Obstetrics & Gynecology Clerkship

Obstetrics and Gynecology is a six-week clerkship during which students learn about all elements of women's health care including pregnancy care, preventive care, management of gynecologic complaints, perioperative care, and gynecologic cancers. Students participate in inpatient and outpatient care of women and encounter a variety of surgical experiences under supervision.

Obstetrics and Gynecology Clerkship Learning Objectives

Medical Knowledge (MK)

1. Demonstrate knowledge of normal physiology of the following: the menstrual cycle (including normal uterine bleeding), physiologic changes in pregnancy, reproduction, and menopause. (MK1)
2. Demonstrate knowledge of preconception care, antenatal care, intrapartum care, and postpartum care. (MK2)
3. Describe the pathophysiology, evaluation and management of the following conditions. (MK3, MK4, MK5)
   
   • abnormal uterine bleeding; infertility; fetal death; abnormal labor, pre-eclampsia, bleeding, and infection; unintended and abnormal pregnancy; menopause; pelvic pain; gynecologic infection; urinary incontinence; cervical dysplasia; anatomic abnormalities; gynecologic malignancies including cervical, endometrial, ovarian and uterine cancer; common breast conditions: mastalgia, breast mass, and nipple discharge
4. Describe the role of contraception to prevent pregnancy. (MK5, MK7)
5. Describe the etiology and management of postpartum depression. (MK6)
6. Explain evidence-based approaches to prevention and screening for cervical and breast cancer. (MK7)
7. Explain how social determinants of health impact the health status of women. (MK7)

Patient Care (PC)

1. Demonstrate ability to obtain a history for women inclusive of obstetric, gynecologic, and sexual history. (PC1)
2. Demonstrate ability to perform a physical exam for women, including breast and pelvic exams. (PC1)
3. Synthesize information collected through history, physical exam, lab evaluation, and imaging to formulate a differential diagnosis. (PC2)
4. Develop an evaluation and management plan for common obstetric and gynecologic conditions using evidence-based recommendations. (PC3)
5. Outline basic principles of perioperative care including pre-operative evaluation, intraoperative management, and post-operative care. (PC3)
6. Participate in patient hand-offs between teams and scheduling of appointments, obtaining records, etc. when necessary for timely patient care. (PC4)
7. Counsel and educate patients appropriately using accurate, up-to-date information regarding routine health maintenance for women, preventive care such as contraception or vaccination, and common conditions in obstetrics and gynecology such as an abnormal pap smear, abnormal uterine bleeding, labor, and pre-eclampsia. (PC5)
8. Perform a screen for domestic violence and provide basic counseling to women who screen positive. (PC5)
9. Demonstrate ability to organize and prioritize clinical responsibilities to provide safe, efficient, effective care during inpatient rounding, evaluation of patients in urgent care settings (ex. labor and delivery exam room) and balance outpatient and inpatient responsibilities. (PC6)
10. Perform various inpatient and outpatient obstetric and gynecologic procedures safely and correctly (see procedure and diagnosis log for examples such as pap smear, wet prep, urethral catheterization). (PC7)

Interpersonal Skills and Communication (CS)

1. Demonstrate effective and therapeutic communication with patients through the use of active listening and appropriate verbal, nonverbal and written skills. (CS1)
2. Demonstrate effective verbal and written presentation of patient information to colleagues. (CS1)
   Foster therapeutic and ethically sound relationships with patients across a broad range of socioeconomic and cultural backgrounds using active listening, appropriate verbal and nonverbal behaviors, respect, empathy, and emotional support. (CS2)
3. Demonstrate sensitivity, honesty, and compassion in difficult conversations including those about domestic violence, reproductive choices, periviability, fetal death, endo of life, adverse events, bad news, disclosure of errors, and other sensitive topics. (CS3)
4. Maintain accurate, comprehensive, timely, and legible medical records. (CS5)

Professionalism (PR)

1. Demonstrate honesty, integrity, respect, and compassion in all interactions with patients, peers, faculty, staff, and other health care professionals in all settings. (PR1)
2. Demonstrate ethical, patient-centered decision making, informed consent and respect for the confidentiality of patient information in all settings (i.e., clinical, academic, electronic, or web-based). (PR2)
3. Demonstrate sensitivity and responsiveness to the personhood of the patient inclusive of culture, race, ethnicity, spirituality, gender, sexual orientation, age, physical characteristics, medical condition, disabilities, socioeconomic status, family-context and other aspects of personal and health beliefs, practices and decisions. (PC3)
4. Demonstrate accountability for academic, patient care, and professional responsibilities, including concern for societal needs. (PR4)
5. Demonstrate responsiveness to patient needs that supersedes self-interest. (PR5)

Personal and Professional Development (PD)

1. Acknowledge personal limitations and mistakes openly and honestly, seek and respond to feedback in a positive way, and demonstrate flexibility and maturity in adjusting one's behavior. (PD1)
2. Demonstrate strategies for analyzing, identifying and improving personal deficiencies in knowledge and skills by setting learning and improvement goals. (PD2)

Practice-based and Lifelong Learning (PL)

1. Demonstrate the ability to retrieve, analyze, and integrate evidence-based information into patient care and clinical decision-making. (PL3)
2. Participate in continuing education activities such as Grand Rounds and Morbidity and Mortality Conference in order to cultivate life-long learning skills and apply foundations of research to patient care. (PL3)
3. Apply principles of medical informatics and patient safety to enhance patient care. (PL4)

Systems-based Learning (SL)

1. Develop an awareness of the impact of health disparities and health care disparities in areas of women's health including gynecologic cancer, perinatal outcomes, and reproductive care. (SL4)

Interprofessional Collaboration (IP)

1. While working with other health professionals, maintain a climate of mutual respect, dignity, diversity, ethical integrity, and trust. (IP2)
2. Communicate effectively and respectfully with other health professionals in a responsive and responsible manner. (IP3)
3. Work with various health care professionals including nurses, social workers, genetics counselors, ultrasound technicians, and financial counselors to improve individual patient care and system performance. (IP4)

Obstetrics and Gynecology Clerkship PxDx Log

Procedure	Output or Input
Perform a gynecologic and sexual history	O,I
Perform an obstetric history	O,I
Perform fetal heart rate check with doppler	O,I
Participate in Contraceptive Counseling	O,I
Observe a gynecologic or obstetric ultrasound	O,I
Observe a gynecologic surgery or gynecologic oncology surger	I
Perform bladder drainage with catheter or Foley insertion	O,I
Observe counseling for a patient who needs or is receiving treatment for gynecologic cancer	O,I
Perform an interpretation a fetal heart rate tracing	O,I
Observe a Cesarean section	I
Participate in a Vaginal delivery	I
Observe a perineal laceration repair	I
Write a postpartum note (perform)	O,I
Diagnosis in the care of patients with the following diagnoses:	Output or Input
Annual exam or well-woman check	O
Routine obstetrical appointment	O
Complication: Miscarriage or threatened miscarriage, ectopic pregnancy, pregnancy of unknown location, molar pregnancy	O,I
Vaginitis including symptomatic STIs, yeast, or bacterial vaginosis, cervicitis, or pelvic inflammatory disease	O,I
Abnormal pap smear or cytology	O,I
Abnormal uterine bleeding	O,I
Menopause or perimenopause	O,I
Urinary Incontinence	O,I
Spontaneous Labor	O,I
Induction of Labor	O,I
Preterm labor or PPROM	O,I
Pre-eclampsia or eclampsia or gestational hypertension	O,I
Intrapartum or Postpartum infection (chorioamnionitis, endometritis)	O,I
Post-operative or postpartum pain management	O,I
Exam	Output or Input
Perform a Clinical breast exam on a patient	O,I
Perform a Clinical pelvic exam on a patient	O,I