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Selectives - OB/GYN

La Clinica Selective

Selective Number: (Oasis - S52o) 1916

Rotation Supervisor: Dr. Megan Bray & Lindsay Horlacher, FNP

Duration: 2 weeks

Available: TBA

Report to: Lindsay Horlacher

Time to Report: 8:30 am

Place to Report: Primary Care Center, 3rd floor back hallway OB/GYN office

Typical day: 8:30 am - 5:00 pm

Prerequisite: Must be able to speak conversational Spanish

Number of students per rotation: 1

Course Description: In collaboration with Yvonne Wernecke, FNP, the Ambulatory Clinic Attending physicians, and OB/GYN Residents, the student will partipate in the evaluation (history, physical, assessment and plan) of Hispanic patients presenting to the clinic for Obstetrical and Gynecologic care.

History: The student will be able to:

  • complete a comprehensive women's medical interview including:
    • menstrual history
    • obstetrical history
    • gynecologic history
    • contraceptive history
    • sexual history - including sexual orientation and function
    • family/genetic history
    • social history
  • assess risk for unintended pregnancy, STIs, cervical pathology, breast malignancy, gynecologic malignancies and domestic violence
  • assess compliance with recommended screening measures specific to women (e.g. Pap, MMG, SBE) in risk-appropriate circumstances
  • demonstrate interpersonal and communication skills that build trust by addressing contextual factors including age, race, culture, language/literacy, socioeconomic class, spiritual/religious affiliations, sexual orientation and disability
  • communicate the results of the ob/gyn and general medical interview by well organized written and oral reports.

Examination: The student will be able to:

  • interact with the patient to gain her confidence and cooperation and assure her comfort and modesty
  • perform a painless obstetric-gynecologic examination as part of a woman's general medical examination, including:
    • breast examination
    • abdominal examination
    • complete pelvic examination
    • recto-vaginal examination
  • communicate the relevant results of the examination in well-organized written and oral reports
  • share results
  • educate the patient regarding breast self-examination

Pap smear and cultures: The student will demonstrate the ability to:

  • perform an adequate Pap smear
  • obtain specimens to detect sexually transmitted diseases
  • handle specimens properly to improve diagnostic accuracy
  • provide an explanation to the patient regarding the purpose of these tests

Diagnosis and Management Plan: The student will be able to:

  • generate a problem list
  • form a diagnostic impression including a differential diagnosis
  • consider economic, psychosocial and ethical issues
  • develop a management plan that includes lab and diagnostic studies, treatment, patient education and follow up plans

Personal Interaction and Communication Skills: The student will be able to:

  • establish rapport with patients
  • work cooperatively with patients, their social supports and other members of the health care team
  • assess his/her own strengths and weaknesses with regards to personal interactions

Legal and Ethical Issues in OB/GYN: The student will be able to:

  • explain issues involved in informed consent
  • demonstrate the role of confidentiality in clinical activities
  • be able to address issues of domestic violence
  • describe ethical issues and basis for conflict in general Ob/Gyn practice

Preventative Care and Health Maintenance: The student will be able to:

  • list age-appropriate screening procedures and recommended time intervals for MMG, DEXA, PAP, STIs and other screening tests
  • counsel patient regarding contraception, domestic violence/abuse, and prevention of TSIs

Preconception Care: The student will be able to:

  • describe how certain medical conditions afffect pregnancy
  • describe hwo pregnancy affects certain medical conditions
  • counsel patients regarding history of genetic abnormalities
  • counsel patients regarding advanced maternal age
  • counsel patients regarding substance abuse
  • counsel patients regarding nutrition and exercise
  • counsel patients regarding medications and environmental hazards
  • counsel patients regarding immunizations

Antepartum Care: The student will be able to:

  • diagnose pregnancy
  • assess gestational age
  • distinguish an at-risk pregnancy
  • assess fetal growth, well-being and maturity
  • appropriate diagnostic studies
  • nutritional needs of pregnant women
  • adverse effects of drugs and the environment
  • perform a physical examination on obstetric patients
  • answer commonly asked questions concerning pregnancy and labor and delivery
  • counsel women with an unintended pregnancy

Contraception and Sterilization: The student will be able to:

  • describe the physiologic basis of contraception (OCPs, ring, patch, diaphragm, IUD, condoms, emergency contraception, sterilization, etc.)
  • describe contraceptive mechanism of action, effectiveness, risks, benefits, side effects, cost, compliance profile, availabilty, reversibility, etc.

The student will have basic understanding of the pathophysiology, diagnosis, treatment and long tern management issues involving the following common gynecologic issues including, but not limited to:

  • endometriosis
  • chronic pelvic pain
  • fibroids
  • dysfunctional uterine bleeding
  • secondary amenorrhea
  • disorders of the breast
  • premenstrual syndrome/dysmenorrhea
  • polycystic ovary syndrome
  • infertility
  • breast problems
  • menopause
  • vulvar and vaginal disease
  • urinary tract infection
  • urinary incontinence
  • sexually transmitted infections

In evey aspect of this selective, the student will have an understanding and appreciation of the provision of obstetrical and gynecologic care to the Hispanic woman and her family. The student will be able to:

  • understand the impact of the Hispanic culture on patient care, making the connection between cutural competency and the individual practitioner level and how that can be integrated into the health care system
  • understand the extent of racial and ethnic differences in the quality of health care, not attributable to known factors such as access to care, ability to pay or insurance coverage
  • understand the potential sources of these disparities, including the role of bias, discrimination and stereotyping at the provider, patient, institutional and health system levels
  • understand the ideals, ethics, diversity of mind/thought/behavior/action, etc. of the Hispanic culture
  • understand the ritual custom, home remedies, alternative medical therapies or medicines that are commonly used in the Hispanic culture
  • formulate recommendations regarding interventions to eliminate health care differences
  • maximize the quality of patient care in a diverse society