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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