OBGU-4071 - Cervical Dysplasia: Diagnosis, Methodologies and Management

OBGU-4071 - Cervical Dysplasia: Diagnosis, Methodologies and Management

Elective Title: Cervical Dysplasia: Diagnosis, Methodologies and Management
Course Number: OBGU-4071
Elective Type: clinical Duration/Weeks: 2 Max Enrollment: 2
Prerequisites: Successful completion of Year 2
Additional Requirements: None
Responsible Faculty Director: Yvette F. Gordon, MD and Amjad Hossain, PhD Periods Offered: 2AB-7AB, 8B, 9AB-10AB, 12AB-13AB including holiday period 8 
Coordinator: Brandie Denton Other Faculty:
Location to Report on First Day:
335 clinical science building (CSB), Conference room in Gyn Suite (3rd floor near CSB auditorium), contact: 409-772-2610 (O) / 281-785-6804 (C)

Cervical dysplasia (CD) may lead to cervical cancer if not timely and properly managed. Literature show cervical neoplasia is the fourth most frequent cancer in women globally. The course is designed to review normal and abnormal pap smears and management of abnormal pap smears based on age and results. Risk factors and management for CD, and the prevention of cervical cancer will also be reviewed. The goal will be to familiarize the student to the ACOG and ASCCP guidelines for screening, managing, and treating cervical dysplasia.

Through knowledge gathered working at UTMB gyn clinic, utilizing ACOG/ASCCP resources and videos on cervical dysplasia (CD), and studying most recent update in the field, the students will be able to: 1) interpret normal and abnormal pap smears, 2) identify the risk factors for CD and how to minimize such risks, 3) know the incidence, prevalence and possible etiologies of the dysplasia, 4) hypothesize basic science explanation of the possible modes of pathogenesis that lead dysplasia to become malignant, 5) familiarize with the ACOG/ASCCP guidelines to be followed in the management of CD and its premalignant and malignant stages, and 6) become familiar with options of management including repeat Pap smears, Colposcopy, LEEP, CKC and Hysterectomy for different stages of CD.

Description of course activities
In orientation (first day of rotation) the course syllabus, schedule, expectations, and requirements will be discussed. How the requirements can be achieved will also be explained. The students will get the specific information of their daily roles and responsibilities laid out in the weekly schedule. Thus, the orientation should sufficiently prepare the students in performing their assigned tasks. In addition, faculty consultation will be available to further address students' needs. Emphasis will be to assist the students in completing their daily tasks.
In first four days in week 1, the students will spend time in dysplasia clinic under the supervision of the gyn faculty and residents to become familiar with the management of abnormal pap smears, evaluation of abnormal pap with Colposcopy and LEEP procedures. The students will also watch ACOG videos to expand their knowledge of the interpretation and management of pap smears based on age, results, and risk factors. The students will also be asked to complete their assigned readings. Based on the above indicated clinic exposure, video watch and assigned readings, the students should be prepared sufficiently to dive deep into literature to gain in-depth knowledge on cervical dysplasia (CD).
On day 5 of the week 1 a session will be arranged preferably in the afternoon to discuss the students' plans, progresses, problem encountered, or any issue they might have. Appropriate feedback and guidance will be given to carry on the project in the second week. In the same session, we will review the different screening tests for abnormal Paps including Colposcopy, LEEP, CKC and Hysterectomy.
In week 2, the students expand their knowledge base by continuing to participate in the gyn dysplasia clinics, reading more literature and/or watching additional videos on CD. Students will be required to prepare a written report or take-home exam. In either case, the students must demonstrate their depth of knowledge on the required learning that are spelled out in the course learning objectives. The written essay or take-home exam answers will be due on Friday of week 2. However, students will be allowed to submit their essays or answers via email on or before Sunday midnight for successful completion of this faculty guided elective.

Type of students who would benefit from the course
The elective should be of particular interest to students who wish to pursue a career in obstetrics and gynecology. Students interested in women's health issues in primary care or related surgical subspecialties would also benefit from this elective.

Weekly Schedule
  Clinical Activities (estimated schedule)  
Day of Week   AM   PM
Monday 8:00 5:00
Tuesday 8:00 5:00
Wednesday 8:00 5:00
Thursday 8:00 5:00
Friday 8:00 5:00
Sunday Week 2: written essay due on or before midnight

 Average number of patients seen per week: 25
 Call Schedule: No

Research Activities (estimated schedule)
Activity Hours per Week
Faculty Contact-Time
Self-Directed Study

Method of Student Evaluation
1.  Clinical Observation
  A. Where are students observed on this elective?
    Inpatient Service   Ambulatory   Surgery   Standardized patients
Patients simulators   Other
  B. Frequency - How often are students observed clinically?
  C. Format - What method(s) are used to document the student's clinical performance?
    Daily oral feedback   End of period oral feedback   Written feedback

2.  Oral Presentation
  A. Audience - To whom does the student present?
  B. Frequency / Duration of Presentation(s)?
  C. Format - What guidelines are set for the student's presentation?
  D. Assessment - Who assesses the student's presentation performance?
    Self-assessment   Peer assessment   Faculty assessment
  E. Method of content selection
    Current cases  Student-selected topic   Assigned topic

3.  Written Assignment (H&P's, notes, papers, abstracts, etc.)
  A. Frequency of written assignment(s)?
    1 assignment
  B. Format - What guidelines are set for the student's written work?
    Will be set jointly by the faculty and student upon discussion
  C. Length of written assignment(s)?
    Abstract   Annotated bibliography   1 - 2 page paper   3+ page paper
  D. Are recent references required?   No    If yes, how are they selected?
    Yes. The references are selected following instructor's recommendation, but should not exceed 10
  E. Method of content selection - e.g. student-selected, relate to cases, etc.?
    Student-selected to fulfill the course learning objectives
  F. Audience - Who assesses the student's written performance?
    Peer Assessment     Faculty Assessment     Other

4.  Examination
    Oral   Written multiple choice   Written essay / short answer   OSCE

5.  Extra Course Activities
  What expectations do you have for the student to demonstrate participation in the elective (e.g. small group activities, seminars, thoughtful questions, providing resources, journal club, resident lecture attendance)?
    In addition to clinic duties and written report, the student is expected to demonstrate professionalism and interpersonal skills reflecting content knowledge during interaction with the faculty.

6.  Additional Costs
  Please list any additional costs and/or purchases (books, materials, movies to watch, etc.) that are required for this course. Include an estimated total cost. If there are no additional costs, please enter "None".

7.  Other Modes of Evaluation
  Please explain below.

8.  If this course is an Acting Internship, please complete the following:
  A. Objectives for the AI should relate directly to the Entrustable Professional Activities (EPAs). Each AI should describe how the four key Year-4 EPAs that our school has identified as being Year-4 skills are assessed. The Year-4 objectives are:
1. Entering and discussing orders/prescriptions.
2. Give or receive patient handover to transition care responsibility.
3. Recognizing a patient requiring urgent or emergent care and initiating management.
4. Obtaining informed consent for tests and procedures.
Specify how the student will be given formative feedback on their clinical skills.

Year-4 students should demonstrate mastery of EPAs they developed in the clerkship year, including recommending and interpreting common diagnostic and screening tests, and performing general procedures of a physician. They should be able to demonstrate masterfully and independently skills they mastered in Years 2-3, including efficiently performing comprehensive admission-notes and succinct daily progress notes and perform accurate, concise, and hypothesis-driven clinical presentations, form clinical questions and retrieve evidence to advance patient care. They should be able to demonstrate basic understanding of and beginning mastery of collaborate as a member of the interprofessional team and identify system failures and contribute to a culture of safety improvement.

List advanced clinical skills that a student will be assured an opportunity to practice.

How specifically will this AI build on developing skills from the clerkship year to prepare students for internship?

What opportunities will typically be available to all students who take this AI (procedures, required presentations, etc.)? What opportunities may be available based on patient load/presentation or student initiative (ie. Writing a case report)?

An AI should have expectation of a minimum of 32 hours per week of clinical responsibilities. Duty hours should be capped at ACGME limits for an intern, thus up to 24 hours followed by 4 hours of activities related to patient safety, education, and handoff. Students cannot work more than 80 hours per week averaged over 4 weeks. They can only have 1 day off in a 7-day work week with 8 hours off between shifts.

Clinical responsibilities will vary depending on specialty, but how is the student functioning with work commensurate to a PGY1 with an appropriate level of training?

How is the student demonstrating drawing clinical conclusions and/or developing a management plan and documentation as an intern would do?

How and by whom will midpoint feedback be provided to the student? How will you remediate deficiencies identified at midpoint?

Acting Internship students often seek letters of recommendation following their experience. How many different Faculty will work directly with the student and have knowledge of the student's abilities to detail in a written evaluation? Describe the degree of supervision and interaction with faculty vs. residents or other providers and how feedback will be obtained if more direct work is with residents or other providers.