Faculty Chair:

Contacts:

John Andazola, MD

Required Experiences:

1. GYN Clinic

2. GYN Operating Room (O.R.) Time

3. Ultrasound Lab

Weekly Schedule:

Sunday	Monday	Tuesday	Wed	Thursday	Friday	Saturday
	Clinic	Clinic	Gtn	Clinic	Gyn
	Gyn	Gyn	Didactics	Gyn	Clinic

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Requirements:

AOA

Women’s Health

The program must provide at least twelve weeks of training in women’s health, including at least four weeks of training during the OGME-1 year.

At a minimum training in women’s health must include:

• Didactic and clinical training experiences.
• Gender specific health care needs of women.
• Domestic violence identification and prevention.
• Gynecology.
• Obstetrics.
• Breast Disease.

The gynecological portion of this training experience shall include both ambulatory and in-hospital patient care. At a minimum this shall include:

1. Family planning.
2. Preventive medicine.
3. Management of the abnormal PAP smear.
4. Disorders of menstruation.
5. Gynecological infections.

ACGME

Residents must have at least 100 hours (or one month) or 125 patient encounters dedicated to the care of women with gynecologic issues, including well-woman care, family planning, contraception, and options counseling for unintended pregnancy. (Core)

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Description of Rotation or Educational Experience

The purpose of the gynecology rotation is to provide a structured learning experience in the pathophysiology, diagnosis, and treatment of diseases of the female reproductive tract as well as common gynecologic conditions and pelvic floor dysfunction. The rotation will provide education in the normal reproductive and hormonal physiology of women throughout their reproductive, perimenopausal, and postmenopausal years. Residents will also learn a core set of gynecologic procedures, assist in common major surgical procedures, and be exposed to appropriate preoperative and postoperative care.

Resident Responsibilities:

• Attend scheduled clinics with the gynecology faculty preceptor, seeing patients independently and in coordination with preceptor during those clinics
• Assist the faculty preceptor with common major surgical procedures in the operating room
• Round on and present daily to the preceptor, those patients currently hospitalized and admitted to the gynecologist’s inpatient service
• Perform gynecology hospital consults in coordination with and with supervision by the faculty preceptor
• Read all assigned readings provided or suggested by the faculty preceptor
• Conduct him/herself in a compassionate, caring, and professional manner to patients and their families

Faculty Responsibilities:

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Patient Care

Goal

Residents must be able to provide gynecologic care that is compassionate, appropriate, and effective for the treatment of gynecologic problems and the promotion of women’s health. Residents are expected to:

Competencies

• Gather accurate and relevant information using medical interviewing, physical examination, and the use of information technology
• Synthesize and apply gathered information to make informed recommendations to patients and their families and to prescribe, perform, and interpret medical procedures relevant to the area of gynecology
• Demonstrate caring and respectful behaviors when interacting with patients and their families. (PC, P, ICS)
• Develop, negotiate, and implement effective patient management plans. (PC, ICS, P, SBP)
• Counsel and educate patients and their families. (PC, PBLI, ICS, P, MK)
• Understand the differences between screening and diagnostic tests essential for generalist practice in obstetrics and gynecology. (PC, MK)
• Provide health care services aimed at preventing health problems or
  maintaining health. (PC, SBP, PBLI)
• Work with health care professionals, including those from other disciplines, to provide patient-focused care. (PC, SBP, P, ICS)
• Discuss treatment options for conditions and symptoms related to the menopausal and geriatric women
• Evaluate and discuss treatment options for pelvic pain
• Manage cervical lesions and abnormal cytology according to current ACOG and ASCCP guidelines

Objectives

After completion of this rotation, a family medicine resident should be able to:

• Perform and document a comprehensive women’s health history and physical exam appropriate to the specialty of gynecology
• Make informed recommendations about preventative, diagnostic, and therapeutic interventions and options based on patient preferences, scientific evidence and clinical judgment
• Develop acute and long term treatment plans based on the unique aspects of the physiology of women
• Obtain a complete medical history, including a history of genetic diseases. (PC, ICS, P)
• Perform an appropriate general or focused physical examination. (PC, P)
• Perform routine screening for selected diseases
• Provide counseling for unintended pregnancy
• Evaluate and treat disorders of abnormal uterine bleeding

Residents should be able to perform independently:

• Gynecologic exam including bimanual exam and obtaining of vaginal and cervical cytology
• Clinical breast exam
• Perform Wet Mount examination.
• Microscopic diagnosis of vaginal smears
• Counseling and prescribing of contraception

Residents should be able to perform with the assistance of a preceptor:

• Colposcopy
• Cervical biopsy and polypectomy
• Endometrial biopsy
• Insertion and removal of IUD’s
• Cryosurgery and cautery for benign disease
• Transvaginal pelvic ultrasound and sonohysterogram

Residents should be exposed to or have assisted with:

• Bartholin duct cyst drainage or marsupialization
• Diaphragm fitting and counseling
• Loop electrosurgical excision procedures
• Dilation and curettage for incomplete abortion
• Hysterectomy, vaginal and abdominal, with and/or without salpingo-oophorectomy
• Hysteroscopy
• Anterior and posterior vaginal repairs
• Tubal ligation
• Exploratory laparoscopy for gynecologic indications

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Medical Knowledge

Goal

Residents must demonstrate knowledge of established and evolving biomedical, clinical, epidemiological, and social-behavioral sciences, as well as the application of this knowledge to patient care. Residents are expected to:

Competencies

• Display knowledge in the areas of normal female reproductive and hormonal physiology, including female growth and development, the menstrual cycle, and menopause
• Know and apply the pathophysiology and epidemiology of diseases and conditions of the female reproductive tract and disorders of the breast
• Use and interpret laboratory and radiological findings related to the field of gynecology
• Demonstrate proficiency in core gynecologic procedures. Perform competently all medical and invasive procedures considered essential for generalist practice in the discipline of obstetrics and gynecology. (PC, MK)
• Recall the indications for and assist in common major surgical procedures in the field of gynecology

Objectives

After completion of this rotation, a family medicine resident should be able to:

• Recall the normal reproductive and hormonal physiology of the menstrual cycle, menopause, and fertility
• Recite current guidelines for preventative exams and studies in the areas of gynecologic cancer, including breast, and osteoporosis screening in women
• Recall treatments for various sexually transmitted diseases and other infectious diseases of the female reproductive tract
• Recite the variations of and describe treatment options for pelvic floor dysfunction and urinary incontinence
• Recall methods for diagnosis of intrauterine and ectopic pregnancies and manage ectopic pregnancies appropriately
• Recognize and suggest treatment for benign and malignant neoplasms of the female reproductive tract
• Recall common diseases of the breast and educate patients in the area of breast health
• Recall ways to recognize, screen for, and suggest support services for sexual assault and domestic violence
• Ages 12 years and younger
  • For the preadolescent patient, obstetrician–gynecology consultation can be performed by a pediatrician or family physician after assessment of the specific problem for which the patient was referred. (PC)
• Ages 13–18 years
  • For adolescents, the obstetrician–gynecologist or family physician serves either as a consultant or as a primary health care provider, depending on the nature of his or her practice and level of expertise in the spectrum of reproductive tract disorders. (See Reference)
  • The following areas warrant special attention in this age group:
    • Assess patients for evidence of substance use (tobacco, alcohol, and other drugs). (PC, ICS, P)
    • Perform a Pap test for sexually active adolescents in accordance with current guidelines. (PC, P)
    • Assess reproductive concerns, such as: (P, PC, MK)
      • Family planning
      • Prevention of STIs
      • Pregnancy care
      • Infertility
    • Test sexually active adolescents for sexually transmitted infections (STIs), such as: (PC, P)
      • Gonorrhea
      • Chlamydia
      • Syphilis
      • Hepatitis B
      • Human immunodeficiency virus (HIV) infection
    • Counsel adolescents about the use of automobile safety belts and bicycle helmets. (PC, ICS, P)
    • Evaluate psychosocial well-being, including issues regarding abuse. (PC, ICS, P)
    • Assess nutritional and growth status. (PC, P)
  • The obstetrician–gynecologist and family physician usually are the chief care providers
• Ages 19–39 years
  • For women ages 19–39 and provide both specialist care in obstetrics and gynecology and primary preventive health care. The following areas warrant special attention in this age group:
    • Describe normal reproductive physiology, including issues such as fecundity and sexuality. (MK, P)
    • Assess reproductive concerns, such as: (P, PC, MK)
      • Family planning
      • Prevention of STIs
      • Pregnancy care
      • Infertility
    • Treat menstrual disorders, such as: (PC, MK, P)
      • Amenorrhea
      • Oligomenorrhea
      • Abnormal uterine bleeding
    • Manage breast disorders, such as: (PC, MK)
      • Mastitis
      • Galactorrhea
      • Mastodynia
    • Evaluate psychosocial well-being including issues regarding abuse. (PC, ICS, P)
    • Describe the principal reproductive health care issues of women with developmental delay and physical disabilities. (MK)
• Ages 40–64 years
  • Women ages 40–64 are in a time of transition and may face reproductive and perimenopausal concerns, medical conditions, and psychosocial issues. The following areas warrant special attention in this age group:
    • Assess and manage reproductive concerns, such as: (PC, MK, P)
      • Family planning until menopause
      • Prevention of STIs
      • Pregnancy care (e.g., offering genetic counseling/prenatal diagnosis with amniocentesis or chorionic villus sampling)
      • Infertility
    • Evaluate and treat perimenopause/menopause concerns: (PC, MK, P)
      • Normal aging, lifestyle modifi cations, and hormone therapy.
      • Risk factors for osteoporosis.
    • Assess risks for cancers (e.g., lung, breast, endometrium, ovary, colon, and skin). (PC, MK, P)
    • Evaluate psychosocial risks and well-being including issues of abuse. (PC, ICS, P)
    • Describe the appropriate interventions to prevent fractures in older women. (MK)
    • List the major risk factors for cardiovascular disease. (MK)
    • Assess risks for cancers (e.g., lung, breast, endometrium, ovary, colon, and skin). (PC, MK)
    • Describe the appropriate assessment for urinary and fecal incontinence. (PC, MK)
• Ages 65 years and older
  • The goal of health maintenance in older women is improvement of the quality of life and prolongation of a disease-free state. The following areas warrant special attention in these patients:
    • Describe the biologic effect of aging on major organ systems. (MK)
    • Describe the psychologic problems that may be associated with aging, such as: (MK)
      • Depression
      • Emotional abuse or neglect
      • Change in sexual function
    • Describe the appropriate interventions to prevent fractures in older women. (MK)
    • Describe the appropriate assessment for urinary and fecal incontinence. (MK)
    • List the major risk factors for cardiovascular disease. (MK)
    • Assess risks for cancers (e.g., lung, breast, endometrium, ovary, colon, and skin). (PC, MK)
    • Describe the altered pharmacokinetics of drugs in the elderly population and the likelihood of drug interactions with medications commonly prescribed in this age group. (MK)
    • List the drugs that most commonly cause adverse reactions in geriatric patients. (MK)
    • Summarize age-related changes in common laboratory values. (MK)
    • Assess nutritional status. (PC, MK)
    • Perform a basic assessment of functional status including: (PC, MK, P)
      • Activities of daily living
      • Mini-mental status examination
      • Capacity for independent decision making

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Practice- Based Learning and Improvement

Goal

Residents must demonstrate the ability to investigate and evaluate their care of patients, to appraise and assimilate scientific evidence, and to continuously improve patient care based on constant self-evaluation and life long learning. Residents are expected to develop skills and habits to be able to :

Competencies

• Identify areas for personal and practice improvement and implement strategies to enhance knowledge, skills, attitudes, and processes of care, as well as making a commitment to life-long learning.
  (MK, P, SBP, PBLI)
• Analyze and evaluate personal practice experience and implement strategies to continually improve the quality of patient care provided using a systematic methodology. (PBLI, SBP, P, MK, PC)
• Identify strengths, deficiencies and limits in one’s knowledge and expertise;
• Identify and perform appropriate learning activities
• Locate, appraise, and assimilate evidence from scientifi c studies related to their patients’ health problems. (PBLI, MK, PC)
• Demonstrate receptiveness to instruction and feedback. (PBLI, ICS, P)

Objectives

The resident should:

• Recognize his/her own limitations
• Ask questions and take self initiative for learning
• Read assigned literature
• Prepare and give a didactic presentation to the residency program on a subject related to the field of gynecology and approved by the faculty preceptor
• Obtain and use information about their population of patients and the larger population from which their patients are drawn. (PBLI, SBP, PC)
• Demonstrate receptiveness to instruction and feedback. (PBLI, ICS, P)
• Apply knowledge of study designs and statistical methods to the appraisal of clinical studies and other information on diagnostic and therapeutic effectiveness. (PBLI, MK, PC)
• Use information technology to manage information, access online medical information, and support their education. (PBLI, P, MK)
• Facilitate the learning of students, other residents, and other health care professionals. (PBLI, ICS, SBP, MK)

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Systems Based Practice

Goal

Residents must demonstrate an awareness of and responsiveness to the larger 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. Residents are expected to:

Competencies

• Coordinate patient care within the health care system relevant to the area of gynecology
• Incorporate considerations of cost awareness and risk-benefit analysis in patient care
• Understand how their patient care and other professional practices affect other health care professionals, the health care organization, and the larger society, and how these elements of the system affect their practices. Understand the processes for obtaining licensure, receiving hospital privileges and credentialing. (SBP, PC, P, ICS)
• Apply current procedural and diagnostic codes to reimbursement requests. (SBP, PC, ICS)
• Advocate for quality patient care and assist patients in dealing with system complexities. (SBP, ICS, P)
• Acknowledge that patient safety is always the fi rst concern of the physician.

Objectives

The resident should show an ability to:

• Identifies women eligible for the BCCSP and understands the process for referral through this system
• Practice cost-effective health care and resource allocation that does not compromise quality of care
• Demonstrate the ability to discuss errors in management with peers and patients to improve patient safety. (SBP, ICS, P, PBLI)
• Develop and maintain a willingness to learn from errors and use errors to improve the system or process of care. (SBP, P, ICS, PBLI, PC, MK)
• Partner with health care managers and health care providers to assess, coordinate, and improve health care and know how these activities can affect system performance. (P, ICS, PC, PBLI)
• Describe the process of quality assessment and improvement including the role of clinical indicators, criteria sets, and utilization review. (SBP, ICS, P, PC)
• Participate in organized peer review activities and use outcomes of such reviews to improve personal and system-wide practice patterns. (SBP, P, ICS, PBLI, PC)
• Demonstrate an ability to cooperate with other medical personnel to correct system problems and improve patient care. (SBP, P, ICS, PC, PBLI)
• Describe the most common reasons for professional liability claims. (SBP, P, ICS)
• Describe a systematic plan for minimizing the risk of professional
  liability claims in clinical practice. (SBP, PC, P, ICS)

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Professionalism

Goal

Residents must demonstrate a commitment to carrying out professional responsibilities and an adherence to ethical principles. Residents are expected to demonstrate:

Competencies

• Demonstrate respect, compassion, integrity, and responsiveness to the needs of patients and society that supersedes self-interest. (P, ICS)
• Demonstrate accountability to patients, society, and the profession.
• Demonstrate uncompromised honesty. (P, ICS)
• Develop and maintain habits of punctuality and effi ciency. (P)
• Maintain a good work ethic (i.e., positive attitude, high level of initiative). (P)
• Demonstrate a commitment to excellence and ongoing professional development. (P, PBLI)
• Demonstrate a commitment to ethical principles pertaining to provision or withholding of clinical care. (P, PC)
• Respect for patient privacy and autonomy
• Sensitivity and responsiveness to a diverse patient population, including but not limited to diversity in gender, age, culture, race, religion, disabilities, and sexual orientation

Objectives

The resident should:

• Accept responsibility for patient care
• Demonstrate dress, hygiene, and manner of speech that consistently reflects professional standard
• Demonstrate an effort to understand and be sensitive to diversities in patient population and health disparities
• Always demonstrates respect for patient autonomy
• Always demonstrates respect for patient privacy
• Maintain confi dentiality of patient information.
• Describe current standards for the protection of health-related patient information. (P, SBP, ICS)
• List potential sources of loss of privacy in the health care system. (P, SBP)
• Demonstrates efforts towards cultural competency
• Describe basic ethical concepts such as: autonomy, benefi cence, justice, and nonmalfeasance. (P, ICS)
• Describe the process of informed healthcare decision making, including the elements that must exist and the specific components of an informed-consent discussion. (P, ICS, PC)

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Interpersonal and Communication Skills

Goal

Residents must demonstrate interpersonal and communication skills that result in the effective exchange of information and teaming with patients, their families, and professional associates. Residents are expected to:

Competencies

• Communicate effectively with patients and families across a broad range of socioeconomic and cultural backgrounds
• Provide effective and professional consultation to other physicians and health care professionals. (ICS, P, SBP, MK, PBLI)
• Elicit and provide information using effective listening, non-verbal, explanatory, questioning, and writing skills. (ICS, P)
• Maintain comprehensive, timely, and legible medical records
• Build effective lecture and teaching skills

Objectives

The resident will:

• Demonstrate the ability to communicate effectively with the patient, the patient’s family and caregivers so the diagnosis is clearly understood
• Demonstrate the ability to establish a plan of care in collaboration with the patient and the patient’s family
• Maintain comprehensive, timely, and legible medical records.
• Report obtained data in a clear and concise but thorough manner
• Provide education to colleagues through the use of a didactic presentation
• Communicate effectively with others as a member or leader of a health care team or other professional group. (ICS, SBP, P)
• Educate patients in the methods of contraception and family planning currently available including efficacy, risks, and benefits of the various methods
• Promote and educate patients in the area of sexual health including diagnosis of sexual dysfunction in women
• Provide counseling to patients in the area of infertility including understanding the indications for and methods of initial evaluation

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Teaching Methods

The resident will be provided a copy of the goals and objectives for the rotation. The resident will be taught via clinical teaching, assigned readings, self-directed learning, role-modeling, and presenting of lectures.

Assessment Method (Residents)

The resident will be assessed through direct observation, review of medical documentation, and written evaluation at the end of the rotation. The resident will receive on-going, one-on-one feedback throughout the rotation, as well as a copy of the completed written evaluation at the end of the rotation. In addition a self assessment tool will be used to assist with evaluation of the Practice-Based Learning competency and a 360o evaluation will be used to assist with evaluation the Patient Care competency. The didactic given by the resident will also be critiqued by the faculty and residents.

Assessment Method (Program Evaluation)

The resident will perform a written evaluation of the rotation and the faculty preceptor at the end of the rotation. The resident will also compile and present a list of all procedures performed or observed in order to identify areas of weakness within the rotation.

Level of Supervision:

The resident will be supervised by the faculty preceptor and all patient care documentation will be reviewed.

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Educational Resources:

Readings

Textbooks

• Williams’ Obstetrics or Gabbe’ Obstetrics, Normal and Problem Pregnancies
• Creasey and Resnik’s Maternal -Fetal Medicine,Principles and Practice
• ACOG Compendium
• Drugs in Pregnancy and Lactation
• PubMed & Cochrane Database
• UpToDate Clinical Reference Library

Videos:

• ECHO Project, bi-weekly teleconferance with University of New Mexico Department of Obstetrics and Gynecology, Maternal- Fetal Medicine

Web Resources:

http://www.ahrq.gov/clinic/uspstfix.htm USPTF guidelines directory

http://www.asccp.org/consensus/cytological.shtml ASCCP consensus guidelines for abnormal cervical screening tests

http://www.asccp.org/consensus/histological.shtml ASCCP consensus guidelines for CIN or CIS

CDC, U.S. Selected Practice Recommendations for Contraceptive Use, 2013

CDC Recommendations for Initiation of Contraception (chart)

AFP, Provision of Contraception: Key Recommendations from the CDC

Other texts and readings as assigned by the faculty preceptor.