Aims and learning outcomes for the 9th semester

Aims

This semester aims to provide a general education in Gynaecology/Obstetrics, Paediatrics and Child Psychiatry for all medical students. The semester will prepare the student to combine theoretical knowledge with clinical practice in a primary care setting and to collaborate with the hospital based maternity and paediatric units (both in- and out-patient based units) in the management of patients. The intention is to contribute to a platform for continuous lifelong learning in Anatomy, Physiology and Pathology of the Reproduction Systems, Gynaecology, Obstetrics, Paediatrics and Child Psychiatry. Throughout the semester we hope to generate interest in the subjects covered and to inspire some students towards research.

At the end of the 9th semester, the student should:

• have acquired the necessary skills and qualifications needed to work within the fields of paediatrics and gynaecology/obstetrics in primary health care.
• be qualified to work in disease prevention, and to have the necessary skills for diagnosing and treating diseases as well as for assessing, maintaining and improving health in the following areas:
  • Child health, infant and adolescent medicine
  • Health of the female genital tract
  • Health before, during and after pregnancy, including delivery and breast-feeding
  • Health in the pre-, peri- and postmenopausal years

The teachers in paediatrics and gynaecology/obstetrics hope the students will enjoy the clinical rotations as well as the other teaching settings. We hope students become really involved in the clinical care of women and children, experience the sense of satisfaction that comes from working with these patient groups. We also hope that the semester promotes interest for further specialization in these medical fields.

Learning outcomes

Obstetrics and Gynaecology, including pathology, anatomy and physiology

Knowledge

At the end of the semester, it is expected that the students will be able to describe:

• preconceptional counselling
• normal physiology of pregnancy and puerperium
• pregnancy complications and medical disorders in pregnancy
• infections in pregnancy
• the normal birth
• complicated/pathological birth
• postpartum complications
• medication in pregnancy
• breast feeding
• medication during breast feeding
• global reproductive health
• prenatal testing: indications for offering screening or targeted genetic testing
• the menstrual cycle
• adolescent gynaecology
• benign tumours of the genital tract and their treatment
• malignant diseases in gynaecology and obstetrics
• vaginal bleeding disorders: diagnosis and treatment
• gynaecological infections: diagnosis and treatment
• pelvic pain
• problems related to sexual dysfunction
• infertility: aetiology, diagnosis and treatment
• contraceptive methods: efficacy, use and side effects
• induced abortion: epidemiology, methods and complications
• pelvic organ prolapse: diagnosis and treatment
• urinary incontinence: causes, diagnosis and treatment
• menopause: physiological changes and treatment of symptoms

At the end of the semester, it is expected that the students will be able to explain:

• different views and ethical issues relating to abortion on request (related to the Norwegian abortion law).
• ethical issues relating to prenatal diagnostics and selective abortion
• ethical issues in modern reproduction technology

In Gynaecological/Obstetrical Pathology and Anatomy, the student must be able to describe:

• macroscopically:
  • the structure and function of the female and male genital organs and the clinical relations between the pelvic bones, joints and ligaments, pelvic floor and viscera
  • the abdominal cavity and the relationship between the peritoneum and the pelvic structures in males and females
  • the surface anatomy of the pelvis and its function as the birth canal
  • the main features of organogenesis of the genital tract, especially relating to developmental malformations
  • the blood supply, lymphatic drainage and innervation of the pelvis (including external and internal genital organs as well as other viscera, skin and sphincters)
  • the development, structure and function of the placenta as well as the fetal blood circulation
  • main features of the development of the skull
• microscopic structure and function of:
  • the testis, epididymis, ductus deferens, prostate, urethra, penis, vagina, vulva, ovaries, uterus and fallopian tubes
• the myometrium and the endometrium, including hormonal changes during the menstrual cycle
• the placenta: development, physiology, umbilical cord and membranes
• the breasts, including changes during puberty and lactation
• physiological mechanisms related to the menstrual cycle, sexual activity, pregnancy, menopause and ageing (in both sexes)
• the pituitary gland/ adrenal glands, and which tests are used in assessing the function of the gonadal and pituitary function

At the end of the semester, it is expected that the students will be able to explain:

• important morphological changes in common gynaecological disorders, diseases related to pregnancy and childbirth (infections, tumours, vaginal bleeding disorders, trophoblastic diseases and placental dysfunction, pathology of infertility including the relevant conditions in men), tumours of the testes
• the causality between morphological changes and the characteristics of the symptoms, aetiology, pathogenesis and prognosis of the diseases of the female genital organs
• how to assess histopathological and cytological test results
• the most important defects and changes associated with male and female infertility

Skills

At the end of the semester, the student will be expected to be able to:

• obtain efficiently a medical history from the gynaecological or obstetric patient
• understand and use antenatal mother health card (Helsekort for gravide)
• judge the size of the pregnant uterus and measure from the symphysis pubis to the fundus of the uterus (SF-m?l)
• palpate the foetal position (Leopold¡¯s/Pawlik¡¯s maneuvres)
• count the foetal heart rate using a midwife (Pinard) stethoscope
• examine and estimate the dilatation of the cervix in labour
• assist a normal birth
• instruct patients on birth control and sterilization
• inform women who apply for induced abortion
• perform a gynaecological examination (inspection and exploration)
• take a cytological sample from the cervix
• insert and remove an IUD (on a mannequin or patient)
• perform an assessment on women using a pessary for pelvic organ prolapse
• identify signs of genital infections and perform relevant tests
• be able to use a light microscopy to identify in sections structures relevant for the
• understanding of the function of the genital organs

In Gynaecological/Obstetrical Pathology and Anatomy

At the end of the semester, the student will be expected to be able to:

• describe the normal function of the above mentioned structures
• identify the above mention structures in macroscopic and microscopic specimens
• identify the organ manifestation of the most common genital diseases, using microscopic and macroscopic examination methods
• describe the most important morphological changes observed in the most common diseases of the vulva, vagina, cervix uteri, endometrium, myometrium, fallopian tubes, ovaries and placenta
• describe the connection between morphological changes and the symptomatology of different diseases, as well as know their aetiology, pathogenesis and prognosis
• recognize and describe the morphological, macroscopic and histological changes in the most common pathological conditions in the female abdomen

Attitudes (generell kompetanse)

At the end of the semester the student should:

• be aware of and be able to reflect on the ethical issues in obstetrics and gynaecology in order to:
  • respect a woman¡¯s choice in difficult ethical situations
  • respect a woman¡¯s right to self-determination
  • treat every woman with compassion and respect
  • ensure empathy towards women with regard to a gynaecological examination
  • understand the importance of objective information to a woman and her family
  • be able to establish and maintain good contact with patients.

Paediatrics and Child Psychiatry

Knowledge

At the end of the semester, the student must be able to describe and explain:

• normal growth and development of the ewborn, the child and the adolescent
• the importance of preventive health care for children, families and society
• how preventative health work for children is organized in Norway
• the most important physical, psychological and social risk factors for the child¡¯s and family¡¯s health
• the Norwegian vaccination program, contraindications and side effects of vaccines
• the importance of correct use of antibiotics to prevent development of bacterial resistance
• how to organize and coordinate intervention and health services for children and adolescents with chronic conditions and disabilities in the community, while maintaining a holistic and family perspective
• how to administer medication at various ages
• how to detect, examine and treat children in life-threatening situations (emergency Paediatrics) (see also special course in the 12th semester)
• the main principles in Adolescent Medicine
• the pathogenesis and pathophysiology of common and important diseases in children
• how to diagnose and manage the common and important diseases in children, With knowledge of symptoms, signs and the treatment guidelines for:
  • diseases and injuries in the CNS
  • allergic diseases in children and adolescents
  • upper and lower respiratory tract diseases
  • gastrointestinal diseases
  • diseases in the kidneys, urinary tract and genital tract
  • heart and circulatory failure
  • diseases of the blood, blood-forming organs and the coagulation system
  • immunological diseases
  • cancer in children
  • hormonal and metabolic diseases
  • bone, muscle and skeletal diseases
  • infectious diseases
  • common intoxications in children and adolescents

The student should have observed the following clinical procedures being performed:

• capillary blood drawing
• vaccination
• administration of intravenous injections and lumbar spinal puncture

In Child Psychiatry,

the student should at the end of the semester be able to describe and explain:

• the psychological and social aspects of chronic illness in childhood
• age specific difficulties and psychiatric disorders
• emotional disturbances with childhood-onset (F93 in ICD-10), such as separation anxiety, social phobia and sibling rivalry
• disturbance of social function (F94) with childhood-onset, especially the reactive or nonspecific attachment disorders
• eating disorders in childhood
• tics disorders (F95)
• signs of abuse and neglect in children and adolescents
• available options from Barnevernet (Child Protection Agency) and other initiatives for chronically ill and disabled children and adolescents

Skills

At the end of the semester, the student must be able to:

• perform clinical examination of a newborn and a child
• estimate nutritional requirements and its management for different age groups and for special childhood diseases
• evaluate the clinical condition, growth and development of the normal newborn and child, both physically and mentally contribute to the prevention of disease, malnutrition, overweight and obesity, injury, child abuse and neglect
• diagnose disease, anomalies and deviations from the expected development
• recognize symptoms and signs of serious illness and to commence intervention and treatment
• stabilize a child¡¯s vital functions at the scene and during transport
• start and follow up medical treatment of the most common diseases in the child and adolescence
• obtain a paediatric medical history
• perform a physical and psychomotor examination at different ages
• assess a child¡¯s general condition
• measurement of body temperature
• assess a child¡¯s fluid balance
• judge fontanels and sutures
• judge the red reflex using an ophthalmoscope
• use an otoscope
• inspect the oral cavity and throat using a spatula and lamp.
• use percussion in examining the thorax
• use the stethoscope in examining the lungs (assisted auscultation)
• use a stethoscope and palpation in examining the heart
• palpate peripheral pulses and measuring the blood pressure
• examine the abdomen using palpation, percussion and a stethoscope
• examine the genital organs
• trigger primitive reflexes
• test muscle tone and power
• test sight and hearing as well as assess speech development
• test fine and gross motor skills
• trigger deep tendon reflexes
• measure head circumference, plot growth curves, and assess puberty
• estimate hip abduction, spinal and foot deformities
• describe and explain the most important morphological changes observed in the most important diseases and the most common pathological conditions in the infant, toddler and child
• understand the reasons for perinatal diseases and death, tumours, inflammation, degeneration and congenital malformations
• explain the connection between morphological changes and symptomatology of different diseases, aetiology, pathogenesis and prognosis (where possible)
• know how to perform a critical review of an autopsy report, assess histopathological and cytological test results

Attitudes

At the end of the semester, the student should have acquired and developed an attitude that:

• ensures empathy with sick children and their life situation
• shows the child and family respect regardless of the type of disease or problem or background
• considers the child and family as active collaborators in the treatment and problem solving process
• cooperate with the child and family
• makes the student able to pass on medical information in an open minded and reflective way
• makes the student actively seek help from more experienced doctors whenever you need it in the clinical work

Pharmacology in paediatrics and gynaecology/obstetrics

Knowledge

At the end of the semester, the student must have knowledge about:

• pharmacology and endocrinology of reproduction and their application in clinical situations
• sex-hormones and contraceptives: efficacy and adverse events
• drugs affecting uterine motility: efficacy and adverse events
• antihypertensive drugs used in pregnancy: safety and contraindications
• drugs in pregnancy: safety
• drugs during breastfeeding
• hormonal replacement therapy
• drug treatment of infections in gynaecology
• cytotoxic drugs for gynaecological cancers
• pharmacological aspects of urinary incontinence
• the fundamentals and principles of drug treatment of disease in newborn children, pre School and school children as well as in adolescents:
  • in the central nervous system
  • in the respiratory tract
  • in the gastrointestinal tract
  • in the kidneys, urinary tract and genital organs
  • in the cardiovascular system
  • in the blood and haemopoietic organs
  • related to hormones and metabolism

Drug prescription (for Norwegian students only)

Knowledge

At the end of the semester, the student must be able to:

• define the regulations that concern drug prescriptions and the different prescription classes (A, B, C)
• define the most important regulations on reimbursement of expenses for essential medication (¡°bl? resept¡±), define where to find information on the prescription group a medication belongs to and if it can be prescribed on ¡°bl? resept¡±
• describe the most important reasons for incorrect use of medication (non-compliance)

Skills

At the end of the semester, the student must be able to:

• fill out the different types of prescriptions
• prescribe technical/ clinical aid remedies (¡°hjelpemidler¡±) and adequate reimbursement options for the patient in paediatrics and gynaecology/obstetrics (e.g. inhalation equipment, incontinence pads etc)