A competency based development of knowledge and skills in Women’s Health through clinical experience, bedside teaching, didactic conferences and readings to achieve competence, proficiency and the foundation for mastery. Clinical Information and Didactics: Residents will rotate through a variety of women’s health related clinics. Contact information: Nancy Dolan, MD Associate Professor of Medicine 675 N. St. Clair Street Suite 18-800 Chicago, IL 60611 312-695-4689 Pager 312-695-1617 Click here Practice Based Learning and Improvement PGY1: Incorporate regular chart review and patient follow up to learn from your clinical care. Teach and mentor students. PGY2/3: Incorporate evidence based medicine into clinical decision making. Review the latest research pertaining to your your patients. Teach and mentor students and interns. Systems Based Practice PGY1: Work in a multi-disciplinary team to provide high quality coordinated care. Ensure accurate and timely documenation through the use of the electronic medical record. PGY2/3: Use knowledge and skills in quality improvement and patient safety to deliver safe and effective care. Apply team leadership skills in appropriate settings. Practice cost effective medicine with an awareness of health care economics and patient insurance status. Interpersonal Skills and Communication PGY1: Use effective listening skills with patients and health care providers. Elicit and provide information using effective nonverbal, explanatory, questioning, and writing skills. PGY2/3: Develop interpersonal and communication skills necessary to run an effective clincal team in the ambulatory. Role model and teach effective communication techniques. Professionalism PGY1: Carry out your professional responsibilities in a timely manner. Adhere to the ethical principles of a patient-centered practice. Be sensitive to a diverse patient population and health care staff. PGY2/3: Understand how biases influence clinical care, patient-physician interactions and health team interactions. Role model and provide feedback to students and interns the principles of humanism in medicine. Patient Care and Medical Knowledge PGY1 - Perform competent breast and pelvic examinations, and feel comfortable doing this. Practice making patients more comfortable during a pelvic exam.
- Identify methods of diagnosis and management of common gynecological symptoms and conditions.
- Identify preventative health guidelines for women of different age groups.
- State common peri- and postmenopausal symptoms and treatments.
- Identify signs of abuse and feel comfortable discussing options with patients.
- Appreciate the importance of gender differences on health and disease.
- Discuss diagnosis and treatment of incontinence.
- List the risks and benefits of various contraceptive methods and apply this to counseling patients about their use. Prescribe oral contraceptives and manipulate them appropriately.
PGY2,3 A. Breast Disease - Identify benign breast diseases and review their relation to malignancy
- Develop thorough clinical breast exam skills. Understand limitations of the clinical exam
- Work-up a palpable mass
- Determine whom to screen. Review the positive and negative effects of screening.
- Identify screening options including ultrasound, mammogram, ductal lavage, and MRI
- Review breast cancer staging. Identify the effect of hormonal receptors.
- Review current surgical and therapeutic options for breast cancer
- Risk-stratify patients for breast cancer and review the evidence for preventive modalities (chemoprevention, prophylactic mastectomy) in high risk patients
- Learn about hereditary cancers and whom to refer to for genetic counseling
- Provide long-term therapeutic options for secondary prevention
B. Cardiology - Identify gender differences in cardiovascular disease (hypertension, ischemic heart disease)
- Counsel patients on preventive measures
- Identify gender specific therapies
- Recognize gender differences in cardiac testing
- Review cardiac conditions more common in women ( ie. MVP, PPHTN)
- Identify risks and benefits of contraception in women with cardiovascular disease
- Learn the effects of pregnancy on pre-existing cardiovascular disease
C. Endocrinology I. Osteoporosis - Review the epidemiology of osteoporosis
- Recognize risk factors
- Counsel patients on lifestyle modification
- Identify pharmacologic and non-pharma (hip protectors, strength training) prevention
- Determine whom to screen based on current guidelines
- Tailor therapy to individual patients
- Learn up-and-coming therapies (annual bisphosphanate therapy, PTH)
II. PCOS - Recognize patients with PCOS based on the clinical criteria
- Identify related medical conditions (metabolic syndrome, hyperinsulinemia, hyperandrogenemia)
- Review current therapeutic options
- Describe the relationship between PCOS and infertility
III. Hirsuitism - Review the differential diagnosis
- Work-up and treat hirsuitism
IV.Thyroid Disease - Review the epidemiology of thyroid diseases (gender differences)
- Describe the effects of pregnancy on thyroid disorders
D. Gynecology I.Vaginitis - Differentiate between forms of vaginitis (history, wet mount, diagnostic studies)
- Treat patients with candidiasis, bacterial vaginosis and trichomoniasis
- Review the association between bacterial vaginosis and obstetric complications
II.STDs - Identify and screen high risk patients
- Differentiate between STDs and their long-term risks
- Treat chlamydia, gonorrhea and herpes
III.Contraception - Describe the available forms of contraception, including their benefits and risks
- Compare the available formulations of oral contraceptive pills (OCPs)
- Identify the relationship between OCPs and cardiac disease, breast cancer, neurologic events and vascular events.
- Review the current data on IUDs and their effect on fertility
- Determine which patients are candidates for emergency contraception
IV.Dysfunctional Uterine Bleeding - Work-up amenorrhea, oligomenorrhea, metrorrhagia
- Provide therapeutic options for non-complicated patients and determine when to refer
V.Sexual Dysfunction - Develop thorough sexual history taking skills
- Identify causes of sexual dysfunction in women
- Learn available therapeutic options
VI.Infertility - Review the differential diagnosis for infertility
- Initiate the work-up and determine when to refer to a specialist
VII.Menopause - Provide counseling and therapy for symptomatic patients
VIII.Hormone Replacement Therapy - Review the current literature on the effects on osteoporosis, breast cancer, cognitive function and cardiac disease
- Counsel patients on risks and benefits of therapy
- Differentiate between traditional hormone replacement therapy and selective estrogen receptor modulators (SERMs). Review indications for each.
E. Gynecologic Oncology I.Cervical Cancer Screening - Compare specificity and sensitivity of the pap smear with the ThinPrep technique
- Review the Bethesda Classification System
- Analyze the role of HPV in the work-up of ASCUS
II.Ovarian Cancer - Review the epidemiology of ovarian cancer
- Identify high-risk patients and provide these patients with options for prevention
- Refer high-risk patients for genetic counseling
- Identify current and future screening techniques
- Review the role of CA-125 testing
F. Health Maintenance - Review age-appropriate screening guidelines
- Counsel patients on lifestyle modification
- Provide therapeutic options when lifestyle modification fails (i.e. smoking cessation, wt loss)
G. Infectious Diseases - Review implications of HIV that are specific to women (i.e. pregnancy, maternal-fetal transmission, cervical cancer)
H. Obstetrics - Review the physiologic changes that occur during pregnancy
- Learn pregnancy’s effect on asthma and management techniques
- Recognize the risks of pre-existing and gestational hypertension in pregnancy and review therapeutic options
- Differentiate between pre-existing and gestational diabetes and develop skills to manage patients during pregnancy
- Identify measures to prevent perinatal transmission of HIV
- Review pregnancy’s effect on coagulation and learn to manage DVTs and PEs
I. Psychiatry - Review the prevalence of psychiatric diseases in women vs. men
- Identify gender-specific psychiatric conditions (PMDD, PMS, postpartum depression) and how to treat them
- Diagnose patients with eating disorders. Learn the medical complications, indications for hospitalization and options for treatment
- Screen patients for domestic violence, develop safety plans and direct patients to available resources
J. Urology - Differentiate between the various forms of urinary incontinence
- Review behavioral, medical and surgical options for urinary incontinence therapy
- Learn to treat chronic UTIs
- Petitti, D. B. Combination Estrogen-Progestin Oral Contraceptives. N Engl J Med . 2003; 349: 1443-1450. (excellent review article)
- Johnson BD, Shaw LJ, Buchthal SD, Merz CNB, Kim HW, Scott KN, et al. Prognosis in Women With Myocardial Ischemia in the Absence of Obstructive Coronary Disease Results From the National Institutes of Health–National Heart, Lung, and Blood Institute–Sponsored Women's Ischemia Syndrome Evaluation (WISE). Circulation. 2004;109:2993-2999. (interesting prospective trial)
- Mosca L, Banka CL, Benjamin EJ, Berra K, et al. Evidence-based guidelines for cardiovascular disease prevention in women: 2007 update. Circulation. 2007 Mar 20;115(11):1481-501. (expert committee recommendations)
- Cummings SR, Black DM, Thompson DE, ; Applegate WB; Barrett-Connor E; Musliner TA,et al . Effect of Alendronate on Risk of Fracture in Women With Low Bone Density but Without Vertebral Fractures: Results From the Fracture Intervention Trial. JAMA.1998; 280: 2077-2082. (randomized, placebo-controlled study)
- U.S. Preventive Services Task Force: Screening for Cervical Cancer: Guide to Clinical Preventive Services. AHRQ Publication No. 03-515A, Agency for Healthcare Research and Quality, Rockville, Maryland, 2003. http://www.ahrq.gov/clinic/uspstf/uspscerv.htm
- Black D. M., Greenspan S. L., Ensrud K. E., Palermo L., McGowan J. A., Lang T. F., Garnero P., Bouxsein M. L., Bilezikian J. P., Rosen C. J., the PaTH Study Investigators. The Effects of Parathyroid Hormone and Alendronate Alone or in Combination in Postmenopausal Osteoporosis. N Engl J Med. 2003; 349:1207-1215. (randomized controlled trial of PTH +/- Alendronate vs placebo)
- Rossouw JE; Anderson GL; Prentice RL; LaCroix AZ; Kooperberg C; Stefanick ML;,et al. Risks and benefits of estrogen plus progestin in healthy postmenopausal women: principal results from the Women's Health Initiative randomized controlled trial. JAMA 2002;288(3):321-33.
- Elmore JG, Armstrong K, Lehman CD, Fletcher SW. Screening for Breast Cancer. JAMA. 2005 Mar 9;293(10):1245-56.
- Ridker PM, M.D., Cook NR, Lee IM,., Gordon D, Gaziano M, Manson JE, et al. A Randomized Trial of Low-Dose Aspirin in the Primary Prevention of Cardiovascular Disease in Women. New Engl J Med. 2005; 352:1293-1304.
- Elmore JG. Barton MB. Moceri VM. Polk S. Arena PJ. Fletcher SW. Ten-year risk of false positive screening mammograms and clinical breast examinations. N Engl J Med. 338(16):1089-96, 1998 Apr 16.
Collection by Dr. Elizabeth Dowling For an extended list of references with direct article links, sign in to the Galter Health Library website at: http://www.galter.northwestern.edu/guides/expand/resident-reading-lists |
