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Selectives - OB/GYN

Teen Health Center Selective

Selective Number: (Oasis - S52g) 1908

Rotation Supervisor: Dyan Aretakis, FNP & Heather Payne, WHNP

Duration: 2 weeks

Available: TBA

Report to: Dyan Aretakis

Time to Report: Please email Dyan Aretakis week before to determine

Typical Day: 8:30 am - 5:15 pm

Place to Report: Teen Health Center, Corner Building

Suggested preparatory reading: Relevant chapters in Contraceptive Technology, 18th Edition; Hatcher, et al; Adolescent Health Care, 4th Edition, Neinstein, editor; Pediatric and Adolescent Gynecology, 4th Edition, Emans, et al, editor

Number of students per rotation: 1

Course Description: The Teen Health Center is a primary care center for teenagers. It is a division of the Children’s Hospital. Typically, 40 to 50% of the visits are ob/gyn related. However this can vary throughout the year. The medical student rotating through the Teen Health Center should expect to see both males and females for a variety of visit types. Additionally, a psychosocial history is an important part of each visit.

Objectives:

History: A gynecological evaluation is an important part of primary health care and preventive medicine in women. A gynecological assessment should be a part of every woman's general medical history and physical examination. Certain questions must be asked of every woman, whereas other questions are specific to particular problems. To accomplish these objectives, optimal communication must be achieved between patient and physician. The student will demonstrate the ability to:

  • perform a thorough obstetric-gynecologic history as a portion of a general medical history, including:
    • chief complaint
    • present illness
    • menstrual history
    • obstretric history
    • gynecologic history
    • contraceptive history
    • sexual history
    • family history
    • social history
  • interact with the patient to gain her confidence and to develop an appreciation of the effect of her age, racial and cultural background, and economic status on her health
  • communicate the results of the obstetric-gynecologic and general medical history by well-organized written and oral reports

Examination: An accurate examination complements the history, provides additional information and helps determine diagnosis and guide management. It also provides an opportunity to educate and reassure the patient. The student will demonstrate the ability 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 Pap smear is one of the most effective screening tests used in medicine today. Proper technique in performing the Pap smear and obtaining specimens for microbiologic culture will improve accuracy. 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

Legal and ethical issues in obstetrics and gynecology: Legal obligations to protect patients' interests are effective only if understood and applied. Recognizing and understanding the basis of ethical conflicts in obstetrics and gynecology will allow better patient care and prevent errors in treatment planning. The student will be able to:

  • explain the issues involved in informed consent
  • demonstrate the role of confidentiality in clinical activities
  • list the local laws requiring the reporting of suspected child abuse and domestic violence
  • discuss the legal and ethical issues in the care of minors
  • describe issues of justice relating to access to obstetric-gynecologic care
  • explain the basis of ethical conflict in maternal-fetal medicine
  • discuss ethical issues raised by induced abortion, contraception and reproductive technology

Preventive care and health maintenance: The student will recognize the value of routine health surveillance as a part of health promotion and disease prevention. The student will be able to:

  • list age-appropriate screening procedures and recommended time intervals for mammograms, pap smears, STI evaluations and others as appropriate
  • counsel patient regarding:
    • contraception
    • prevention of sexually transmitted diseases
    • domestic abuse/violence

Antepartum care: Antepartum care promotes patient education and provides ongoing risk assessment and development of an individualized patient management plan. The student will be able to cite methods 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: An understanding of the medical and personal issues involved in decisions regarding contraceptive methods is necessary to adequately advise patients requesting contraception. The student will be able to explain:

  • physiologic and pharmacologic basis of action
  • effectiveness
  • benefits and risks
  • financial considerations of the various methods of contraception

Abortion: Induced abortion is a reproductive option considered by some patients. Regardless of one's personal views, the practitioner should be aware of the techniques, management and complications of induced abortions. The student will be able to list:

  • surgical and non-surgical pregnancy termination methods
  • potential complications of abortion, such as:
    • hemorrhage
    • infection
  • psychosocial considerations of abortion

Sexually transmitted infections and urinary tract infections: To prevent sexually transmitted infections and minimize their impact on health, the physician should understand their basic epidemiology, diagnosis and management. The student will be able to list:

  • organisms and methods of transmission, symptoms, physical findings and evaluation and management of the following:
    • gonorrhea
    • chlamydia
    • herpes simplex virus
    • syphilis
    • human papillomavirus infection
    • human immunodeficiency virus (HIV) infection
    • hepatitis B virus infection
  • public health concerns, including:
    • screening programs
    • costs
    • prevention and immunizations
    • partner evaluation and treatment

Puberty: The maturation of the reproductive system at the time of puberty is accompanied by physical and emotional changes that are part of this normal transition. In order to provide appropriate care and counseling, the physician must have an understanding of the normal sequence of puberty and recognize deviation from the norm. The student will be able to describe:

  • normal puberty, including:
    • physiological events that take place in the hypothalamic-pituitary-ovarian axis and their target organs
    • sequence of and expected ages at which these changes occur
    • psychological aspects
  • abnormal puberty, including:
    • characteristics
    • causes and diagnostic approach to early or delayed puberty onset

Amenorrhea: The absence of normal menstrual bleeding may represent an anatomic or endocrine problem. A systematic approach to the evaluation of amenorrhea will aid in the diagnosis and treatment of its cause. The student will be able to list:

  • definitions of primary amenorrhea, secondary amenorrhea and oligomenorrhea
  • causes of amenorrhea
  • evaluation methods
  • treatment options

Hirsutism and virilization: The signs and symptoms of androgen excess in a woman may cause anxiety and may represent serious underlying disease. The student will be able to:

  • cite normal variations in secondary sexual characteristics
  • list definitions of hirsutism and virilization
  • list causes including ovarian, adrenal, pituitary and pharmacological
  • evaluate the patient with hirsutism or virilization

Normal and abnormal uterine bleeding: The occurance of bleeding at times other than expected menses is a common event. Accurate diagnosis of abnormal uterine bleeding is necessary for appropriate management. The student will be able to:

  • describe endocrinology and physiology of the normal menstrual cycle
  • distinguish abnormal uterine bleeding from dysfunctional uterine bleeding
  • list causes of abnormal uterine bleeding
  • evaluate and diagnose abnormal uterine bleeding
  • describe therapeutic options

Dysmenorrhea: Dysmenorrhea is often the impetus for women to seek health care. Accurate diagnosis guides effective treatment. The student will be able to cite the following:

  • definitions of primary and secondary dysmenorrhea
  • causes of dysmenorrhea
  • managment strategies

Sexuality and modes of sexual expression: All physicians should be able to provide a preliminary assessment of patients with sexual concerns and make referrals when appropriate. The student will be able to describe:

  • physiology of male and female sexual response
  • physiologic, emotional and societal influences on sexuality during the following life events:
    • childhood
    • adolescence
    • reproductive years, including pregnancy and postpartum
    • menopausal and postmenopausal years
  • patterns of sexual function and dysfunction

Sexual assault: Individuals who are victims of sexual assault often have significan physical and emotional sequelae. The student will be able to explain medical, forensic, psychological evaluation and treatment, and follow-up of:

  • child sexual assault victim
  • adult sexual assault victim
  • acquaintance rape

Domestic violence: Domestic violence affects a significant proportion of the U.S. population in all economic classes and walks of life. All physicians should screen for the presence of domestic violence. The student will be able to:

  • cite prevalence and incidence of violence against women, elder abuse, child abuse
  • assess the involvement of any patient in domestic violence situations
  • counsel patients for short-term safety
  • counsel patients regarding local support agencies for long-term managment and resources
  • counsel patients requiring resources for batterers and perpetrators of domestic violence