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Obstetrics/Gynecology


Students participate in 2 separate activities during their Obstetrics and Gynecology Clerkship. The first is a set of 3 workshops and the 2nd is an OSCE. The Workshops are held in small groups. The OSCE consists of 3 stations where students interview a standardized patient for 10 minutes and then receive 5 minutes of feedback from the standardized patient. Each standardized patient received special training in giving feedback. After all the students have finished the OSCE a debriefing is held. At the debriefing each station is reviewed with a faculty member.

Workshops

#1 Domestic Violence

  • Goals:
    Students will be able to identify patients involved in violent relationships, asses for safety and provide appropriate support.
  • Objectives: By the end of the session students will:
    Know the epidemiology of domestic violence.
    Recognize signs of domestic violence.
    Practice screening patients for domestic violence.
    Asses for patient safety and connect to resources.
  • Outline:
    20 minutes Interactive discussion
    30 minutes Practice
    10 minutes Debrief
    60 minutes Total
  • Resources:
    Faculty notes-teaching points, role play.
    Handout-NYS DOH Physician's Reference Card.
    References
    AMA: Diagnostic and Treatment Guidelines on Domestic Violence. 1994.

#2 Sexuality

  • Goal:
    Students will learn how to discuss sexual practices, risks and functioning with a patient.
  • Objectives:
    Learn to elicit an accurate, complete sexual history in a sensitive, non-judgmental manner.
    Modify interview technique appropriately to ask about sexual behavior (closed to open ended
    questions).
    Elicit basic information about patient's sexual activities including number and gender(s) of
    partners and knowledge of partners' high risk behaviors.
    Elicit information regarding potential high risk sexual behaviors in patient.
    Learn to elicit clear descriptions of behaviors, concerns and dysfunction when relevant.
    Deal with emotional barriers to discussing sexuality.
    Screen for possible sexual dysfunction.
    Screen for possible sexual abuse.
    Screen for risk of unwanted pregnancy/discussion of birth control.
  • Outline:
    Discussion and mini-lecture covering information about and attitudes toward talking with patients about sex. Review 3 videotaped scenarios to highlight specific challenges in the sexual history. Practice taking a screening sexual history using role play. Summarize and debrief.
    Total time 80 minutes

Scenarios:
#1 54 year old female, postmenopausal, married, monogamous, with dyspareunia secondary to vaginal dryness.

#2 40 year old female, homosexual with girlfriend of 5 months (monogamous), concerned about risk of HIV from vaginal secretions.

#3 68 year old female, widowed, dating a man for 9 months and considering starting a sexual relationship but concerned about HIV/STD risks.

  • Resources:
    Faculty Notes-Teaching points
  • References:
    1. Williams S. The Sexual History. In Lipkin M, Putnam SM, Lazare A, eds. The Medical Interview Clinical Care, Education and Research. NY: Springer-Verlag, 1995:122-133.


#3 Pre-natal Testing/Genetic Counseling

  • Goal:
    Students will learn how the triple test and amniocenteses are used to identify fetal abnormalities. Students will practice discussing both of these procedures with patients taking into account the patients family and personal medical history in a sensitive and non-judgmental manner.
  • Objectives:
    By the end of the session students will:
    Know the test characteristics of the triple test and amniocentesis.
    Educate a patient about both of these tests and negotiate a plan.
    Incorporate a patient's personal and family medical history into decision-making.
    Communicate in a sensitive and non-judgmental manner.
    Acknowledge and respect patient preferences for testing/no testing.
  • Workshop Outline:
    15 minutes Mini-lecture (Tripletest, Amnio)
    30 minutes Practice
    Case #1 15 week pre-natal visit, discuss positive triple test results, discuss amnio.
    Case #2 Older woman referred for Down Syndrome Screening (Amnio), sister has DS.
    5 minutes Debrief
    50 minutes Total time
  • Resources:
    Faculty Notes-lecture notes, teaching points
    Handouts-Test characteristics/role plays
    References- ACOG Educational Bulletin, Number 228, September 1996.

OSCE

Station #1-Sexually Transmitted Disease
Goals: This station is designed to test for students' ability to:
Deliver distressing news to a patient
Recognize and respond to emotions
Educate patient
Use General Communication Skills

Patient Scenario (detailed role description available on request):
You are a 30 year old woman with no significant medical problems visiting your gynecologist to follow-up on your annual pap smear and exam. The nurse called yesterday to ask that you come back to see the doctor today. You are worried that something was wrong with one of the labs and are concerned that you may have cancer.

Student Instructions: You are seeing a patient to follow up on a routine annual Pap and Pelvic. Unexpectedly the results reveal evidence of HSV.
1. Tell patient the lab results
2. Educate the patient about treatment/prognosis for HSV
3. Arrive at a mutually acceptable plan


Station #2-Abnormal Pap Smear
Goals: This station is designed to test for students' ability to:
Deliver distressing news to a patient
Recognize and respond to emotions
Educate patient
Use General Communication Skills

Patient Scenario (detailed role description available on request):
You are a 45 year old woman who was called back to see your gynecologist because of an abnormal pap smear. You have never had an abnormal pap smear in the past and are not sure what that means (do you have cancer, will you need surgery?)

Student Instructions:
Ms. Smith had a pap smear and pelvic exam 3 weeks ago. Her pap smear came back with ASCUS. The nurse called to schedule a repeat visit for today.
1. Tell patient the lab results
2. Educate the patient about cervical cancer and screening
3. Arrive at a mutually acceptable plan


Station #3-Sexual History
Goals: This station is designed to test for students' ability to:
· Elicit an accurate, complete sexual history in a sensitive, nonjudgmental manner.
· Use general communication skills

Patient Scenario:
At this time you are sexually active with your boyfriend who you have been dating for about four months. As far as you can tell your current boyfriend has not had any history of sexually transmitted diseases and does not have any other risky behaviors (IV drug abuse). You are using the diaphragm to prevent pregnancy and you had thought it also protected you from sexually transmitted diseases.
You have had 4 other partners (all male) in the past and were not aware that they had any sexually transmitted diseases. Also you have never had any sexually transmitted diseases.

Student Instructions:
You were called out of the room to answer a phone call, now you are back in the room and need to ask about her sexual history.
Your task is to elicit a complete sexual history.

 



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