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Gynecologic Surgery

COURSE TITLE, DEPT. & COURSE NO; OBG 813, Gynecologic Surgery Advanced Gynecologic Surgery Elective, OBG, Course No. TBD COURSE DESCRIPTION: CREDIT or If Year IV Elective, Number of Weeks (2-4) 2 or 4 week year IV elective. Course Location: CHH, St. Mary’s Hospital, Laparoscopic Skills Laboratory, MU Medical Center

COURSE DIRECTOR AND COURSE CONTACT NAME PHONE NUMBERS, E-MAIL ADDRESSES: Course Director: Contact Name: Stephen Feaster, MD Fran Mooney 304 691-1460 304 691-1456 [email protected] [email protected] COURSE OBJECTIVES/COURSE OUTLINE/PROPOSED SCHEDULE: Course Objectives: 1) To demonstrate knowledge of the surgical anatomy of the female pelvis 2) To understand the rationale for surgical and non-surgical management of common gynecologic problems including a. Abnormal Uterine Bleeding b. Pelvic Floor Dysfunction c. Benign Neoplasm of the Female Reproductive Tract 3) To begin to develop laparoscopic surgical skills

Course Outline: 1) Student will be responsible for the pre and post operative management of patients undergoing surgical procedures for benign gynecologic diseases. 2) Student will learn the evaluation, ambulatory management, and surgical options to treat female pelvic floor dysfunction. 3) Students will be required to demonstrate knowledge of the anatomy of the female pelvis. 4) Students will be required to demonstrate basic laparoscopic skills.

Proposed Schedule*: Monday am/pm-Gynecologic surgery; CHH or St. Mary’s Hospital Tuesday am/pm-Gynecologic surgery; CHH or St. Mary’s Hospital Wednesday 7am-Ob/Gyn Grand Rounds 8 am-Robotic Surgery 2pm-5 pm Laparoscopic skills lab Thursday am Gynecologic surgery; CHH or St. Mary’s Hospital Pm Gynecologic surgery; CHH or St. Mary’s Hospital OR Laparoscopic skills lab Friday am Urogynecology clinic-MU Medical Center, 4th floor OR Gynecologic Surgery-CHH or St. Mary’s Hospital Pm Laparoscopic Skills Lab *As the number and types of procedures is highly variable, the course directory desires to maintain flexibility in making assignments to maximize learning opportunites.

INSTITUTIONAL GOALS AND OBJECTIVES MET OR ADDRESSED

At the end of this course, the student will met the following clinical and basic science objectives:

Patient Care: Student will receive instruction on and manage patients with benign gynecologic problems including 1) Surgical and Non-Surgical treatment options 2) Pre- and Post-operative management of patients undergoing procedures for benign gynecologic diseases 3) Management of unexpected complications of gynecologic surgeries

D:\Docs\2017-12-13\06b0ccc5edb083300a1b950a90064fe4.doc Medical Knowledge: Student will receive instruction on and demonstrate knowledge of: 1) Surgical anatomy of the female pelvis 2) Surgical and Non-surgical treatment options for benign gynecologic problems 3) Expected outcomes and risks associated with common gynecologic procedures 4) Identify and know common use of instruments commonly in the performance of gynecologic procedures Practice Based Learning and Improvement: Students will 1) Pre-read about procedure the night before procedure performed 2) Self-review surgical anatomy of the female pelvis 3) Self-directed practice of laparoscopic skill 4) Student will use online resources for reading assignments (Students are strongly encouraged to become student members in the American College of Obstetricians and Gynecologists. Membership is complimentary and will give student online access to selected publications, many of which are assigned reading for elective. Please see website: http://www.acog.org/departments/membership/medstudentapp.cfm Interpersonal and Communication skills: Student will demonstrate 1) Ability to discuss proposed procedure with patient and family 2) Discuss pre- and post-operative care with faculty and residents Professionalism 1) Student will demonstrate ability to give informed consent Systems Based Practice: Student will receive instruction regarding 1) Pre operative surgical requirements including medical clearance and precertification of procedures 2) Understand the costs of various treatment options for women with benign gynecologic diseases 3) Understand the principles of cost containment for various benign gynecologic procedures 4) Understand how to assist patients and families in procuring medical equipment for home use after gynecologic procedures, if needed TEACHING METHODS AND ASSESSMENT: Course will be taught by the full time and volunteer faculty of the Department of Obstetrics and Gynecology. Instruction will include 1-2 hours formal instruction on laparoscopic skills. There is no designated lecture time. Student is expected to spend 2-4 hours per week in laparoscopic skills lab. The remainder of the elective will be spent in the care of patients, under supervision, at both CHH and St. Mary’s Hospital. Elective is weekdays only. There is no night call, but student is expected to demonstrate practice based learning and improvement skills when not otherwise assigned. Expected hours per week = 60

Subjective evaluation and grading will be provided by the faculty upon completion of elective. Student will be required to take and pass (see grading policy) a written mcq examination with emphasis on surgical anatomy of the female pelvis and surgical and non-surgical management of gynecologic problems including possible complications of the procedure, pre- and post- operative management strategies, and patient safety. MCQ Exam will be based on required reading assignments (see below) Laparoscopic skills will be evaluated by demonstration of mastery of required skills in the laparoscopic simulation laboratory.

Subjective evaluation by the faculty will be completed utilizing elective evaluation form (see attached). Student will receive feedback after each surgical procedure and for 4 week elective from the course director at midpoint.

GRADING POLICY: Letter Grade OR PASS/FAIL: Letter grade will be assigned as follows: 50% of grade subjective evaluation by the faculty Faculty will be asked to assign numerical grade 50% determined by MCQ administered last day of elective Grading Scale <70%=F 70-79=C 80-89=B >90=A

D:\Docs\2017-12-13\06b0ccc5edb083300a1b950a90064fe4.doc Demonstration of basic competence in laparoscopic skills as determined by skill examination on last day of elective. See attached.

Student will be apprised of performance upon the completion of each procedure. Formal mid-point feedback will be given for 4 week electives. Students receiving a grade of <70% on MCQ will be given the opportunity to retake a similar examination. Average of 2 MCQ examinations will be used to determine final grade.

ATTENDANCE POLICY: INCLEMENT WEATHER POLICY: Students will be required to attend daily as scheduled. Absences and Inclement Weather as per SOM rules.

TEXT: Reading Requirements: ACOG Practice Bulletins: 104 Antibiotic Prophylaxis for Gynecologic Procedures 99 Management of Abnormal Cervical Cytology and Histology 96 Alternatives to Hysterectomy in the Management of Uterine Leiomyoma 89 Elective and Risk-reducing Salpingoophorectomy 85 Pelvic Organ Prolapse 84 Prevention of Deep Vein Thrombosis and Pulmonary Embolism 63 Urinary Incontinence in Women 51 Chronic Pelvic Pain 14 Management of Anovulatory Bleeding 11 Medical Management of Endometriosis

ACOG Committee Opinions: 440 The Role of Transvaginal Ultrasonography in the Evaluation of Postmenopausal Bleeding 421 Antibiotic Prophylaxis for Infective Endocarditis 395 Surgery and Patient Choice 371 Sterilization of Women, Including those with Mental Disabilities 327 Do Not Use Abbreviations 310 Endometriosis in Adolescents

Berek and Novaks Gynecology, 14th Ed, Pages 75-127

POLICY STATEMENT ON MAJOR PROJECTS, EXAMINATIONS AND OTHER ASSIGNMENTS (DUE DATES, MAKE-UPS) INCLUDING POLICY STATEMENT ON HOLDING GRADES UNTIL COURSE EVALUATIONS ARE COMPLETED: Date of MCQ and Laparoscopic skills evaluation will be afternoon of last day of elective. Student may request MCQ to be administered at any time during elective. Grades will be help pending evaluation of elective. Make up dates will be determined by course director.

PLAGERISM POLICY/ACADEMIC INTEGRITY POLICY STATEMENT: As per MUSOM rules.

ADDITIONAL INFORMATION OR COMMENTS: Approved by Year IV Subcommittee – April 27, 2005 Approved by Curriculum Committee - May 19, 2005 rainesD:\Docs\2017-12- 13\06b0ccc5edb083300a1b950a90064fe4.doc Approved by Dean McKown – May 24, 2005

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