1

ROYAL COLLEGE OF MEDICINE PERAK

DEPARTMENT OF OBSTETRICS & GYNAECOLOGY



YEAR 3 MBBS

OBSTETRICS & GYNAECOLOGY
(RMB 30704)
2014-2015




STUDENTS COURSE GUIDE



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Dear students,

Welcome to the Department of Obstetrics and Gynecology.
In Year 3, Womens health module will last for 4 weeks and you will have 7 weeks Obstetric and
Gynaecological posting in year 5. Hospital Raja Permaisuri Bainun will be your designated
teaching hospital.
In this 4 weeks period, you are expected to achieve the foundation on reproductive health
issues basing on what you have learnt in preclinical years. Students are advised to use their time
optimally and learn as much as possible in this short period of time.
Your teaching faculty comprises lecturers from UniKL RCMP and adjunct lecturers from Hospital
Raja Permaisuri Bainun. The teaching faculty is committed to deliver quality medical education
and facilitate your learning during this four weeks posting. Similar enthusiasm is expected from
you as well.
This course guide will explain what is expected of you throughout your posting in the
Department of Obstetrics & Gynaecology. Your lecturers are available and ever willing to assist,
guide and facilitate your learning. Do not hesitate to approach them. Finally, I wish you good
luck and hope your learning experience with us will be a pleasant one.


Sincerely,


DR. SAW OHN MAR

Senior lecturer, Discipline of Obstetrics and Gynaecology
Year 3, Obstetrics and Gynaecology Module Coordinator
University Kuala Lumpur
Royal College of Medicine Perak











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TABLE OF CONTENTS PAGE


1. General course information
1.1. Course Details 4
1.2. Academic staff and contact 5-6


2. Aims, Objectives and Outcomes (Graduate attributes)
2.1. Aims 7
2.2. Learning Objectives 8-10
2.3. Learning Outcome 11


3. Detailed learning Objectives
3.1. Obstetrics 12-14
3.2. Gynaecology 15-16


4. Teaching and learning methodology 17-18


5. Assignments and posting requirement 19


6. Administrative policy 20-21


7. Assessment 22-23


8. Learning resources 24


9. Teaching outline (Objectives and contents) 25-37













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UNIVERSITY KUALA LUMPUR, ROYAL COLLEGE OF MEDICINE PERAK

1.General course information

1.1 Course Details

Name of course: Obstetrics and Gynaecology

Course code: RMB 30704

Coordinating unit: Faculty of Medicine

Level: Undergraduate

Location: UniKL RCMP and Hospital Raja Permaisuri Bainun


Course Description: This module is to introduce to the students the fundamentals of
Obstetrics and Gynaecology. Emphasis will be on comprehensive history taking,
systematic physical examination and a rational approach to patient management. Basic
skills will also be introduced.

Prerequisite: Passed Year 2 MBBS, Uni KL

Assumed back ground: you are expected to revise areas that have been addressed
during the previous years of MBBS program:
Clinical sciences
Biomedical sciences
Basic professional development skills












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1. 2. Academic staff

Associate Professor Dr. Syed Rahim Bin Syed Hamid
Deputy Dean, Associate Professor
Consultant Obstetrician & Gynaecologist

Associate Professor Chua Chin Tong
Associate Professor
Consultant Obstetrician & Gynaecologist

Associate Professor Fatehpal Singh Malhi
Associate Professor
Consultant Obstetrician & Gynaecologist

Dato Dr Sarjeet Singh Sidhu
Senior Lecturer
Consultant Obstetrician & Gynaecologist

Dr Saw Ohn Mar
Senior Lecturer
Year 3, Womens Health Module Coordinator
Consultant Obstetrician & Gynaecologist

Dr Hakim Gharib Bilal
Senior Lecturer
Consultant Obstetrician & Gynaecologist











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MINISTRY OF HEALTH MALAYSIA



HOSPITAL RAJA PERMAISURI BAINUN IPOH PERAK

Dato Dr. K. Mukudan
Head of Department of Obstetrics & Gynaecology
Adjunct Lecturer
Consultant Obstetrician & Gynaecologist Infertility consultant


Dr. Japaraj Robert Peter
Adjunct Lecturer
Consultant Obstetrician & Gynaecologist Fetomaternal Medicine

Dr. Aruku Naidu
Adjunct Lecturer
Consultant Obstetrician & Gynaecologist Uro-Gynaecologist






Course Contact

For any questions, concerns, comments regarding the posting, feel free to contact:

Dr. Saw Ohn Mar
Senior Lecturer
Year 3 ,Womens Health Module Coordinator
05 2432635 Ext. 164
sawohnmar@rcmp.unikl.edu.my

Nur Syafiqah Aziati Binti Md Radzi
Administrative Officer for Student Clerkship
University Kuala Lumpur Royal College of Medicine Perak
05 2432635 Ext: 283
nursyafiqah@rcmp.unik.edu.my



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2. Aims, Objectives and Outcome (Graduate attributes)

2.1. Aims

Aims
1. To equip the students with basic clinical competence in the field of obstetrics and
gynaecology
2. To train the students with a strong foundation in application of relevant knowledge,
effective skills and attitudes
3. To produce graduates who will be committed to the medical and professional ethics

Goals
The educational policy of the Department of Obstetrics and Gynaecology is to doctors
who are able to:

1. Apply their knowledge and skills in an effective and judicious manner whilst
demonstrating an attitude that is appropriate and desirable.

2. Function effectively in any healthcare setting (hospital, healthcare centres, etc)

3. Recognize and analyze health problems at the level of the individual, family and
community, and solve these problems through health promotion, disease prevention,
treatment and rehabilitation, using the available resources in a cost-effective manner.

4. Demonstrate sensitivity towards religious, moral, cultural and traditional values of the
community they serve.

5. Lead and play an effective role in the healthcare team.

6. Accept the principle of life-long learning.


















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2.2 Learning Objectives

2.2.1. General Objective
This Year 3 Womens Health module is designed to provide a learning process for the
students to acquire knowledge and skills in obstetric and gynaecology so that they can
apply what they have learnt effectively in a holistic and professional manner that is
expected as a doctor. It also prepares them to be leaders in the field of medicine in both
the local context and globally.


2.2.2. Specific Objectives

At the end of the module, the students should be able to:

1.apply the knowledge of basic sciences to understand pathogenesis of clinical
conditions in Obstetrics and Gynaecology

2.be familiar with the terms and definitions that is pertinent to the discipline

3.obtain a comprehensive history in obstetrics and gynaecology

3.1.obtain menstrual, obstetric, gynecologic, family, social history

3.2. ask screening questions for urinary incontinence, sexual dysfunction, domestic
violence, substance abuse, psychosocial problems, and gynaecological malignancies

3.3. assess the risks for sexually transmitted infections, cervical pathology and
gynecologic malignancies.

3.4. obtain sexual history in related to any specific condition


4.perform relevant and systematic examination; both general and organ system
specific and development of skills

4.1. perform focused general and system specific examination in systematic manner

4.2.perform obstetric examination

4.3.perform abdominal, pelvic and recto-vaginal examinations for gynaecological
conditions in most appropriate way for individual groups: adolescents, reproductive,
elderly population

4.4.properly take sample and interpret a Pap smear, wet mount, and swabs for
culture and sensitivity after providing explanation to patients regarding the purpose
of these tests

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4.5.present the findings written or oral in well organized manner using medical
terminology

4.6.observe and perform common clinical procedures


4.7.perform normal delivery of babies and suture episiotomies



5.formulate reasonable provisional and differential diagnoses for common obstetric
and gynaecological conditions

5.1.identify all the problems that the patient have

5.2.identify the most important problem or condition

5.3.synthesize the provisional diagnosis

5.4.formulate differential diagnoses

5.5.select relevant facts from history and findings from physical examination to get
most likely cause and other possible causes of the patient chief complaint or main
problem

6.justify and interpret investigations for obstetric and gynaecological problems

6.1.investigate appropriately according to the patients problem considering cost-
effectiveness
6.2.understand and interpret the results of commonly used investigations
6.3.understand the clinical and laboratory manifestation of both common and
important diseases
6.4.plan further investigation when it is necessary

7.formulate a rational plan of management for common conditions

7.1.apply clinical reasoning in solving problems
7.2.construct appropriate management plan
7.3.understand and apply evidence based medicine
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7.4.offer available treatment options
7.5.understand importance of patients involvement in decision making
7.6.Plans for follow up and continuity of care with community based clinics
7.7.Consider economic, psychosocial and ethical issues

8.understand reproductive health issues in community:

8.1..understand the community screening and high risk screening for gynaecological
malgnancy

8.2.assess the risk and provide age appropriate counseling (i.e.contraception,
sexually transmitted disease prevention)

9.demonstrate effective communication skills

9.1.establish rapport with patients

9.2.build trust and cooperation of patients, including being mindful of contextual
factors such as culture, ethnicity, socioeconomic status, religion, sexual orientation,
disability

9.3.communicate test results to the patients and/or family members
9.4.inform valid information for available treatment options
9.5.explain common surgical procedures; steps and risks and take consent
9.6..provide health education and counseling and breaking the bad news

9.7.work cooperatively with the health care team, the patient and supportive
members


10.display professionalism:

10.1.recognize your own limitation knowing your strengths and weaknesses

10.2.Adhere to assignments

10.3.punctuality to clinics, lectures, grand rounds

10.4.present a professional image in both demeanor and attire

10.5.actively participate in learning opportunities
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10.6.demonstrate responsibility and dependability with patient care

10.7.display teamwork

10.8.respect confidentiality of patients information and clinical documentation



2.3 Learning outcomes

At the end of this module, the students will be able to:

1. apply the knowledge of basic sciences in understanding pathogenesis of clinical
conditions in obstetrics and gynaecology
2. be familiar with the terms and definitions that is pertinent to the discipline
3. obtain comprehensive history in obstetrics and gynaecology
4. perform relevant and systematic physical examination in obstetrics and gynaecology
5. formulate reasonable provisional and differential diagnoses for common obstetric and
gynaecological condition
6. perform, justify and interpret relevant investigations in obstetrics and gynaecology
7. formulate a rational plan of management for common conditions in obstetrics and
gynaecology
8. demonstrate effective communication skills.







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3. Detailed learning outcome
3.1.Obstetrics


3.1.1.History and examination
1. Learn etiquette in taking history, how to do pregnancy dating
2. Develop obstetric history taking skill including demographic details, regarding this
pregnancy including investigations done, past obstetric history, gynaecological
history, past medical and surgical history, psychiatric history, family history, social
history, drug and allergy history
3. Identify the risks and problems
4. Learn basic principles of infection control for clinical examination
5. General examination including height and weight, thyroid, breast examination
when necessary
6. Develop skill in obstetric examination


3.1.2.Female pelvis and fetal skull
learn fetal and maternal anatomy relevant to the mother
1. Maternal pelvis: inlet ,mid cavity, outlet, pelvic floor and perineum
2. Understand clinical pelvimetry and its relevance
3. The fetal skull: the bones, sutures and fontanalles, the diameters of the skull



3.1.3.Physiological changes in pregnancy
Discuss the changes in maternal organs and systems as pregnancy progress in adaptation to the
increasing demand of the fetal growth and development.
1. Describe early pregnancy changes, volume homeostasis, hematology including
haemostasis and coagulation, the immune response, changes in respiratory,
cardiovascular, gastrointestinal and kidney and urinary tract system.
2. Understand changes in reproductive system, breasts and lactation, endocrine system
and skin changes.
3. Be aware of biochemical changes with normal parameters in pregnancy, changes in
metabolism with normal and abnormal weight gain



3.1.4.Antenatal care
1. Describe the models of available antenatal care in Malaysia, Hospital, shared care with
general practitioners, community clinics, care for pregnant mother in rural and remote
area
2. Understand the purposes and practices of antenatal care.
3. Conduct of the booking visit and arrange follow-up visits.
4. Use of imaging techniques, screening for abnormality and appropriate screening and
antenatal tests.
5. Manage follow up visits and give health education
6. Manage follow up visits manage normal pregnancies
7. Evaluate and identify abnormal pregnancies


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3.1.5.Normal and abnormal labour
1. Describe signs and symptoms of onset of labour
2. Define the stages of labour
3. Describe the monitoring of labour in all three stages
4. Discuss Obstetric analgesia in labour be aware of risk and benefits of pharmacological
methods and non-pharmacological methods
5. Discuss the importance of use of partogram
6. Discuss abnormal first stage, second stage and third stage of Labour and underlying
causes

3.1.6.Normal and abnormal puerperium
1. Discuss physiological changes and normal signs and symptoms including uterus
involution, lochia, breast changes
2. Describe the diagnosis and outline management plan of common problems of the
puerperium including pain, constipation and breast complications
3. Discuss the causes and outline the management of puerperal pyrexia
4. Post caesarean section care
5. Lactation; physiology and benefits, pathology-mastitis and cracked nipples, drugs and
lactation

3.1.7.Antepartum haemorrhage (APH)
1. Define APH and discuss causes and Incidence
2. Describe diagnosis of of a woman with APH
3. Discuss most important causes of APH: Placenta praevia and placental abruption
in details and comparing incidence, types, clinical features, maternal and
fetal complications and diagnosis
4. Outline the management approach for a woman presenting with APH including
emergency management


3.1.8.Postpartum haemorrhage (PPH)
1. Define primary and secondary PPH
2. Understand the risk factors and aetiology of postpartum haemorrhage
3. Describe the sequential management PPH including use of oxytocics for PPH due to
uterine atony
4. Outline emergency management of severe PPH and understand the importance of team
approach to manage as an obstetric emergency


3.1.9.Hypertensive disorders of pregnancy
1. Define and classify hypertensive disorders in pregnancy and know the risk factors for
developing superimposed preeclampsia
2. Understand the effects of hypertension on the mother and the foetus
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3. Monitor mother and fetus with pregnancy induced hypertension
4. Discuss investigations and treatment outline
5. Be aware the signs and symptoms of imminent eclampsia and describe appropriate
management
6. Understand the principles of management of eclampsia


3.1.10.Diabetes affecting pregnancy
1. Understand the importance of prenatal counseling
2. Understand the types of diabetes and indications for screening test for GDM
3. Describe the maternal and fetal complications of diabetes
4. Outline the management of diabetes in pregnancy , guidelines for glucose monitoring,
importance of diet control, indications for insulin therapy and intrapartum and
postpartum management
5. Fetal and neonatal complications and monitoring

3.1.11.Abnormal lie, presentation and malposition
1. Explain the various terms used in relation to lie and presentation
2. List predisposing factors for abnormal presentation at term
3. Describe the types of breech, antenatal management of breech, delivery options
4. Discuss the timing, contraindication and risks of external cephalic version and observe
the procedure
5. List factors affecting transverse lie and principles of the management
6. Briefly describe diagnosis and management outline of face and brow presentations
7. Discuss on the common vertex malpositions of occipito-posterior and occipito-
transverse

3.1.12.Cardiotocography (CTG)
1. Antanatal and intrapartum CTG: understand indication and limitations
2. Demonstrate CTG reading and interpretation : Understand normal(reactive), non-
reassuring (suspicious) and abnormal CTG (Pathological)
3. Discuss patho-physiology of abnormal features, cause and management of a woman
with abnormal CTG

3.1.13.Partography
1. Discuss the importance of maternal and foetal monitoring in labour using partogram
2. Describe and demonstrate the documentation of progress of labour in the partogram
3. Define abnormal labour
4. Diagnose abnormal labour: prolonged latent phase, primary dysfunctional labour or
secondary arrest with partogram

3.2.14.Episiotomy
1. Define episiotomy and discuss the prevalence , indication, types of episiotomy and
complications
2. Observe the technique of episiotomy
3. Learn the repair technique
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3.2.Gynaecology
3.1.1 Menstrual cycle
1. Understand the hypothalmo-pituitary ovarian axis with changes in hormone levels
positive and negative feed back mechanisms to maintain normal menstrual cycle
2. Describe follicle development , ovulation and corpus luteum formation and changes in
endometri um
3. Discuss the clinical relevance of each phase in order to explain the menstrual disorders,
infertility and use of hormonal contraception

3.2.2.Complications in early pregnancy
1. Describe the clinical features, principles of diagnosis and management of early
pregnancy complications including different types of miscarriages, abortion, ectopic
pregnancy, trophoblastic disease and hyperemesis gravidarum

3.2.3.Menstrual disorders (Heavy menstrual bleeding and dysfunctional bleeding)
1. Define various terms used to describe menstrual disorder
2. Discuss aetiology of heavy menstrual bleeding (menorrhagia)
3. Learn to take history for heavy menstrual bleeding including assessment of severity of
bleeding
4. Discuss investigations and outline management options of menstrual disorders; medical
vs non medical, hormonal vs non-hormonal, conservative surgery vs radical surgery


3.2.4.Gynaecological malignancies
1. State the types and epidemiology of gynaecological cancers.
2. Discuss the premalignant condition of cervix and screening modalities
3. Understand the aetiology or risk factors, histological types, FIGO staging,
clinical presentation, diagnostic methods, investigations, principles of treatment for
carcinoma cervix, carcinoma endometrium and ovarian carcinoma


3.2.5.Menopause and Hormone replacement therapy
1. Define menopause
2. Understand the pathophysiology of menopause
3. Discuss the effects of menopause
4. Outline the management of menopause and HRT: benefits and risks, contraindications
and side effects
5. List alternative and complementary therapies



3.2.6. Sub-fertility (Infertility)
1. Understand the factors which may adversely affect the natural conception
2. State the causes of male and female infertility
3. Learn to take relevant history and do focused examination for a woman with subfertility
problem
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4. Investigate ovulation, tubal patency and husbands semen analysis
5. Outline management principles of infertile couple according to the cause


3.2.7.Contraception
1. List various types of contraception
2. Describe basic facts of contraception regarding availability, acceptability, effectiveness,
mechanism of action, indications, contraindications, benefits of different contraceptive
methods
3. Learn procedures like insertion IUDs, female sterilization and vasectomy and
implications
4. Effectively counsel on contraception
5. Discuss emergency contraception and its role



3.2.8.Vulvo-vaginal infection
1. List the causes of vaginal discharge including the micro-organisms that can cause
excessive vaginal discharges
2. Discuss the signs and symptoms, predisposing/risk factors
3. Understand how to diagnose vaginal infection
4. State the treatment principles including pharmacological agents used to treat the
infection
5. Describe the acute complication and chronic consequences from vulvo- vaginal
infection including causes, clinical presentation and management outline of Bartholins
cyst and abscess





















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4.0 TEACHING LEARNING METHODOLOGY

( A ) Concept Lectures ( 1 hours each session)

Students will be given concept lectures in topic which are the fundamentals in obstetrics &
gynaecology.

Topics

1. History and examination in obstetrics & Gynaecology
2. The female pelvis and fetal skull
3. Physiological changes in pregnancy
4. Menstrual cycle


( B ) Guided Tutorials ( 1 hours each session )

Students are required to prepare and present tutorials in obstetrics & gynaecology

Topics

( a ) Obstetrics

1. Antenatal care
2. Normal & abnormal labour
3. Normal & abnormal puerperium
4. Postpartum haemorrhage
5. Antepartum haemorrhage
6. Hypertensive disorders in pregnancy
7. Diabetes in pregnancy
8. Abnormal lie and presentation and mal-position

( b ) Gynaecology

1. Complications of early pregnancy ( miscarriage, ectopic pregnancy, molar pregnancy,
hyperemesis gravidarum )
2. Menstrual disorders (Heavy menstrual bleeding and dysfunctional uterine bleeding )
3. Gynaecological malignancy
4. Menopause & HRT
5. Subfertility (Infertility)
6. Contraception
7. Vulvo-vaginal infection





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( C ) Practical skills workshop ( 2 hours each session )

Students will be taught skills in obstetric and gynaecology which include examination
technique, procedure and interpretation skills.
1. Partogram workshop
2. Cardiotocography ( CTG ) workshop
3. Episiotomy workshop
4. Pap smear and pelvic examination workshop

( D ) Bedside teaching ( 2 hours each session )

Students will be divided into 2 groups where both the sessions in obstetrics and gynaecology will
be carried out concurrently. There will be a total of 14 bedside teaching sessions.




4.0. Mentoring students

Each student will be assigned to a designated lecturer who will be his/her mentor during the
posting. The students are encouraged to have regular meetings with their mentors. Your mentor
will be your advisor and monitor your progress throughout the posting. However, the students
are not confined to their designated mentors and can approach any lecturer in the discipline if
desired.


4.1. Ward rotation

Students will be divided into two groups for ward placement. You will be in gynaecology ward
for 2 weeks and obstetric ward ( labour room & maternity ward ) for 2 weeks. Students in the
obstetric ward will have one week in the labour room and one week in the maternity ward.




4.2. Ward work, clinics and delivery suite on-call

Students are expected to attend wards every morning according to their respective posting
placement (i.e. labour room, maternity ward and gynaecological ward). They are expected to
know about patients in the ward and to present the cases during ward rounds. Students are
expected to tag along with the house officers for procedures and ward work. The students are
also expected to attend antenatal and gynaecological clinics according to the schedule given.
The students are encouraged to do active but supervised learning during delivery suite on-call.
Students will be put on on- call roster once a week from 5 pm to 10 pm. Attendance for on call is
mandatory. Your lecturers may drop by to supervise you.


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5.0 Posting requirements and assignment

5.1 Case write up

Students are expected to complete and submit one case write up either obstetrics or
gynaecology .

A standard format of writing up the case discussion will be given to you. You may discuss with
your mentor regarding the case. Students are advised not to take the case discussion task lightly
because marks of case discussion write up are taken into account for continuous assessment for
the end of phase examination. The case write is due by 4 pm on Monday of 4
th
week. Those
who fail to submit case write up on time will be given ZERO mark.


5.2 Log Book
All students are required to maintain a log book of observation and experience. It must be
obtained on the registration day to this posting from the Department of Obstetrics and
Gynaecology, University Kuala Lumpur Royal College of Medicine Perak (UniKL-RCMP).
On satisfactory completion that includes performance of the minimum number of procedures as
stipulated in the log book, it must be certified by the Posting Supervisor to indicate satisfactory
completion of training, and certified as satisfactory by the Coordinator of the posting. The log
book must be submitted to the Department for formal approval before the completion of
clinical posting. Last day for submission of the log book is by 9.00 am on the Wednesday of the
4
th
week. Those who fail to submit their log book on time will be given ZERO mark. The log book
contributes 5% of the continuous assessment marks and may determine the grade in the end of
posting examination. Failing to submit the log books also amounts to unsatisfactory completion
of the posting.


















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6.0 Administrative Policies

Even though you may not physically be at UniKL RCMP campus, please abide by both University
Kuala Lumpur Royal College of Medicine Perak policies and the departments policies.


6.1 Honor code

All students are required to abide by the HONOR CODE set forth by the University Kuala Lumpur
Royal College of Medicine Perak.


6.2 Attendance policy

Attendance is required at all teaching activities. If you are absent, you must notify the attending
lecturers and the Student Clerkship Coordinator. The department will only grant medical and
excused absences and in an emergency situation.

Unexpected absence: In the case of an unexpected, single day absence due to illness, you must
notify the lecturer in-charge and the Module Coordinator. If you are unable to contact the
module coordinator, you should notify the staff in Academic Office. If the absence is of greater
duration than one day, you MUST notify the Academic Office, the supervising attending
lecturers, and module coordinator.

Planned absence: In the case of planned absence, you must have prior approval from the
department for planned period. Preferably, the student should meet with the module
coordinator as far in advance as possible to discuss the requests and obtain the permission of
the clerkship coordinator to be absent from assigned responsibilities.

The department has ZERO TOLERANCE for absenteeism and you may be barred from sitting the
end posting examination if you fail to meet the attendance requirement.



6.3. Dress code

All medical students must abide the professional dress code. Each student has the responsibility
to uphold the name of UniKL RCMP at all times.

1. PLEASE DO NOT WEARS JEANS, SHORTS or T-SHIRTS ON THIS SERVICE at any time, at
orientation and didactic sessions.

2. Ties are highly recommended for men.

3. Wear your name tag/ID at all times, even in the Operating Theater and Labor and
Delivery Room.

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4. Wear your clean white coat especially in clinic and on ward rounds.



6.4.Professional Demeanor

In addition to the medical schools Student Code of Professional Conduct, the following
guidelines should be followed during this clerkship,

1. Students should refrain from using inappropriate language and discussing problems of a
sensitive or controversial nature within earshot of patients, hospital visitors or hospital
staff.

2. Students are expected to introduce themselves (as a medical student) to nurses,
patients, residents and attending physicians. For the laboring patient, a student should
always meet both patient and attending as early in the process as possible and get
verbal permission from both to participate in her care. You may ask the resident also to
introduce you to the patient.

3. Demonstrate respect for patients, families, colleagues, and members of the health care
team.

4. Demonstrate compassion, integrity and honesty.

5. Abide by HOSPITAL ETHICS and hold medical information in strict confidence.

6. Acknowledge limitations, seek and accept feedback.

7. Commitment to learning.



















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7.0 Assessment

7.1. End of posting examination

Only students who have fulfilled the posting requirements will be allowed to sit for the end
posting examination. Students will be briefed about the examination prior to it. The examination
will usually be on Thursday of 4
th
week.


7.2 Examination


Assessment Task No of questions Duration Weightage
Multiple Choice
Question (MCQ)

10 themes

20 minutes 20%
Modified Essay
question (MEQ)

1 Obstetrics
1 Gynaecology
40 minutes
(20 minutes for each
question)
40%
Static Multistation 6 multi static
stations
30 minutes
(5minutes per station)
40%



7.3.Passing Criteria

Students who obtain at least 50% marks are deemed to have passed the examination. However
in special circumstances the Discipline of Obstetrics & Gynaecology can decide on a students
grade. The examination results will be notified and relevant feed back on the examination will
be given at the end of the posting.


7.4 Continuous Assessment

The performance of the student will be assessed throughout the posting.
The marks awarded for continuous assessment is added in some percentage to the end of phase
examination marks to determine final marks.
Students are advised to take the continuous assessment component seriously as it will affect the
end of phase examination grades.
The components taken into account for the continuous assessment are

1. One case write-up : 15%
2. Log book : 5%
3. MCQ marks : 20%
4. MEQ /SAQ marks : 30%
5. Multistation marks : 30%

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7.5. End of phase examination

The end of phase examination will be conducted after completion of all postings within
the phase.

7.6. Obstetric and gynaecological questions contribution in the final examination

The components for end of phase examination include

1. Extended matching question ( EMQ )
2. Modified essay question ( MEQ )
3. Objectively Structured Clinical Examination ( OSCE )



































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8. Learning resources

8.1.Recommended Text books


1. Baker PN, Kenny LC .Obstetrics by Ten Teachers. 19
th
ed. London : Hodder &
Stoughton Ltd; 2011

2. Monga A, Dobbs S .Gynaecology by Ten Teachers. 19
th
ed. London : Hodder
& Stoughton Ltd; 2011


8.2.Supplementary Text books (recommended for reference):

1. Miller AWF, Hanretty KP. Obstetrics Illustrated. 7
th
ed. Elsevier Science; 2010

2. Bain CM, Burton K, McGavigan CJ. Gynaecology Illustrated. 6
th
ed.
Churchill;2011

3. Cunningham F, Leveno K, Bloom S, Hauth J, Rouse D, Spong C. Williams
Obstetrics. 23
rd
ed. The McGraw Hill;2010

4. Oates JK, Abraham S. Llewellyn Jones Fundamentals of Obstetrics &
Gynaecology. 9
th
ed. Mosby Elsevier;2010

5. 5.Keith Edmonds. Dewhursts textbook of Obstetrics and gynaecology. Wiely-
blackwell. February 2012




8.3. Useful websites

1.UniKL RCMP e-LMS
2.Guidelines from www.rcog.org.uk
3.Canada question bank available from UNIKL RCMP
4. Ministry of Health Malaysia, clinical guidelines ( www.moh.gov.my )










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Teaching outlines (Complete outline including references can be available in ELMS of
respective lecturer and module coordinator )

Title

History and examination in Obstetrics and Gynaecology
Aims & Objectives



1. To be familiar with common terms that are used in
obstetrics & gynaecology
2. To be able to take a comprehensive and relevant history in
obstetrics & gynaecology
3. To be able to carry out systematic examination in both pregnant and
non pregnant female.
4. To be able to perform proper pelvic examination for both
obstetric and gynaecological patients

Lecture Contents




1. Common terms in obstetrics & gynaecology
2. History taking with emphasis to menstrual history, obstetric
history, gynaecology history
3. General and abdominal examination of a pregnant woman
4.Obstetric vaginal examination
5. Gynaecological vaginal examination which includes both
speculum and digital examination

Title Female pelvis

Aims & Objectives



1. To teach the students regarding the anatomy of the female pelvis
(bones and ligaments) and its clinical relevance
2. To expose them to its relevance in Obstetrics management i.e. its
importance during pregnancy and labour.
3. To know the different types of pelvic shapes and how this affects
labour and its progress
4. To know the abnormalities of the pelvis
5. To know what are pelvic diameters and assessment of pelvic
adequacy.
Lecture Contents









1. Anatomy of the female bony pelvis.
2. What are: False and True Pelvis.
3. Effects of pregnancy on the pelvis.
4. The dimensions and landmarks of the pelvis: Inlet, Mid-cavity,
outlet.
5. How to perform clinical pelvimentry
6. What are True Conjugate and Obstetrics conjugate.
7. Types of female pelvis and its clinical significance.



26


Title The Fetal Skull
Aims & Objectives



1. To know the anatomy of the fetal skull.
2. To know the relevance of fetal skull diameters and the phenomena
of moulding.
3. Correlate the findings with progress of labour and identify problems
based on the changes in fetal skull status.
Lecture Contents









1. Anatomy of the fetal skull
2. Sutures- their importance.
3. Identification of Fontanelles- the anterior and posterior
fontanelle.
4. The concept of moulding and the grades of it.
5. The diameters of the fetal skull ; how each differing position
reflects a different presentation (vertex, brow, face) and the
degree of fetal head flexion.
6. Clinical relevance of the diameters of foetal skull

Title Physiological changes in pregnancy
Aims & Objectives

To understand the changes and adaptations of the maternal organ systems
to meet the demands of fetal growth and development during pregnancy
Tutorial Contents






1. Changes in weight
2. Changes in metabolism
3. Changes in the abdominal wall
4. Breast changes
5. Changes in the endocrine system
6. Haematological changes
7. Reproductive organ changes
8. Changes in the CVS
9. Changes in respiratory system
10. Gastrointestinal tract changes
11. Urinary tract changes


27

Title Physiology of menstrual cycle
Aims To have an understanding on physiology of the menstrual cycle to help
understand menstrual disorders
Objectives 1. To describe mechanisms involved in the normal menstrual cycle
2. To understand the clinical relevance of each phase
3. To discuss physiology with clinical application in menstrual disorders
Lecture Contents 1. Control of menstrual cycle
a. Hypothalamo-pituitary (HPO) axis:
i. Hypotalamus: Gonadotrophin hormone (GnRH)
production; function & control (positive and negative
feedback)
ii. Anterior pituitary: Follicular stimulating hormone and
luteal hormone production; function & control (positive
and negative feedback); Inhibin & activin hormone
b. Ovary:
i. Ovulation phase: follicular, ovulation, luteal
ii. Ovarian hormone: oestrogen and progesterone; function
and control.
2. Endometrium
a. Normal menstruation
i. Endocrine influence
ii. Endometrial shedding and repair

b. Endometrial phase:
i. The proliferative phase
ii. The secretary phase



Title Antenatal Care (ANC)
Aims & Objectives



Follow a definite plan for antenatal care management, including
investigations and treatment modalities.
Look out for possible complications and risk factors that occur
at particular gestation ages
Provide adequate health care education to the mother.
Tutorial Contents









The aims and principles of antenatal care.
Booking visit: timing of visit, History and examination, Identifying : low,
intermediate and high risks pregnancies, dating of the pregnancy,
antenatal investigations arranged at the first visit.
Subsequent antenatal visits: results interpretation, Routine medications;
TT Injections, Haematinics, identify complications
Provision of health information during antenatal visits.
Principles on determining time and mode of delivery
28
Title Normal and abnormal labour
Aims & Objectives To guide the students to understand the process and management of
normal labour and identify abnormal labour.
Tutorial Contents






1. Normal labour :
Definition, Signs & symptoms of labour from history, physical
examination and vaginal examination
Stages of labour: first stage (latent & active phase) , second
stage and third stage
Mechanisms of labour : with emphasis on pelvic diameter at
inlet, midcavity and outlet and also different fetal position
occipito anterior, occipito-transverse and posterior
Maternal and foetal monitoring during labour including usage
of partogram and cardiotocography
Standard management in three stages of labour including
pain relief in labour, active management of third stage
2. Abnormal labour
In 1
st
, 2
nd
and 3
rd
stage of labour and underlying causes
First stage 1.Prolonged latent phase, 2.primary dysfunctional labour 3.
secondary arrest of labour and diagnosis by the use of patogram for
recognition.
Recognition of abnormal lie, presentation and malposition during labour
Outline of management according to the stage of labour augmentation
of labour and indications for Caesarean -section

Title Normal and abnormal puerperium
Aims & Objectives

To make the students understand the physiological processes that take
place following delivery and be able to appreciate any abnormal
changes.
Tutorial Contents




1. Definition of puerperium
2. Physiological changes in the various systems after delivery
genital tract, urinary tract, alimentary tract, circulatory system,
musculoskeletal system,
3. Lactation and breast care .
4. Recognition puerperal complications and principles of
management haemorrhage, puerperal pyrexia and infections ,
UTI, affective disorders



29
Title Antepartum haemorrhage (APH)
Aims & Objectives To understand antepartum hemorrhage and its consequences thereby
help reduce morbidity and mortality associated with it.
Tutorial Contents









Definition of antepartum haemorrhage
Discuss causes and risk factors associated with antepartum
haemorrhage
Establish the definitive diagnosis in a woman with antepartum
haemorrhage
Discuss the most important causes of APH: Placenta praevia and
placental abruption in details and comparing
o Incidence
o Types
o Clinical features
o Maternal and foetal complications
o Diagnosis
Outline the basic principles of management in APH including
emergency management


Title Post partum Haemorrhage ( PPH )
Aims & Objectives



1. To understand the mechanism of haemostasis following delivery
2. To be able to define and classify post partum haemorrhage
3. To know the causes of PPH
4. To know risk factors and clinical presentation of post partum
haemorrhage
5. To know the principles of management of postpartum
haemorrhage and the importance of team work in the
management of severe PPH

Tutorial Contents




1. Normal haemostasis following delivery
2. Definition of PPH
3. Classification of PPH
4. Risk factors for postpartum haemorrhage
5. Causes of PPH
6. Signs and symptoms of hypovolaemia
7. Principles of management of post partum haemorrhage
including of emergency management

30
Title Hypertensive disorders of pregnancy
Aims & Objectives



1. To understand patho-physiology of hypertension in pregnancy
2. To be able to classify hypertensive disorders in pregnancy
3. To understand clinical presentation of hypertensive disorders of
pregnancy
4. Understand the fetal and maternal complications of
hypertension in pregnancy
5. To have an understanding of the principles of management

Tutorial Contents





1. Patho-physiology of hypertension in pregnancy
2. Definition and classification of hypertension in pregnancy
3. Symptomatology of hypertension in pregnancy
4. Investigation in hypertensive disorders of pregnancy
5. Principles of management of a hypertensive mother
6. Effects of hypertension to the pregnant mother
7. Effects of hypertension to the fetus
8. Pathophysiology and principles of management of
eclampsia and other complications


Title Diabetes in pregnancy
Aims & Objectives



1. To understand glucose metabolism in pregnancy
2. To be able to classify diabetes in pregnancy
3. Screening for diabetes in pregnant women
4. Understand the fetal and maternal effects of diabetes
5. To understand basic principle in management of diabetic
pregnancies
Tutorial Contents




1. Overview of glucose metabolism in pregnancy
2. Definition and classification of diabetes in pregnancy
3. Indications for and method of performing oral glucose
tolerance test (MOGTT)
4. Interpretation of MOGTT results
5. Effects of diabetes on the pregnant mother
6. Effects of diabetes on the fetus
7. Basic outline of management in diabetic pregnancies



31


Title Abnormal Foetal Lie and Presentation and malpositions

Aims &
Objectives
1. To understand the definitions of normal and abnormal foetal lie and
presentation
2. To recognize the common foetal malpresentaions (breech and transverse lie),
the associated factors and the management of such.
3. To recognize face and brow presentations and know the principles of their
management.
4. To be aware of the common vertex malpositions (OP and OT) and their
management.

Tutorial
Contents
1. An explanation of the various terms used in relation to lie and presentation.
2. Factors affecting the common malpresentation (lie) of breech and the types
of breech and the management.
3. Factors affecting transverse lie and principles of the management.
4. Brief description of the management principles of face and brow
presentations.
5. A discussion of the common vertex malpositions of OP and OT




Title Complications in Early Pregnancy
Aims & Objectives



1. To help understand physiology and symptoms of early pregnancy
2. To familiarize them with common early complications of pregnancy,
including: A) Ectopic pregnancy. B) Miscarriage. C) Gestational trophoblastic
disease and D) Hyperemesis gravidarum.
3. To know how to diagnose and manage complications of early pregnancy.
4.To know consequences of the above complications.

Tutorial Contents








1. 1.Types of miscarriages
2. Signs and symptoms of early pregnancy complications
3. Principles of history taking and associated diagnostic methods.
4. Clinical presentation and pathophysiology of early pregnancy
complications.
5. 6. Principles of treatment of early pregnancy complications
including basic operating procedures.



32


Title Menstrual Disorders
(Heavy Menstrual Bleeding (Menorrhagia) and dysfunctional uterine
bleeding)
Aims & Objectives


1. Understand the term heavy menstrual bleeding, its causes and
its symptomatology
2. To know indications and methods of diagnostic procedures
3. To understand the principles of management of HMB

Tutorial Contents





1. Definition of the various terms used to describe abnormal
menstruation.
2. Causes of heavy menstrual bleeding (HMB) (menorrhagia)
3. Symptomatology of heavy menstrual bleeding including assessment
of the severity
4. Investigations in patients with HMB
5. Drugs used for treatment of HMB
6. Basic principles of management of HMB including treatment options.




Title

Gynaecological Malignancies
Aims &
Objectives



1. To know what are the common gynaecological cancers.
2. To know the epidemiology of gynaecological cancers
especially cancer of cervix, cancer of ovary and endometrial cancer
3. To know the screening and prevention of gynaecological cancer
4. To know the basic principles of management

Lecture
Contents





1. Epidemiology of gynaecological cancers
2. Risk factors of gynaecological cancers
3. Clinical presentation of gynaecological cancers
4. Staging of gynaecological cancers
5. Principles of treatment of gynaecological cancers
6. Prognosis of gynaecological cancers
7. Brief overview about pre malignant lesions of the cervix
8. Screening modalities for the cancers including tumour markers







33


Title Menopause and hormone replacement therapy (HRT)
Aims & Objectives

1. To understand pathophysiology and effects of menopause
2. To be able to manage menopause effectively using various treatment
modalities
Tutorial Contents





1.Definition of peri-menopause , menopause and premature menopause
2.Pathophysiology of menopause
3. Symptoms and effects of menopause
3.Investigations in the menopausal woman
4. Hormone replacement therapy; contraindication, complications, risks
6. Alternative treatment outline for menopause
After presentation-
-Role playing on menopause counseling
-Quiz




Title Subfertility (Infertility)
Aims & Objectives



1. To help students understand the definition of subfetility
2. To be able to identify common causes of subfertility
3. To know the common fertility investigations and the reasoning behind
them.
4. To understand the principles of management and availability of ART
options.

Tutorial Contents






1. Definition of subfertility
2. The importance /significance of this problem to the family
3. Causes of subfertility
4. Management outlines/ principles including basic subfertility work
up, including different available options.











34


Title Contraception
Aims & Objectives


1. To have knowledge about the various forms of contraception
available.
2. To be able to offer appropriate contraception to women
requiring it.
3. To understand the mechanism of action of the various
contraceptive methods
4. To be aware of the side effects and contraindications of the
various contraceptive methods
Tutorial Contents






1. Definition of contraception
2. Characteristics of an ideal contraception
3. Types of contraceptive method i.e. rhythm, lactational
amenorrhoea, barrier, hormonal contraception, intrauterine
contraceptive device, male and female sterilization,
emergency contraception
4. Mechanism of action of various contraceptive methods
5. Side effects and contraindications specific contraceptive
method
6. Issues related to sterilization
7. Emergency contraception and its role

Title Vulvo-Vaginal infections

Aims & Objectives 1.To understand the nature and role of physiological vaginal discharge
2.Know the common causes of pathological vaginal discharge
3.Know the differential diagnoses
4.Know the investigations to establish diagnosis
5.Know the common treatments for the vulvo-vaginal conditions
Tutorial Contents 1. The nature and role of physiological vaginal discharge.
2. Causes of Pathological Vaginal Discharge
i. Infective (non-sexually transmitted) vaginal discharge
ii. Infective (sexually transmitted) vaginal discharge
iii. Non-infective causes of vaginal discharge
3. Investigations in a patient with vaginal discharge
4. Discussion of diagnosis, management and complications of common
conditions causing vaginal discharge: Bacterial vaginosis, Candidiasis,
35
Trichomoniasis, Gonorrhoea, and Chlamydia
5. Causes, clinical presentation and management of Bartholins
Cyst/Abscess
Title Partogram Workshop

Aims and
Objectives
1. To provide knowledge related to partogram and how to plot on
it
2. To understand application of partogram as an essential part of
labour management
3. To recognize abnormal labour using the partogram

Lecture Contents

1. Evidence-based facts on partogram
2. Partogram component : labour progress, fetal & maternal
monitoring
3. Detailed information about how to plot partogram
4. Interpretation of partogram

Small group
discusssions
1. Exercises with 3 case scenarios to plot partogram , interpret
the finding and give action plan




Title

Cardiotocography(CTG)
Aims & Objectives



1. To understand and interpret the cardiotocogram
2. Able to carry out appropriate course of action when an abnormal CTG
is encountered
Practical Contents








1. Definition and interpretation of the components of the
cardiotocograph
2. Features of a normal CTG
3. Features of an abnormal CTG including explanation for these
changes.
4. Various types of abnormal CTG and the appropriate course of
action
5. Exercises in CTG interpretation









36





Title

Episiotomy Workshop
Aims & Objectives



To understand the principles in performing and repairing episiotomies
according to acceptable standards.
Practical Contents





1. Definition of episiotomy
2. Types of episiotomy
3. Indications for episiotomy
4.Instruments used for episiotomy
5. How to perform an episiotomy
6. Structures that are cut in an episiotomy
7. How to repair an episiotomy
8. Complication of episiotomy and its repair

itle Pelvic examination
Aims &
Objectives
At the end of the this workshop, the student will demonstrate the ability to:
A. Interact with the patient in a way that elicits confidence and cooperation
B. Assure the patients trust, comfort and modesty.
C. Perform the complete examination in a sensitive manner.
D. Use appropriate medical terminology and communication skills when
performing the exam
Workshop
Contents
(Use of a
mannequin,
and this is a
follow-up to
the Pap
smear.
A bimanual
recto-vaginal
examination
is not taught
in this
workshop).

1. Explaining and obtaining permission to do the pelvic examination
2. Ensuring the presence of a chaperone
3. Organising the equipment and ensure that the clinical examination area is
prepared before commencing the procedure.
4. Positioning of the patient and proper draping to preserve modesty.
5. Importance of a good light source for visualization
6. Donning gloves
7. Inspection of the external genitalia
8. Introduction of two fingers of the dominant hand into the vagina.
9. Palpation of vaginal walls for any obvious abnormality.
10. Introduction of the non-dominant hand on the abdomen to make it a bimanual
examination.
11. Palpation of cervix and cervical os, noting any pain.
12. Palpation of uterus ; for position, size, consistency, mobility & tenderness, and
shape.
13. Palpation of right & left adnexa for ovarian and adnexal abnormalities.
14. Removes examining fingers from the vagina with care and noting any blood
staining or discharge.
37

15. Proper disposal of gloves and equipment. 16.
Thanking the patient and answering any questions.


Title Papanicolaou Smear (Pap smear)
Aims &
Objectives


At the end of the this workshop, the student will demonstrate the ability to:
A. Know the instruments used for taking a pap smear
Perform a papanicolou smear properly
B. Visualise the cervix and identify any abnormalities
C. Take an adequate Pap smear
D. Obtain adequate specimens for cytological analysis
E. Handle specimens properly to improve diagnostic accuracy
F. Provide an explanation to the patient regarding the purpose of these tests
Workshop
Contents
(using a
mannequin)









1. Explaining and obtaining permission to do the Pap procedure
2. Ensuring the presence of a chaperone
3. Organising the equipment and ensure that the clinical examination area is
prepared before commencing the procedure.
4. Labeling the slide correctly
5. Preparing a good light source for visualization
6. Positioning of the patient and proper draping to preserve modesty
7. Donning gloves
8. Inspection of the external genitalia
9. Knowing the parts and working of Cusco speculum
10. Warming & lubricating the Cusco speculum
11. Proper and gentle insertion of the speculum
12. Using Ayres spatula and knowing which end is suitable for the nulliparous,
menopausal and parous cervix.
13. Using the endocervical brush to sample the endocervical canal
14. Importance of, and identifying, the squamo-columnar junction for adequate
sampling
15. Making a thin smear without overlapping of specimens from the ecto and
endocervix on the glass slide.
16. Spraying and fixing the specimen immediately.
17. Proper removal of the speculum without hurting the patient.
18. Proper disposal of gloves and equipment
19. Thanking the patient and answering any questions.
20. Introduction to Thin-prep Pap smear and use of liquid medium.