Gynecology PGYII

Description of Rotation or Educational Experience

The Gynecology experience is conducted in the PGYII year and is comprised of one 4 week rotational block with an assigned Gynecologist preceptor. This rotation is primarily an outpatient experience in the private-office setting, but a portion may occur in the inpatient setting where the resident has the opportunity to participate in hospital-based procedures (usually as the first surgical assistant to the preceptor). The rotational goal is to educate and train the resident physician in the diagnosis and treatment of gynecological problems and diseases that are commonly encountered in a Family Medicine practice.

The Resident is also expected to:

• Participate in Colposcopy Clinics at the Northwest Family Medical Center with residency faculty on Thursday’s. The residents learn the Colposcopy procedure with biopsies and ECC’s, if indicated.  They also perform LEEP’s and cryotherapy.  

The provision of women’s gynecologic health services are an essential and integral part of family medicine. The goal of this rotation is for the resident to learn to provide sensitive, up-to-date, well-informed care to women at all stages of their life.

Goal I: To achieve competence in diagnosing and managing common gynecological conditions as appropriate for the Family Physician

Goal II: To achieve competence in recognizing and referring complex gynecological disorders

Other educational experiences:

·        Opportunities for learning generated by patient care on the Inpatient Service and other hospital services including the Emergency Room.

·        Opportunities for learning in all three years of training by experiences gained with diagnosing and treating gynecologic problems and diseases from their own continuity patient panel at the FMC.

·        AHEC NW noon conferences on gynecological topics which are longitudinal.

Patient Care

Goal

Residents must be able to provide patient care that is compassionate, appropriate, and effective for the treatment of health problems and the promotion of health.  Residents are expected to:

Competencies

·         Recognize, diagnose, manage, and/or refer for the gynecology problems that may present to his/her practice.

·         Advocate and employ preventive health measures in their female patients within their continuity panel in the Family Medicine Center.

Objectives

·         The resident will be able to discuss the most common gynecologic problems that are encountered within their practice.

·         The resident will learn how to perform an appropriate gynecologic history and physical examination for pediatric, adult, and geriatric patients, including a complete and comprehensive breast and pelvic examination.

·         The resident will be able to discuss the principles of accepted preventive health measures for women including: pap smears, self-breast exams, mammography, bone density measurement, colorectal cancer screening, etc.

·         The resident will learn to appreciate the multiple factors that play a role in a woman’s overall health including interactions between family, socioeconomic status, relationships, and their community.

Medical Knowledge

Goal

Residents must demonstrate knowledge of established and evolving biomedical, clinical, epidemiological, and social-behavioral sciences, as well as the application of this knowledge to patient care.  Residents are expected to:

Competencies

·         Physiology of the Menstrual Cycle (physiology and premenstrual syndrome)

·         Principles and Methods of Contraception

·         Diagnosis and Management of Infertility

·         Interpretation and Management of the Abnormal Pap Smear

·         Principles of Breast Cancer Screening

·         Osteoporosis Prevention and Treatment

·         Diagnosis and Management of Urinary Incontinence

·         Diagnosis and Management of STDs/PID

·         Diagnosis and Management of Menopause

·         Management of Irregular Menstrual Bleeding

·         Recognition and management of Gynecologic malignancies

·         Management of Bartholin’s Cyst/Abcess

Objectives

The resident will:

·         Review and discuss the physiology and common abnormalities of the normal menstrual cycle.

·         Become familiar with the various contraceptive methods including: hormonal adjuncts, intra-vaginal and intra-uterine devices, and barrier methods; and have the opportunity to learn procedural skills such as diaphragm fitting, placement/removal of IUDs.

·         Learn the diagnostic workup of infertility problems.

·         Learn and demonstrate proficiency in performing an adequate pap smear.

·         Learn to interpret a standard pap smear report and the diagnostic and management strategy in addressing various pap smear abnormalities.

·         Demonstrate understanding of the indications for colposcopy and will have adequate opportunity to perform and become proficient in colposcopy examinations under the direct supervision of either their Gynecology preceptor, or by the Family Medicine faculty in the Northwest Family Medical Center. This will include performing a cervical biopsy and/or endocervical curettage when clinically indicated. They also have the opportunity to perform and become proficient in LEEP’s and cryotherapy.  

·         Become proficient in the clinical breast examination.

·         Demonstrate understanding of the principles and indication of mammography for the purpose of screening for breast cancer.

·         Learn the recommendations for calcium and vitamin D supplementation for the prevention of osteoporosis.

·         Learn the indications for ordering a bone density study to screen/diagnose osteoporosis.

·         Be able to interpret a bone density study report.

·         Become familiar with treatment options for treating osteoporosis.

·         Learn the diagnostic and treatment strategy for managing urinary incontinence in the female patient.

·         Perform a comprehensive assessment for the workup of STDs and learn the treatment recommendations for various STDs.

·         Appropriately counsel their patients on strategies to prevent the development of STDs.

·         Recognize the signs of menopause and be familiar with the diagnostic and management of the symptoms of menopause in their patients.

·         Understand the indications for and be able to perform an endometrial biopsy.

·         Become familiar with the diagnostic approach to the patient with suspected gynecologic malignancy (breast malignancy, ovarian cancer, endometrial cancer, premalignant and malignant disease of the cervix)

·         Demonstrate knowledge of the technique and be proficient in performing an incision and drainage of an Bartholin’s cyst/abcess.

Systems Based Practice

Goal

Residents must demonstrate an awareness of and responsiveness to the larger context and system of health care, as well as the ability to call effectively on other resources in the system to provide optimal health care.  Residents are expected to:

Competencies

• Work effectively in various health care delivery settings and systems relevant to their clinical specialty

·         Practice cost-effective healthcare and resource allocation that does not compromise quality of care

·         Advocate for quality patient care and assist patients in dealing with system complexities

• Work to control health care costs and allocate resources to provide high quality care.

Objectives

• The resident will gain an understanding of the delivery of care to the gynecology patient regardless of their socioeconomic status and will learn to utilize available resources to assist their patients in receiving needed screening and therapeutic treatments (i.e. Breast Care program).

Professionalism

Goal

Residents must demonstrate a commitment to carrying out professional responsibilities and an adherence to ethical principles.  Residents are expected to demonstrate:

Competencies

• Compassion, integrity, and respect for others
• An understanding of the desire of women to be treated as competent participants in their health care, in a caring and compassionate fashion.
• An awareness of the role that being female plays in bringing women into the health care system more frequently than men.
• An appreciation of the role that women play in the health of the family including choosing a health care provider, diet and other issues of family care.
• The realization that a woman's health is affected not only by medical factors but also by family, life cycle and socioeconomic status.
• An awareness that many research studies of accepted medical practices and procedures have excluded women.

Objectives

The resident will be sensitive to concerns by their patients regarding gynecologic disorders and address all concerns in a timely manner. The resident is expected to take time to educate their patients about preventative care measures.

Interpersonal and Communication Skills

Goal

Residents must demonstrate interpersonal and communication skills that result in the effective exchange of information and teaming with patients, their families, and professional associates.  Residents are expected to:

Competencies

• Communicate effectively with physicians, other health professionals, and health related agencies
• Demonstrate an awareness of the importance of physician and patient working as partners to promote optimal health.
• Demonstrate interpersonal and communication skills that result in effective information exchange with patients, families and colleagues
• Work effectively with others as a member of a healthcare team.
• Recognize the psychosocial and economic impact of disease on the individual and family.

Objectives

The resident is expected to learn how to effectively communicate and convey patient care issues with Family Medicine faculty and/or Gynecologist consultant in order to facilitate appropriate and timely care for their patients.

The Teaching Methods

Didactic lectures by the Gynecology preceptor or at designated curriculum conferences, clinical teaching, case-based teaching, role-modeling.

Assessment Method

At the conclusion of each resident rotation, the residency coordinator sends a formative-type, rotation-specific performance evaluation form to the rotations’ supervising physician.  When the completed evaluation is returned, the resident physician and the resident’s faculty advisor review the evaluation and attest to reviewing it by signing/initialing the form.  Next, the program director reviews and attests to the document.  Once all three have reviewed and attested the evaluation, it is included in the resident’s permanent file. 

Each resident is asked to evaluate the rotation and supervising physician(s) at the end of the rotation.  The resident’s faculty advisor and program director review the evaluation and attest to reviewing it by signing/initialing the form. These evaluations are filed together by resident year.

Educational Resources

References available at the AHEC Library:

Speroff L, Glass RH, Kase NG, “Clinical Gynecologic Endocrinology and Infertility”, 6th Edition, Baltimore, Williams & Wilkins, 1999.

“Guidelines for Women’s Health”, ACOG, 1996.

“Contraceptive Technology”, 17^th Edition, 1998.

Sexually Transmitted Diseases (Two Volumes)

1 – Holmes, et al, 3^rd Edition, 1999

2 – “A Physician Tells You What You Need to Know”, 1998.

Burghardt, Erich, “Colposcopy Cervical Pathology Textbook and Atlas”, Thieme, 3^rd Edition, 1998.

References Available at Family Medical Center:

American Society of Colposcopy and Cervical Pathology – Basic Colposcopy Case Based Studies

References Distributed at Beginning of Rotation:

“Managing Contraception”, 2007-2009, Zieman, Hatcher, Cwiak, Darney, Creinin and Stosur.

“Algorithms” by the American Society for Colposcopy and Cervical Pathology.

1. 2006 Consensus Guidelines for the Management of Adolescents with Cervical Cytological and Histological Abnormalities.
2. 2006 Consensus Guidelines for the Management of Women with Cervical Histological Abnormalities.
3. 2006 Consensus Guidelines for the Management of Women with Cervical Cytological Abnormalities.

Numerous handouts regarding Colposcopy, Cryosurgery, LEEP, etc