Boston Medical Center Department of OB/GYN

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4th Year Electives

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Boston Medical Center
One Boston Medical Center Place
Boston, MA 02118
617.638.8000
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Curriculum

Jump to:	Ambulatory Clinic	Labor And Delivery	Gynecology Inpatient Service
Didactic Sessions	Orientation Case Discussions	Lectures	Clinical/Surgical Skills Didactic Sessions
Surgical Skills Workshop	Labor and Delivery “Chalk Talks”	Gyn Service “Chalk Talks”	Online Modules

Ambulatory Clinic

Students will receive teaching by a continuity preceptor in the outpatient setting, subspecialty and the medical student team in the women's center throughout the six week clerkship.

By the end of the OB/GYN Clerkship with an Ambulatory Clinic Preceptor, the BUSM III student will be able to

Demonstrate the communication skills necessary for establishing a rapport with patients by demonstrating good communication skills in an ambulatory clinic
Obtain a history and perform the physical examination with proper documentation in the office medical record.
Perform a quality breast and pelvic examination, Pap smear, and cultures as indicated.
Apply the gynecological screening procedures and recommended time intervals for the performance of the Pap smear, breast and pelvic examination, and mammography.
Participate in patient education and develop skills in behavioral modification to improve health, for example, use of contraceptives, preconception counseling, prevention of STD's, exercise and nutrition, drugs, alcohol, smoking, domestic abuse, and sexual assaults.
Focus on learning and management of common gynecological problems.
Recognize obstetrics and gynecology's subspecialties including gynecological oncology, maternal fetal medicine, reproductive endocrinology and urogynecology.

Labor and Delivery (antepartum, intrapartum and postpartum care)

By the end of the OB/GYN Clerkship Labor and Delivery component, the BUSM III student will be able to

List the signs and symptoms of normal labor
Describe the three stages of normal labor
Recognize common abnormalities of labor
Differentiate the methods of delivery with the indications and contraindications of each
Evaluate common puerperal complications
Describe each of the following antepartum procedures and list the indications and contraindications for each:

Ultrasound
Chorionic villous sampling
Amniocentesis and cordocentesis
Antepartum fetal assessment

Describe each of the following intrapartum procedures and list the indications and contraindications for each

IntrapartumSurveillance
Induction and augmentation of labor
Episiotomy
Operative vaginal delivery
Breech delivery
Cesarean delivery

Identify the pertinent issues regarding vaginal birth after cesarean delivery
Recognize the normal postpartum events allow appropriate care, reassurance and early recognition of abnormal events.
Discuss the normal maternal physiologic changes of the postpartum period
Describe the components of normal postpartum care and the appropriate postpartum patient counseling
Recognize that labor is expected to progress in an orderly and predictable manner.
Identify careful observation of the mother and fetus during labor that allows early detection of abnormalities so that management can be directed to optimize outcome.
Describe methods of fetal surveillance
Discuss fetal and maternal effects of oxytocin administration
List conditions supportive of for vaginal birth after cesarean (VBAC)
Discuss strategies for emergency management of breech, shoulder dystocia and cord prolapse.
List the normal physiologic and anatomic changes of the breast during the pregnancy and lactation
Recognize and treat common postpartum abnormalities of the breast,
Provide the reasons why breast feeding should be encouraged
Identify commonly used medications which are appropriate and inappropriate to use while breast feeding
Counsel the lactating patient about commonly asked questions, such as frequency, duration, inadequate production of milk, etc.

Gynecology Inpatient Service

By the end of the OB/GYN Clerkship Inpatient Gynecology Component, the BUSM III student will be able to

After being on the Inpatient Gynecology service, the BUSM III student will be able to:

Describe the key components of pre-operative evaluation and planning, including the history and physical, the process of informed consent and the indications for medical clearance
Describe the common perioperative prophylactic measures, including steps taken to reduce infection and deep venous thrombosis
describe the components of post-operative care
List common post-operative complications and their management.
Describe each of the following out patient procedures and list the indications and complications of each of the following:

Colposcopy and cervical biopsy
Cone biopsy
Cryotherapy
Electrosurgical excision of the cervix
Endometrial biopsy
Hysterosalpingography
Pelvic ultrasonography
Pregnancy termination
Vulvar biopsy

Describe each of the following inpatient procedures and list the indications and complications of each of the following

Dilation and Curettage
Hysterectomy
Hysteroscopy
Laparoscopy
Laser vaporization

Describe each of the following common diagnostic breast procedures and list the indications and complications of each

Mammography
Needle aspiration of breast mass

Didactic Sessions

Didactic sessions will all be taught using cased based learning. The students will be assigned a reading assignment in the selected text Hacker and Moore . 4 th Edition. Zhang J; Gilles JM; Barnhart K; Creinin MD; Westhoff C; Frederick MM. 2004.

To view schedules for orientation, or the Wednesday Didactic and Skills Sessions, please click here.

Orientation Case Discussions

Pelvic Pain

By the end of the Pelvic Pain Lecture and reading in the Essentials of Obstetrics and Gynecology 4th Edition, the BUSM III student will be able to:

Define acute pelvic pain and chronic pelvic pain and chronic pelvic pain are common symptoms and that may result from a variety of causes, including gastrointestinal, urinary, musculoskeletal, and emotional as well as gynecologic conditions
Identify the signs and symptoms of pelvic inflammatory disease, endometriosis and pelvic pain
Provide a differential diagnoses.

Endometriosis

By the end of the Endometriosis Lecture and reading in the Essentials of Obstetrics and Gynecology 4th Edition, the BUSM III student will be able to:

Recognize Endometriosis is a common problem in women of reproductive age, which may result in pelvic pain, infertility, and menstrual dysfunction
List the chief complaints of a patient that may present with endometriosis
Identify the symptoms of endometriosis in a female patient presenting with abdominal pain
Describe the physical exam findings a patient may have with endometriosis
Outline a plan for managing endometriosis

Dysmenorrhea

By the end of the Dysmenorrhea Lecture and reading in the Essentials of Obstetrics and Gynecology 4th Edition, the student will be able to:

Successfully take a gynecologic history detailed enough to distinguish various types of dysmenorrheal and chronic pelvic pain.
Fluently describe and discuss the differential diagnosis of dysmenorrhea and pelvic pain.
Discuss a sequential evaluation and management of pelvic pain

Domestic Violence

By the end of the Domestic Violence Lecture and reading in the Essentials of Obstetrics and Gynecology 4th Edition, the BUSM III student will be able to:

Identify the prevalence and incidence of violence against women
Utilize different strategies of screening for domestic violence.
Perform a preliminary assessment for a victim of domestic violence and counsel her regarding short and long term resources.

Taking a Relevant Ob/Gyn History

By the end of the OB/GYN Patient History Lecture and reading in the Essentials of Obstetrics and Gynecology 4th Edition, the BUSM III student will be able to:

Recognize a gynecological evaluation is an important part of primary health hare and preventative medicine for women.
Summarize a thorough ob/gyn history as a portion of a general medical history, including chief complaint, presenting illness, menstrual history, obstetric history, gynecologic history, sexual history, family history and social history.
Communicate with the patient with sensitivity to her age, gender racial and cultural background, sexual orientation, personality, mental state, and economic status.

Routine Prenatal Care

By the end of the Routine Prenatal Care Lecture and reading in the Essentials of Obstetrics and Gynecology 4th Edition, the BUSM III student will be able to:

Diagnose a pregnancy. Recognize presumptive signs and symptoms of pregnancy and calculate EDD, with appropriate assessment of gestational age.
Identify medical problems that put pregnancy at risk and formulate a plan of care during a 1 st prenatal visit.
Propose routine screening prenatal labs.
Explain nutritional needs in pregnancy.
Determine factors in family history that put the patient at risk of fetal anomalies.
Recognize mental health issues that put the pregnancy at risk.
Write a problem list and management plan.

Maternal Adaptations to Pregnancy

By the end of the Maternal Adaptations to Pregnancy Lecture and reading in the Essentials of Obstetrics and Gynecology 4th Edition, the BUSM III student will be able to:

Recall that the physiologic adaptations to pregnancy will allow the student to better understand the impact of pregnancy in health and disease
Discuss the maternal physiologic anatomic changes associated with pregnancy
Identify the physiologic functions of the placenta and fetus
Discuss the effect of pregnancy on common diagnostic studies.

Small Group Teaching Sessions

Students will be divided in to 3 small groups. The size of the groups will be dependent on the overall number of students in each block with no more than 8 students per group. Group members will be the same with the same preceptor for the whole six weeks of the clerkship. The format of the sessions is a case based discussion

1st Trimester Bleeding

By the end of the 1st Trimester Bleeding Small Group Discussion, the BUSM III student will be able to:

Recognize that bleeding is common in early pregnancy and its evaluation may not only affect the outcome of pregnancy, but also will help to reassure the patient
Develop a differential diagnosis for first trimester bleeding
Differentiate the types of spontaneous abortion
Define recurrent abortion
List the complications of spontaneous abortion
Identify the causes and complications of septic abortion.
Develop the differential diagnosis for abdominal pain in the first trimester
Identify risk factors for ectopic pregnancy
Evaluate a patient suspected of having an ectopic pregnancy
Describe the treatment options for patients that present with an ectopic pregnancy

Abnormal Uterine Bleeding

By the end of the Abnormal Uterine Bleeding Small Group Discussion, the BUSM III student will be able to:

Describe the normal menstrual cycle
Define abnormal uterine bleeding
Explain the etiologies of abnormal uterine bleeding
Portray the evaluation methods of abnormal uterine bleeding
Depict the therapeutic options of abnormal uterine bleeding
Counsel patients about each therapeutic option and sequelae

Tubal Ovarian Abscess / Pelvic Inflammatory Disease

By the end of the Tubal Ovarian Abscess / Pelvic Inflammatory Disease Small Group Discussion, the BUSM III student will be able to:

Illustrate the pathogenesis of salpingitis
List the signs and symptoms of salpingitis
Explain the management of salpingitis
Identify the long-term sequelae of salpingitis including: tubo-ovarian abscess, chronic salpingitis, ectopic pregnancy and infertility
Counsel the patient about the public health concerns for sexually transmitted infections including screening programs, costs, prevention and immunizations, and partner evaluation and treatment.

Medical Surgical Complications in Pregnancy

By the end of the Medical Surgical Complications in Pregnancy Small Group Discussion, the BUSM III student will be able to:

Recognize that common medical and surgical conditions can significantly impact pregnancy
Differentiate between the management of common medical and surgical conditions in the nonpregnant and pregnant states
Discuss the potential impact of the above conditions on the gravid patient and the fetus/newborn, as well as the impact of pregnancy on each condition, if any
Describe the initial management of each condition in the pregnant patient

Benign Pelvic Masses

By the end of the Medical Surgical Complications in Pregnancy Small Group Discussion, the BUSM III student will be able to:

Discuss the prevalence of benign pelvic masses
Describe the symptoms and physical findings in patients with benign pelvic masses
Apply diagnostic methods to confirm benign pelvic masses
List the indications for medical and surgical treatment of benign pelvic masses

Lectures

Ovarian Neoplasms

By the end of the Ovarian Neoplasm Lecture, the BUSM III student will be able to:

Outline the approach to a patient with an adnexal mass
Compare the characteristics of functional cysts, benign ovarian neoplasm and ovarian malignancy
List the risk factors for ovarian ancer
Explain the histological classification of ovarian neoplasm

Prolapse/Incontinence

By the end of the Prolapse/Incontinence Lecture, the BUSM III student will be able to:

Incorporate screening questions for urinary incontinence when eliciting a patient history
Discuss the difference between stress, urge and overflow incontinence
Obtain pertinent history components to differentiate between incontinence types
Identify the following elements on physical exam: cystocele, rectocele, vaginal vault/uterine prolapse
List behavioral, medical and surgical methods to appropriately treat incontinence and pelvic organ prolapse

Breast Disease

By the end of the Breast Disease Lecture, the BUSM III student will be able to:

Demonstrate the performance of a comprehensive breast exam
Discuss diagnostic approach to a woman with the chief complaint breast mass, nipple discharge or breast pain
List history and physical findings that may suggest:

Mastitis
Carcinoma
Fibrocystic changes
Intraductal papilloma
Fibroma

Contraception

By the end of the Contraception Lecture, the BUSM III student will be able to:

Describe the physiologic basis of contraception (OCPs, emergency contraception, patches, rings, IUD, sterilization, etc.)
Explain the effectiveness of each form of contraception
Counsel the patient regarding the benefits and risks for each form of contraception
Cite the financial considerations of the various forms of contraception
Discuss the methods of male and female sterilization
List the risks and benefits of surgical procedures, including the potential surgical complications, failure rates and the rate of successful reversibility

Infertility

By the end of the Infertility Lecture, the BUSM III student will be able to:

Define infertility
Describe the causes of male and female infertility
Illustrate the evaluation and management of infertility
List the psychosocial issues associated with infertility

Menopause

By the end of the Menopause Lecture, the BUSM III student will be able to:

Identify the symptoms and clinical findings associate with menopause
Explain the physiology and endocrinology responsible for the symptoms and clinical findings
Recognize the diseases to which a menopausal woman is susceptible
Determine what further testing is appropriate in early menopause
Propose any treatments for normal menopausal symptoms and conditions associated with menopause
Counsel menopausal women about lifestyle changes and health maintenance appropriate for this stage

Preterm Labor

By the end of the Preterm Labor Lecture, the BUSM III student will be able to:

Cite the risk factors for preterm labor
Distinguish preterm labor from Braxton Hicks contractions
Identify the causes of preterm labor
Counsel the patient regarding the signs and symptoms of preterm labor
Describe the initial management of preterm labor
List indications and contraindications of medications used to treat preterm labor
Explain adverse events associated with the management of preterm labor
Counsel the patient who has experienced prior preterm birth
Discuss cervical incompetence

Premature Rupture of Membrane

By the end of the Premature Rupture of Membranes Lecture, the BUSM III student will be able to:

Summarize the history physical findings and diagnostic methods to confirm rupture of membranes
Cite the factors predisposing to premature rupture of membranes
List the risks and benefits of expectant management versus immediate delivery
Describe the methods to monitor maternal fetal status during expectant management
Counsel the patient with preterm premature rupture of membranes

Hypertensive Disorders in Pregnancy

By the end of the Hypertensive Disorders in Pregnancy Lecture, the BUSM III student will be able to:

Define hypertension in pregnancy
Classify hypertension in pregnancy
Describe the pathophysiology of preeclampsia-eclampsia syndrome
Enumerate the symptoms of preeclampsia-eclampsia syndrome
Manage a patient with preeclampsia-eclampsia syndrome
Discuss with the patient the indications of MgS04
Counsel the patient concerning the maternal and fetal complications associated with preeclampsia-eclampsia syndrome

Vulvar and Vaginal Disease

By the end of the Vulvar and Vaginal Disease, the BUSM III student will be able to:

Diagnose and manage a patient with vaginitis
Interpret a wet mount examination
Describe dermatologic disorders of the vulva
Evaluate a patient with vulvar symptoms
Explain the risk factors for vulvar neoplasms
List the indications for vulvar biopsy

Amenorrhea

By the end of the Amenorrhea Lecture, the BUSM III student will be able to:

Define amenorrhea and oligomenorrhea
Describe the etiologies of amenorrhea and oligomenorrhea
Discuss the evaluation methods for amenorrhea and oligomenorrhea
Explain treatment options for amenorrhea and oligomenorrhea
Counsel patients who decline therapy

Clinical/Surgical Skills Didactic Sessions

Pelvic Exam/Pap Smear

After completing the pelvic exam skills session the BUSM III student will be able to:

Interact with the patient to gain her confidence and cooperation, and assure her comfort and modesty
Perform an appropriate abdominal examination
Perform a complete pelvic examination including bimanual examination, recto-vaginal examination (when indicated) in a sensitive manner
Obtain an adequate Pap smear
Obtain specimens to detect sexually transmitted infections
Handle specimens properly to improve diagnostic accuracy
Use accurate medical terminology to describe

Normal female anatomy
Appearance of common pathology of the female urogenital tract

Communicate the relevant results of the pelvic examination in well-organized written and oral reports

Normal Spontaneous Vaginal Delivery Workshop

After completing the normal spontaneous vaginal delivery teaching, the BUSM III student will be able to perform the following:

Leopold's Maneuvers
Diagnosis of Malpresentation and management options
Cardinal movements during labor
Cervical exam during labor

Surgical Skills Workshop

After viewing the videos of knot tying and suturing the students will break up into three groups with their preceptor. The preceptor will then repeat a demonstration of a two handed square note. The students will begin to work with their own kits and the practice knot tying for one half of the remaining time. The preceptor should divide their time between all the students to be able to give individual feedback. The second half of the remaining time will be spent on suturing in a similar format.

After completing this workshop the BUSM III student will be able to:

Successfully tie a two handed knot.
Successfully tie a surgeons knot.
Exhibit the ability to perform an interrupted and running suture.
Adequately approximate artificial tissue edges.

Case Presentation

After completing of the case presentation, the BUSM III student will be able to:

Recognize that an oral presentation in a concise and orderly manner is a key skill of any physician and the case presentation will assist the student in mastering this skill
Have all the information necessary for clinical problem solving of the patient
Present the chief complaint of the patient
Formulate a differential diagnosis or problem list of the patient
Discuss the findings of the physical examination and update the differential diagnosis
Discuss procedures and laboratory tests ordered and why
Present the pathophysiology of the patient's problem
Review the management for the patient based on current literature

Labor and Delivery “Chalk Talks”

“Chalk Talks” represent guidelines for a 5 minute teaching session in a clinical setting and represent the most common clinical issues encountered in inpatient Ob/Gyn.

Normal Labor

After completing of the “Chalk Talk” on Normal Labor, the BUSM III student will be able to:

List the signs and symptoms of labor
Describe the three stages of labor and recognize common abnormalities
Explain the steps of a vaginal delivery
Illustrate the different methods of deliver with the indications and contraindications of each

Electronic Fetal Heart Rate Monitoring

After completing of the “Chalk Talk” on Electronic Fetal Heart Rate Monitoring, the BUSM III student will be able to:

Perform fetal auscultation
Interpret electronic fetal monitoring strips

Abnormal Labor

After completing of the “Chalk Talk” on Abnormal Labor, the BUSM III student will be able to:

List abnormal labor patterns
Describe methods of fetal surveillance
Discuss fetal and maternal complications of abnormal labor
List indications and contraindications for oxytocin administration
List indications for a vaginal birth after cesarean section
Discuss strategies for emergency management of breech, shoulder dystocia and cord prolapse

Group B Beta Streptococcus

After completing of the “Chalk Talk” on Post Partum Care, the BUSM III student will be able to:

Recognize Group B Beta Streptococcus in pregnancy
Discuss the potential impact of the above conditions on the gravid patient and the fetus/newborn, as well as the impact on pregnancy, if any
Describe the initial management of each condition in the pregnant patient

Post Date Pregnancy

After completing of the “Chalk Talk” on Post Partum Care, the BUSM III student will be able to:

Identify the normal period of gestation
Discuss the complications of post-maturity

Post Partum Care

After completing of the “Chalk Talk” on Post Partum Care, the BUSM III student will be able to:

Discuss the normal maternal physiologic changes of the postpartum period
Describe the components of normal postpartum care
Explain the appropriate postpartum patient counseling

Post Partum Fever

After completing of the “Chalk Talk” on Post Partum Care, the BUSM III student will be able to:

List the risk factors for postpartum infection
Describe the pathophysiology of postpartum infection
Identify the organisms involved in postpartum infection
Explain the evaluation and management of the patient with postpartum infection

Post Partum Hemorrhage

After completing of the “Chalk Talk” on Post Partum Care, the BUSM III student will be able to:

List the risk factors for postpartum hemorrhage
Formulate a differential diagnosis of postpartum hemorrhage
Describe the immediate management of the patient with postpartum hemorrhage

Breastfeeding

After completing of the “Chalk Talk” on Breast Feeding, the BUSM III student will be able to:

List the normal physiologic and anatomic changes of the breast during pregnancy and the postpartum periods
Recognize and treat common postpartum abnormalities of the breast.
List the reasons why breast feeding should be encouraged
Identify commonly used medications which are appropriate and inappropriate to use while breast feeding.
Counsel the lactating patient about commonly asked questions, such as frequency duration, inadequate production of milk etc.

Gyn Service “Chalk Talks”

Post Operative Fever

After completion of this “chalk talk” on Post Operative Fever the BUSM III year student will be able to:

Identify the various sources of post-operative fever
Describe the typical time frame in which to expect the different febrile complications.
Propose appropriate diagnostic and treatment plans for post-operative fever.

Post Operative Complications VTE

After completion of this “chalk talk” on Venous Thrombo Embolism the BUSM III year student will be able to:

Recognize the diseases and medical conditions that predispose a patient to VTE
Formulate a diagnostic and treatment approach for post-operative VTE

Post Operative Complications Anemia/Respiratory

At the completion of this “chalk talk” the BUSM III year student will be able to:

Determine who is at risk for post-operative anemia or respiratory complications
Identify and manage post-operative anemia
Detect post-operative respiratory complications
Generate a diagnostic and treatment plan for post-operative respiratory complications

Preoperative Care

After completion of this “chalk talk” the BUSM III year student will be able to:

Describe routine preoperative care
Identify those patients who would require medical clearance
Recognize which medical conditions must be optimized pre-operatively and managed peri-operatively

Online Modules

Legal and Ethical Issues in Obstetrics and Gynecology

By the end of the Legal and Ethical Issues in Obstetrics and Gynecology online module, the BUSM III student will be able to:

Recall that the legal obligations to protect patient's interests are effective if understood and applied
Recognize the basis of ethical conflicts in ob/gyn will allow better patient care and prevent critical errors in treatment planning
Discuss issues involved in informed consent, confidentiality, local laws involving suspected child abuse and domestic violence, ethical conflict in maternal fetal medicine and ethical issues raised by abortion, contraception and reproductive technology

Viral Disease in Pregnancy