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 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.
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”, 17th Edition, 1998.
Sexually Transmitted Diseases (Two Volumes)
1 – Holmes, et al, 3rd Edition, 1999
2 – “A Physician Tells You What You Need to Know”, 1998.
