Clerkship Objectives & Learning Outcomes

The overall goals for the second year OBGYN Clerkship are listed below. Our purpose is to outline the “core” of OBGYN knowledge, skills and professional attitudes that are fundamental for all medical students. We have also mapped those specific objectives to the institutional objectives.

Clerkship Objectives

Knowledge 

The student will learn:

    1. Health maintenance and preventive care for women, including age-related issues in cancer screening, screening for other common adult-onset illnesses, nutrition, sexual health, vaccination, and risk factor identification and modification. (MK4)
    2. Acute and chronic conditions common in women’s general and reproductive health, including their diagnosis and treatment. (MK5)
    3. Principles of physiology and pharmacology applicable to women from puberty through their reproductive life and menopause, especially pregnancy and age-related changes. (MK1, MK2, MK3)
    4. Prenatal, intrapartum and post-partum care of normal pregnancy and common pregnancy-related complications as well as the care of women with acute or chronic illness throughout pregnancy. (MK5)
    5. Fetal and immediate neonatal assessment. (MK5)

Skills 

The student will demonstrate competence in:

  1. Communication skills
      • Interacting effectively and sensitively with patients, families, and health care teams in verbal and written presentations. (C1)
      • Recognize the important role of patient education in the prevention and treatment of disease. (C1)
      • Verbal Presentations: Organize a case presentation to accurately reflect the reason for the evaluation, the chronology of the history, the details of physical findings, the differential diagnosis and the suggested initial evaluation. Include age specific information and precise description of physical findings.  Justify the thought process that led to the diagnostic and therapeutic plan. (C2)
      • Written Documentation: Document the independent clinical thinking of the student.  When using templates, or their own prior documentation, students should carefully adjust the note to reflect newly completed work and to ensure the note is a useful addition to the medical record. (C2)
  2. History Taking: From patients in more complex situations such as in the emergency and labor setting, collecting complete and accurate information and focusing appropriately. (PC1)
      • Describe how to modify the interview depending on the clinical situation—inpatient, outpatient, acute and routine settings. (PC1)
  3. Physical Exams:  complete and focused depending on indication and condition. (PC2)
  4. Clinical Problem Solving:  Using data from history, physical, labs, and studies to define problems, develop a differential diagnosis, and identify associated risks. (PC4, PC5)
  5. Clinical Decision Making:  Incorporating patient data with patient needs and desires when formulating diagnostic and therapeutic plans. (PC5)
  6. Evidence-Based Medicine: Ability to conduct an evidence-based search surrounding a specific clinical question and to appropriately evaluate the literature to answer such question. (PBL12)
  7. Self-Education:  Recognizing knowledge deficits and learning needs through a reflective self-assessment process, plan or seek assistance in remediation of knowledge deficits, develop key critical thinking and problem solving skills.  Seek feedback. (PBL11, PBL13)

Professionalism

The student will be expected to:

    1. Demonstrate compassion, empathy, and respect toward patients, including respect for the patient’s modesty, privacy and confidentiality. (P1)
    2. Demonstrate communication skills with patients that convey respect, integrity, flexibility, sensitivity and compassion. (P1)
    3. Demonstrate respect for patient attitudes, behaviors, and lifestyle, paying particular attention to cultural, ethnic and socioeconomic influences. (P5)
    4. Function as an effective member of the health care team, demonstrating collegiality and respect for all members of the health care team. (P2)
    5. Demonstrate a positive attitude and regard for education by demonstrating intellectual curiosity, initiative, honesty, responsibility, dedication to being prepared, maturity in soliciting, accepting and acting on feedback, flexibility when differences of opinion arise and reliability. (PBL13)
    6. Identify and explore personal strengths, weaknesses, and goals. (PBL14)

Learning Outcomes

 

Instructions

You should plan to complete all of the ILOs. Even if you do not participate in every subspecialty listed, you are still responsible for completing the associated ILOs.

If you do not encounter a patient, participate in a didactic session or a simulation corresponding to a particular ILO, please go to APGO.org, click on “Objectives.” read the associated outline/sample case and answer the questions.

This is not a substitute for completing your Required Clinical Experiences (RCEs). You must also complete your RCEs as you go.

Gynecology (Outpatient Clinic)

    1. Develop competence in the medical interview and physical examination of women and will incorporate ethical, social and diversity perspectives to provide culturally competent health care.

□  Perform pelvic exam (including speculum and bimanual examination)
□  Perform clinical breast exam
□  Conduct, record and present GYN patient H & P 

2.  Apply recommended prevention strategies to women throughout the lifespan.

 □  Annual well-woman exam

3.  Recognize your role as a leader and advocate for women. (one of the following) 

□  Domestic violence screening, teen pregnancy

 4.  Describe menstrual cycle physiology, discuss puberty and menopause, and explain normal and abnormal bleeding.

□  Menopause/perimenopause
□  Abnormal uterine bleeding

 5.  Develop a thorough understanding of contraception, including abortion and sterilization.

□  Contraceptive counseling

6.  Provide a preliminary assessment of patients with sexual concerns.

□  Take a sexual history 

7.  Demonstrate knowledge of common benign gynecological conditions.

□  Vulvar/vaginal benign disease
□  Fibroids
□  Endometriosis

8.  Formulate a differential diagnosis of the acute abdomen and chronic pelvic pain.  

□  Pelvic pain
□  Ectopic pregnancy

9.  Describe the etiology and evaluation of infertility
10.  Describe common breast conditions and outline the evaluation of breast complaints.

□  Perform clinical breast examination
□  Breast mass
□  Nipple discharge
□  Mastitis 

11.   Pelvic Organ Prolapse-

□  Discuss the levels of pelvic organ support
□  Identify symptoms
□  Identify risk factors
□  Identify surgical and non-surgical treatment options for prolapse

12.  Lower Urinary Tract Symptoms

□  Take a history regarding voiding and storage disorders to identify symptoms of irritation, obstruction, and incontinence
□  Define types of urinary incontinence: stress, urge, mixed, overflow, functional, continuous
□  Explain primary evaluation for urinary incontinence: urinalysis, post void residual, voiding diary, stress test
□  Identify treatments for Incontinence: physical therapy, behavioral, medications, pessary, surgery
□  UTI management- antibiotic choice, prophylaxis

 13.   Describe gynecologic malignancies including risk factors, signs and symptoms and initial evaluation. 

□  Abnormal Pap smear
□  Postmenopausal bleeding
□  Adnexal mass/cyst

Gynecologic Surgery

1.  Gynecology Perioperative Care-

 

□  Perform pelvic exam and digital rectal exam. (may be under anesthesia)
□  Insert Foley catheter
□  Demonstrate ability to write the following notes-
     
  • GYN preoperative note, including appropriate studies and prophylaxis
  • GYN operative note
     
  • GYN postoperative note   
  • GYN postoperative progress note

2.  Demonstrate familiarity with gynecologic procedures. 

□  Observe hysterectomy
□  Observe laparoscopy
□  Observe other gynecology procedure (enter below)
     
i.      ____________________
   
ii.     ____________________
   
iii.    ____________________
     
iv.    ____________________
     
v.     ____________________

Obstetrics

1.  Demonstrate knowledge of preconception care including the impact of genetics, medical conditions and environmental factors on maternal health and fetal development.

□  Preconception care
□  1st trimester care
□  Prenatal diagnosis
 

2.  Explain the normal physiologic changes of pregnancy including interpretation of common diagnostic studies.

□  New OB prenatal visit
□  Routine prenatal care follow-up visit
□  Conduct, record and present OB patient history
 

3.  Describe common problems in obstetrics.

□  Diabetes in pregnancy
□  Preeclampsia/eclampsia
□  3rd trimester bleeding
□  Peripartum infection
□  1st trimester bleeding
 

4.  Demonstrate knowledge of intrapartum care. 

□  Present patient for labor admission
□  Clinical course of labor
□  Premature rupture of membranes (PROM)
□  Preterm labor (PTL)
□  Normal Spontaneous Vaginal Birth (NSVD), participate/observe
□  Observe perineal laceration repair
□  Write delivery note
 

5.  Demonstrate knowledge of postpartum care of the mother and newborn.

□  Postpartum discharge instructions
□  Current breastfeeding recommendations regarding indications/contraindications
□  Postpartum hemorrhage
□  Write postpartum note
□  Present postpartum patient