Learning goals

The genital system

Normal Anatomy and Physiology:

Macroscopically:

• The structure of the female and male genital tract and the important practical relations of the pelvic bones, joints and ligaments, pelvic floor and viscera.
• The abdominal cavity and the relation between the peritoneum and the pelvic structures in both genders.
• The surface anatomy of the pelvis and its function as the birth canal.
• The main features of organogenesis of the genital tract, especially development of malformations.
• The blood supply, lymphatic drainage and innervation of the pelvis.
• The structure and function of the placenta.

Microscopic structure and function of:

• The testis, epididymis, ductus deferens, prostate, urethra, penis, vagina, vulva, ovaries, uterus and fallopian tubes.
• The endometrium and cervix, including hormonal changes during the menstrual cycle.
• The placenta: development, umbilical cord and membranes.
• The breasts and the changes during lactation.

Physiology and Biochemistry

• physiological mechanisms related to the menstrual cycle, sexual activity, pregnancy, menopause and ageing (in both genders)
• The physiology, biochemistry, endocrinology and pharmacology of reproduction applied to clinical work: analytical endocrinology (pituitary gland/sex hormones/adrenal glands).
• To know and understand the different blood tests used in assessing the function of the gonads and pituitary gland.

Reproductive Pathology

• Knowledge of the most important defects and changes associated with male and female infertility

Obstetrics and Gynaecology

The student will learn to combine theoretical knowledge with practice in a primary care setting and to collaborate with the hospital based maternity units (both in- and out-patient based units) in the management of patients. The objective is to be aware of and reflect on the ethical issues obstetrics and gynaecology in order to:

• respect a patient¡¯s choice in difficult ethical situations
• respect a woman¡¯s right to self-determination
• treat women with compassion and respect regardless of background
• ensure empathy towards women with regard to a gynaecological examination
• understand the importance of objective information to a woman and her family

The student should be able to demonstrate knowledge of and understanding of:

• the normal physiological changes of pregnancy and puerperium
• complications of pregnancy and what conditions require referral to a specialist unit
• the normal birth
• complicated/pathological birth
• pathological conditions after birth
• medication in pregnancy
• breast feeding
• medication in breast feeding
• oestrogen substitution in menopausal and elderly women
• vaginal bleeding disorders, diagnostic tests and treatment
• gynaecological infections, diagnostic tests and treatment
• benign tumours of the genital tract
• the different types of gynaecological cancers and their treatment
• causes of pelvic pain and problems related to sexual dysfunction
• causes of infertility, their diagnosis and treatment
• diagnosing genital descent (uterovaginal prolapse)
• causes of urinary incontinence, their investigation and treatment
• important morphological changes in common gynaecological disorders, diseases related to pregnancy and childbirth (infections, tumours, vaginal bleeding disorders, trophoblast diseases and placental dysfunction, pathology of infertility including the relevant conditions in men)
• the causality between morphological changes and the characteristics of the symptoms, aetiology, pathogenesis and prognosis of the disease
• how to perform a critical review of an autopsy report, assess histopathological and cytological test results
• the different views and ethical issues in the debate on the Norwegian abortion law (abortion on request)
• the various ethical approaches to prenatal diagnostics and selective abortion
• the various ethical approaches to modern reproduction technology

Practical skills

The student shall acquire practical skills to be able to:

• instruct patients on birth control and sterilization
• inform women who apply for abortion
• perform a gynaecological examination ( both inspection and exploration )
• identify signs of genital infections and perform relevant tests
• take a cytological sample from the cervix
• insert and remove an IUCD
• perform an assessment on women using a pessary for uterovaginal prolapse
• understand and use Helsekort for gravide
• perform prepregnancy and antenatal care
• judge the size of the pregnant woman¡¯s uterus and measure from the symphysis pubis to the fundus of the uterus (SF-m?l)
• palpate the fetal position (Leopolds/Pawliks h?ndgrep)
• count the fetal heart rate using a midwife (Pinard) stethoscope
• guide mothers who have problems breast feeding
• examine and estimate the effacement and dilatation of the cervix in labour
• assist a normal birth

Pathology

The student shall be able to:

• identify the organ manifestation of the most frequent genital diseases, using microscopic and macroscopic examination methods
• explain the most important morphological changes observed in the most common diseases of the vulva, vagina, cervix uteri, endometrium, myometrium, fallopian tubes, ovaries and placenta
• explain the connection between morphological changes and the symptomatology of different diseases, as well as know their aetiology, pathogenesis and prognosis
• perform a critical review of an autopsy report and assess histopathological and cytological test results
• ecognize and describe the morphological, macroscopic and histological changes in the most common pathological conditions in the female abdomen

Paediatrics and Child Psychiatry

The teachers in paediatrics hope you enjoy the clinical rotation and want you to become really involved in the clinical care of the children so that you gain some of the sense of satisfaction comes from working with children. We hope as well that you will develop a sense of the emotional intensity involved in illness in children.

The aim of this course is to acquire the skills and qualifications needed to work in the field of child health. This includes knowledge of physical and mental development in normal children as well as prevention, curative treatment and the social aspects of paediatrics.

Together with a respectful attitude, these skills will benefit the child, her/his family and society. We also hope this will encourage further study, permanent interest and perhaps interest in doing research in this field.

The course is a standardized basic education for all doctors regardless of which specialization they choose later.

Required skills:

• to evaluate the growth and development of the normal child, both physically and mentally.
• to contribute to the prevention of disease, malnutrition, injury, child abuse and neglect.
• to diagnose disease, anomalies and deviations from the expected development.
• to recognize symptoms and signs of serious illness and to commence intervention and treatment
• to stabilize a child¡¯s vital functions at the scene and during transport
• to start and follow up medical treatment of the most common diseases in the child and adolescence
• 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 familiar perspective

Content:

To acquire and develop an attitude that:

• ensures empathy with ill children and their life situation.
• shows the child and family respect regardless of the type of disease or problem.
• considers the child and family as active collaborators in the treatment and problem solving process.
• makes the student able to pass on medical information in an open minded and reflective way.
• whenever help is needed it is actively sought out.

Knowledge

Growth and development

Objectives: The students should be qualified in these areas:

• basic knowledge about normal growth and development
• collecting and selecting data about a child¡¯s development and independently draw conclusions from this information
• assessing a child¡¯s state of nutrition
• estimate nutritional requirements and its management for different age groups and for special childhood diseases

Prophylactic Paediatrics

Objectives: The students should know:

• the importance of preventive health care for children, families and society
• how preventative health work for children is organized
• the most important physical, psychological and social risk factors for the child¡¯s and family¡¯s health
• the vaccination program, contraindications and side effects of vaccines

Curative Paediatrics

Objectives: The students should know:

• how to detect, examine and treat children in life-threatening situations(emergency Paediatrics) (see special course in the 12. semester)
• how to examine a newborn
• 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

The students should recognize the symptoms, signs and know the treatment guidelines for:

• diseases and injuries in the CNS
• 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

Pathology

The students should:

• know and be able to explain the most important morphological changes observed in the most important diseases in the infant, toddler and child.
• be concerned with the reasons for perinatal diseases and death, tumours, inflammation, degeneration and congenital malformations.
• be able to 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.
• recognize and describe the morphological, macroscopic and histological changes in the most common pathological conditions in the infant, toddler and older child.

Child Psychiatry

The student should know:

• 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 non-specific attachment disorders.
• tics disorders (F95)
• signs of abuse and neglect in children and adolescents.
• available options from Barnevernet and other initiatives for chronically ill and disabled children and adolescents

Clinical skills in paediatrics

The student must develop skills in:

• cooperating with the child and family.
• obtaining a problem oriented medical history.
• performing a physical and psychomotor examination at different ages.
• assessing a child¡¯s general condition.
• assessing a child¡¯s fluid balance.
• judging fontanels and sutures.
• judging the red reflex using an ophthalmoscope.
• using an otoscope.
• inspecting the oral cavity and throat using a spatula and lamp.
• using percussion in examining the thorax.
• using the stethoscope in examining the lungs (assisted auscultation).
• using a stethoscope and palpation in examining the heart.
• palpating peripheral pulses and measuring the blood pressure.
• examining the abdomen using palpation, percussion and a stethoscope.
• examining the genital organs.
• triggering primitive reflexes.
• testing muscle tone and power.
• test sight and hearing as well as assess speech development.
• testing fine and gross motor skills.
• triggering deep tendon reflexes.
• measuring head circumference, plot growth curves, and assess puberty.
• estimating hip abduction, spinal and foot deformities.

• capillary blood drawing.
• vaccination.
• administration of intravenous injections, lumbar spinal puncture.
• measurement of body temperature.
• how to administer medication at various ages.

Pharmacology and related areas:

a) pharmacology and endocrinology of reproduction and their application in clinical situations.

b) sex-hormones and contraceptives

c) drugs affecting uterine motility

d) antihypertensive drugs used in pregnancy

e) drugs in pregnancy

f) drugs during breastfeeding

g) hormonal replacement therapy

h) drug treatment of infections in gynaecology

i) cytotoxic drugs for gynaecological cancers

j) pharmacological aspects of urinary incontinence

k) the fundamentals and principles of drug treatment of disease in children and 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 student only)

The student must know:

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