Obstetrics & Gynecology

Obstetrics & Gynecology

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Acting Internship – Gynecologic Oncology (OB4 905C-4)

Attendance: Students may not take off on the rotation start date. To get full credit, students may not miss more than 2 days during the rotation. See the attendance policy for other details.

Location: Carilion Clinic GynOnc 1 Riverside

Available: June 2015 - July 2016

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

Number of students per rotation: 2 (only 1 in December)

Prerequisites:

3rd year medical students who have successfully completed their 3rd year ob/gyn clerkship and is in the second half of their 3rd year or a 4th year medical student who has successfully completed their ob/gyn clerkship

Overview:

This is a sub-internship elective designed for a student interested in obstetrics and gynecology or a surgical subspecialty. It is also a good selection for a student interested in pathology or oncology.  The student will gain experience in the outpatient evaluation of patients with potential gyn malignancies.  Students will observe and assist with surgical cases including robotic cases.  The student will gain an understanding of postoperative management of complicated surgical patients and will round on these patients with the gyn oncology team as an acting sub-intern.  The student will be expected to present a topic of their choosing to the team at the end of the rotation or participate in an oral exam given by one of the gyn oncologists.  The 4th year student will participate in the same didactic curriculum with the residents.  There is no call responsibility but the student will be expected to participate in inpatient rounds during 2 of the 4 weekends.

 

Objectives: 

  1. The student will be able to list the symptoms, physical findings and diagnostic methods for patients with ovarian cancer
  2. Describe the clinical manifestations and gain a basic understanding of treatment options for Vuvlar cancer
  3. Understand the risk factors for cervical cancer and the appropriate indications for screening
  4. Discuss the management of patients with an abnormal pap test
  5. List risk factors for endometrial cancer
  6. Discuss the management of patients with postmenopausal bleeding
  7. Describe the methods for diagnosing endometrial cancer
  8. Become familiar with the management of patients with endometrial cancer
  9. Discuss the management of patients with an adnexal mass
  10. Describe the general mechanisms of action of different chemotherapeutic agents
  11. Summarize appropriate preoperative evaluations for individual patients (appropriate imaging, lab tests, antibiotics, DVT prophylaxis, etc)
  12. Understand management of postoperative pain
  13. Demonstrates an understanding of appropriate postoperative management when it comes to the following:  diet, ambulation, urinary function, DVT prophylaxis, wound care
  14. Has a basic understanding of the evaluation process for postoperative complications: fever, ileus, wound complications, electrolyte imbalances, thromboembolism and respiratory complications

 

 

Maternal Fetal Medicine (OB4 905D-4)

Attendance: Students may not take off on the rotation start date, but must attend check in and system orientation with our Visiting Student Affairs Office 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: June 2015 - July 2016

Duration: Four (4) weeks, starting Monday and ending Friday with some Saturday rounds

Number of students per rotation: 1

Prerequisites:

4th year medical student who has successfully completed their 3rd year ob/gyn clerkship rotation

 

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 the genetic counseling sessions, ultrasounds, maternal fetal medicine consults and prenatal visits.  The student will interact with the Maternal Fetal Medicine attendings, ob residents, genetic counselors and ultrasound technicians. 

 

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 have limited participation in intrapartum management during this rotation during assigned sessions (performing vaginal deliveries or cesarean deliveries).

 

The student will attend Friday morning didactics with the residents and they will also be expected to complete a brief presentation on an obstetrical subject.  There is no call requirement.

 

Textbook: Creasy and Resnick

 

Objectives:

  1. The student will gain an understanding of medical and surgical condition in pregnancy.  They will demonstrate an understanding of potential consequences of conditions in pregnancy such as:
    1. Anemia
    2. Diabetes mellitus
    3. Urinary tract disorders
    4. Infectious diseases
    5. Cardiac disease
    6. Asthma
  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 the antenatal care may differ in these pregnancies
  6. The student will participate in prenatal diagnostics and demonstrate an understanding when screening or diagnostic tests may be appropriate
  7. The student will participate in genetic/ perinatal counseling when fetal anomalies are identified

 

OBGyn Boot Camp (OB4 905E-2)

 

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 28 - April 11, 2016

Duration: 2 weeks, Monday - Friday

Number of students per rotation: 6

Prerequisites: Letter of Intent from IM Chair/Advisor validating your intent to pursue residency in the same field as the elective

Overview:

This 2 week elective is designed for 4th 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 exual assault and domestic violence

Procedural Skills

  1. Obtain gynecologic history, menstrual history, sexual history and perform a speculum exam,, bimanual exam, 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 (one and two 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 3rd 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

Urogynecology (OB4 905B-2)

Location: CRCH UroGyn Clinic Suite 400

Available: June 2015 - July 2016

Duration: 2 weeks, starting any Monday and ending Friday

Number of students per rotation: 1

Prerequisites:

3rd year medical student who has successfully completed their 3rd year ob/gyn clerkship and is in the second half of their 3rd year or a 4th year medical student who has successfully completed their ob/gyn clerkship

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 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

 

 

Reproductive Endocrinology and Infertility (OB4 905A-2)

Location:  REI Clinic, 1231 S Jefferson St./OR at CRMH on 4th floor

Available:  June 2015 – July 2016

Duration: 2 weeks, Monday - Friday

Number of students per rotation: 1 per session (2 students per month)

Preceptor:  Emily Evans-Hoeker, MD

Prerequisites:  3rd or 4th year medical student who has successfully completed their 3rd year ob/gyn clerkship rotation

Attendance: Student may not miss more than 1 day during the rotation to get full credit

 

Overview: This elective is designed for a student interested in obstetrics and gynecology or primary care with a strong emphasis on Women’s Health.  This rotation will expose the student to the evaluation and management of patients with infertility, endometriosis, menstrual abnormalities, polycystic ovary syndrome, uterine fibroids and obesity. Students will also be exposed to the evaluation and management of transgender patients. The student will also gain exposure and learn to perform transvaginal ultrasounds in infertility and gynecologic patients as well as patients in the first trimester of pregnancy.

 

Objectives:

  1. Describe the physiology of the hypothalamic-pituitary-ovarian axis and discuss the normal menstrual cycle
  2. Describe the pharmacology of medications used to induce ovulation
  3. List the major causes of primary or secondary amenorrhea
  4. Describe the causes of galactorrhea and the appropriate workup
  5. Select tests to determine a diagnosis of PCOS
  6. Describe the medical/ surgical treatments for patients with PCOS when they don’t desire pregnancy and when they do
  7. Discuss the most common causes of recurrent pregnancy loss
  8. List the principle causes of primary and secondary infertility
  9. Demonstrate an understanding of an infertility work up
  10. Describe the different reproductive technologies

 

Schedule:

  • OR schedule may vary from week to week so please check with the attending
  • The REI clinic is located at 1231 S. Jefferson Street and the Operating Room (OR) is located at Carilion Roanoke Memorial Hospital 4th floor.

 

Textbook:  Beckmann’s, Obstetrics and Gynecology, 7th edition