Clerkship Competencies

Competency-Based Learning Objectives for Medical Students Completing Fourth Year at Tulane University School of Medicine

The members of the ACGME developed the Competency-Based Learning Objectives for Medical Students Completing Fourth Year. These are a compilation of the professional behavior, clinical skills, medical knowledge and issues regarding family and societal influences in health care that each medical graduate must have acquired prior to graduation. The following objectives will be stressed during the Ob-Gyn clerkship.

I. Professional Behavior

All areas of this section will be addressed during clinical interactions with patients, staff, faculty and peers.

  • Enhancing communication skills through interpersonal skills
  • Professionally and compassionately relating news of serious acute or chronic illness or congenital abnormality to patients and family.
  • Identifying, organizing, and recording accurately in the patient record the information needed to appropriately address the patient’s problem/condition
  •  Self education by utilizing key information sources, literature searches, decision support systems, and assessing the quality of this information/studies and application to clinical practice.
  • Developing a productive interaction with patients, encouraging patient autonomy, maintaining confidentiality and maintaining continuing personal responsibility for the patient’s health care.
  • Describing the professional and ethical issues facing physicians when encountering and treating the economically disadvantaged.
  • Identifying and presenting in an unbiased manner potentially controversial health care issues, including reproductive choice, maternal-fetal conflicts and religious conflicts with the provider
  • Professional dress and manner in patient care areas
  • Recognize your own limitations—assess your own strengths and weaknesses
  • Adhere to assignments
  • Present a professional image in both demeanor and attire
  • Actively participate in learning opportunities
  • Demonstrate responsibility and dependability with patient care
  • Display teamwork
  • Punctuality to clinics, lectures, grand rounds

II. Clinical Skills / Care of Patients

Perform both comprehensive and problem-focused histories and physicals for both obstetric and gynecology patients and for both adolescent and adult females

Interviewing, History and Physical Examination

  • How to obtain menstrual, obstetric, gynecologic, family, social history
  • Learn to incorporate screening questions for urinary incontinence, sexual dysfunction, domestic violence, substance abuse, psychosocial problems, and breast and reproductive cancers
  • Assess risk for unintended pregnancy, sexually transmitted infections, cervical pathology, breast and gynecologic malignancies, and domestic violence
  • Obtain basic sexual history
  • Take the appropriate history and age-appropriate physical exam on sexual assault victims
  • Communicate well-organized written and oral reports and use accurate medical terminology for normal female anatomy, for appearance of common pathology of female urogenital tract and breast disorders



Accurately perform breast, abdominal, complete pelvic, and recto-vaginal examinations

Diagnostic Skills

Properly collect, handle, interpret and provide explanation to patient regarding purpose of the following tests:

  • Pap smear (cytology results)
  • Pregnancy tests - urine & serum
  • Cultures for sexually transmitted diseases
  • Hormonal assays
  • Wet prep Screening and Health Maintenance
  • Assess primary and preventive health screening for all women
  • Recommend age appropriate screening for early detection of cancer (i.e. mammogram, breast self-exam, pap, occult blood/colonoscopy)
  • Educate patient regarding breast self-examination
  • Recommend age appropriate screening for prevention and early detection of disease (lipid profile, diabetes, blood pressure)
  • Recommended immunizations for women and in pregnancy
  • Demonstrate ability to provide age appropriate counseling (i.e. contraception, sexually transmitted disease prevention, domestic violence, sexual assault victims and their short term safety)
  • Know prevalence and incidence of violence against women, elder abuse, and child abuse Pharmacology and Therapeutics Identify pharmacokinetics and volume distribution of medication in the pregnant woman, utilize the pregnancy classification system in the PDR to select drugs


Patient Education

  • Prevention/Health Screening: self breast exam, mammograms, pap smears, safe sex, osteoporosis
  • Hospital discharge education: postpartum care, breastfeeding, wound care, use of medication, activity restrictions,


Technical Skills

  • Pelvic and breast examination
  • Place and remove skin staples
  • Demonstrate surgical scrub and sterile techniques
  • Perform a vaginal delivery
  • Obtain a pap smear and cervical cultures
  • Episiotomy repair
  • Assist with common surgical procedures: hysterectomy, cesarean section, laparoscopy


Emergency Situations

  • Recognize hemorrhagic and septic shock, either obstetrical or surgical
  • Recognize an acute abdomen


Critical/Perioperative Care

  • Complications of labor and delivery including pre-eclampsia, preterm labor, premature rupture of membranes, hemorrhages, abruption, fetal distress, and dysfunctional labor and shoulder dystocia.
  • Pre-surgical evaluation of surgical risks factors, indication for surgery, principles of informed consent


III. Medical Content Knowledge

Generate a problem list, form a diagnostic impression and develop a management plan

  • Formulate a differential diagnosis
  • Include laboratory and diagnostic studies
  • Possible treatment options
  • Patient education and counseling
  • Plans for follow up and continuity
  • Consider economic, psychosocial and ethical issues


Diagnose and manage obstetrical conditions

  • Show ability to diagnose pregnancy and assess gestational age
  • Understand anatomic and physiologic changes of pregnancy and its effects on common laboratory and diagnostic studies
  • Demonstrate knowledge of ways medical or surgical illnesses can affect or be affected by pregnancy (anemia, diabetes, asthma, cardiac disease, substance abuse, urinary tract disorders, infections such as herpes, rubella, Group B streptococcus, Hepatitis, HIV, HPV, CMV, toxoplasmosis, Varicella, parvovirus)
  • Counsel patients preconceptually on substance abuse, nutrition, exercise, medications, environmental hazards, immunizations.
  • Distinguish an at-risk or high risk pregnancy
  • Manage normal labor and delivery (know signs, symptoms, and stages of labor)
  • Describe and understand basic evaluation and management of abnormal/complicated labor and delivery (third trimester bleeding, preterm labor, premature rupture of membranes, hypertension in pregnancy, isoimmunization)
  • Know evaluation of common puerperal complications
  • Recognize signs and symptoms of postpartum blues, depression, psychosis
  • Understand lactation
    • Normal anatomic and physiologic changes of breast
    • Common postpartum abnormalities of breast and how to treat
    • Why breastfeeding is encouraged
    • Commonly used medications which are acceptable or unacceptable to use


Diagnose and manage gynecological conditions

  • Demonstrate knowledge of contraception (physiologic basis, effectiveness, side effects, risks, benefits) and sterilization for males and females (risks, benefits)
  • Have knowledge of basic techniques available for abortion and potential complications
  • Outline symptoms, signs, risk factors, and tests used to confirm and treat ectopic pregnancy
  • Develop differential diagnosis and evaluate first trimester abdominal pain and vaginal bleeding
  • Differentiate types of spontaneous abortions, including septic
  • Describe initial management of abnormal pap smear
  • Know signs and symptoms, physical and clinical findings, evaluation methods, risk factors of the following:
    • Vaginitis, common sexually transmitted infections, and salpingitis
    • Urinary tract infections
    • Endometriosis
    • Dysmenorrhea
    • Dermatologic diseases of vulva, vulvar symptoms
    • Acute pelvic pain
    • Uterine leiomyoma
    • Adnexal mass, ovarian cancer
    • Cervical and endometrial cancer
  • Outline diagnostic workup of breast mass, pain and nipple discharge; know history and physical findings of common breast conditions
  • Describe normal and abnormal reproductive endocrinology & infertility
    • Menstrual cycle
    • Abnormal uterine bleeding
    • Menopause; symptoms and physical findings of hypoestrogenic state
    • Definition and causes of male and female infertility oligomenorrhea/amenorrhea
  • Know patterns of female sexual dysfunction


IV. Interpersonal and Communication Skills

  • Demonstrate interpersonal and communication skills
  • Establish rapport with patients
  • Build trust and cooperation of patients, including being mindful of contextual factors such as culture, ethnicity, socioeconomic status, religion, sexual orientation, disability
  • Work cooperatively with the health care team, the patient, and her social support
  • Establish rapport and be visible to faculty and residents to be fairly evaluate

V. Practice Based Learning and Improvement

  • Evaluation and remediation of personal deficiencies
  • Application of scientific literature to patient management

VI. Systems Based Practice

  • Work effectively on the healthcare team
  • Respect and cooperation for all participants of the health care system
  • Adaptability to changing health care environment
  • Understand how to call on system resources to provide care that is of optimum value, considering systems of health financing