Central Michigan University Physician Assistant Program COURSE OBJECTIVES for CLINICAL CLERKSHIP in OBSTETRICS and GYNECOLOGY

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1 Central Michigan University Physician Assistant Program COURSE OBJECTIVES for CLINICAL CLERKSHIP in OBSTETRICS and GYNECOLOGY The mission of the Central Michigan University Physician Assistant (PA) Program is to produce well-educated and highly-skilled Physician Assistants who provide evidence-based medical services within the interdisciplinary primary care environment, with an emphasis on diversity and service to medically underserved populations in rural or urban communities. PROGRAM GOALS 1. Medical Skills & Competence: PA students will know and explain the differences between good health and states of illness, and in collaboration with their supervising physicians be able to screen for and diagnose, formulate care plans, and treat the common health problems of individuals across the lifespan, and their families and communities. 2. Evidence-Based Learning: Students will demonstrate their understanding of the importance of medical research as it relates to clinical practice, in order to utilize evidence based medical literature to formulate patient management plans. 3. Systems-Based Learning and Interprofessional Education: PA students will understand how patient care relates to the healthcare system as a whole. Graduates will be prepared to work effectively in interprofessional healthcare teams to improve patient care outcomes. CLINICAL CLERKSHIP COURSE DESCRIPTION This clerkship is designed to provide the student with an outpatient experience in the care of the female patients, and the impact of disease processes on the reproductive system. The student will develop the skills and knowledge necessary to evaluate, manage, and educate the patient in areas such as annual exams, birth control, infertility, menstruation, sexuality, pregnancy, pre and postnatal care, menopause and relationships. CLINICAL CLERKSHIP COURSE FORMAT The methods of learning will include any or all of the following: observation, participation in direct outpatient and inpatient care, demonstration, individual research, case presentations and interaction with the team of health care professionals on staff in the clinic and hospital(s) where the preceptor does rounds. The student is responsible for the material in the required texts as well as readings assigned by the preceptor. CMU 2008, 2011 (AH), revised Feb (gardo1jj@cmich.edu) Page 1 of 6

2 COURSE GOALS* At the conclusion of this clerkship the student will have the skills and knowledge necessary to; evaluate, document, manage and educate the patients about the common problems of the female patient and understand the impact of related disease processes on the individual and family. This will include areas such as annual exams, birth control, infertility, menstruation, sexuality, pregnancy, pre- and post- natal care, menopause and relationships. The student will be familiar with the indications, contraindication, side effects and dosing guidelines for the medications commonly used in an OB/GYN practice. *Note: The CMU PA Program s core and embedded clinical rotations provide comparable experiences over the course of the program. Each clinical site has different resources, culture, philopsphy, and patient casemix; these factors coupled with the service setting (whether inpatient or outpatient), patient throughput processes and the types of communities served, all impact patient access to care, patient volume, and the types of patients seen on a weekly basis. As a result, the program assesses student exposure to the various domains of medical education for each clinical rotation and over the course of the clinical year through student data management in our clinical tracking database and extensive monitoring by faculty of student outcomes performance including patient casemix, interventions and procedures, case presentations, formative reviews, and formal summative assessment. REQUIRED READINGS (coursework textbooks from first year studies) A Comprehensive Review For the Certification and Recertification Examinations for Physician Assistants, by C.B. O'Connell, S. F. Zarbock. Publisher: Wolters Kluwer. Step-Up to Medicine, by S. Agabegi & E. Agabegi. Publisher: Wolters Kluwer. ADDITIONAL REQUIRED READINGS (Physician Assistant Education Association, 2012) The Women s Health topic list, as referenced in Appendix A and available at outlines the medical conditions students need to understand in order to prepare for their end-of-rotation (EoR) case presentations and examinations; The Women s Health Skills Competency Blueprint List - In order to build competence in addressing various medical conditions, students are to understand and gain the following clinical skills (as referenced in Appendix B and available at PAEA Learning Supplement to the skills competency blueprint, detailing the learning objectives pertaining to: o History Taking and Physical Examination Skills o Diagnostic Studies o Diagnosis o Health Maintenance o Clinical Intervention o Clinical Therapeutics o Scientific Concepts CMU 2008, 2011 (AH), revised Feb (gardo1jj) Page 2 of 6

3 SUPPLEMENTAL RECOMMENDED READING (optional) Kaufman, S.; Stead, L ; Holmes, J.; Schachel, P. First Aid for the Obstetrics and Gynecology Clerkship. 3rd Ed. New York: McGraw-Hill Medical Publishing Co.; (First Aid Clinical Clerkship Series, Dynamed, OBJECTIVES On successful completion of this clerkship in Obstetrics and Gynecology, the PA student should be able to: 1. Perform a complete breast cancer screening exam; which includes: Complete breast exam Interpretation of findings Listing indications for mammography Delineation and correlation of the patient s risk factors Instructing patient on self-breast examination techniques 2. Perform a complete pelvic examination; which includes: Patient instruction Proper draping of the patient Inspection of external genitalia Speculum exam Obtaining and mounting of PAP smears Obtaining specimens of cervical fluids for culture Obtaining and interpretation of vaginal smears for; KOH and Saline preps and culture Bimanual exam 3. Document a problem oriented history, physical examination, assessment and plan in the outpatient or obstetrical records. 4. State the indications, contraindications, major side-effects/adverse reactions and correct dosing schedules for medications commonly used in a OB-GYN practice, to include Estrogen replacement therapy Contraception Use of medications during pregnancy and lactation Rho-GAM CMU 2008, 2011 (AH), revised Feb (gardo1jj@cmich.edu) Page 3 of 6

4 5. Relative to the care provided by the physician assistant, evaluate and treat patients with the common medical disorders listed below. Cervical disease and neoplasia Ectopic pregnancy Endometriosis Pelvic Inflammatory Disease Premenstrual syndrome Sexually transmitted Diseases Vaginitis and cervicitis 6. For patients presenting with the conditions listed below: A. Perform a problem-oriented history and physical examination and communicate the results in written and oral form B. List related differential diagnoses C. Determine a tentative diagnosis D. Direct a primary care diagnostic evaluation, and E. Order a primary care-level clinical treatment plan, which includes: Pharmacologic and non-pharmacologic interventions Patient education Further diagnostic studies Appropriate referrals or consultation; and Follow up Abnormal PAP smears Adenexal mass/tenderness Amenorrhea Breast mass/discharge Contraception Domestic violence or abuse Dysfunctional uterine bleeding Dysmenorrhea Enlarged uterus HIV exposure Infertility Menopause/Climacteric Pelvic Pain Post-menopausal bleeding Rape or sexual assault Vaginal discharge/itching Vulvar masses /neoplasms CMU 2008, 2011 (AH), revised Feb (gardo1jj@cmich.edu) Page 4 of 6

5 7. Conduct a primary care-level evaluation of patients presenting with signs and symptoms of pregnancy, to include: A. Diagnosis of pregnancy Calculation of Estimated Dates of Confinement (EDC) using Nagle s rule Estimation of gestational age based on historical and clinical findings Ordering of laboratory tests indicated during pregnancy B. Prenatal/antenatal care and counseling Describe maternal physiologic changes associated with pregnancy Perform initial and routine prenatal examinations on an obstetrical patient Answer questions regarding nutrition, intercourse and exercise Recognize normal patterns and progress of fetal gestation, and techniques to assess fetal growth and well being Discuss breast feeding or lactation suppression Determine current medications and discuss consequent risk to the fetus 8. Recognition and complications of pregnancy to include: Abortion Antenatal testing Exposure to teratogenic substances Fetal death Gestational diabetes Hyperemesis gravidarum Molar pregnancy Pregnancy induced hypertension Premature rupture of membranes Preterm labor Rh Isoimmunization Rubella exposure Third trimester bleeding 9. Relative to the care provided by the Physician Assistant, provide treatment for the pregnant patient with the following: Acute gastroenteritis Bronchitis/Pneumonia Gastritis Hemorrhoidal disease Mild asthma Peptic ulcer disease Upper respiratory infections Urinary tract infection Vaginitis and vaginal discharge CMU 2008, 2011 (AH), revised Feb (gardo1jj@cmich.edu) Page 5 of 6

6 10. Evaluate the patient in labor and perform, with assistance, an uncomplicated vaginal delivery with demonstrated awareness of: A. The stage, duration and progression of labor B. The presence of abnormal fetal heart rates during labor C. The presence of meconium staining in amniotic fluid D. The presence of prolapsed or nuchal umbilical cord E. The steps used in the evaluation and treatment of post-partum sepsis and hemorrhage Appendices A Physician Assistant Education Assocation (PAEA) Clerkship Topic List, retrieved February 28, 2014 from B PAEA Skills Competency List Blueprint, retrieved February 28, 2014 from CMU 2008, 2011 (AH), revised Feb (gardo1jj@cmich.edu) Page 6 of 6