Population Health
- Identify patients at increased risk for sexual abuse and/or domestic violence
- List the components of a history on a sexual assault victim (child, adult and acquaintance rape)
Menstrual Cycle, Including Puberty and Menopause
- Define and describe the etiologies of amenorrhea and oligomenorrhea
- Describe the normal menstrual cycle including hormonal and histologic changes
- Define and describe the etiologies of abnormal uterine bleeding as well as its diagnosis and management
- Define and describe primary and secondary dysmenorhea as well as its diagnosis and potential treatment
- Describe appropriate management of menopausal/perimenopausal symptoms
Obstetrics
- Discuss the maternal physiologic anatomic changes associated with pregnancy
Common Problems in Obstetrics
- Recognize and discuss management for the following medical and surgical conditions in pregnancy:
- Anemia
- Diabetes mellitus
- Chronic hypertension
- Urinary tract disorders
- Infectious diseases, including: herpes, rubella, group B streptococcus, HIV, toxoplasmosis, cytomegalovirus, human papillomavirus, varicella and parvovirus
- Cardiac disease
- Asthma
- Alcohol, tobacco and substance abuse
- Surgical abdomen including appendicitis
Medical Complications in Pregnancy
- Recognize and discuss management for the following medical complications in pregnancy:
- Gestational diabetes
- Preeclampsia/eclampsia
- Postpartum hemorrhage
- First trimester bleeding
- Develop a differential diagnosis for first trimester vaginal bleeding
- Differentiate the types of spontaneous abortion
- Discuss management of first trimester loss
Breast Health and Pregnancy
- List the normal physiologic and anatomic changes of the breast during pregnancy and the postpartum periods
- List the reasons why breast feeding should be encouraged
Labor and Delivery
- List the signs and symptoms of labor
- Describe the three stages of labor and recognize common abnormalities
- Describe the steps of vaginal delivery
- Describe the evaluation of common puerperal complications
Gynecology
Gynecologic Disorders
- Diagnose a patient with vaginitis
- Describe dermatologic disorders of the vulva
- Describe the pathophysiology, diagnosis and management of urinary tract infections
- Describe the pathophysiology, diagnosis and management of salpingitis
Screening for Reproductive Cancers
- Identify the risk factors for cervical neoplasia and cancer
- Describe the initial management of a patient with an abnormal Pap smear
- Describe the symptoms and physical findings in patients with uterine leiomyomas
- List the risk factors, signs, and symptoms of endometrial carcinoma
- Compare the characteristics of functional cysts, benign ovarian neoplasm and ovarian malignancies
Reproductive Endocrinology and Infertility
- Define infertility
- Describe the most common causes of male and female infertility
- Describe the treatment of these forms of infertility
- Explain polycystic ovarian syndrome (PCOS)
- Explain the following methods of inducing pregnancy and their appropriate application:
- Preimplantation genetic diagnosis - PGD
- In vitro fertilization and embryo transfer
- ICSI - intracytoplasmic sperm injection
- Blastocyst transfer of embryos
- List the chief complaints a patient with endometriosis may have and the differential diagnosis and management
- Describe the psychological impact of infertility
Practice-Based Learning and Improvement
Students are expected to investigate and evaluate their patient care practices by appraisal and assimilation of scientific evidence.
OB/Gyn Primary Care
- Demonstrate the ability to assess patient compliance with recommended screening measures specific to women
Population Health
- List age-appropriate screening procedures and recommended time intervals for the following tests:
- Mammogram
- Bone density
- Pap tests
- STI evaluation
Obstetrics
Teratogenicity and Embryology
- Exhibit the appropriate method in counseling patients regarding the:
- Effects of substance abuse on pregnancy
- Impact of medications and environmental hazards on pregnancy
- Need for immunizations and the possible side effects on pregnancy
- Discuss the effect of pregnancy on common diagnostic studies
Systems-Based Practice
Students are expected to demonstrate an awareness of the larger context and system of health care and effectively call on system resources to provide optimal care.
- Identify resources to help victims of sexual abuse and/or domestic violence
- Explain the role and contribution of each member of the team who cares for the patient
Interpersonal and Communication Skills
Students are expected to effectively communicate and collaborate with patients, their families and health professionals.
- Demonstrate interpersonal and communication strategies to deal with patients and families in culturally sensitivity manner
- Exhibit awareness of the important contextual factors such as culture, ethnicity, language, socioeconomic class, etc., in interaction with patients
- Organize patient information in a cohesive and thorough written note
- Provide clear, concise and accurate oral presentations
Professionalism
Students are expected to demonstrate a commitment to carrying out professional responsibilities, and to be responsive and compassionate.
- Demonstrate respect for peers, faculty, staff and patients; and tolerate differences
- Exhibit concern and compassion for others and put patient first
- Synthesize feedback given by faculty, staff and peers
- Be prepared to take responsibility for accomplishing assigned tasks, and accept responsibility for errors
- Meet deadlines and be punctual
- Comply with the institutional dress code
- Demonstrate trustworthiness in relation with others, including maintaining confidentiality