Detailed Curriculum for the Imperial Undergraduate Course in Obstetrics and Gynaecology

History Taking and Clinical Examination

Knowledge Criteria	Clinical Competency	Professional Skills and Attitudes	Training Support	Evidence and Assessment
Summarise an obstetric and gynaecological history.	Be able to take & analyse an obstetric and gynaecological history in a succinct and logical manner	Show empathy and develop rapport with patients Appreciate the importance of psychological factors for patients and their relatives Be aware of the interaction of social factors with the patient’s illness.	Introduction to history taking on Induction Day. Written guidance on history taking in course log book. Tutorials based on case presentation Teaching ward rounds Outpatient presentations.	D.O.P.S recorded in Log Book. History taking Station in final OSCE exam
Understand the pathophysiological basis of physical signs	Be able to perform a basic obstetric and gynaecological examination specifically: Abdominal palpation of a pregnant and non-pregnant abdomen Vaginal Examination Bimanual Cusco’s, Sims speculum	Respects patients’ dignity and confidentiality Acknowledge and respect cultural diversity Appreciate the need for a chaperone Provide explanations to patients	½ day training in clinical examinations in O&G e-learning resource in vaginal examination, abdominal palpation and taking blood pressure. Seminar on Good Medical Practice RCOG Guidelines for Gynaecological Examination. URL on course web page	D.O.P.S recorded in log book Requirement for key skills to be signed off before final examination allowed OSCE station examining smear taking.
Understands the components of effective verbal and non- verbal communication	Listening skills Use open questions where possible Avoid jargon Give clear information and feedback and share information with patients	Demonstrate an understanding of: Respecting patient’s views. The use of appropriate verbal and non verbal communication	Attending clinics such as: Pre conception clinics Gynaecological outpatients GUM clinics TOP clinics Ante natal clinics	Direct observation Communication skills Osce’s

Audit and Research

Knowledge Criteria	Clinical Competency	Professional Skills and Attitudes	Training Support	Evidence and Assessment
Understand the audit cycle Understand the difference between audit and research	Describe an audit exercise: How to define standards How to prepare project How to collate data How and why of repeat audit cycle	Use audit to improve clinical practice	Formal seminar on the confidential enquiries	Knowledge part of final MBBS

Ethics and Legal Issues

Knowledge Criteria	Clinical Competency	Professional Skills and Attitudes	Training Support	Evidence and Assessment
Understand the principles and legal issues surrounding informed consent. Be aware of diversity Be aware of the legal status of the unborn child/fetus and the implications- particularly the abortion act.	Be able to consent a patient for a physical examination and to take a smear. Be able to sign or decline to sign a blue form	Give appropriate information in a manner that patient’s and relatives understand and assess their comprehension Be aware of the patient’s needs as an individual Respect diversity	Seminar on informed consent and minimum standards of communication Ethics and Law seminar- TOP/Fetal status. DOH and RCOG consent guidelines – URL available on course web page RCOG ethics committee advice- available through web page.	D.O.P signed off for receiving consent for a cervical smear. Knowledge examination.
Be aware of relevant strategies to ensure confidentiality Be aware when confidentiality might be broken. Understand the principles of data protection. Understand the role of the interpreter and what patient advocate means	Use and share information appropriately	Respect the right to confidentiality Be aware of the requirements of children/adolescents/special needs patients	GMC good medical practice Ethics and Law Seminar Day Attendance on Ward Rounds, Case discussion. Attending GOPD and ANC.	Knowledge examination Core thread of OSCE stations Logbook and DOPS
Be aware of the indications for section under the mental health act		Able to obtain suitable evidence, or know whom to contact. Act with compassion at all times.	Ethics and law seminar Attendance on Labour ward, GOPD and ANC	Core Logbook Knowledge testing

Basic Anatomy and Surgical Skills

Knowledge Criteria	Clinical Competency	Professional Skills and Attitudes	Training Support	Evidence and Assessment
Basic anatomy of the pelvis Name and uses of common surgical instruments Common obstetric and gynaecological operations Common complication of surgery. General pathological principles Relevant basic sciences	To be able to describe the  important anatomical landmarks of the pelvis. Interpret pre-operative investigations Recognise potential co-morbidity Choose appropriate operation Explain simple operative procedures to the patient. Advise on post operative course.	Selection of operative procedure with due regard to degree of urgency, likely pathology and anticipated prognosis Recognition that decision making is a collaborative process between doctor and patient.	A ½ day seminar in pelvic anatomy Theatres Labour Ward tutorials. Gynaecology Ward work Pre operative ward rounds Library and Textbooks Lecture programme	Knowledge testing- MBBS DOP in log book

Appendix to anatomy and surgery - details of Knowledge Criteria:

• Legal issues around consent to surgical procedures, including consent of minors (and "Gillick competency"), adults with incapacity and adults and children in emergency situations
• Name and mode of use of common surgical instruments
• Complications of surgery including:
  • DVT/ pulmonary embolism
  • Infection (wound, urinary tract, respiratory, intra-abdominal and pelvic)
  • Primary and secondary Haemorrhage (intra-operative and postoperative)
• Regional anatomy of the pelvis, abdomen, breast.
• Relevant bones, joints, muscles, blood vessels, lymphatics, nerve supply and histology.
• Characteristics, recognition, prevention, eradication and pathological effects of commonly encountered bacteria, viruses, Rickettsia, fungi, protozoa, parasites and toxins, including an understanding of the principles of infection control
• A basic understanding of the principles of nutrition, water, electrolyte and acid base balance and cell biology.
• A basic understanding of the general pathological principles including general, tissue and cellular responses to trauma, infection, inflammation, therapeutic intervention (especially by the use of irradiation, cytotoxic drugs and hormones), disturbances in blood flow, loss of body fluids, hyperplasia and neoplasia.

Ultrasound in Obstetrics and Gynaecology

Knowledge Criteria	Clinical Competency	Professional Skills and Attitudes	Training Support	Evidence and Assessment
Principles of ultrasound Principles of Nuchal translucency Principles of scanning in early pregnancy, including ectopic pregnancy Ultrasound features of the normal and abnormal postmenopausal endometrium		Interpretation of screening tests Communication of issues of screening and relative risk with patients	Lecture programme Discussions in tutorial groups Attending ANC Attending GOPD	Knowledge based examination MBBS Skills based examination MBBS

Maternal Complications of Pregnancy

Knowledge criteria	Clinical competency	Professional skills and Attitudes	Training support	Evidence/ Assessment
To understand the epidemiology, aetiology, pathophysiology, clinical characteristics, prognostic features and management of the following: - Hypertension Common kidney disease Common heart disease Common Liver disease Diabetes, type 1, type 2 and gestational. Other endocrinopathies Common gastrointestinal disorders Common respiratory diseases Psychological/Psychiatric disorders Common infectious diseases Common neurological diseases Maternal complications due to Pregnancy	Diagnosis and simple investigation and management of : thromboembolism pregnancy-induced hypertension impaired glucose tolerance insulin-dependent diabetes essential hypertension kidney disease liver disease maternal haemoglobinopathy coagulation disorders acute abdominal pain asthma inflammatory bowel disease intercurrent infection psychological disorders infectious disease epilepsy drug and substance abuse domestic violence	Ability to recognise abnormality Competence in formulating list of differential diagnoses Ability to direct investigations in order to determine correct diagnosis Competence in formulating management plan	Lecture programme Tutorials Labour Ward attachment GOPD and ANC attendance Ward Rounds Text books and journals	Core Logbook Knowledge and skills examination. MBBS.

Appendix to maternal complications of pregnancy– Details of Knowledge Criteria

To understand the epidemiology, aetiology, pathophysiology, clinical characteristics, prognostic features and management of the following:-

Hypertension:	definitions aetiological theories organ involvement (mother, fetus) diagnosis drug therapy
Kidney disease:	urinary tract infection pyelonephritis
Pulmonary diseases:	asthma infection embolism aspiration syndrome
Neurological disorders:	epilipesy cerebrovascular disease migraine
Bone and joint disorders:	backache symphyseal separation
Psychological disorders:	puerperal disorders (blues, depression) mood disorders reaction to pregnancy loss
Gastrointestinal disorders:	nausea vomiting hyperemesis gastric reflux abdominal pain appendicitis inflammatory bowel disease intestinal obstruction
Heart disease:	congenital rheumatic ischaemic cardiomyopathy heart failure
Liver disease:	cholestasis hepatitis acute fatty degeneration
Circulatory disorders:	anaemia sickle cell disease thalassaemias thromboembolism transfusion
Disorders of carbohydrate metabolism:	diagnosis hazards (maternal, fetal, neonatal) diet drugs (insulins, oral hypoglycaemic agents)
Other endocrinopathies:	Thyroid (diagnosis, assessment, antibodies, therapy, fetal hazards) Pituitary (prolactinoma, hypopituitarism, diabetes insipidus)
Infectious diseases:	investigation of pyrexia principles (prevention, detection, isolation) therapy (prophylaxis, immunization, antibiotics, antiviral agents) maternal (septic abortion, preterm premature rupture of membranes, preterm labour, chorioamnionitis, puerperal sepsis, mastitis, urinary tract infection, wound infections, septic shock, malaria, other tropical infections and infestations) fetus and neonate (streptococci, gonococci, syphilis, toxoplasmosis, listeria, haemophilus, chlamydiae, mycoplasmas, ureaplasma, herpes hominis, rubella, cytomegalovirus, varicella, hepatitis A, hepatitis B, hepatitis C, parvovirus, influenza, human immunodeficiency virus, neonatal sepsis)
Maternal complications due to pregnancy:	antepartum haemorrhage amniotic fluid embolism Sheehan’s syndrome

Management of Labour

Knowledge Criteria	Clinical Competency	Professional Skills and Attitudes	Training support	Evidence/ Assessment
Mechanisms of normal labour Induction and augmentation of labour Drugs acting upon the myometrium Structure and use of partograms Regional anaesthesia, analgesia and sedation Fetal wellbeing and compromise Pre-term labour/ premature rupture of membranes Multiple pregnancy in labour Severe pre-eclampsia and eclampsia Understanding issues surrounding IUD (including PM) Manage haemorrhage	Advise on Pain relief Perform a normal vaginal delivery without supervision Interpret a CTG Assess and perform the basic first aid measures in the face of cardiopulmonary collapse	Use of appropriate protocols and guidelines Ability to respect cultural/religious differences in attitudes to childbirth	CTG training during lecture course Perinatal mortality and morbidity meetings Human tissue act- URL to review of Alder Hay When are they trained in CPR ?	Log book MBBS examination

Management of Labour (detail)

Knowledge Criteria:

Mechanisms of normal labour Mechanism of spontaneous vaginal delivery Methods of induction of labour; indications, contra-indications and complications Methods of augmentation of labour; indications, contra-indications and complications Drugs acting upon the myometrium Structure and use of partograms Transfusion Types and methods of action of regional anaesthesia including epidural (lumbar, caudal), spinal, pudendal nerve block; indications and contra-indications Types and methods of action of analgesia and sedation including narcotics, hypnotics, psychotropics, non-steroidal anti-inflammatory drugs; indications, contra-indications Complications of anaesthesia and analgesia including cardiac arrest, respiratory arrest, aspiration, drug reactions Assessment of fetal wellbeing using fetal heart rate monitoring and fetal scalp blood sampling Causes and management of fetal compromise including cord prolapse and intra-uterine fetal death Causes and management of maternal collapse including massive haemorrhage, cardiac problems, pulmonary and amniotic embolism, drug reactions, trauma Haemorrhage including placental abruption, placenta praevia, vasa praevia, ruptured uterus, coagulation defects, iatrogenic causes Causes, mechanisms of action and complications of pre-term labour/ premature rupture of membranes including fetal pulmonary maturity, infection risks Preterm labour including therapy (antibiotics, steroids, tocolysis), , methods of delivery (induction of labour, timing, mode),basic understanding of outcomes, risks Role and types of cervical cerclage Multiple pregnancy in labour Severe pre-eclampsia and eclampsia

Management of Delivery

Knowledge Criteria	Clinical Competency	Professional Skills and Attitudes	Training Support	Evidence and Assessment
Mechanisms of normal delivery Operative vaginal delivery Retained placenta Caesarean section Sterilisation procedures	Manage a normal delivery	Emotional implications for patient and family and staff Realistic recognition of own competence level Use of appropriate protocols and guidelines	Attachment to labour ward Tutorials Lecture programme Text books Journals	DOP and Log book MBBS exam

Knowledge Criteria

Operative /complex vaginal delivery: Malpresentation (brow, face, shoulder, variable lie) Malpositions Outlet forceps Mid-cavity forceps Rotational forceps Vacuum extraction Assisted breech delivery Twin delivery High order multiple births Shoulder dystocia Indications for and complications of caesarean section Routine repeat acute emergency Sterilisation procedures General anaesthesia induction agents inhalation agents prophylactic measures complications resuscitation intensive care

Post Partum Problems

Knowledge Criteria	Clinical Competency	Professional Skills and Attitudes	Training support	Evidence/ Assessment
Normal and abnormal post partum period Techniques for the control of post partum haemorrhage Post partum postoperative complications	Appropriately manage: The normal puerperium including contraception Breast problems Puerperal psychological disorders Post partum sepsis Primary and secondary haemorrhage Acute maternal collapse	Empathy with women and their families where puerperal problems arise	Compulsory tutorial on the puerperium