Obstetrics and Gynecology Electives and Selectives

Attendance: Students may not take off on the rotation start date, but must attend check in and system orientation with Visiting Student Affairs on rotation start date. To get full credit, students may not miss more than two (2) days during the rotation. See the attendance policy for other details.

Location: CRCH MFM Clinic Suite 400

Available: July – June

Duration: 2 or 4 weeks, starting Monday and ending Friday with some Saturday rounds

Number of students per rotation: 1

Prerequisites:

• Fourth-year medical student who has successfully completed their third-year OB/GYN clerkship rotation
• Letter of Recommendation from chair/advisor that can validate applicant's interest in OB residency

Overview:

This elective is designed to provide the participating student with exposure to the breadth of high-risk obstetrics. The student will be expected to evaluate and manage high-risk obstetrical patients in the office and hospital setting. In the outpatient setting, the student will participate in genetic counseling sessions, ultrasounds and Maternal Fetal Medicine consults. The student will interact with the Maternal Fetal Medicine attendings, OB residents, genetic counselors and sonographers.

The student will gain experience with the management of acute and high-risk obstetrical conditions by rounding daily on the antepartum service with the residents and faculty. The student will be participating in intrapartum management during this rotation.

The student will attend Friday morning didactics with the residents and will be expected to complete a brief presentation on an obstetrical subject of their own choosing.

There is no call requirement for this rotation.

Textbook: Creasy and Resnick

Objectives:

1. The student will gain an understanding of medical and surgical conditions in pregnancy. The student will demonstrate an understanding of potential consequences of the following conditions in pregnancy: anemia, diabetes mellitus, urinary tract disorders, infectious diseases, cardiac disease, asthma and surgical abdomen.
2. The student will demonstrate knowledge of the isoimmunization and how to prevent this during pregnancy.
3. The student will participate in the antepartum management of multifetal gestations.
4. The student will be able to discuss the basic management of patients in preterm labor.
5. The student will be able to define fetal growth abnormalities and understand how antenatal care may differ in these pregnancies.
6. The student will participate in prenatal diagnostics and demonstrate an understanding of when screening or diagnostic tests may be appropriate.
7. The student will participate in genetic/perinatal counseling when fetal anomalies are identified.

Attendance: Students may not take time off on the rotation start date. To get full credit, students may not miss more than 1 day during the rotation. See the attendance policy for other details.

Location: CRCH UroGyn Clinic Suite 400

Available: July – June

Duration: 2 or 4 weeks, starting any Monday and ending Friday

Number of students per rotation: 1

Prerequisites:

• Fourth-year medical student who has successfully completed their third-year OB/GYN clerkship rotation
• Letter of Recommendation from chair/advisor that can validate applicant's interest in OB/GYN residency

Overview:

This elective has broad applicability and is designed for a student interested in primary care, obstetrics and gynecology, surgery or urology. 

This rotation will expose the student to the evaluation and management of patients with all types of pelvic floor disorders (prolapse, urinary and bowel incontinence, fistulas and bladder pain syndromes). The student will be involved in the outpatient management of patients with the above conditions. They will become familiar with medical and surgical management options. The student will have an opportunity to participate in fitting pessaries and observing urodynamics and outpatient cystoscopy. 

At least one day a week will be spent in the operating room and the student will be responsible for following postoperative patients during their hospital stay. Students will also participate in Friday morning didactics with the residents.

Objectives:

1. Explain the normal anatomic support of the pelvic organs.
2. Characterize the major types of urinary incontinence.
3. Gain a basic understanding of urodynamics and how these studies are used to guide treatment options.
4. Elicit a history in a patient with suspected pelvic organ prolapse or urinary incontinence.
5. Perform a focused physical exam in a patient with pelvic organ prolapse.
6. Discuss medical and surgical treatment options for urogynecologic disorders.

Attendance: Students may not take off on the rotation start date. To get full credit, students may not miss more than 1 day during the rotation. See the attendance policy for other details.

Location: CRMH

Available: March 30 – April 12, 2026 (offered once a year)

Duration: 2 weeks, Monday - Friday

Number of students per rotation: 6

Prerequisites: 

• Fourth-year medical student who has successfully completed their third-year OB/GYN clerkship rotation
• Letter of Recommendation from chair/advisor that can validate applicant's interest in OB/GYN residency

Overview: 

This two-week elective is designed for fourth-year medical students who will enter an obstetrics and gynecology residency after graduation. This elective will include self study, lectures, computer modules, simulation and some clinical time. The goal of this elective is for each student to achieve Milestone 1 in preparation for entering residency.

Objectives:

Office Practice Milestone 1

Didactic Knowledge

1. Understand and conduct well-women visits with age-appropriate testing and counseling
2. Understand the evaluation and screening for breast disease throughout the lifecycle
3. Understand the pathophysiology and evaluation of post-menopausal bleeding
4. Basic understanding of the various forms of contraception
5. Understanding, evaluation and management of abnormal pap smears
6. Understanding and counseling for aneuploidy screening and prenatal diagnostic procedures
7. Basic understanding and assessment of the patient presenting with infertility
8. Basic understanding of options and counseling for an undesired pregnancy
9. Basic understanding of the physiology and pathophysiology and evaluation of menopause
10. Basic understanding of the pathophysiology, microbiology and treatment for UTI, STI, vaginal infections and vulvar infections
11. Basic understanding of testing for gestational appropriate prenatal care strategies
12. Basic understanding of prevalence and screening for sexual assault and domestic violence

Procedural Skills

1. Obtain gynecologic history, menstrual history and sexual history; perform a speculum exam, bimanual exam and breast exam; and differentiate normal and abnormal findings
2. Obtain cervical samples for a pap smear and cultures
3. Perform outpatient endometrial biopsy (simulation)
4. Perform IUD insertion (simulation)
5. Understand principles of colposcopy examination
6. Be familiar with and understand principles of hysteroscopy, energy sources and fluid management
7. Understand performance and clinical correlations of basic gyn ultrasound
8. Understand indications for and interpretations of antenatal testing
9. Perform and interpret wet mount examination for vaginal discharge

Gynecology Milestone 1

Didactic Knowledge

1. Basic understanding of physiology and the normal menstrual cycle
2. Basic understanding of the physiology and pathophysiology of dysfunctional/abnormal uterine bleeding
3. Basic understanding of the pathophysiology, microbiology and evaluation of STIs
4. Basic understanding of the diagnosis and treatment of ectopic gestation and first trimester bleeding
5. Basic understanding of the epidemiology, pathophysiology and principles of treatment of reproductive tract malignancies
6. Basic understanding of the pathophysiology and evaluation of patients with urinary incontinence and/or pelvic organ prolapse
7. Basic understanding of indications and alternatives for hysterectomy(abdominal/ vaginal/laparoscopic)
8. Basic understanding of anatomy and intraoperative complications of commonly performed gyn surgery
9. Basic understanding for routine postoperative care and management of postoperative complications
10. Basic understanding of evaluation of ovarian cysts/adnexal masses
11. Basic understanding of the evaluation of acute pelvic pain

Procedural Skills

1. Understand principles of and basic performance of D&C and manual uterine evacuation
2. Basic laparoscopic skills (simulation)
3. Know the names and uses of surgical instruments
4. Proficiently tie knots (1 and 2-handed)
5. Know the types of suture, their use and time to dissolve
6. Place suture correctly
7. Appropriate patient positioning and maintenance of aseptic technique
8. Know how to maintain an environment of patient safety (time out/surgical consent)

Obstetrics Milestone 1

Didactic Knowledge

1. Normal physiology of labor, conduct of normal labor and delivery
2. Basic understanding of the physiology of fetal monitoring
3. Basic understanding of the pathophysiology and management of gestational hypertensive diseases
4. Basic understanding and management of diabetes complicating pregnancy
5. Basic understanding of the etiology and management of preterm labor
6. Basic understanding and management of third trimester bleeding
7. Basic understanding and management of patients with spontaneous abortion
8. Basic understanding of the pathophysiology and management of patients with postpartum fever
9. Basic understanding and management of patients with postpartum hemorrhage
10. Maternal physiologic adaptions to pregnancy and the puerperium
11. Basic understanding of the management of common antepartum complications, to include nausea and vomiting, UTI and pyelonephritis
12. Basic understanding of postpartum care, to include breastfeeding and contraception

Procedural Skills

1. Obtain an accurate obstetrical history
2. Perform accurate cervical assessments for labor progress
3. Perform evaluation of patients with suspected rupture of membranes
4. Fetal monitor strip interpretation
5. Conduct a spontaneous vaginal delivery
6. Repair a first- or second-degree laceration (simulation)
7. Know the basic steps of a cesarean delivery
8. Basic ultrasound skills: simple morphometrics, AFI, position, placental location, BPP

Location: CRMH and possibly other Carilion Hospitals

Available: July – June

Duration: 4 weeks, starting any Monday and ending Friday

Number of Students per Rotation: 1

Prerequisites: 

• Letter of Recommendation from OB Chair/Advisor validating applicant's intent to pursue residency in OB
• Fourth-year medical student who has successfully completed their third-year OB/GYN clerkship rotation

Attendance: Students may not take time off on the rotation start date. To get full credit, students may not miss more than 1 day during the rotation. See the attendance policy for other details.

Overview: 

This course is designed for exposure to the assessment and treatment of advanced gynecologic pathology. This experience will provide experience in both the clinic and operating room for patients with chronic pelvic pain symptoms.

The student will participate directly in all aspects of care, including initial outpatient consult and workups in clinic; decision analysis of treatment modalities including but not limited to physical exam assessment, surgical planning, medical regimens, incorporations of pelvic physical therapy, trigger point injections; and amendment of treatment plans. Emphasis will also be placed on intra-operative exposure and participation in laparoscopic and hysteroscopic surgeries each week.

The student will be required to observe the duties of an on-call physician (home call for one weekend) during the clerkship.

Travel will be involved to Carilion Rockbridge Community Hospital in Lexington, Virginia, and to Carilion Franklin Memorial Hospital in Rocky Mount, Virginia.

Objectives: 

At the end of this course, students will be able to:

1. Formulate a differential diagnosis for clinical referrals of refractory pelvic pain.
2. Order tests to elucidate the most likely diagnoses.
3. Incorporate and perform a complete pelvic pain exam for assessment.
4. Discuss surgical evaluation and treatment approaches for the following: endometriosis, fibroids, ovarian cysts, endometrial polyps, “frozen” pelvis, tubo-ovarian abscess, peritoneal inclusion cysts.
5. Discuss approaches to evaluate surgical risk in patients with advanced comorbidities (ex. morbid obesity, history of blood clots, poorly controlled diabetes, large pathology, history of abdominal mesh, etc.).
6. Effectively communicate and collaborate in multidisciplinary teams.

The Minimally Invasive Gynecology Surgery (MIGS) division provides treatment to individuals with advanced surgical pathology and chronic pelvic pain. Due to the complexity of their medical care, these patients are often treated in incomplete, isolated fashions with multiple subspecialties focused on partial treatments of multimodal medical and surgical issues. The MIGS division works in conjunction with additional medical consulting: Reproductive Endocrinology and Infertility (REI), Urogynecology, Gastrointestinal (GI)) services to provide a centralized treatment regimen of medical and surgical services for patients with advanced abdominal and pelvic pathology. Students will engage in the workup and assessment of patients with pelvic pain and understand the importance of coordination of multidisciplinary-based care.