Gynecology

Overview

The goal of the gynecology rotation is to provide the resident with the ability to perform a routine gynecological exam, understand and execute pertinent gynecological cancer screening, diagnose and treat sexually transmitted diseases, understand female physiology including: fertility, contraception, pregnancy; also the signs and symptoms of menopause, osteoporosis, and pelvic floor dysfunction including but not limited to urinary incontinence.  The gynecology rotation includes a combination of outpatient care with local gynecologists, AFP attendings, and the Women's Health and Wellness clinic.  Plus, first assist with gynecological surgeries in the Altoona Regional Health System.  This rotation allows residents to be familiar and comfortable addressing these gynecological issues with their patients.

During the outpatient portion of the rotation the resident spends time with local gynecologists performing office gynecological procedures and addressing patient problems. The resident works with Altoona Family Physicians attendings learning, performing, and managing colposcopy.  Our program has a colposcopy microscope with a teaching head so the attending can watch while the resident performs the entire procedure.  Finally, the resident spends time at the Women's Health and Wellness Center managing teen to elderly gynecological complaints. The autonomy during this portion of the rotation builds the confidence needed to practice gynecology after graduating.

After completing the month of gynecology the resident will be competent to inquire, address, and manage most gynecological complaints received in primary care and the emergency department.  In addition, the resident will have the knowledge of when to consult their local gynecological specialist.

Gynecology and Women’s Health Curriculum

SAMPLE SCHEDULE: 

Rotation description:  Gynecology is taught both longitudinally and during the gynecology month long rotation. Longitudinal experience includes didactic mid-day lectures, continuity of care patients in the Family Medicine Offices, gynecology patients seen in the Rural rotation  and  AFP Colposcopy clinic – minimum 4 half days during the Gynecology rotation and minimum 4 half days during the COFME II rotation in the PGY 2 and OGME 2 years.

The gynecology month in the PGY2/OGME2 year of training involves the following experiences:

Contact Information:

Kathleen Sweeney DO 889-2020

Blair Medical OB/GYN Phone: 946-0612 Fax 941-3038

Dr. Marie A Wetzel Phone: 946-0429 Fax 946-9299

Altoona OB/GYN Phone: 944-7097 Fax 944-5557

Hospital Responsibilities:  Round on all OR patients that you have assisted on in surgery,

Check Dr. Wetzel, Altoona OB GYN and Blair Medical OR schedule in advance so you will be prepared for the cases and on time. If you are delayed in Surgery on Wednesday AM, please call Altoona OB GYN office and alert them to your estimated arrival time.

Rotational Goals:

The resident will progressively acquire the knowledge, skills and attitudes to properly assess and treat women of all ages throughout the lifecycle.

The resident will develop sensitivity to the unique needs of his or her women patients in regards to not only direct gynecologic problems, but overall maintenance of health and the unique aspects of treating and preventing medical conditions in women.

Provide a framework for the resident so that they may provide a wide range of medical services such as preventive care, diagnosis of general medical illnesses, as well as treatment of disease processes unique to women.

Offer the resident a range of educational resources so that the resident can maintain and expand their knowledge in gynecology through out his or her career.

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 of their women patients.  Residents are expected to:

Objective 1.  The PGY1/OGME1 resident will demonstrate appropriate pelvic exam and breast examination to the preceptors in the Altoona Family Physician office. They will attend didactic conference on pelvic examination and pap smears. Success will be measured by conference attendance and faculty evaluation in the AFP and WFP offices.

Objective 2.  The PGY1/ OGME1 resident will present every patient during the first 6 months of training to the family physician preceptor who will model and advise the resident regarding a caring, compassionate and respectful approach to his or her female patients. Success will be measured by faculty evaluation and observation.

Objective 3. The PGY2/OGME2 resident will interact appropriately with women patients and provide effective care of patients in the gynecology month during colposcopy clinic and in the Women’s Health and Wellness program. This will be measured by direct observation by faculty in Colposcopy clinic and feedback by the nursing staff and physicians assistants of the AFP and WHW program. It will also be assessed during videotaping of appropriate patients (no pelvic or breast exams) by the behavioral scientist of PGY1 residents with feedback given directly to the resident and his or her advisor.

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 the care of women patients.  Residents are expected to:

Objective 1. The PGY2/ OGME2 resident will take the following pre test and post test from FP Essentials Monographs during the Gynecology rotation as follows:

The resident will read the monographs and demonstrate competency by achieving 100 percent scores and submitting his or her answer sheets to administrative personnel. These monographs cover a breadth of the gynecology and women’s health curriculum and serve to both assess and increase resident knowledge base.

Objective 2. The resident will take the pre and post test for the colposcopy course and a clinically oriented test regarding triage of pap smears in preparation for the course.  Answer keys will be provided.

Goal 1.

The resident will acquire the following knowledge, skills and attitudes regarding the health care of his or her women patients:

Skills:

Objective 1. The PGY1 and OGME1 resident will observe one colposcopy during Altoona Family Physicians colposcopy clinic during the COFME I rotation. This will be measured by faculty evaluation.

Objective 2. The PGY1/OGME1 and PGY2/OGME2 will attend the two day Altoona Family Physicians Colposcopy Course. They will be taught the skills necessary to focus the colposcope, obtain a pap smear, and perform endometrial sampling, endocervical curettage and cervical biopsies. The residents will demonstrate competence in these procedures and have this measured by completion of a procedure checklist of each procedure supervised by course faculty.

Objective 3. The PGY1/OGME1 and PGY2/OGME2 residents will also learn and demonstrate cryotherapy and LEEP during colposcopy workshops completion measured by course faculty.

Objective 4. All  PGY1/OGME1 residents will view the breast exam DVD at didactic conference and have the opportunity to ask questions of faculty. Competence will be measured by faculty evaluation at the AFP office.

 Objective 5. All PGY1/OGME1 residents will demonstrate preparation and evaluation of wet preps for bacteria and yeast. They will also learn how to perform office pregnancy tests and controls and urinalysis and urine dipsticks and controls during the laboratory curriculum under the direction of the office laboratory technologist. She will directly observe competence and evaluate residents via the office staff evaluation process.

Knowledge:

Objective 1. All residents will attend didactic conferences in July/August reviewing all current cervical cancer screening guidelines. Mastery will be measure by preceptors as they review resident triage plans of pap smears in the Altoona Family Physician office. Residents will be give handouts yearly at AFP colposcopy course updating guidelines and visit www.asccp.org for additional information.  A test on these guidelines is given during the colposcopy course with answer key. Residents also will present cases at colposcopy course that utilize the ASCCP guidelines for triage of pap smears and post colposcopy results.

Objective 4. All residents will review materials relevant to gynecologic cancer in monographs 340 and 314 with mastery measure by 100% accuracy on pre and post tests.

Objective 5. Didactic conferences regarding breast and ovarian cancer prevention will be incorporated into conference schedule.

Objective 6. PGY1/OGME1 and PGY2/OGME2 residents will learn about risk factors and assessment of endometrial cancer during the AFP colposcopy course and be assessed by course faculty via interaction in small group workshop.

Objective 7. PGY1/OGME1 and PGY2/OGME2 residents will learn about the treatment and prevention of cervical cancer during the case presentations at the AFP colposcopy course. PGY2/OGME2 and PGY3/OGME3 residents will select cases of CIN and cancer and present them at the course. Mastery will be measured via faculty evaluation.

Objective 8. The resident will formulate preventive health plans for women patients at the AFP and WFP offices and demonstrate these to family physician preceptors verbally during office hours and via chart review by faculty.

Objective 9. Residents will attend didactic conferences concerning preventive health for women and apply this knowledge in the AFP and WFP offices. Topics will include nutritional needs, cancer screening guidelines, exercise, osteoporosis, smoke cessation, and coronary artery disease. The resident will demonstrate and apply this knowledge in the care of patients at AFP and WFP.

Objective 10. The PGY2/OGME2 resident will demonstrate ability to treat STD and infections at the WHW, AFP and WFP offices. This will be measured by completion of assigned FP Essentials pre and post tests and review of patients and charts by family practice faculty.

Objective 11. Residents will understand reproduction and fertility issues and demonstrate ability to counsel their patients and partners. This will be reviewed in FP Essentials, Core Content Family Medicine conferences, and during the gynecology experiences at Altoona Ob Gyn office. Residents will demonstrate their understanding during care of patients at the AFP and WFP office and review with preceptors.

Objective 12. Residents will demonstrate competence in advising women in a culturally sensitive manner regarding family planning, contraception and counseling for unattended pregnancy. This will include oral, injectable, natural, barrier, IUD and emergency contraception.  They will gather needed information via reading in FP Essentials assignments and didactic lectures and apply this knowledge in the care of patients at the AFP and WFP offices and WHW during the gynecology month and longitudinally. Faculty will measure competency via precepting and chart review of AFP, WFP and WHW records.

Objective 13. The resident will demonstrate understanding of the causes, prevention and treatment options for women with uterine prolapse, incontinence and pelvic floor dysfunction.  Knowledge will be obtained via FP Essentials assignments and didactic conferences. Progress will be measured via pre and post test in FP Essentials, conference attendance tracking and provision of care to women with these issues longitudinally in the AFP and WFP office and during the gynecology month at Altoona Ob Gyn and in the operating room with evaluation by faculty.

Objective 14. The resident will demonstrate knowledge of disorders of menstruation including dysfunctional uterine bleeding, amenorrhea and premenstrual syndrome longitudinally at the AFP and WFP offices and during Altoona OB Gyn office experiences. The resident will complete assigned FP Essentials topics and measure competence by 100% scoring of pre test and post tests. The resident will also attend didactic sessions on these topics attendance will be tracked on conference sheets.

Objective 15. The resident will provide care to women in the perimenopause and menopausal age group. He or she will demonstrate how to assess these women for medical diseases, prevent complications such as osteoporosis, and advise women on therapies and lifestyle modifications that will lessen the symptoms of menopause that they find troubling. The resident will provide this care longitudinally at AFP and WFP, in PGY2/OGME2 year in WHW, and in PGY3/OGME3 on the Rural rotation.

Knowledge will be gained from FP Essential monograph on Midlife Care of Women and measured by 100% correct completion of pre and post tests.

Didactic conferences will be provided on this topic including review at Family Medicine Core Content conference. Faculty will evaluate residents’ abilities to discuss these issues and formulate plans for patients during precepting at the AFP and WFP offices.

Objective 16. The resident will demonstrate knowledge of sexual health of women throughout the lifecycle. This topic is discussed during precepting individual patient encounters longitudinally at AFP and reading of FP Essentials. PGY2/OGME2 and PGY3/OGME3 residents provide this care at WHW and Altoona OB/GYN.  This is also addressed during care of patients at the Juniata College Health Center under the direction of Dr. Seims.  Evaluation is by faculty observation and FP Essentials testing.

Objective 17. All residents will attend didactic conference given by Altoona Regional radiologists regarding mammography and stereotactic core biopsy of the breast. Residents’ attendance will be tracked on conference schedules by administrative assistants.

Objective 18. Residents will demonstrate knowledge of diseases of the breast and prevention of breast cancer and breast cancer risk assessment. They will discuss these issues during Core Content of Family Medicine conference. The resident will provide care to patients with breast lumps and cysts, making appropriate referrals as indicated. Didactic conference will be scheduled with oncologist and radiologists and interventional radiologists with attendance tracked by administrative assistants via conference sheets.

Attitudes:

The resident will develop attitudes that encompass:

 Source :AAFP Reprint No.282

Recommended Curriculum Guidelines for Family Medicine Residents

Women’s Health

Objective 1.The resident will demonstrate a caring, compassionate and respectful approach to the women’s role as an informed participant in her health care decisions and those affecting her family during care in continuity office and inpatient setting as measured by faculty evaluation.

Objective 2. The resident will recognize the need to empower the female patient in the decision-making process and provide information to enable the female patient to make decisions in continuity office and inpatient setting as measured by faculty evaluation.

Objective 3.  The resident will demonstrate an awareness that many medical disorders manifest differently or exclusively in women in continuity office and inpatient setting as measured by faculty evaluation.

Objective 4. The resident will understand that a woman’s health is affected not only by medical problems, but also by family, career, life cycle, relationships and community in continuity office and inpatient setting as measured by faculty evaluation.

Objective 5. The residents will demonstrate an appreciation of the role that women play in the health of the family by selecting a health care provider, providing

 family care and making lifestyle decisions for the family, including meal and activity selections in continuity office and inpatient setting as measured by faculty evaluation.

Objective 6.  The resident will demonstrate an awareness that many research

studies previously excluded women, along with an awareness of current research studies that are addressing medical issues and practices that present differently or are unique to women as discussed in Family Practice rounds and PBLI articles.

Practice- Based Learning and Improvement

Goal

Residents must demonstrate the ability to investigate and evaluate their care of patients, to appraise and assimilate scientific evidence, and to continuously improve patient care based on constant self-evaluation and life long learning.  Residents are expected to develop skills and habits to be able to:

       Objective 1. Faculty will review and evaluate resident referrals at the AFP office.

Objective 1. Residents will participate in the Critical Appraisal curriculum and complete pre and post tests to demonstrate they have the tools to  integrate scientific studies in the care of women patients.

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:

Professionalism

Goal

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

Competencies

Objective 1. This will be measured by observation by faculty and staff in the outpatient and inpatient settings and by the program director’s direct observation.

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:

Sources

ACGME Outcomes project www.acgme.org

Residency Solutions http://www.aafp.org/online/en/home/aboutus/specialty/rpsolutions/eduguide.html

FP Essentials published by the Home Study program of the AAFP

Resources:

Tutorials from the Carl J. Shapiro Institute for Education and Research at Harvard Medical School and Beth Israel Deaconess Medical Center

http://research.bidmc.harvard.edu/VPtutorials/midlife/default.htm

reviewed May 9, 2009