Gynae Training Manual

INTERMEDIATE MODULE
IN
OBSTETRICS & GYNAECOLOGY

REQUIREMENTS FOR TRAINING & EXAMINATION
2010
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THE COLLEGE OF PHYSICIANS AND SURGEONS PAKISTAN would appreciate any criticism, suggestions, advice from the readers and users of this document. Comments may be sent in writing or by e-mail to the CPSP at: National Directorate Residency Program (NDRP) College of Physicians and Surgeons Pakistan (CPSP) 7th Central Street, Defence Housing Authority, Karachi-75500. ndrp@cpsp.edu.pk
II
Contact Details:
College of Physicians and Surgeons, Pakistan. 7th Central Street, Phase II, D.H.A. Karachi - 75500. Phone: 99207100-10, UAN 111-606-606 Facsimile: 99266450 Website: www.cpsp.edu.pk
CONTENTS
INTRODUCTION
TRAINING AND EXAMINATION
ASSESSMENT
10
TRAINING FOR INTERMEDIATE MODULE
23
USEFUL ADDRESSES AND TELEPHONE NUMBERS
III
INTRODUCTION
The College was established in 1962 through an ordinance of the Federal Government. The objectives and functions of the College include: promotion of specialist practice by securing improvement of teaching and training; arranging postgraduate medical, surgical and other specialist training; holding and conducting examinations for awarding College diplomas and admission to the Fellowships of the College; and promotion of research.
Since its inception the College has actively pursued improvements in postgraduate medical education in Pakistan. Currently, the College offers Fellowships in fifty three disciplines compared to the initial few in Medicine, Surgery, Paediatrics and Obstetrics and Gynecology in 1963. Structured training programs have been developed, criteria for recognition of training institutes have been laid down, and format of
Intermediate Module in Obstetrics & Gynaecology 2010
examinations has been improved with unbiased objective, reliable and candidate friendly methods of assessment. Fellowship training can be undertaken in over 130 accredited medical institutions
throughout the country and 106 accredited institutions abroad. Over 2000 supervisors are involved in the CPSP training programs.
The College has established 12 Regional Centers including five Provincial Headquarter Centres in the country to coordinate the training and examination, and facilitate the candidates of these areas.
Constant efforts are made to improve the standards of examinations and make them relevant, transparent, objective and fair to the candidates. In its endeavor to decrease inter-rater variability, and increase fairness and transparency, the College has introduced the use of assessment forms for scoring of all the components of clinical and oral examinations. Another step in this direction is the introduction of Task Oriented Assessment of Clinical Skills (TOACS) in the FCPS II Clinical Examinations in a number of disciplines from September 2001.
INTERMEDIATE MODULE
To ensure better training, the CPSP introduced an Intermediate Module Examination in several disciplines in 2001. This mid-training assessment strengthens the monitoring and in-training assessment systems by providing trainees with an estimate of mid-training competence. It also serves as a diagnostic tool for trainees and supervisors, provides a curricular link between basic and advanced training, and an opportunity for sampling a wider domain of knowledge and skills. Vide Notification No. 6-1 / Exam-04 / CPS / 1438 S and R, the Intermediate Module (IMM) examination is mandatory eligibility requirement for all FCPS II examination as from September 2007 and onward. Candidates are required to complete two years training in Obstetrics and Gynaecology, attend all mandatory workshops and take the Intermediate Module examination. In case of failure in the Intermediate Module examination, the trainees are permitted to continue their training in the chosen specialty but must pass the Intermediate Module examination prior to appearing in the final FCPS II examination.
TRAINING AND EXAMINATION

GENERAL REGULATIONS Candidate will be admitted to the examination in the name (surname and other names) as given in the MBBS degree and PMDC certificate. CPSP will not entertain any application for change of name on the basis of marriage / divorce /deed. REGISTRATION AND SUPERVISION All training must be supervised, and trainees are required to register with the Research and Training Monitoring Cell (RTMC) within 30 days of starting their training for Intermediate Module. In case of delay in registration, the start of training will be considered from the date of receipt of application by the RTMC. Registration forms are available in RTMC and in the Regional Centers. They can also be downloaded from the CPSP Website. Training is compulsorily monitored by an approved supervisor who is a CPSP fellow or a
specialist with relevant postgraduate qualifications registered at the RTMC. APPROVED TRAINING CENTRES Training must be undertaken in units, departments and institutions approved by the College. A current list of approved institutions is available from the College and its Regional Centres as well as on the College website: www.cpsp.edu.pk
BASIC MEDICAL TRAINING PROGRAM FOR INTERMEDIATE MODULE

DURATION
The duration of training for the Intermediate Module (IMM) is two years; the Intermediate Module examination is taken on completion of the basic training.
ROTATIONS
Three months of rotation in any two of the following disciplines, one of which is mandatory before appearing in the Intermediate Module examination. Second rotation may be completed in next two years: - Medicine - Neonatology - Diagnostic imaging
COMPONENTS OF TRAINING
Mandatory Workshops It is mandatory for all Intermediate Module trainees to attend the following CPSP certified workshops in the two year of training: 1. Introduction to Computer and Internet 2. Research Methodology and Dissertation Writing 3. Surgical Skills 4. Communication Skills Any other workshop/s as may be introduced (e.g. ACLS and ATLS) by CPSP. Logbook Trainees are required to maintain a logbook in which entries of academic/ professional work done during the period of training should be made on a daily basis, and signed by the supervisor. Completed and duly certified logbook will form a part of the application for appearing in IMM examination.
E-logbook The CPSP council has decided to introduce E-logbook system for all trainees in FCPS from January 2009. Upon registration with RTMC each trainee is allotted a registration number and a password to log on to the e-logbook on the CPSP website. The trainee is required to enter all work performed and the academic activities undertaken in the logbook on daily basis. The concerned supervisor is required to verify the entries made by the trainee. This system ensures timely entries by the trainee and prompt verification by the supervisor. It also helps in monitoring the progress of trainees and vigilance of supervisors. Research (Dissertation/Two Papers) One of the training requirements for fellowship trainees is a dissertation or two research papers on a topic related to the field of specialization. For trainees in Obstetrics & Gynaecology the dissertation synopsis or abstracts of the research papers must be submitted for approval to the Research and Evaluation Unit (REU) by the end of first year of the Intermediate Module. General Requirements Training should incorporate the principle of gradually increasing responsibility, and provide each trainee with a sufficient scope, volume and variety of experience in a range of settings that include inpatients, outpatients, emergency and intensive care.
Instructional Methodology Teaching occurs using several methods that range from formal lectures to planned clinical experiences. Aspects covered will include knowledge, skills and attitudes relevant to the discipline in order to achieve specific learning outcomes and competencies. The theoretical part of the curriculum presents the current body of knowledge necessary for practice. This can be imparted using lectures, grand teaching rounds, clinico-pathological meetings, literature reviews and presentations, journal clubs, self directed learning, conferences and seminars. Clinical learning is organized to provide appropriate expertise and competence necessary to evaluate and manage common clinical problems. Demonstration in outpatient and in patient clinics and procedural skill trainings on simulators, mannequins and patients are all practical training modalities.
ASSESSMENT
ELIGIBILITY REQUIREMENTS For appearing in Intermediate Module examination a candidate should have:
q
Passed FCPS-I in Obstetrics and Gynaecology or granted exemption by CPSP. Registered with the Research and Training Monitoring Cell (RTMC). Completed two years of training under an approved supervisor in an institution recognized by the CPSP. A certificate of completion of training must be submitted.
q q q
Submitted attested logbook. Submitted certificates of attendance of mandatory workshops. Synopsis for dissertation/abstracts of two research papers must be submitted.
It is important to note that all applicants must undertake IMM examination before taking Fellowship examination of the relevant
specialty. EXAMINATION SCHEDULE

q
The Intermediate Module theory examination will be held twice a year. Theory examinations are held in various cities of the country usually at Abbottabad, Bahawalpur, Faisalabad, Hyderabad, Islamabad, Karachi, Nawabshah, Larkana, Lahore, Multan, Peshawar and Quetta centres. The College shall decide where to hold TOACS examinations depending on the number of candidates in a city and shall inform the candidates accordingly.
English is the medium of all examinations for theory, practical and viva. The College will notify of any change in the centres, the dates and format of the examination. A competent authority appointed by the College has the power to debar any candidate from any examination if it is satisfied that such a candidate is not a fit person to take the College examination because of using unfair means in the examination, misconduct or other disciplinary reasons.
EXAMINATION FEE
q
Fee deposited for a particular examination shall not be carried over to the next examination in case of withdrawal, absence or exclusion. Applications along with the prescribed examination fee and required documents must be submitted by the last date notified for this purpose before each examination. The details of examination fee and fee for change of centre, subject, etc shall be notified before each examination.
FORMAT OF EXAMINATION
Intermediate Module examination consists of the following two components: q Theory examination: It consists of: Paper I Paper II
q
100 One best type of MCQs in each paper. (70 Obs. 30 Gynae)
Clinical examination: TOACS (Task Oriented Assessment of Clinical Skills).
TOACS
TOACS will comprise of 12 to 20 stations with a change time of one minute for the candidate to move from one station to the other. The stations may have an examiner, a patient or both. Structured clinical tasks will be set at each station. At stations where no examiner is present the candidates will have to submit written responses to short answer questions/ MCQs on a response sheet. There will be two types of stations: static and interactive. On static stations the candidate will be presented with patient data, a clinical problem or a research study and will be asked to give written responses about the questions asked. At the interactive stations the candidate will have to demonstrate a competency, for example, taking history, performing a clinical examination, counseling, assembling an instrument, etc. One examiner will be present at each interactive station and will either rate the performance of the candidate or ask questions testing reasoning and problem-solving skills.
Pass/Fail Criteria Candidates have to pass the theory to be eligible to take the TOACS examination.
TRAINING FOR INTERMEDIATE MODULE

GIO (GENERAL INSTRUCTIONAL OBJECTIVES):
By the end of 2nd year in Obstetrics and Gynaecology, a trainee shall be able to: KNOWLEDGE: 1. Discuss etiology, pathogenesis, epidemiology and management of disorders in Obstetrics and Gynaecology, as given in the section on Specific Learning Outcomes (SLO). 2. Show initiative to become life long self-directed learners tapping on resources including clinical material, faculty, Internet and on-line learning programs and library. 3. Discuss principles of basic sciences as applied to Obstetrics and Gynaecology like hemorrhage, blood transfusion, shock, sterilization of instruments, infection, antibiotics, inflammation, repair, and healing. SKILLS: 1. Take a comprehensive and pertinent history of a patient presenting with Obstetrical and Gynaecological complaints. 2. Perform detailed Physical examination in a rational sequence that is both technically correct as well as methodical. 3. Elicit Physical signs without discomfort to the patient. 4. Evaluate patient in the setting of Outpatients Department, Hospital wards, Labour Room, Day care surgery, Emergency Department and attending calls in other departments for problems related to Obstetrics and Gynaecology. 5. Formulate a working diagnosis and consider relevant differential diagnosis. 6. Order a set of relevant investigations considering availability, diagnostic yield, cost-effectiveness, side effects, and implications for management.
10
7. Decide and implement suitable effective treatment considering safety, cost factors, complications and side effects. 8. Practice proper procedures in operating theatres and labor wards including gowning, gloving, use of various sutures, surgical principles, and use and working of electro medical equipment. 9. Assist at major surgeries and perform minor procedures under supervision. 10. Maintain follow-up of patients at appropriate intervals, recognizing new developments and/or complications and offering sensible management protocols. ATTITUDES: 1. Counsel patients and relatives in patient's preferred language exhibiting good communication skills, empathy and empowerment to patients. 2. Exhibit emotional maturity and stability, integrity, ethical values and professional approach, sense of responsibility in day-today professional activities. 3. Take proper informed consent for physical examination and ensure confidentiality and appropriate environment for intimate physical examination. 4. Call for help judiciously in emergency situations and referral as required. 5. Maintain detailed and accurate documentation regarding patient management and procedures. PROCEDURES: The level of competence to be achieved each year is specified according to the key, as follows: 1. Observer status. 2. Assistant status. 3. Performed under direct supervision. 4. Performed under indirect supervision. 5. Performed independently Note: Levels 4 and 5 for practical purposes are almost synonymous
11
First Year
3 Months
Level Cases Level Cases Level Cases Level Cases
COMPETENCIES
6 Months 9 Months 12 Months
Total Cases 1st Year
Obstetrics Antenatal ( OPD & WARD)

4 4 3 3 2 1 3 1 3 1 10 2 30 4 5 1 5 30 10 30 4 30 30 2 30 3 5 2 5 3 30 2 30 3 30 3 30 4 30 30 30 30 5 30 10 30 3 30 4 30 5 5 4 4 5 2 5 1 3 30 5 30 5 30 5 30 5 30 5 30 5 30 30 30 30 30 30 30 10 30 10 120 120 120 120 120 120 120 25 120
Actual or demonstration on video models
Eliciting Pertinent history
Performing physical examination
Requesting appropriate investigations
Interpreting the results of investigations
12
Deciding and implementing appropriate treatment
Managing immediate complications
Maintaining follow-up
Using ultrasound (basic)
Fetal monitoring (including CTG)
Amniocentesis
Management of medical disorders in pregnancy
40
First Year
3 Months
COMPETENCIES
6 Months Total Cases 1st Year 9 Months 12 Months
Obstetrics Intrapartum (Labour Room)

2 2 2 2 2 2 1 1 2 1 1 1 1 1 1 1 2 2 10 3 2 2 2 1 1 1 1 2 3 10 3 3 3 3 2 2 1 2 2 3 10 3 4 4 4 2 2 2 2 2 3 1 2 3 2 3 2 3 4 3 3 2 4 5 3 3 2 3 10 3 10 12 8 11 40 5 3 2 12 30 5 5 30 5 2 3 2 2 2 2 2 30 5 5 30 10 2 4 3 3 3 3 3 30 5 5 30 10 3 4 4 4 4 4 4 30 5 5 30 10 3 120 20 20 120 35 10
13
Obstetrics Postnatal
1 2 1 20 50 5 2 3 2 20 50 5 3 3 3
Assessment on admission Medical induction of labour Surgical induction of labour Management of normal labour Performing and repairing episiotomy Repair of vaginal and perineal tears (excluding third degree tears) Repair of third degree tears Repair of cervical tears Immediate management of post-partum haemorrhage Outlet forceps delivery Vacuum extraction Caesarean section Repair of ruptured uterus (cases distributed in 12 months) Obstetric hysterectomy (as above) Correction of (acute) inverted uterus (as above) Breech, twin delivery, destructive operations, craniotomy etc.
Resuscitation of neonate Contraception counseling / advice Insertion of IUCD
20 50 5
3 4 3
20 50 5
80 200 20
Intermediate Module in Obstetrics & Gynaecology, 2010
First Year
3 Months
COMPETENCIES
6 Months 9 Months 12 Months
Total Cases 1st Year
Gynaecology OPD & Ward

4 4 3 3 2 1 3 2 2 1 2 1 2 5 5 15 10 20 20 20 20 20 20 20 -
(number of cases distributed in 12 months)

20 20 20 20 20 20 20 10 15 5 5 2
14
Taking Pap smears
Arranging assessment by an anesthetist
Colposcopy
Hystero-salpingography (injection of dye)
LLETZ / Cauterization of cervix /cryosurgery
First Year
3 Months
COMPETENCIES
6 Months Total Cases 1st Year 9 Months 12 Months
Gynaecology Operative Skills (B1 General Skills) (number of cases distributed in 12 months)
3 1,2 5 5 10 10
Scrubbing
Opening & Closing abdomen
Gynaecology Operative Skills (B2 Operations)
15
Evacuation of Retained products of conception Dilatation & Curettage Cervical Biopsy Polypectomy Marsupilization of Bartholins Cyst Minilaparotomy (for tubal ligation) Drainage of abscess Post-partum tubal ligation Diagnostic laparascopy Hysteroscopy Ovarian cystectomy Laparotomy for ectopic pregnancy Myomectomy Abdominal hysterectomy Vaginal hysterectomy Repair of prolapse
2 2 2 2 2 2 2 2 1 1 1 1 1 1 1 1
5 5 2 2 2 5 2 5 5 5 3 5 1 5 2 2
5 5 2 2 2 5 2 5 5 5 3 5 1 5 2 2
Second Year
15 Months
Level Cases Level Cases Level Cases
COMPETENCIES
18 Months 21 Months
Total Cases 2nd Year
Obstetrics Antenatal (OPD & WARD)

5 5 5 5 5 5 5 3 5 4 10 30 30 5 5 4 30 5 30 5 30 30 30 30 10 30 5 30 30 5 30 5 5 5 5 5 5 5 30 5 30 5 30 30 30 30 30 30 30 10 90 90 90 90 90 90 90 30 30 5 30 5 30 90 Actual or demonstration on video models 15 5 15 5 15 45
16
Using ultrasound (basic)
Fetal monitoring (including CTG)
Amniocentesis
Management of medical disorders in pregnancy
Second Year
15 Months
COMPETENCIES
18 Months Total Cases 2nd Year 21 Months
Obstetrics Intrapartum (Labour Room)
17
Obstetrics Postnatal
4 5 5 20 50 10 5 5 5
Assessment on admission Medical induction of labour Surgical induction of labour Management of normal labour Performing and repairing episiotomy Repair of vaginal & perineal tears (excluding third degree tears) Repair of third degree tears Repair of cervical tears Immediate management of post-partum haemorrhage Outlet forceps delivery Vacuum extraction Caesarean section Repair of ruptured uterus Obstetric hysterectomy Correction of inverted uterus (acute) Breech, twin delivery, destructive operations, craniotomy etc.
5 5 5 5 5 5 3 4 5 4 5 4 3 3 3 4
30 5 5 30 10 2 3 4 2 3 15 3
5 5 5 5 5 5 3 5 5 5 5 5 3 3 3 4
30 5 5 25 10 2 3 4 4 3 15 3
5 5 5 5 5 5 4 5 5 5 5 5 4 4 4 4
30 5 5 25 10 2 4 4 4 3 15 5 3 2 2
90 15 15 80 30 6 8 10 12 10 9 45 5 3 2 8
Resuscitation of neonate Contraception counseling / advice Insertion of IUCD
20 50 10
5 5 5
20 50 10
60 150 30
Second Year
15 Months
COMPETENCIES
18 Months 21 Months
Total Cases 2nd Year
Gynaecology OPD & Ward

4 4 3 3 2 2 4 3 3 2 3 2 10 15 10 5 2 20 20 20 20 20 20 20 -

20 20 20 20 20 20 20 10 15 10 5 2
18
Taking Pap smears
Arranging assessment by an anesthetist
Colposcopy
Hystero-salpingography (injection of dye)
LLETZ / Cauterization of cervix /cryosurgery
Second Year
15 Months
COMPETENCIES
18 Months Total Cases 2nd Year 21 Months
Gynaecology Operative Skills (B1 General Skills) (number of cases distributed in 12 months)
4 3,4 15 5 15 5
Scrubbing Opening and Closing abdomen
Gynaecology Operative Skills (B2 Operations)
19
Evacuation of Retained products of conception Dilatation and Curettage Cervical Biopsy Polypectomy Marsupilization of Bartholins Cyst Minilaparotomy (for tubal ligation) Drainage of abscess Post-partum tubal ligation Diagnostic laparascopy Hysteroscopy Ovarian cystectomy Laparotomy for ectopic pregnancy Myomectomy Abdominal hysterectomy Vaginal hysterectomy Repair of prolapse
3 3 3 3 3 3 3 3 2 2 2 2 2 2 2 2
5 5 3 3 2 5 3 5 5 5 3 5 2 5 3 3
5 5 3 3 2 5 3 5 5 5 3 5 2 5 3 3
Intermediate Module in Obstetrics & Gynaecology, 2010
ROTATIONS
Level Cases
NEONATOLOGY (Three Month Rotation)

1,2,3,4 1,2,3,4 1,2,3,4 1,2,3,4 1,2,3,4 1,2,3,4 1,2,3,4 1,2,3,4 1,2,3,4 1,2,3,4 1,2,3,4 1,2,3,4 1,2,3,4 1,2,3,4 10 each 10 each 5 each 5 each 5 each 5 each 5 each 5 each 10 each 10 each 10 each 10 each 10 each 10 each
Neonatal Examination
Neonatal Resuscitation
Emergency drug dosage and side effects
I / V fluids in first seven days
Management of LBW
Recognition of Sepsis & emergency care
ROTATIONAL TRAINING
20
IMCI (Integrated management of Childhood illness)
Vaccination
Recognition and emergency management of danger signs like:
i. Jaundice
ii. Respiratory distress
iii. Convulsions
iv. CCT
v. Anaemia
vi. Peripheral Circulatory Failure
ROTATIONS
Level Cases
MEDICINE (Three Month Rotation)

1,2,3,4,5 1,2,3,4,5 1,2,3,4,5 1,2,3,4 1,2,3,4 1,2,3,4 1,2,3,4 1,2,3,4,5 1,2,3,4,5 1,2,3 1,2,3 1 5 10 each 10 each 10 each 10 each 10 each 10 each 10 each 10 each 10 each 5 each 5 each 5 each 3
Medical problems relevant to OBG / GYN like.
Diabetes Mellitus
Hypertension
Liver Disease
Anaemia
Renal Diseases
21
Thyroid Diseases
Epilepsy
Viral Diseases
Preventive Management
History, examination, Appropriate investigation and treatment of
Paracentesis
Aspiration
Liver Biopsy
Case Presentation/ Journal Club
ROTATIONS
Level Cases
DIAGNOSTIC IMAGING (Three Months Rotation)

1,2,3,4 1,2,3,4 1,2,3 1,2,3 1,2,3 1,2 1,2 1,2,3 1,2,3 1,2,3,4 1,2,3,4 1,2 1,2 10 each 10 each 10 each 10 each 10 each 10 each 10 each 10 each 10 each 15 each 10 each 5 each 5 each
Basics of Ultra Sound Scan
Diagnosis of IUT Pregnancy
Fetal Biometry
Placental Localisation
22
BPP
Diagnosis of Ectopic pregnancy
Identification of normal ovary & Uterus
Ovarian Follicle
Ovarian Cyst alongwith its characteristics
Interpertation of X-Ray Chest
Interpertation of HSG
Interpertation of CT
Interpertation of MRI
USEFUL ADDRESSES AND TELEPHONE NUMBERS

1. Regional Offices of the CPSP MUZAFFARABAD CMH Muzaffarabad Azad Kashmir TEL: 058810 - 43307 FAX: 058810 - 43902 Email: ssgr-brehman@cpsp.edu.pk ABBOTTABAD Ayub Hospital Complex Abbottabad TEL: 0992-383330 Email: rc_abbottabad@cpsp.edu.pk PESHAWAR Hayatabad Medical Complex Phase IV, Hayatabad, Peshawar UAN: 091-111-666-666 TEL: 091-9217011, 091-9217320-1 FAX: 091-9217062 Email: rc_peshawar@cpsp.edu.pk ISLAMABAD P.I.M.S, Ravi Road, Sector G- 8/ 3 Islamabad. UAN: 051-111-666-666 TEL: 051-9262590-1, FAX: 051-9262592 Email: rc_islamabad@cpsp.edu.pk FAISALABAD Punjab Medical College Faisalabad UAN: 041-111-666-666 TEL: 041-9210131, 9210366-8 FAX: 041-9210224 il:rc_faisalabad@cpsp.edu.pk LAHORE Next to INMOL, Hospital New Muslim Town, Block-D Lahore. UAN: 042-111-666-666 TEL: 042- 9231320-8 FAX: 042- 9231327 Email: rc_lahore@cpsp.edu.pk MULTAN Nishtar Medical College, Distt. Jail Road, Opp Circuit House, Multan. UAN: 061-111-666-666 TEL: 061-9200946, 9200952 Email: rc_multan@cpsp.edu.pk BAHAWALPUR Quaid-e-Azam Medical College Bahawalpur TEL: 062- 9250461 Email: rc_bahawalpur@cpsp.edu.pk NAWABSHAH Peoples Medical College for Girls Nawabshah TEL: 0244-9370271, 9370479 FAX: 0244-9370478 Email: rc_nawabshah@cpsp.edu.pk LARKANA Chandka Medical College Larkana TEL: 074 9410726 Email: rc_larkana@cpsp.edu.pk
23
HYDERABAD Liaquat University Hospital, Jamshoro Hyderabad TEL: 022-3877393 Email: rc_hyderabad@cpsp.edu.pk KARACHI 2. Departments of CPSP Karachi UAN 021-111-606-606
q
QUETTA CPSP Bolan Medical College Sandeman Civil Hospital TEL: 081- 9202424 Email: rc_quetta@cpsp.edu.pk
OVERSEAS CPSP CENTRES 3. Saudi Arabia RIYADH Saudi Commission for Health Specialities, Diplomatic Quarter, P.O. Box 94656 Riyadh -11614, KSA. TEL: 966-1-4822415 Ext: 156/141 966-2-6401000 Ext: 25843 Email: medexam5@scfhs.org 4. Nepal KATHMANDU T.U. Institute of Medicine Maharajganj, Kathmandu, Nepal TEL: 977-1- 416224 Email: cpsp@iomdit.org.np
Examination (FCPS Part I) 9207100 -10 Ext: 311 Examination (FCPS Part II) 9207100 -10 Ext: 215 Department of Medical Education 9207100 -10 Ext: 305 Registration, Training & Monitoring Cell 9207100 -10 Ext: 320
For further Information visit the College website at : www.cpsp.edu.pk
24
ADDENDUM IMM PROSPECTUS OBSTETRICS AND GYNECOLOGY

This Addendum is to be read after Page 22 of the prospectus The course during IMM covers following areas of Gynaecology & Obstetrics:
1. GYNAECOLOGY (Weightage 30%):

s
s s
s s s s s
Topics where low level of knowledge (up to diagnosis) is required:

s s s s
Radiotherapy Oncology Endoscopy Urinary Fistulas
Development of Female Genital organs-normal and abnormal, especialy intersexes, obstruction of outflow tract and urogenital maldevelopment Amenorrhoea Gynaecological Endocrinology, especialy Hirsutism and Virilism, PCO Endometriosis, Perineal and Pelvic infections, especialy Bartholin gland problems, Vaginal discharge, STIs, PID Menstrual disorders, especialy Menorrhagia, Dysmenorrhoea, PMS, DUB Disorders of early pregnancy, especialy Abortion, Ectopic Pregnancy, GTD and their management Menopause, Hormone Replacement Therapy Pelvic Floor Disorders and UV Prolapse Infertility Contraception and Sterilization Pre and Postoperative assessment, preparation and management. Gynaecological procedures, e.g. cervical smear, insertion of pesseries, Hysterosalpingography, Ultrasonography. Minor Operative Gynaecological surgery
2. OBSTETRICS (weightage 70%):

1. Normal Pregnancy, Labour and Puerperium - Antenatal Care - Intrapartum care, Maternal and fetal monitoring - Postpartum care - Analgesia / Anaesthesia during labour - Normal Puerperium - Breast feeding / complications - Prenatal diagnosis 2. Abnormal Pregnancy, Labour and Puerperium - Malpresentation - Malposition - In-coordinate uterine action - CPD - Obstructed labour - 3rd stage complications - Induction of labour - Pre Term Labour - Surgical complications (Appendicitis, Perforated peptic ulcer, Pancreatitis cholethiasis / cholecystitis, renal colic). - Neonatal care / Resuscitation
3. Medical complications of Pregnancy - Cardio vascular diseases - Renal and urinary tract disorders - Diabetes in pregnancy - Endocrine disorders - Hepatic and G.I.T disorders - Haemotological disorders of pregnancy - Thromboembolic disorders - Psychiatric and neurological disorders - Dermatological disorders - Neoplastic diseases
4. Operative / Instrumental Interventions - Forceps delivery - Vacuum delivery - Breech extraction - Shoulder dystocia - Ceasarian section / Ceasarian Hysterectomy - Episiotomy - Perineal tears, cervical tear - Rupture uterus, inversion of uterus - Manual removal of placenta - Cephalocentesis 5. Epidemiology - Maternal mortality / morbidity - Biostatistics - Reproductive Health - Domestic Violence

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INTERMEDIATE MODULE

OBSTETRICS & GYNAECOLOGY

;GDD=?= G> H@QKA;A9FK 9F< KMJ?=GFK H9CAKL9F

TRAINING AND EXAMINATION

TRAINING FOR INTERMEDIATE MODULE

USEFUL ADDRESSES AND TELEPHONE NUMBERS

Intermediate Module in Obstetrics & Gynaecology 2010

Intermediate Module in Obstetrics & Gynaecology 2010

TRAINING AND EXAMINATION

BASIC MEDICAL TRAINING PROGRAM FOR INTERMEDIATE MODULE

Intermediate Module in Obstetrics & Gynaecology 2010

specialty. EXAMINATION SCHEDULE

Clinical examination: TOACS (Task Oriented Assessment of Clinical Skills).

TRAINING FOR INTERMEDIATE MODULE

Intermediate Module in Obstetrics & Gynaecology 2010

Intermediate Module in Obstetrics & Gynaecology 2010

Intermediate Module in Obstetrics & Gynaecology 2010

Total Cases 1st Year

Obstetrics Antenatal ( OPD & WARD)

Eliciting Pertinent history

Performing physical examination

Requesting appropriate investigations

Interpreting the results of investigations

Deciding and implementing appropriate treatment

Managing immediate complications

Using ultrasound (basic)

Fetal monitoring (including CTG)

Management of medical disorders in pregnancy

Obstetrics Intrapartum (Labour Room)

Resuscitation of neonate Contraception counseling / advice Insertion of IUCD

Intermediate Module in Obstetrics & Gynaecology, 2010

Intermediate Module in Obstetrics & Gynaecology 2010

Total Cases 1st Year

Gynaecology OPD & Ward

(number of cases distributed in 12 months)

Eliciting Pertinent history

Performing physical examination

Requesting appropriate investigations

Interpreting the results of investigations

Deciding and implementing appropriate treatment

Managing immediate complications

Taking Pap smears

Arranging assessment by an anesthetist

Hystero-salpingography (injection of dye)

LLETZ / Cauterization of cervix /cryosurgery

Opening & Closing abdomen

Gynaecology Operative Skills (B2 Operations)

(number of cases distributed in 12 months)

Intermediate Module in Obstetrics & Gynaecology 2010

Intermediate Module in Obstetrics & Gynaecology 2010

Total Cases 2nd Year

Obstetrics Antenatal (OPD & WARD)

Eliciting Pertinent history

Performing physical examination

Requesting appropriate investigations

Interpreting the results of investigations

Deciding and implementing appropriate treatment

Managing immediate complications

Using ultrasound (basic)

Fetal monitoring (including CTG)

Management of medical disorders in pregnancy

Obstetrics Intrapartum (Labour Room)

Resuscitation of neonate Contraception counseling / advice Insertion of IUCD