We strive to integrate the curriculum across all 4 years of medical school so that it builds upon itself and complements the students’ advancing clinical skills. Dr. France Galerneau oversees an outstanding 1st - and 2nd -year curriculum that begins with the physiology of reproduction and progresses to more advanced topics, like the pathophysiology of PCOS, preeclampsia, and gestational trophoblastic disease. These topics are taught both in lecture and small groups by a very dedicated departmental faculty, including Dr. Lubna Pal and Dr. Pinar Kodaman. This strong foundation prepares students for their clinical experience during the third-year clerkship in Ob/Gyn.
The Ob/Gyn clerkship provides students with an opportunity to experience the field in the clinical setting with a fantastic cadre of residents, midwives, nurses, OR staff, and attendings. The clerkship starts with a series of simulation experiences and basic instruction. Every student has a session with a Gynecologic Teaching Associate who helps the student learn and practice breast and pelvic examinations and guides each student in how to help a woman through these exams by verbal and non-verbal communication. This program is directed by Dr. Shefali Pathy and Nancy Kellet, RN. Obstetric simulations follow with the NOELLE birth simulator, expertly led by Dr. Scott Casper and Cheryl Raab, RN. Students rave about this training because it prepares them to participate in the care of laboring women during their birth experiences. Later in the clerkship, Dr. Ozan Bahtiyar uses different simulators to teach students how to perform ultrasound to visualize both normal and abnormal anatomy.
One of our newest and most exciting initiatives on the Ob/Gyn clerkship is the development of a Shared Decision Making Curriculum. Shared Decision Making is the communication that occurs between a physician and a patient when important medical decisions need to be made. This form of counseling was first developed and described in relation to family planning, but it is widely applicable to other issues and specialties. We have developed a series of realistic clinical scenarios, including a broad range of topics related to unplanned pregnancy, postmenopausal hormone therapy, contraceptive counseling, amniocentesis, and conservative vs. radical treatment for gynecologic malignancies. Professional actors have been trained in these scenarios to serve as standardized patients so medical students can learn and practice options counseling. Every session is observed, and faculty preceptors and peers provide immediate feedback to students. This initiative is supported by the Cavanagh Endowment, a recent gift to the Yale School of Medicine dedicated to improving the education and communication skills of future physicians regarding reproductive health.
Later in the clerkship, the students have a unique session with ovarian cancer patients (survivor sessions), and is led by Ms. Joanne Bilyard. In this forum, women share their personal experiences when being diagnosed and treated for ovarian cancer. Students are able to ask questions and talk with these women about what types of patient-doctor interactions were helpful and which ones were not. Students treasure this rare opportunity to hear firsthand about these women's experiences.
Perhaps one of the most highly praised aspects of our clerkship is the 6-week didactic curriculum that we run every Thursday. This series of small group seminars and interactive sessions, covering contraception to menopause, is one of the most popular at the medical school. The success of this curriculum derives from the high-quality faculty and their dedication and love for teaching. We also engage in a weekly discussion on ethics, professionalism, and challenging situations in the clinical setting, providing an open forum for discussion about students’ experiences as they transition into the medical setting, often unfamiliar territory with shifting rules and boundaries. We discuss topics such as caring for patients who do not speak English during labor, pelvic exams under anesthesia and informed consent, and professionalism in the surgical suite.
Throughout the six-week clerkship, students also meet regularly for Clinical Reasoning Workshops led by our extraordinary cadre of community faculty members, including Drs. Achong, Ross, Asis, Cwik, Flaherty, Simon, and Fine. These workshops ensure that all students have an opportunity to consider some of the most common Ob/Gyn scenarios, such as pelvic pain and abnormal bleeding, even if they do not encounter a patient with these symptoms during their clerkship.
Lastly, we strive to motivate students to explore the quality of the evidence regarding the many controversial topics in our field: when to honor a maternal request for Cesarean delivery; when to perform vaginal delivery after Cesarean section; how many embryos should be placed during in vitro fertilization; whether to recommend postmenopausal hormone therapy or cord blood banking, and so on. Students encounter these issues while they are with us during their 6-week clerkship and often walk away confused as they listen to all the contradictory opinions of co-workers. Therefore, we have designed a forum in which students engage in formal debates centered on such common controversies. The debate-style approach motivates them to find the highest-quality evidence to support their assigned stance on each controversial topic and also forces them to scrutinize the literature on both sides to identify limitations. This leads to an engaging and often very entertaining debate in which all students participate and ultimately learn about the topics. This forum provides an opportunity to teach students to think critically and practice self-directed learning, ultimately preparing them for the ever-changing literature and the decisions they and their patients will face.
We believe that Ob/Gyn presents a unique set of clinical experiences and challenges for all students, helping them to reach their full potential as compassionate and knowledgeable physicians able to provide optimal care for women in all specialties.