Obstetrics and Gynaecology
Aim
By the end of the 3 week placement the students will be able to elicit an appropriate obstetric and gynaecologic medical history, perform an appropriate physical exam, obtain indicated lab studies, assess the results, formulate a management plan, and implement appropriate therapy for common problems encountered in obstetrics and gynaecology . The student may have some areas of weakness but will, overall, be safe.
It is important to remember that the primary purpose of this experience is to prepare Physician Associate students to deal professionally and confidentially with women’s health issues they may encounter in a variety of healthcare settings. The focus is therefore on the diagnosis and/or management of common and important obstetric and gynaecological conditions.
Objectives
Physical Examination
The student will be able to perform an appropriate physical examination including a thorough breast, abdominal, and pelvic exam.
Clinical Judgement in diagnosis and management:
The student will use laboratory and diagnostic studies appropriately to support or modify tentative diagnostic impressions.
Therapeutics and prescribing:
Aware of pharmacologic therapy, demonstrating understanding of the indications, contraindications, major side-effects/adverse reactions and correct dosing schedules for medications commonly used in obstetric and gynaecologic practices
Clinical Planning and Procedures
The student will analyse information obtained from the history, physical examination, recognize and diagnose obstetric and gynaecologic emergencies, formulate a problem list, develop a comprehensive prioritised differential diagnosis, utilise all available clinical data to accurately determine the diagnosis and appropriately manage common obstetric and gynaecologic emergencies
The following conditions, taken from the Matrix specification of Core Clinical Conditions for the qualified Physician Associate, are included here as guidance to the type of conditions and the level of competence that may be expected. It is NOT an agenda to be covered comprehensively.
Conditions covered in placement
Below is an extensive but not exhaustive list of conditions that PA students are encouraged to see by the end of their 3 week rotation in Obs and Gynae.
Students will be able to describe for each of these conditions:
1. Signs and symptoms
2. Cause and natural history
3. Diagnostic lab tests
4. Appropriate therapeutic and management consideration
Once qualified, PAs are expected to diagnose a patient on initial presentation with these conditions and will not usually require further referral.
Dysfunctional Uterine Bleeding
Premenstrual Syndrome
Uncomplicated Pregnancy
Cervicitis
Vaginitis
Prenatal diagnosis/care
Dysmenorrhoea
Abnormal smear
Menorrhagia
PA student should have an understanding of the following conditions but may not have the knowledge or resources to confirm the diagnosis or to manage the conditions safely:
Endometritis
Prolapsed Uterus
Cervical Dysplasia
Cervical Cysts
Neoplasm of vagina/vulva
Cystocoele
Rectocoele
Bartholin’s cyst
Amenorrhoea
Polycystic Ovarian Syndrome
Leiomyoma (Fibroids)
Complicated Pregnancy
Pregnancy induced hypertension
Ectopic Pregnancy
Gestational diabetes
Abortion/termination
Abruptio placenta
Placenta previa
Postpartum haemorrhage
Premature rupture of membranes
Rh incompatibility
Multiple gestation
Dystocia