Undergraduate : 481 GYN
Summary of Course Contents
Students spend 12 weeks in the department. This constitutes their entire obstetrics training. Due to the cycle system, every batch may do obstetrics straight after finishing Level 12 or after rotating through other cycles e.g. medicine, surgery, etc. Student, however, have been given courses in medicine and surgery during or before Level 12 and, therefore, they should have the background in clinical practice. During these 12 weeks, it is impossible to cover all topics in details. Emphasis is put on graduating general physicians who have enough basic knowledge in obstetrics.
The following is a concise outlook of the curriculum.
1. Course Objectives
1.1 General Objectives To graduate a physician who:
1.1.1 Is aware of the personal qualities and attitudes required by a physician caring for women.
1.1.2 Has acquired adequate basic knowledge and skills in obstetrics which enable him/her to proceed into subsequent general practice, speciality training or research activities.
1.2 Specific Objectives At the end of the course the student is expected to:
1.1 Perform, record and interpret a full obstetrics and gynaecology history.
1.2 Carry out, record and interpret a complete physical examination in all obstetrics and gynaecology groups.
1.3 Identify and solve common clinical problems in obstetrics and gynaecology by providing a provisional diagnosis and appropriate differential diagnosis.
1.4 Recognize urgent and emergency situations in obstetrics and gynaecology and be able to outline an appropriate plan of action.
1.5 Outline a general plan of investigations and management of common obstetrics and gynaecology problems as they relate to Saudi Arabia.
1.6 Demonstrate an understanding of how to use the laboratory to reach a diagnosis of common obstetrics and gynaecology problems.
1.7 Demonstrate knowledge of community problems related to woman's health.
1.8 Demonstrate knowledge of preventive aspects of woman's health problems and how to implement them.
1.9 Recognize her limitations concerning management of obstetrics and gynaecology patients and the need to consult and cooperate with others to provide optimum care.
1.10 Interact with women or relatives in a gentle, emphatic and appropriate manner.
2. Instructional strategies
2.1 Didactic teaching: Lectures, tutorials and seminars Series of lectures, tutorials and seminars covering selected topics in obstetrics and gynaecology will be delivered to all students together at the beginning of the course.
2.1.1 Obstetrics
1. Anatomy of female pelvis and foetal skull.
2. Anatomy of female genital organs and pelvic floor.
3. Fertilization, Implantation, Embryology of female genital tract, foetal circulation.
4. Physiology - Normal menstrual cycle ovulation.
5. Physiology - Changes in pregnancy, haematological, bio-chemical Physiology - Changes in pregnancy, genito - urinary, endocrine.
6. First stage of labour - Active.
7. Second stage of labour - Management.
8. Third stage of labour - Pain relief in Obstetrics.
9. Puerperium and lactation; breast changes, complications.
10. Placenta and its functions; placental abnormalities; umbilical cord; amniotic fluid.
11. Placental hormones and functions, placental insufficiency and placental function tests; I.U.F.G.R.
12. Antenatal care; lie; presentation position.
13. Pregnancy diagnosis and differential diagnosis.
14. Foetal and maternal monitoring in pregnancy and labour.
15. High-risk pregnancy - Identification and follow-up. Grand multipara.
16. Bleeding in early pregnancy.
17. Bleeding in late pregnancy.
18. Postpartum collapse and uterine rupture.
19. Coagulopathy in OB/GYN.
20. Anemias in pregnancy.
21. Haemolytic disease of the newborn blood groups and Rh-factors.
22. Heart and Respiratory disease in pregnancy.
23. Diabetes in pregnancy.
24. Drugs in pregnancy and teratogenic effects.
25. Hypertensive disorders in pregnancy.
26. Endotoxic shock and renal failure.
27. ABU and UTI in pregnancy.
28. Congenital anomaly and A/N diagnosis.
29. Fertility control-hormonal and barrier methods.
30. Haemoglobinopathies.
31. Abnormal menstrual cycle - DUB.
32. Amenorrhoea; primary, secondary.
33. Male and female infertility; causes, investigation, management.
34. Vaginal flora, discharge; bacterial STD's.
35. Viral STD's.
2.1.2 Gynaecology
1. Physiology - changes in puberty.
2. Menopause and its problems.
3. Malignant tumors of vulva, vagina and uterus.
4. Abnormalities of the pelvic support.
5. Urinary and fecal incontinence.
6. Uterine fibroids; Adenomyosis.
7. Benign ovarian tumors.
8. Malignant ovarian tumors.
9. Trophoblastic disease.
10. CIN; cytology and colposcopy.
11. Malignant tumors of cervix.
12. Cytogenetics and gender diagnosis.
13. PID, acute and chronic.
2.1.3 Tutorials
1. Malpositions, abnormal presentation
2. Cephalo-pelvic disproportion, pelvimetry, trial of labour, abnormal labour.
3. Foetal distress, abnormal CTG, IUFGR.
4. Preterm labour, PROM, cervical incompetence.
5. Acute abdomen in OB/GYN.
6. Perinatal and maternal mortality.
2.2 Clinical teaching
2.2.1 Formal teaching During the first week of clinical teaching, sessions are spent in demonstration of obstetric history taking and physical examination of different systems. During the subsequent weeks, bedside teaching, clinic attendance and theater sessions are conducted by teaching staff each week. One of these is utilized as a supervised ward round on all t he patients followed by the students.
2.2.2 Ward, Labour Ward, Accident & Emergency and Ultrasound rotations During rotations, students are divided into groups of 12-15 students each. They rotate through the gynae, postnatal and antenatal wards, Labour ward, Accident and Emergency and Ultrasound.
2.2.3 Attending the continuous medical education in the department.
3. Evaluation of students During each rotation, medical students will be evaluated by:
3.1 Continuous assessment exam - which holds 40% of the total marks and consists of: ·
Written exam (MCQs) ·
Clinical exam ·
Spot exam
3.2. Final examination - which holds 60% of the total marks and consists of ·
Written exam (MCQs) ·
Clinical exam ·
Spot exam Recommended Books
1. Obstetrics - Illustrated Garrey/Govan - Hodge - Callender Churchill Livingstone Third Edition
2. Fundamentals of Obstetrics and Gynaecology Volume 2, Gynaecology Derek Llewellyn - Jones Elbs Fourth Edition
3. Gynaecology - Illustrated A.D.T. Govan - Hodge - Callender Churchill Livingstone Third Edition
4. Obstetrics by Ten Teachers Stanley G. Clayton T.L.T. Lewis and G.D. Pinker Arnold 14th Edition I.
I. Course 481
Obstetrics & Gynaecology during 1 Academic year, 3 (12/52) courses will be held one for female students and 2 for male students. In addition, a Summer Course of 8 weeks will be run for those who have failed during the previous year.
II. Course Organization
The integrated course will contain 50 Lectures, 6 Tutorials, Case Presentation, Grand Rounds and On-Calls (covering A&E and Labour Ward).
III. Daily Activities
These include Ward rounds with bedside teachings, clinics attendance and theater sessions.
IV. Three sessions of training in instruments, obstetrics and gynaecological X-rays + USS and Museum specimens will be held. V. Tutorials Same as above. In addition to the above activities students are required to keep log books containing his-her attendance and activities. It will also contains 3 written case histories and one long commentary.
V. Examination
1. Theoretical Includes 2 examinations. Continuous written exam carrying 40 marks and Final written exam carrying 60 marks.
2. Clinical It also includes 2 exams. One Continuous clinical and one Final clinical. It includes long case, short case and spot exam. The Marking System is as follows:
Continuous Clinical Exam Marks
Course 451
Short Case 15
Spot Exam 10
Tutorials 15
Course 452
Long case 40
Final Clinical Exam
Course 451
Short Case 20
Spot exam 40
Course 452
Long case 60
Exam sample:
SHORT ANSWER QUESTIONS:
I. Why doesn’t ABO incompatibility cause problems in fetus?
- fetal RBC’s have fewer ABO type antigens à not as antigenic
- most of the antibodies are IgM and do not cross the placenta
- rarely becomes progressively severe in future pregnancies
II. List Three contraindicated vaccines in pregnancy?
- measles
- mumps
- rubella
III. List Four risk factors for placenta accrete?
- cesarean delivery
- puerperal curettage
- hysterotomy
- tubal re-implantation
- manual removal of placenta
- previous uterine curettage
- endometritis
IV. What is the definition of the obstetrical conjugate?
Diameter of pelvis from mid symphysis to sacral promontory= 10 cm or more.
MCQs:
I. A 42-year-old woman who has been a longstanding patient of yours comes to your office for her routine annual examination. She has recently been divorced, and she acquired a new sexual partner within the past 6 months. She has no history of abnormal Pap test results. Her examination is unremarkable, but her Pap tests result indicates atypical squamous cells of undetermined significance (ASCUS). The most appropriate management is?
a. Repeat Pap test in 6 months
b. Colposcopy
c. Viral testing for human papillomavirus (HPV) subtype
d. Repeat Pap test using the Thin prep system
e. Screening of new partner for HPV
II. A 16 year-old girl is evaluated for primary amenorrhea. Physical examination reveals Tanner stage III breast and pubic hair development with an absent vagina. The most likely diagnosis in this patient is?
a. Isolated gonadotropin deficiency
b. Androgen insensitivity syndrome
c. 5-reductase deficiency
d. XX pure gonadal dysgenesis
e. Müllerian agenesis