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I. GENERAL INFORMATION
Demonstrate the ability to identify basic gynecologic pathologic conditions, and differentiate between gynecological and abdominal pathology requiring surgical intervention. Demonstrate the ability to manage gynecologic problems, including emergency procedures and pathology/trauma involving pelvic and abdominal organs.
II. GOALS & OBJECTIVES
Competency-Based Knowledge Objectives:
Describe the components of a complete gynecological assessment, including an accurate history and physical examination.
Outline the anatomical relationships of the pelvic organs and the lower intra-abdominal organs.
Discuss the physiology and pathophysiology of gynecologic conditions and disease, including:
Intrauterine pregnancy
Benign disease of the ovaries (e.g., cysts and the complications of torsion and bleeding)
Ectopic pregnancy
Carcinoma of the ovary, uterus, cervix uteri, vagina, and vulva
Outline the differential diagnoses for pelvic pathology such as:
Salpingitis versus appendicitis
Mittelschmerz bersus bleeding ovarian cyst
Fibroid uterus bersus other intra-abdominal masses
Cysts vs. tumors
Summarize the categories of information provided by the following types of studies:
Imaging (ultrasound, computed axial tomography, magnetic resonance imaging)
Cytology of ascitis fluid
Intravenous pyelography and cystoscopy
Gastrointestinal contrast studies and sigmoidoscopy
Explain the basis of preferred treatment for the following conditions:
Uterine bleeding
Ectopic pregnancy
Ovarian cysts with bleeding, enlargement or torsion
Endometriosis
Carcinoma of the ovary, uterus, vagina, and vulva
Fibroids
Normal pregnancy and its complications requiring Caesarean section
Summarize the principles of the following surgical procedures:
Hysterectomy
Salpingectomy
Oophorectomy
Laparoscopy
Vulvectomy
Radical groin dissection
Discuss the management of an ovarian mass unsuspected at laparotomy by considering:
Biopsy versus oophorectomy
Surgical staging (peritoneal washings, contralateral ovarian biopsy, omentectomy)
Consultation (family, gynecologist)
Competency-Based Performance Objectives:
Perform pelvic examinations, only initially under direct supervision:
Part of every womans general physical examination
Significant for patient to be evaluated for abdominal or pelvic surgery
Critical for patients who must undergo abdominal or pelvic surgery
Evaluation of traumatically-injured female
Participate as part of the surgical team in performing multiple gynecological surgery procedures:
Perform as surgical assistant during earliest training stages
Perform surgical procedures when experienced and under supervision:
Pelvic laparoscopy
Oophorectomy
Salpingectomy
Hysterectomy
Formulate differential diagnoses of pelvic infection and masses to consider:
Common infections (endometritis, salpingitis, tubo-ovarian abscess)
Common organisms (gonococcus, Chlamydia, anaerobic bacteria)
Differentiating findings on pelvic and abdominal examination (mass, tenderness, signs of peritoneal irritation, ultrasound imaging, fever, leucocytosis)
Identify all normal pelvic structures visually and through palpation during laparotomy.
Manage general surgical problems of the pregnant patient.
Diagnose ectopic pregnancy and perform a salpingostomy under direct supervision.
ACGME Core Competencies
Patient Care that is compassionate, appropriate, and effective for the treatment of health programs and the promotion of health. Surgical residents must:
Demonstrate manual dexterity appropriate for their training level.
Be able to develop and execute patient care plans appropriate for the residents level.
Medical Knowledge about established and evolving biomedical, clinical, and cognate (e.g., epidemiological and social-behavioral) sciences, as well as the application of knowledge to patient care. Surgical residents are expected to critically evaluate and demonstrate knowledge of pertinent scientific information.
Practice-based learning and improvement that involves the investigation and evaluation of care for their patients, the appraisal and assimilation of scientific evidence, and improvements in patient care. Surgical residents are expected to :
Critique personal practice outcomes.
Demonstrate recognition of the importance of lifelong learning in surgical practice.
Interpersonal and communication skills that results in the effective exchange of information and collaboration with patients, their families, and other health professionals. Surgical residents are expected to:
Communicate effectively with other health care professional.
Counsel and educate patients and families.
Effectively document practice activities.
Professionalism, as manifested through a commitment to carrying out professional responsibilities, adherence to ethical principles, and sensitivity to patients of diverse backgrounds. Surgical residents are expected to:
Maintain high standards of ethical behavior.
Demonstrate a commitment to continuity of patient care.
Demonstrate sensitivity to age, gender and culture of patients and other health care professionals.
Systems-based practice, as manifested by actions that demonstrate an awareness of and responsiveness to the large 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. Surgical residents are expected to:
Practice high quality, cost effective patient care.
Demonstrate knowledge of risk-benefit analysis.
Demonstrate an understanding of the role of different specialists and other health care professionals in overall patient management.
III. EVALUATION
A computerized evaluation will be completed by the faculty at the end of each rotation. Additionally, you are required to submit your evaluation of the rotation and faculty to the residency director.
IV. CONTACT: Dr. Michael Brown
Altru Hospital
1000 South Columbia Road
Grand Forks, ND 58201
SCORE CURRICULUM COMPONENTS
CATEGORY 26: GYNECOLOGY
DISEASES/CONDITIONS
BROAD
Ovarian neoplasms
Ectopic pregnancy
Pelvic inflammatory disease
Incidental ovarian mass/cyst
FOCUSED
Endometriosis
Ovarian neoplasms
-Benign
-Malignant
Uterine neoplasms
-Benign
-Malignant
Cystocoele
Rectocoele
OPERATIONS/PROCEDURES
ESSENTIAL " U N C O M M O N
" H y s t e r e c t o m y
" S a l p i n g o - o o p h o r e c t o m y
C O M P L E X
" C a e s a r i a n s e c t i o n
" R e p a i r c y s t o c o e l e
" R e p a i r r e c t o c o e l e
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4/9/09; 4/21/09; 4/23/09; 5/25/10
GYNECOLOGY
ROTATION LIAISON: Dr. Michael Brown
INSTITUTION: Altru Hospital
LEVEL(S): PGY-2
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