Education

University of Alabama School of Medicine Goals and Objectives for the Educational Program Leading to the MD Degree

Vision

The University of Alabama School of Medicine aspires to achieve national recognition in medical student education comparable to that received for its research and patient care for its ability to
produce physicians with the essential knowledge, skills, and professionalism to successfully continue their professional education and pursue a variety of careers to better serve Alabama and the nation through health promotion, medical research, and disease prevention and treatment.

Mission

The mission of the University of Alabama School of Medicine is to produce quality physicians who (1) possess all essential knowledge, skills, and professionalism and who possess skills and the habit of life-long learning, (2) possess the ability to work in and lead future health care systems, (3) will help meet the health care and research needs of Alabama and the nation, and (4) reflect the population and composition of Alabama.

UNDERGRADUATE MEDICAL EDUCATION GOALS AND OBJECTIVES

Professionalism and Communication

1. Each student will develop and cultivate personal and professional qualities of ethics, commitment to patient well being, commitment derived from the role accorded physicians in society, and an understanding of their own personal strengths, weaknesses, obligations, and limitations.

a. Ethics:

Each student will...

• Understand, value, and practice basic ethical concepts, moral reasoning, and patient, societal, and professional responsibility in the educational and health care context.
• Exhibit personal qualities of honesty, integrity, reliability, altruism, dependability, open-mindedness, and intellectual curiosity.

b. Commitment to patient well being:

Each student will...

• Understand, value, and practice compassionate treatment of patients, including a respect for their privacy and dignity, a commitment to advocate the interests of his/her patients over his/her own selfish interests, a commitment to provide care irrespective of their ability to pay, advocacy for the needs of individual patients and of patient groups, an understanding of the roles of other health care professionals, and a commitment to collaboration with other health care professionals as needed to achieve the best interests of the patient.

c. Obligations derived from role of physicians in society:

Each student will...

• Understand and value the role given to physicians in society and thereby practice personal lifelong learning as a means of achieving personal and professional excellence in clinical care.
• Understand the need to place societal needs ahead of those of any physician colleague whose performance is substandard and/or unethical.
• Recognize and value collaboration among health care disciplines, between the physician and patient and his/her family, and among community and governmental organizations, and industry for achievement of optimal care for patients.

d. Understanding of self:

Each student will...

• Understand the importance of self-awareness as a means of recognizing his/her own limitations in knowledge and clinical skills.
• Value and develop, through self-reflection, critical self-appraisal, and openness to feedback, skills for continuous improvement as a provider of health care.

2. Each student will understand and value the importance of honest and effective communication with patients and their families, other health professionals, and society.

a. Patients and their families:

Each student will...

• Understand, appreciate, and possess skill in educating and counseling patients as a means of involving them meaningfully in decision-making and thereby enabling and encouraging them to understand the importance of their personal responsibility in their own health.
  
• Develop and practice interpersonal skills that facilitate development of effective and empathetic relationships with patients and their families and effective collaborations with other health care professionals.
  
• Develop and practice skills in producing and handling in a confidential and appropriate manner oral and written communication with patients and colleagues.

b. Other health professionals:

Each student will...

• Value the importance of and practice accurate, professional, and productive communication with colleagues at all levels and in all locations concerning each patient.
• Develop skills for using information technology to manage information, access online medical information, and communicate with team members in the interests of patients.

c. Society:

Each student will...

• Value the importance of physicians addressing health care needs and problems at the societal level and, when possible, taking a leadership role in the societal response to issues/problems that arise.

Biomedical Knowledge and Clinical Skills

1. Each student will acquire a fund of biomedical, psychological, and social knowledge, develop the skill of obtaining information from the patient, and assess the collected information in the light of the latest, critically evaluated medical literature.

a. Foundation of knowledge:

Each student will...

• Understand the normal human structure and function of the body and its major organ systems and the molecular, biochemical, and cellular mechanisms that are important in maintaining the body's homeostasis.
• Understanding various causes (genetic, developmental, metabolic, toxic, microbiologic, autoimmune, neoplastic, degenerative, traumatic, and behavioral) of maladies and the ways in which they operate on the body.
• Know the rationale and application of the therapeutic options relevant to the various mechanisms of disease.
• Understand and be able to apply the social and behavioral sciences, epidemiology, and humanities to important non-biologic and cultural factors that contribute to health or disease.

b. Information from patient:

Each student will...

• Develop an ability and skill for eliciting through an accurate and comprehensive medical history and physical exam all information that is relevant.
• Develop an ability to organize the information from all sources, including epidemiology.
• Understand appropriate tests and procedures to be ordered on the basis of findings from the medical history and physical exam in the light of epidemiological knowledge.

c. Comparison with literature:

Each student will...

• Develop an ability to access medical literature, critically analyze this literature, understand how medical knowledge is generated, and assess the literature's relevance to the clinical case under consideration.

2. Each student will demonstrate the ability to apply information compiled from all sources into a coherent prioritized differential diagnosis and make appropriate
clinical decisions.

Each student will...

• Demonstrate an ability to recognize a situation requiring rapid intervention, take steps to implement appropriate emergency care, know the pathophysiological rationale for particular management approaches, and explain methods of
  monitoring effectiveness of therapy and avoidance of complications.
  
• Demonstrate the ability to synthesize and integrate the pertinent facts from the history, physical, and laboratory data, formulate a hypothesis, and, if appropriate, order additional tests and procedures for confirmation, relying on knowledge of the most frequent clinical, laboratory, radiologic, and pathologic manifestations of common maladies..
• Understand the contribution to patient care provided by other health professionals and when to obtain their consultation.
• Demonstrate the ability to integrate psychological and social issues and apply them to clinical situations.
• Develop a diagnosis, establish causation, and formulate management strategies.

3. Each student will demonstrate sound clinical judgment, solid technical and procedural skills, and compassionate interpersonal skills.

Each student will...

• Understand the clinical problems (and their treatments) unique to the various patient categories, including age, gender, and culture.
• Demonstrate skill in the evaluation of patients at various levels of medical care, including impatient, ambulatory, home care, etc. and the subsequent management appropriate for each level of care.
• Understand when to use medical and invasive procedures.
• Demonstrate skills in performing appropriate basic medical and invasive procedures considered essential for entering any area of graduate medical education.
• Understand the basic issues relating to the care of critically ill patients.
• Understand the principles and application of fluid management, pharmacologic management, and nutritional management.
• Understand common acute and chronic illnesses and their effect on the patient, family, and society.
• Understand and value the importance of working collaboratively with health care professionals, including those from other disciplines, to provide patient focused
  care.
• Know the role of prevention in health care and demonstrate skills in providing health care services and health care information aimed at maintaining health through recognition and reduction of risk factors that contribute to major causes
  of morbidity and mortality for individual patients and large populations across the life span.
• Know the role of patient education as a means of involving patients actively in their health care and demonstrate skill in patient counseling/educating that makes the patient a part of the decision making process.

Social and Community Contexts of Health Care

The student will develop an understanding of the social, cultural, and community factors that contribute to and affect patients' health status and influence the health care system and patients' access to care.

The student will...

• Understand the epidemiological factors that place the individual patient, as well as patient populations in general, at risk for disease or injury.
• Understand and value gender, ethnic, and cultural issues at work in the physician-patient encounter and in the patient's response to disease, treatment, and wellness.
• Understand the effects of chronic disease, trauma, violence, alcohol and drug abuse, and tobacco use on the patient, family, society, and community.
• Understand the importance of and develop skills in addressing psychosocial, economic behavioral, and community factors when negotiating with patients on
  health-related lifestyle modification.
• Understand basic principles of health care economics.
• Understand the importance of advocating for quality in patient care.

 

Educational Objectives

APGO Medical Student Educational Objectives 8th Edition

This edition is designed to provide an organized and understandable set of objectives for all medical students, regardless of future specialty plans. The knowledge, skills and attitudes are intended to be both a resource for course design for faculty and clerkship directors, and a useful study guide for medical students.  Each educational objective is linked to the level of competence a student should be expected to achieve, the best methods of evaluation and the representative general competency as defined by the ACGME.  

At a minimum, we expect all of our students to master Priority 1 objectives (the essential elements are listed below) and be exposed to the majority of Priority 2 objectives and skills. These essential objectives and skills have been adapted from APGO and are summarized below:

• Clinical skills in the medical interview and physical exam with attention to OB Gyn history and genitourinary examination.
• Collect and interpret cervical cytology results
• Understand and be able to counsel women on  modern contraceptive technology
• Differential diagnosis of the “acute abdomen” – pelvic infection, ectopic pregnancy, adnexal torsion, appendicitis, diverticulitis, renal calculi
• Physiologic adjustments that accompany normal gestation, including effects on lab test results
• Social and health policy aspect of women’s health, ethical issues, sterilization, abortion, domestic violence, adolescent pregnancy, access to health care, etc.
• Menstrual cycle, normal and abnormal function, including menopause
• Infertility
• Intrapartum care and common problems in obstetrics
• Breast health, including breastfeeding
• Vaginal and vulvar disorders
• Screening for reproductive cancers

 
Minimum Requirements for the Performance of OB Gyn Procedures

The OB Gyn clerkship directors from all three UA SOM campuses met, developed, and quantitated a list of OB Gyn procedures that all students must meet as minimum requirements during the 8 week clerkship rotation.  These minimum requirements were developed using the Priority 1 Objectives from the APGO Medical Student Educational Objectives 8th Edition document as a guide. The procedures have been identified by APGO as requiring a "show how" or "do" competency level and the quantity selected was based on prior experiences from all 3 campuses. The goal is for students to gain as much clinical experience as possible and not be limited by these minimum guidelines.
 
MINIMUM REQUIREMENTS: Minimum requirements were set for each, as noted in ( ):

1. Inpatient Obstetrics –
   • Evaluate OB patients presenting to Labor and Delivery Triage Unit.(5)
   • Follow patients intrapartum (during labor). (5)
2. Outpatient Obstetrics - Perform prenatal evaluations in the OB Clinics. (5)
3. Inpatient Gynecology – Follow and manage postoperative Gyn patients. (5)
4. Outpatient Gynecology - Evaluate patients with gynecologic problems. (5)
5. Conferences –Must attend at least 80% of scheduled student conferences.
6. Procedures –
   • Perform a breast exam and counsel patient on self-examination (5)
   • Perform a patient-centered pelvic examination (5).
   • Perform an adequate Pap smear and obtain specimens to detect STDs (5).
   • Assess gestational age via physical exam of the pregnant woman (5)
   • Describe/demonstrate or perform a vaginal delivery (5)
   • Perform fetal auscultation and interpret electronic fetal monitoring (5)
   • Counsel patients on contraception (5)
   • Diagnose and manage patient with vulvovaginal symptoms (5)
   • Interpret a wet mount microscopic examination (5)

Click Here to print these minimum requirements in a Check List format.

 

Core Clinical Competencies

The members of the Medical Education Committee University of Alabama School of Medicine developed the Core Clinical Competencies. These are a compilation of the professional behavior, clinical skills, medical knowledge and issues regarding family and societal influences in health care that each graduate of the UASOM 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.

II. Clinical Skills

Interviewing, History and Physical Examination

• Sexual, menstrual and obstetrical history
• Family history as it relates to risk factors for disease and possible congenital anomalies/risks

Exam: Abdominal, genito-urinary-rectal, and breast

Diagnostic Skills: Indications and interpretation of the results for the following tests:

• Pap smear (cytology results)
• Pathology of the genital tract-cervix, endometruim, uterus, ovaries
• Pregnancy tests - urine & serum
• Cultures for sexually transmitted diseases
• Hormonal assays

Screening and Health Maintenance:

• Risk factors for common chronic illnesses and gynecologic disease
• Indications and interpretation of periodic screening tests including the impact of age, ethnicity and other risk factors in women
• Routine prenatal care and deviations from the routine course
• The impact of life style choices on health and disease

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

Ambulatory Problems (female reproductive)

• Pre-conceptive counseling for women with chronic common medical conditions affecting the prenatal course and delivery
• Common causes of acute and chronic pelvic pain
• Common breast complaints
• Common causes of abnormal vaginal bleeding patterns including complications of pregnancy
• Primary and secondary amenorrhea
• Vaginitis
• Common causes of urinary problems: UTI, urinary incontinence
• Management of estrogen deficiency
• Contraceptive counseling and management

Inpatient Problems

• Labor, delivery and postpartum
• Pyelonephritis
• Pregnancy complications such as hypertension

Infectious Conditions

• HIV infection
• STD
• Post operative/post-delivery infections
• Infectious agents as they pertain to pregnancy

Neoplastic Conditions

• Cancer of uterus, ovaries, cervix
• Benign neoplasms of uterus, ovaries, cervix and breast

Genetics

• Identify those diseases/conditions for which screening is appropriate preconceptively or during pregnancy

Age-Related Issues

• Normal life cycle physiology and how it impacts on the pathology with particular emphasis on menstrual cycle, puberty and menopause
• Anticipation of female reproductive life cycle changes including physiologic factors and provide education to the patient to help maximize the acceptance of and adaptation to these normal life stages.
• Physiological, emotional, and societal influences of sexuality throughout life stages and their relationship to illness and health in traditional and alternative expression of sexuality.

Gender, Ethnic, Cultural Issues

• Respect for the individual’s values, goals and concerns regarding reproductive choices, infertility, safe sex, and contraception
• Effects of family relationships on health and illness
• Complex behavioral change and other factors involved in patient compliance with medical plan