Obstetrics & Gynecology Session Level Objectives

Academic Half-Days

1) Whole Group Orientation with the Clerkship Director

• Discuss the impacts of gender inequity in medicine on patients and healthcare providers.

 2) Vaginal Delivery Simulation Sessions

• Describe the cardinal movements of labour.

• Identify fetal position.

• Perform cervical assessment for labour progress.

• Perform a simulated vaginal delivery.

• Deliver a placenta in a simulated setting.

• Describe the options for operative vaginal delivery.

3) Normal Labour and Delivery

• Describe the initial assessment of the labouring patient.

• Describe the characteristics of false labour.

• Describe the stages and mechanisms of normal labour and delivery.

• Describe the techniques to evaluate the progress of labour.

• Describe the management of normal delivery.

• Describe the assessment of the placenta and umbilical cord for abnormalities.

• Describe the technique of vaginal laceration repair.

• Describe the principles of 'Active Management of Labour'.

• List options for pain management during labour.

• Describe the indications for antimicrobials in labour and delivery.

4) How to Read a Non Stress Test

• Describe the standards of monitoring in labour including clinical and electronic fetal monitoring.

• Describe the approach to reading a non-stress test.

• Recognize normal, atypical and abnormal fetal heart tracings.

5) Obstetric History and Physical Exam 

• Discuss elements of obstetric history including fetal activity, bleeding, contractions and discharge.

• Discuss elements of obstetric physical exam including maternal blood pressure, leopold’s maneuver, symphyseal fundal height and fetal heart rate.

• List methods to diagnose pregnancy.

• List methods to calculate gestational age.

• List methods to identify an at-risk pregnancy.

• List methods to assess fetal growth and well-being.

• Discuss assessment for infections in pregnancy including STIs and TORCH organisms.

6) Gynecologic History & Exam

• Take a thorough menstrual, contraceptive, obstetric and sexual history using a trauma-informed approach.

• Describe the key elements of a pelvic examination (external genitalia, speculum examination and bimanual examination) and special tests (rectovaginal examination, cervical dilation check, myofascial examination) and when each would be required based on patient presentation.

• Prepare the proper tools required for pelvic examination, including mirror, set-up, chaperone, speculum, Q-tips, etc.

7) Contraception

• Describe the physiologic or pharmacologic basis of action and effectiveness of various contraceptive methods.

• List the benefits and risks of the various methods.

• Discuss the methods of surgical sterilization, including risks, benefits, surgical complications, failure rates and reversibility.

8) Complications in Pregnancy

• Identify a patient experiencing pre-term labour.

• Describe an approach to the management of a patient experiencing pre-term labour.

• Describe an approach to a patient presenting with bleeding in the second or third trimester, including placenta previa, vasa previa, placental abruption, and uterine rupture.

9) Hypertensive Disorders of Pregnancy

• Compare and contrast diagnostic features of gestational hypertension and preeclampsia.

• Describe the approach to management of gestational hypertension and preeclampsia.

• List maternal and fetal complications of gestational hypertension and preeclampsia.

10) Ectopic Pregnancy

• List risk factors predisposing patients to ectopic pregnancy.

• Describe symptoms and physical findings suggestive of ectopic pregnancy.

• Discuss methods and tests used to confirm the diagnosis of ectopic pregnancy.

• Select appropriate medical and surgical treatment options.

11) Multi-Fetal Gestation 

• Differentiate the features of etiology of monozygotic, dizygotic, and multi-zygotic gestation.

• Counsel a patient on the complications of multifetal gestation.

• Discuss enhanced monitoring requirements of a multifetal gestation compared to singleton pregnancy.

12) Isoimmunization 

• Describe the pathogenesis of red blood cell isoimmunization

• Explain the rationale for use and dosage of rhesus D immunoglobulin prophylaxis during pregnancy.

• Explain the clinical circumstances under which isoimmunization is likely to occur.

• Describe how to order a rhesus D immunoglobulin in the outpatient setting, including consent for blood products.

13) Prenatal Genetic Testing 

• Discuss the management of a patient with a positive prenatal genetic screening test including amniocentesis, chorionic villous sampling, genetic counseling and pregnancy termination.

14) Menstrual Cycle Abnormalities

• Differentiate primary and secondary amenorrhea, and oligomenorrhea.

• Construct a differential diagnosis for primary and secondary amenorrhea including central, ovarian and uterine causes as well as pregnancy.

• Discuss investigations and initial management plan for primary and secondary amenorrhea.

• Construct a differential diagnosis for abnormal vaginal bleeding for pre and post menopausal patients.

• Interpret clinical investigations in abnormal vaginal bleeding.

• Construct an initial management plan for abnormal vaginal bleeding.

15) Vulvovaginal Discharge and Pruritus

• Develop a differential diagnosis for vulvovaginal discharge and pruritus including physiologic, infectious and inflammatory causes.

• Interpret investigations including pH, wet smear, KOH test, and vulvovaginal/cervical swabs.

• Discuss initial management of infectious and non-infectious causes of vulvovaginal discharge and pruritus.

16) Menopause

• Discuss management of menopausal symptoms, including vasomotor symptoms, sleep and mood disturbance, and GSM (Genitourinary syndrome of menopause).

• Discuss the implications of the Women’s Health Initiative study and its impact on menopausal care.

• List risks, benefits, duration and options for MHT (Menopausal hormone therapy).

• Counsel patients on the risk implications of bioidentical hormone therapy.

17) Chronic Pelvic Pain 

• Identify common causes of chronic pelvic pain.

• Demonstrate an approach to a comprehensive history and physical examination for a patient with chronic pelvic pain.

• List initial investigations and management of chronic pelvic pain.

18) Pre-pregnancy Assessment

• Identify age appropriate screening procedures & recommended time intervals for:

  • • Pre-pregnancy immunizations

    • Pap smear and general health examination

    • Age and risk-appropriate screening for reproductive cancers

• Develop a management plan of pre-pregnancy care, including:

  • • Laboratory and diagnostic studies

    • Patient education (such as nutrition, smoking cessation, etc.)

    • Risk factors for intimate partner violence

19) Abnormal Labour/ Active Management of Labour

• List indications and contraindications for oxytocin administration. 

• Recognize abnormal progress of labour which may require intervention. 

• Describe the diagnosis and management of abnormal fetal presentations. 

20) Puerperium and Post-partum Hemorrhage

• Discuss the components of active management of the third stage of labour.

• List risk factors for postpartum hemorrhage.

• Diagnose the cause of acute and late postpartum hemorrhage.

• Demonstrate management of the patient with acute and late postpartum hemorrhage.

• Discuss the components of debrief with the patient and family after postpartum hemorrhage.

21) Post-Partum Care

• Demonstrate appropriate postpartum care, including assessment and management of:

  • • Breastfeeding

    • Perinatal mood disorders

    • Bowel and bladder symptoms

    • Contraception

    • Endometritis and wound infection

22) Gynecologic Cancers

• Describe a diagnostic approach to pelvic masses.

• Discuss the diagnosis and investigation of postmenopausal bleeding.

• Discuss an approach to screening for HPV infection, cervical dysplasia and neoplasia.

• Discuss investigation and management of cervical dysplasia, including the role of colposcopy. 

23) 1st Trimester Bleeding 

• Develop a differential diagnosis for first trimester bleeding.

• Distinguish between different types of spontaneous abortion.

• Describe the management of different types of spontaneous abortion.

• Recognize the need for specialty referral in the case of recurrent pregnancy loss.

• Diagnose a molar pregnancy, including the need for specialty care referral.

24) Shoulder Dystocia

• Discuss risk factors for shoulder dystocia.

• Demonstrate management of shoulder dystocia in a simulated setting.

25) Prolapse & Incontinence 

• Diagnose pelvic organ prolapse.

• Diagnose stress versus urge versus overflow incontinence.

• Demonstrate conservative management strategies including:

  • • Lifestyle modification

    • Pharmacologic management, including vaginal estrogen and incontinence medications

    • Pelvic physiotherapy

    • Pessary

• Identify indications for specialty and surgical care for patient presenting with pelvic organ prolapse or incontinence.

26) Abnormal Uterine Bleeding

• Evaluate abnormal uterine bleeding in patients of various ages.

• Initiate management for causes of abnormal uterine bleeding, including:

  • • Structural etiologies (Fibroids, Polyps, etc.)

    • Hormonal (Anovulatory bleeding, intermenstrual bleeding, etc.)

    • Systemic (bleeding disorder, thyroid disorder, prolactinoma)

Required Encounters

CLINICAL ENCOUNTER

• First prenatal visit

• Menstrual disorder

• Pelvic pain

• Postpartum exam

• GHTN / preeclampsia

• Preterm labor / PPROM

CLINICAL PROCEDURE

• Pelvic exam / Pap smear

• Laparoscopy/laparotomy (assist)

• Vaginal delivery

• Cesarean delivery (assist)