This clinical block will give students experience with benign and malignant gynecological problems. During this two-week rotation, students will join the Benign Gynecology and the Gynecology Oncology teams and assist in caring for emergency room consultations, in-patient consultations from other services, and pre-operative, intra-operative, and postoperative care of Gynecologic surgical cases. One week will be spent on the Benign Gynecology service and one week on the Gynecology Oncology service.

On the Gynecology Oncology service students will attend morning and afternoon rounds as scheduled daily, Tuesday morning Tumor conference, and Chapter Review session on Friday afternoon.

On the Benign Gynecology week, students will round on patients daily on weekdays. They will be expected to attend and participate in Gyn faculty teaching sessions (topic or chapter review) and pre-operative conference. Students will be expected to participate in surgical cases: review the preoperative work-up prior to the case, introduce themselves to patient, be available to observe the case, and assist in documentation, orders, and postoperative checks.

For the Benign Gynecology service, students will be responsible for presenting a 10-15 minute article presentation at the end of each week.  The presentation will allow students to cover an assigned article, demonstrate literature review, and demonstrate the ability to discuss and answer questions.  Each presentation will contribute 5% to the students final grade.

Learning Objectives for Gynecology Block:

Cognitive:

Students should become familiar with the following topics:

• Normal menstrual cycle, amenorrhea, and abnormal uterine bleeding
• Normal and Abnormal Puberty
• Contraception and Sterilization
• First Trimester Bleeding and Abortion
• Uterine fibroids
• Menopause
• Infections- vaginitis, sexually transmitted diseases, PID
• Infertility
• Hirsutism and Polycystic Ovarian Syndrome
• Vulvar disorders
• Pelvic relaxation and urinary incontinence
• Pelvic Pain including dysmenorrhea, endometriosis, ectopic pregnancy
• Neoplasms of Vulva, Cervix, Uterus, Ovaries, Gestational Trophoblastic Disease
• Sexual Assault
• Gynecological Procedures:
  Tubal ligation and laparoscopy, Hysteroscopy and D&C, Hysterectomy (vaginal, abdominal, laparoscopic), Surgery for Urinary incontinence and pelvic relaxation, Surgery for Gyn Cancers

Knowledge and Skills expectations:

By the end of the Gynecology block students will be expected to competently

1. Write a complete operative note
2. Discuss the normal hospital course after a routine Gyn surgical procedure
3. Discuss the appropriate work-up and differential for postoperative low urine output, fever, and wound problems
4. Discuss the relevant history, examination, and laboratory or radiology work-up involved in ER assessments of
   1. pelvic pain and
   2. abnormal vaginal bleeding
5. Briefly describe the differences between types of hysterectomies (supracervical, simple, radical, vaginal, laparoscopic)

Directed studying recommendations:

1. Web-based learning:
   • Gynecological Cancer link
   • Sexually Transmitted Diseases- updated information on diagnosis
     and treatment regimens through the CDC web-site
   • American Cancer Society - this link brings you to page for medical
     professionals - choose link to specific GYN related cancers for information
   • Virtual Hospital (patient education on Gyn topics)
2. Reviewing Gynecology-related sample questions/ answers to prepare for NBME shelf examination. (Binder of sample questions available through the Clerkship Coordinator)
3. Reading the assignments for that week's Wednesday faculty teaching sessions.