Section: Module 3: Lesson 8: Gynecologic Procedures | Obstetrics and Gynecologic Clerkship for Medical Students | NextGenU.org
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Student Learning Outcomes:
Upon completion of this module, students you will be able to:- Describe the key components of preoperative evaluation and planning, including history, physical examination and describing key elements of informed consent (including risks, benefits, alternatives and social and environmental factors that may impact informed consent).
- Discuss in-depth the ethical and legal aspects of informed consent, ensuring students can effectively communicate with patients, addressing concerns and answering questions.
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Describe common measures for the prevention of infection, deep venous thrombosis and other perioperative complications, with key consideration for patient safety.
- Describe the components of postoperative care within a framework of interprofessional teamwork, with consideration of patient handover communication.
- Discuss common postoperative complications.
- Describe the communication of operative findings and complications to patients and family.
- Describe the key members of an operating room team within a framework of interprofessional teamwork.
- Describe key components of a preprocedural or preoperative time out.
- Understand how surgical management can emotionally impact a patient and her family, with consideration of social and environmental factors.
- Describe common outpatient and inpatient gynecologic procedures with their indications, contraindications and possible complications
1. Pelvic ultrasonography
2. Colposcopy and cervical biopsy
3. Excisional procedures of the cervix
4. Vulvar biopsy
5. Endometrial biopsy
6. IUD insertion and removal
7. Contraceptive implant placement and removal
8. Dilation and curettage
9. Hysteroscopy
10. Laparoscopy
11. Tubal ligation
12. Hysterectomy and bilateral salpingooophorectomy
13. Pregnancy termination
- Demonstrate the ability to complete procedural tasks and general procedures of a physician
1. Sterile technique
2. Foley catheter insertion
3. Basic suturing
4. Knot tying
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Students mustMark as done
Required Learning Resources and Activities
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Students mustView
Read the entire article. (16 minutes)
MSD Manual - 2020
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Students mustView
Read the entire article. (23 minutes)
ACOG Committee - 2021
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Students mustView
Read the entire article. (16 minutes)
MSD Manual - 2023
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Students mustView
Read the content under the heading "4. Characteristics of team members". (7 minutes)
Intechopen - 2020
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Students mustView
Read the entire article. (2 minutes)
University of Rochester Medical Center Rochester, NY - 2023
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Students mustViewStart discussions: 1
Introduction:
This case serves to explore the management of menorrhagia due to a fibroid uterus in a patient with a complex medical history. The case focuses on perioperative management and the importance of interdisciplinary communication. This teaching case aims to understand the perioperative management of complex patients, the importance of interdisciplinary communication and coordination, as well as the importance of informed consent and patient communication.
Case Profile:
The patient is a 42-year-old G0 woman suffering from menorrhagia as a result of a fibroid uterus. Despite oral iron therapy, she has anemia with a hematocrit of 28%. Her periods last 10-14 days each month. She was diagnosed with lupus and anti-phospholipid antibody syndrome at the age of 27. Her primary symptoms are arthritis, and she had a history of deep venous thrombosis (DVT) 8 years ago. Although her lupus isn't currently flaring, she takes prednisone 5 mg per day and warfarin 2.5 mg per day. She has no other medical issues, and her only surgery was an adenoidectomy at the age of 18, during which she reportedly experienced "more bleeding than usual" but did not require a transfusion. She seeks definitive surgical management with a hysterectomy. She is married, works as a department manager, and has never had children. Her physical exam shows a BP of 120/75, a weight of 165, and a height of 5’6”. She has several small bruises on her extremities. Her uterus is palpable just below her umbilicus but is non-tender. The pelvic exam is significant only for the enlarged uterus. Pelvic ultrasound confirms a large fibroid uterus with normal ovaries. Labs show an INR of 2.5, normal chemistry panel.
Activity Questions:
What would be your approach to obtaining surgical consent from this patient?
Hint: Consider all aspects of informed consent, including procedure details, risks, benefits, and alternatives.
What are the main surgical risks this patient faces?
Hint: Consider both intra-operative and post-operative risks associated with her underlying medical conditions and the proposed surgery.
What steps can you implement to mitigate these risks?
Hint: Consider preoperative preparations, perioperative measures, and post-operative care.
Which other health professionals would you consult before and after surgery?
Hint: Think of the interdisciplinary approach needed for optimal care for this complex patient.
What measures can you implement post-operatively to assess for and diagnose complications?
Hint: Consider physical signs, potential lab work, and monitoring strategies.
If an incidental cystotomy occurs and is repaired during the hysterectomy, how would you communicate this information to the patient and her family?
Hint: Reflect on the importance of transparency, empathy, and clear communication in a difficult situation.
Who are the key members of an operating room team?
Hint: Review the roles of the surgeon, anesthesiologist, and nursing staff.
What are the key components of a surgical timeout?
Hint: Consider the purpose of a surgical timeout and its key components, according to the World Health Organization.
Share: To share your work, click the "Add a new discussion topic" button under this post and paste your work into the "Message" box. Remember to reference others' intellectual property when necessary. All references should follow the 7th Edition APA formatting. For further instructions, see the resource on the Himmelfarb Health Sciences Library: APA citation resource (Note: references are excluded from word counts).
Interact: To complete the activity, you must reply to at least two posts made by your peers in a respectful and professional manner. Make sure your post engages your peers' ideas by including a reflection on their comments, sharing ideas about other potential difficulties and involved parties, or asking thought-provoking questions. If a peer comments on your post, please reply. To post a reply, click "Reply" on a particular discussion, write your feedback, and then click "Post to forum."