Unit I - Approach to the Patient

A: Attitudes and Psychological Skills

The student will be able to:

1. Be aware of his or her own attitude towards women and their unique health problems and issues.

2. Respect patient's anxieties related to embarrassment, fear or disease, and confidentiality and despite these factors be able to gain the patient's confidence and cooperation.

3. Recognize the importance of transmission of information and patient education as an integral part of every gynecological and obstetrical history and physical examination.

4. Describe the psycho-social effects of physiological events such as puberty or pregnancy upon the patient and the family and be able to provide emotional and social support and education to patients in these circumstances.

5. Provide initial counseling and support in situations involving potential or acute emotional reactions related to:

- grieving after pregnancy loss
- gynecological surgery
- sexual dysfunction
- gynecological cancer and death
- infertility investigations, and specific therapies for infertility
- family dysfunction, including domestic violence

6. Describe the potential effects of illness and treatment modalities on a woman's sexuality and future reproductive potential.

B: History

The student will be able to:

1.Obtain the following basic elements of a reproductive history;

- chief complaint
- menstrual history (last normal menstrual period, interval, duration, amount,
intermenstrual bleeding, dysmenorrhea, menarche and menopause dates)
- present illness
- vaginal bleeding
- pain or mass in the abdomen, vagina, or breast
- discharge in the vagina or breast
- urinary symptoms
- gastro-intestinal symptoms
- genito-urinary prolapse symptoms
- vulvar pruritus
- infertility
- past history
- obstetrical
- gynecological
- contraceptive
- sexual
- medical
- surgical
- social
- medications
- allergies
- family history including genetically determined diseases and history of breast, ovarian or gastro-intestinal malignancies.
- social, occupational and marital history.

C. Physical Examination

The student will be able to:

I. With respect to the non-pregnant patient

1. Examine the breast and teach methods of breast self-examination.

2. Examine the abdomen, demonstrating the following elements;

- inspection
- palpation
- eliciting point of maximal tenderness
- eliciting signs of peritoneal irritation
- assessment of masses
- assessment of organ size
- percussion
- auscultation

3. Examine the pelvis and recognize abnormalities in the following structures;

- vulva
- vagina
- cervix
- uterus
- adnexa
- rectal-vaginal septum

II. With respect to the pregnant patient

1. Examine the abdomen identifying the following;

- symphysis-fundal height measurement
- assessment of fetal lie, presentation, position and attitude using Leopold's maneuvers

2. Ballotment of the presenting part

3. Auscultation of the fetal heart

4. In early pregnancy assess gestational age on bimanual pelvic examination

5. Examine the pelvis identifying the following;

- adequacy of the bony pelvis
- cervical dilatation and effacement
- fetal position and presentation
- fetal station
- status of the membranes

D. Diagnosis and Management Plan

After completing the written history and physical examination, the student will be able to:

1. Generate a problem list, differential diagnosis and plan of management. The plan of management should include the appropriate investigations, treatment, patient education and plans for continuing care of the patient. 

E. Well Woman Care Health Promotion and Disease Prevention

The student will be able to:

1. Explain the importance of periodic "well-woman" examinations.

2. Recommend the frequency of periodic health examinations.

3. Recommend proven screening procedures for health promotion and disease prevention.

4. Outline the educational needs of the woman attending for a periodic health examination.