0 calificaciones0% encontró este documento útil (0 votos)
42 vistas5 páginas
This document provides guidance for medical students on completing a simulation workshop station focused on gynecological exams. It outlines the objectives of performing breast exams, pelvic exams, and counseling patients. It includes required readings and guidelines on health maintenance. Detailed instructions are provided on positioning patients, inspecting and palpating breasts and pelvic structures, using a speculum, and maintaining patient privacy and comfort throughout physical exams. The goal is for students to practice and demonstrate competency in core gynecological exam skills.
This document provides guidance for medical students on completing a simulation workshop station focused on gynecological exams. It outlines the objectives of performing breast exams, pelvic exams, and counseling patients. It includes required readings and guidelines on health maintenance. Detailed instructions are provided on positioning patients, inspecting and palpating breasts and pelvic structures, using a speculum, and maintaining patient privacy and comfort throughout physical exams. The goal is for students to practice and demonstrate competency in core gynecological exam skills.
This document provides guidance for medical students on completing a simulation workshop station focused on gynecological exams. It outlines the objectives of performing breast exams, pelvic exams, and counseling patients. It includes required readings and guidelines on health maintenance. Detailed instructions are provided on positioning patients, inspecting and palpating breasts and pelvic structures, using a speculum, and maintaining patient privacy and comfort throughout physical exams. The goal is for students to practice and demonstrate competency in core gynecological exam skills.
OBGYN
Clerkship
OBGYN
Simulation
Workshop
Training
Guide
GYN
Simulation
Station
GYN
Simulation
Station
Objectives:
After
completing
the
GYN
Simulation
station,
students
should
be
able
to:
Perform
a
breast
exam
Perform
a
pelvic
exam
Counsel
a
patient
on
health
maintenance
issues
Workshop
Preparation
Required
Readings
Beckman
CRB,
Ling
FW,
et
al.
Chapter
1:
The
womens
health
examination.
Obstetrics
&
Gynecology,
6th
edition.
2010
Lippincott
Williams
&
Wilkins.
pp
1-14.
Beckman
CRB,
Ling
FW,
et
al.
Chapter
2:
The
obstetrician-gynecologists
role
in
screening
and
preventive
care.
Obstetrics
&
Gynecology,
sixth
edition.
2010
Lippincott
Williams
&
Wilkins.
pp
15-22.
Beckman
CRB,
Ling
FW,
et
al.
Chapter
3:
Ethics
in
obstetrics
and
gynecology.
Obstetrics
&
Gynecology,
6th
edition.
2010
Lippincott
Williams
&
Wilkins.
pp
23-28.
Review
Health
Maintenance
guidelines
Students
should
understand
basic
screening
guidelines
for
cervical
cancer,
breast
cancer,
colon
cancer,
osteoporosis,
and
sexually
transmitted
diseases.
They
should
also
be
familiar
with
CDC
vaccination
guidelines.
United
States
Preventive
Services
Task
Force
(USPSTF)
American
Congress
of
Obstetricians
and
Gynecologists
(ACOG)
American
Society
for
Colposcopy
and
Cervical
Pathology
(ASCCP)
Center
for
Disease
Control
(CDC)
National
Cancer
Institute
(NCI)
National
Osteoporosis
Foundation
(NOF)
Weill
Cornell
Medical
College
in
Qatar
Kristina
Sole,
MD,
FACOG
Hands-On
Practice!
Wash
hands
prior
to
and
after
the
patient
encounter!
Breast
Exam
Draping
and
positioning
(The
SPs
will
wear
the
breast
models)
Wear
gloves
to
protect
the
breast
model
material
Patient
wears
the
gown
opened
to
the
front.
Keep
patients
breasts
covered
when
not
being
examined.
Sit
patient
on
the
exam
table
for
breast
inspection
and
lymph
node
palpation,
and
place
in
supine
position
for
the
breast/nipple
exam.
Drape
gown
over
lap
while
sitting
and
over
body
while
supine
Inspection
Instruct
patient
to
sit
with
arms
raised
over
head
and
fingers
clasped
behind
head.
Inspect
the
breasts,
looking
for
skin/nipple
changes
Instruct
patient
to
sit
with
hands
on
hips
and
shoulders
rolled
forward.
Inspect
the
breasts,
looking
for
skin/nipple
changes
Student
should
demonstrate
maneuvers
to
the
patient
so
that
she
can
copy
them.
Lymph
nodes
Stand
in
front
of
patient
Palpate
bilateral
supraclavicular
nodes
while
patient
is
sitting
Palpate
bilateral
axillary
nodes
while
patient
is
sitting.
Student
should
support
the
ipsilateral
arm
during
palpation
by
either
holding
the
upper
arm
or
resting
the
arm
on
the
students
shoulder.
Nodes
should
be
palpated
in
the
axillary
space
superiorly,
anteriorly,
and
medially
Do
not
palpate
through
the
gown
Breast/nipple
exam
Pull
out
table
foot
extension,
and
place
patient
in
the
supine
position
on
exam
table
with
ipsilateral
arm
raised
over
head
Ensure
that
sheet
covers
legs/torso
Appropriate
draping:
uncover
only
one
breast
at
a
time
Palpate
breast
(all
four
quadrants
or
radial
exam),
using
superficial
and
deep
palpation.
Breast
tissue
extends
to
axilla.
Palpate
nipple
and
express
nipple
to
check
for
discharge
Repeat
breast/nipple
exam
on
other
side,
remember
to
place
ipsilateral
arm
over
head
Cover
breasts
with
gown
when
finished
Weill
Cornell
Medical
College
in
Qatar
Kristina
Sole,
MD,
FACOG
Pelvic
Exam
Position
and
drape
the
patient
Wash
hands/wear
gloves
(The
SPs
will
lie
in
dorsal
lithotomy
position
with
the
pelvic
model
positioned
on
the
exam
tables
foot
extension
and
between
the
SPs
legs)
Patient/model
should
be
kept
draped
as
much
as
possible
during
the
exam
Patient/model
should
be
covered
up
immediately
after
the
exam
Adjust
table
height
Adjust
and
turn
on
light
source,
and
focus
light
on
vulva
Ensure
that
all
equipment
is
readily
available
Ask
patient
if
she
is
comfortable
Examination
of
external
genitalia
Sit
on
stool
in
front
of
patient.
Inspect
and
palpate
labia
minora,
labia
majora
Inspect
clitoris,
urethral
meatus,
Skenes
glands
Palpate
for
Bartholins
gland
cysts
Inspect
and
palpate
posterior
fourchette/introitus
Inspect
perineum
Inspect
anus
and
perianal
area
Speculum
exam
Warm
up
speculum
using
warm
water
Apply
small
amount
of
lubricant
to
speculum
Inform
patient
that
you
will
start
exam
Lay
gloved
hand/speculum
on
inner
thigh
to
prepare
patient
Insert
speculum
at
45%
angle
and
rotate
after
insertion
Push
speculum
into
vagina
gently
and
at
a
downward
angle,
aiming
toward
the
sacrum
Once
fully
inserted,
open
speculum
and
identify
the
cervix.
Lock
speculum
in
place
and
keep
one
hand
on
the
speculum
at
all
times
so
that
it
doesnt
fall
out
of
the
patient.
Inspect
cervix,
fornices,
and
vaginal
walls
Identify
the
presence
and
appearance
of
mucus
discharge
Pap
smear
Inform
patient
that
pap
smear
will
be
collected
Wipe
off
cervix
with
cotton-tipped
swab
Use
plastic
spatula
to
make
a
circumferential
sweep
around
ectocervix,.
Remove
and
place
spatula
in
container
for
liquid-based
cytology
Insert
cytobrush
into
endocervical
canal
and
rotation
1-2
times.
Remove
and
place
cytobrush
in
container
for
liquid-based
cytology
May
use
specialized
pap
combi-brush
instead
of
spatula/cytobrush.
Unlock
speculum
and
allow
it
to
close
while
gently
removing
it
from
the
vagina.
Inspect
vaginal
sidewalls
during
speculum
removal.
(Spatula/cytobrush
can
be
smeared
on
a
slide
and
fixed
with
hairspray/cytofixative,
if
liquid-based
cytology
is
not
available)
Weill
Cornell
Medical
College
in
Qatar
Kristina
Sole,
MD,
FACOG
Bimanual
exam
Stand
up
Inform
patient
that
bimanual
exam
(internal
exam)
will
be
performed
Insert
two
fingers
(index
and
middle
fingers)
of
the
dominant
hand
into
the
vagina
to
the
cervix
Gently
grasp
cervix
between
fingers
and
move
the
cervix
horizontally
to
elicit
cervical
motion
tenderness
Place
fingers
in
the
posterior
fornix
and
lift
cervix/uterus,
while
using
the
non-dominant
hand
to
palpate
the
uterus
abdominally.
Palpate
from
umbilicus
to
pubic
symphysis
Place
fingers
in
bilateral
fornices
and
push
antero-superiorly,
while
using
the
non-dominant
hand
to
palpate
the
adnexa
abdominally.
Palpate
from
bilateral
ASIC
to
pubic
symphysis
Watch
patient
to
assess
for
pain/discomfort
Remove
fingers
from
vagina
Rectovaginal
Exam
Continue
standing
Inform
patient
that
a
rectovaginal
exam
will
be
performed
While
instructing
the
patient
to
valsalva,
insert
the
middle
finger
of
the
dominant
hand
into
the
rectum,
and
the
index
finger
of
the
dominant
hand
into
the
vagina
Palpate
the
rectovaginal
septum
Palpate
the
posterior
cul-de-sac
with
the
vaginal/rectal
fingers
while
palpating
the
uterus/adnexa
abdominally
with
the
other
hand
Palpate
the
cardinal
ligaments
lateral
to
the
cervix
Assess
rectal
tone
Remove
fingers
from
rectum/vagina
Cover
up
patient
with
abdominal
hand
Remove
gloves
and
wash
hands
Leave
the
room
to
allow
the
patient
to
get
out
of
dorsal
lithotomy
position.
(A
retroverted
uterus
is
more
easily
palpated
on
RVE
than
on
BME)
(Adnexal
masses
can
often
be
palpated
on
RVE
and
not
on
BME)
Weill
Cornell
Medical
College
in
Qatar
Kristina
Sole,
MD,
FACOG
Additional
Resources
Lu
MC,
Williams
III
J,
Hobel,
CJ.
Chapter
1:
A
life-course
perspective
for
womens
health
care.
Hackers
and
Moores
Essentials
of
Obstetrics
&
Gynecology.
2010
Saunders.
pp
3-11.
Lu
MC,
Williams
III
J,
Hobel,
CJ.
Chapter
2:
Clinical
approach
to
the
patient.
Hackers
and
Moores
Essentials
of
Obstetrics
&
Gynecology.
2010
Saunders.
pp
12-21.
Suggested
Websites
New
England
Journal
of
Medicine
has
online
videos
in
clinical
medicine.
This
is
the
link
for
the
pelvic
examination
video:
http://www.nejm.org/doi/full/10.1056/NEJMvcm061320
Cleveland
Clinic
Womens
Health
Maintenance
Guidelines:
http://my.clevelandclinic.org/Documents/Family_Health_Centers/womens-health- guidelines.pdf
The
following
websites
have
womens
health
maintenance
recommendations:
United
States
Preventive
Services
Task
Force
(USPSTF):
http://www.uspreventiveservicestaskforce.org/
American
Congress
of
Obstetricians
and
Gynecologists
(ACOG):
http://www.acog.org/
American
Society
for
Colposcopy
and
Cervical
Pathology
(ASCCP):
http://www.asccp.org/
Center
for
Disease
Control
(CDC):
http://www.cdc.gov/
National
Cancer
Institute
(NCI):
http://cancer.gov/
National
Osteoporosis
Foundation
(NOF):
http://www.nof.org/