Gynecology/Women's Health
I. Rationale
Family physicians provide primary care for women of all ages. Therefore, knowledge of gynecologic problems and their management is essential. In addition, the family physician must know when and how to work with gynecologic consultants when such problems need further intervention.
This curriculum has two components: the focused rotation in gynecology and the longitudinal component which takes place over time in the Family Medicine outpatient clinics and on other rotations where gynecologic topics may be covered.
II. Competencies
Medical Knowledge
Goal:
A. Develop a broad knowledge base of symptoms, physical exam, diagnoses and interventions.
B. Understand normal growth and development of women.
C. Understand the physiology of menstruation.
Objectives:
A. Know how to diagnose and manage:
1. Primary amenorrhea
2. Secondary amenorrhea
3. Dysfunctional uterine bleeding
4. Sexual assault
5. Fibroids
6. Menopause
7. Abnormal cervical cytology
8. Infections of the reproductive tract
9. Incontinence
10. Breast masses
11. Endometriosis
12. Pelvic pain
B. Learn the management of fertility problems.
C. Understand the role of the family physician in the operative care of the female patient
undergoing gynecologic surgery including:
1. Preoperative evaluation
2. Assisting in the operating room
3. Recognizing and managing both gynecologic and medical complications of gynecologic
Surgery
Learning ActivitiesX / Attending Rounds / X / Research Conference / X / Outpatient Clinics
X / Multidisciplinary Rounds / Ethics/Comm Conference / X / Direct Patient care
Grand Rounds / X / Specialty Conference / Resident Seminar
X / Sub-Specialty Conference / X / Noon Conference / X / Journal Club
Morning Report / X / Faculty Supervision / X / Readings
X / Didactics / Procedures
Other
Evaluation Methods
X / Attending Evaluation / x / Directly Supervised Procedures / Morning Report
Program Dir
Review / X / In-Training Exam / X / Faculty Supervision and Feedback
X / 360 ᵒ evaluation / Videotape Review / Quarterly Review
Other
Patient Care
Goal: Provide Evidence Based Care to patients with gynecological conditions.
Objectives:
A. Learn to perform a gynecologic exam in a manner that is effective and as comfortable as
possible for the patient.
B. Learn to perform a breast exam in a manner that is effective and as comfortable as possible for
the patient.
C. Learn to take a comprehensive history for abnormal reproductive bleeding.
D. Become competent in the following procedures:
1. Colposcopy
2. Endometrial biopsy
3. Endocervical curettage
4. Cervical biopsy
5. Bartholin cyst drainage or marsupialization
6. Obtaining vaginal and cervical cytology
7. Cervical polypectomy
8. Culdocentesis (be familiar with technique)
9. Cryosurgery
10. IUD insertion
E. Demonstrate the ability to perform the listed procedures including:
1. knowing indications/contraindications
2. giving informed consent
3. addressing patient questions/concerns
4. preparing patient for the procedure
5. performing the procedure
6. handling complications
7. proper follow-up
Learning ActivitiesX / Attending Rounds / Research Conference / X / Outpatient Clinics
X / Multidisciplinary Rounds / Ethics/Comm Conference / X / Direct Patient care
Grand Rounds / Specialty Conference / Resident Seminar
Sub-Specialty Conference / Noon Conference / Journal Club
X / Morning Report / X / Faculty Supervision / Readings
Didactics / X / Procedures
Other
Evaluation Methods
X / Attending Evaluation / X / Directly Supervised Procedures / Morning Report
Program Dir
Review / In-Training Exam / X / Faculty Supervision and Feedback
X / 360 ᵒ evaluation / Videotape Review / Quarterly Review
Other
Interpersonal/Communication Skills
Goal: Residents will develop and demonstrate effective information exchange and teaming with patients, their families, and other health professionals.
Objectives:
A. Develop skills for interviewing that allow accurate, complete collection of information regarding symptoms, family, and community environment that affect the patient.
B. Develop skills in communicating results, educating patients and their families, dealing with sensitive issues for patients and families, and negotiating a plan of treatment with the patient and family.
C. Understand issues surrounding chaperoning genital exams.
D. Learn to provide family planning counseling.
E. Be able to give the patient informed consent on any diagnostic or therapeutic procedures to be performed in a manner understandable to the patient.
F. Learn to communicate efficiently and effectively with gynecologic consultants.
Learning ActivitiesX / Attending Rounds / Research Conference / X / Outpatient Clinics
X / Multidisciplinary Rounds / Ethics/Comm Conference / X / Direct Patient care
Grand Rounds / Specialty Conference / Resident Seminar
Sub-Specialty Conference / Noon Conference / Journal Club
X / Morning Report / X / Faculty Supervision / Readings
Didactics / X / Procedures
Other
Evaluation Methods
X / Attending Evaluation / X / Directly Supervised Procedures / X / Morning Report
Program Dir
Review / In-Training Exam / X / Faculty Supervision and Feedback
X / 360 ᵒ evaluation / Videotape Review / Quarterly Review
Other
Practice Based Learning and Improvement
Goal: The resident should develop skills in evaluating their own patient care, appraising and assimilation of scientific evidence to improve patient care.
Objectives:
A. Identify resources for personal education and develop a plan for ongoing education in gynecology.
B. Identify Point of Care learning resources.
C. Utilize Electronic Medical Records Decision aid tools and templates for patient care.
D. Recognizes strengths and weaknesses of knowledge and skills in self and others.
E. Appropriately code for services provided and procedures done.
F. Integrate health maintenance into care as appropriate.
G. Document all procedures performed and the diagnoses of patients managed.
Learning ActivitiesX / Attending Rounds / Research Conference / X / Outpatient Clinics
X / Multidisciplinary Rounds / Ethics/Comm Conference / X / Direct Patient care
X / Grand Rounds / X / Specialty Conference / X / Resident Seminar
Sub-Specialty Conference / Noon Conference / Journal Club
Morning Report / X / Faculty Supervision / Readings
X / Didactics / X / Procedures
Other
Evaluation Methods
X / Attending Evaluation / X / Directly Supervised Procedures / X / Morning Report
X / Program Dir
Review / In-Training Exam / X / Faculty Supervision and Feedback
360 ᵒ evaluation / Videotape Review / Quarterly Review
Other
Professionalism
Goal: Residents will demonstrate a commitment to carrying out professional responsibilities, adherence to ethical principles, and sensitivity to a diverse patient population.
Objectives:
A. Demonstrate integrity, honesty, respect and a commitment to excellence in all activities.
B. Demonstrate sensitivity, respect and adapt appropriately to the social and cultural issues of each patient.
C. Display initiative and resourcefulness in patient care and in solving problems.
D. Be timely in attendance of activities and completion of tasks.
Learning ActivitiesX / Attending Rounds / Research Conference / X / Outpatient Clinics
X / Multidisciplinary Rounds / X / Ethics/Comm Conference / X / Direct Patient care
X / Grand Rounds / X / Specialty Conference / Resident Seminar
Sub-Specialty Conference / Noon Conference / Journal Club
X / Morning Report / Faculty Supervision / Readings
Didactics / Procedures
Other:
Evaluation Methods
X / Attending Evaluation / Directly Supervised Procedures / X / Morning Report
X / Program Dir
Review / In-Training Exam / X / Faculty Supervision and Feedback
X / 360 ᵒ evaluation / Videotape Review / X / Quarterly Review
Other
Systems Based Practice
Goal: demonstrate an awareness of and responsiveness to the larger context and system for health care and the ability to effectively call on system resources to provide care that is of optimal value.
Objectives:
A. Utilize and understand the importance of appropriate referral or consultation with gynecologists.
B. Distinguish between primary management of skin disorders and appropriate referral.
C. Support of the individual and family through consultation, evaluation and treatment.
D. Understand the psychosocial and economic impact of gynecological disease on the individual and family and use of the health care system to assist as needed.
E. Learns most cost effective ways to manage gynecological conditions.
Learning ActivitiesX / Attending Rounds / Research Conference / X / Outpatient Clinics
X / Multidisciplinary Rounds / X / Ethics/Comm Conference / X / Direct Patient care
Grand Rounds / X / Specialty Conference / Resident Seminar
Sub-Specialty Conference / Noon Conference / Journal Club
Morning Report / Faculty Supervision / X / Readings
Didactics / Procedures
Other
Evaluation Methods
X / Attending Evaluation / Directly Supervised Procedures / Morning Report
X / Program Dir
Review / In-Training Exam / X / Faculty Supervision and Feedback
X / 360 ᵒ evaluation / Videotape Review / Quarterly Review
Other
IV. Instructional Strategies
A. Observation of preceptor
B. Assessment by actual patient in preceptor's office and on gynecology service
C. Management of actual patients in continuity clinic
D. Case discussions/ lectures/conferences
E. After clinic conferences
F. Colposcopy slide review
G. Independent reading
H. Procedural learning
V. Evaluation Strategies
A. Observation of resident by gynecology preceptor
B. Observation of resident by clinic preceptor
C. Procedure/diagnosis documentation
D. End of rotation evaluation
VI. Implementation Methods
Schedule Template:
Monday Tuesday Wednesday Thursday Friday
GYN GradyMorning / GYN Grady / FMC
Morning / Colposcopy clinic
Lisa Flowers / GYN Grady
GYN Grady
Afternoon / GYN Grady / FMC
Afternoon / FMC Afternoon / GYN Grady
The resident will need to keep a log of all procedures performed and turn this in to the Program Director’s office at the end of the rotation.
GYN preceptors should carefully evaluate all procedures performed by the FM resident in order to assist in evaluating procedural competency.
Residents will initially be oriented to the preceptor’s clinic. After an initial familiarization period (no more than 1-2 days, if that), the residents should then begin seeing patients and presenting cases to their preceptors.
Contact:
Dr. Carla Roberts
Office: 404·616-3540 (Ph)
404·521·3549 (fax)
GYN Clinic Address: Program Coordinator: Aimee Moynihan
Grady Memorial Hospital (GYN Clinic Phone#: 404-616·8055)
2"' floor- 2K
80 Jessie Hill .lr. Drive
Atlanta, GA 30303
Dr. Flowers: Grady Cancer Center of Excellence
9th B floor on Tuesday at 9am-5 pm
or Thursday 9 am-1 pm. 404-489-9045 clinic number
Note: The 2nd Wednesday pm of each month is Nursing Home Visit for PGY3s.
VII. Suggested Reading
AFP Essentials Monographs (Women’s Genitourinary conditions #314, Midlife care of women #278, Menstrual Disorders # 255, Genital Cancer #287)
Last Updated April 19, 2013