Advanced Clinical Elective in Reproductive Endocrinology and Infertility

Credits: 4.00 CREDITS (Clinical Elective)
Sites: BIDMC
Directors: Thornton, Kim
Prerequisites: HMS Principal Clinical Experience (Core Clinical Clerkships) or equivalent
Offered: Offered only in Aug, Oct, Jan, Mar and May
Open to Exclerks: No (HMS only)
Students will evaluate patients presenting with a range of reproductive endocrine and infertility problems. They will be responsible for obtaining a comprehensive history and focused exam on new reproductive endocrine and infertility patients, focusing on the key factors that impact a couples reproductive concerns. The students will be instructed in the technique involved in performing hysterosalpingograms and sonohysterograms in the office and will assist with these procedures. Students will have the opportunity to observe reproductive surgery in an outpatient surgicenter. They will be able to observe IVF procedures and spend time observing embryologists handle gametes and embryos in the embryology laboratory. Students will be taught the basics of performing a semen analysis and sperm preparation for intrauterine insemination.

The student will be assigned primarily to two attending physicians at Boston IVF The student will see 1-2 new patients each day in coordination with the attending, present findings in oral and written form to that attending and develop an evaluation plan to be discussed with the attending. The student will be expected to perform the physical exam on this patient under the supervision of the attending. Additional clinical experience will include time in the IVF OR suite observing IVF procedures and the IVF laboratory, observation in the andrology laboratory to learn the basics of performing a semen analysis and sperm preparation for intrauterine insemination, instruction in the technique of hysterosalpingograms and sonohysteorgrams and observation of follicular, prenatal and gynecologic ultrasounds. The student will spend time in an out patient surgicenter observing reproductive surgery, will be expected to attend all departmental and divisional conferences and will be expected to prepare a brief presentation for weekly discussion with the attending to whom he/she is assigned based on a patient seen in the office.
Learning Goals:
Gain understanding of the various causes of male and female infertility and the underlying pathophysiology behind the various disorders.
Describe the evaluation and management of the various causes of infertility
Describe the physiologic changes in the hypothalamic-pituitary-ovarian axis associated with puberty, the normal menstrual cycle and changes that occur in the perimenopausal transition/menopause
Discuss the pathophysiology of common reproductive endocrine conditions: primary and secondary amenorrhea, polycystic ovarian syndrome, hyperprolactinemia,
Incorporation of Basic Science Content and Evidence-Based Medicine:
The students will participate in the weekly reproductive endocrine conference to gain an understanding of various endocrine, and or infertility topics. The student will be expected to prepare a comprehensive PowerPoint presentation on a topic of clinical interest based on a patient or problem that was encountered during their rotation, with medical literature review providing evidenced based support for the clinical evaluation and management of this problem as well as discussion of the underlying pathophysiology of the clinical problem. This presentation will be given at our weekly reproductive endocrinology conference attended by faculty, fellows, residents and medical students.
Evaluations will be based on observation of their ability to evaluate and develop a management plan and present evaluation in both oral and written form. Understanding of basic pathophysiology of disease as evidenced by patient assessment and student case presentations. Abiltiy to preform basic procedures will be evaluated. Interpersonal communication style, professionalism, initiative and ability to work with a team will also be evaluated.
Grade Criteria:
High Honors:
Student will obtain a consistent and thorough history even in complex patients and perfom a comprehensive physical exam consistently identifying important findings. Student will cogently summarize information in a oral and written form and demonstrate thorough understanding of the pathophysiology of the clinical presentation as information is summarized, resulting in a differential diagnosis and comprehensive evaluation and/or treatment plan that reflects understanding of the clinical presentation. Student will be expected to communicate effectively with patients, demonstrate understanding of the impact of cultural factors that may impact care and integrate this information. The student is inquisitive, demonstrates initiative, is an avid reader and works exceptionally hard thus preforming at a level that encourages independence.
Student preforms history and exam thoroughly in patients who present with straightforward clinical problems, and is able to perform a thorough and focused exam. Knowledge base and understanding of the pathophysiology of the clinical presentation is generally solid allowing student to present in both oral and written form a focused, organized and thorough differential diagnosis, plan for evaluation and management. Student is extremely reliable, and self motivated and is tirelessly working to improve clinical skills and knowledge base.
The student obtains an accurate history in straightforward patients, but is less thorough in more complex patients. Physical exam skills are appropriate, however focuses on major findings, occasionally missing more subtle findings.
Presentations in both oral and written form incorporate essential elements, however lack depth. These presentations are generally sufficiently organized to enable the student to communicate the basic evaluation and treatment plan. Student is able to communicate effectively with patients, however is often less empathatic and may not understand the impact of cultural or social factors that may impact decision making. Student works will with others, is generally reliable, works hard to improve knowledge base.
Student is unable to obtain the information from a patient history and is not able to perfom a targeted physical exam. Knowledge base has sufficient deficits to prevent the student from to ascertaining critical information to thoroughly evaluate a patient. Written and oral presentations thus lack critical information. Unable to create a complete differential diagnosis and therefore unable to focus the evaluation or establish a treatment plan. Communication skills are poor and student has difficulty interacting with patients or the health care team. Is often poorly motivated and required extensive direction, knowledge of the literature is shallow.
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