Specific Gynaecology Objectives
Physiological Changes:
The resident must have an extensive knowledge of the changes in normal reproductive physiology from birth to senescence.
Pediatric and Adolescent Gynaecology:
The resident must have a working knowledge of the pathophysiology, investigation, diagnosis, and management of gynaecologic problems in children and adolescents. These problems include developmental abnormalities, precocious and delayed puberty, abnormal vaginal discharge and bleeding, sexual abuse, family planning, teenage pregnancy and the medico legal aspects of consent and confidentiality specific to this age group.
Reproductive and Endocrine Disorders:
The resident must have extensive knowledge of normal physiology and pathophysiology, investigation, diagnosis, and treatment in the areas of menstrual irregularity, amenorrhea, dysfunctional uterine bleeding, hormonal under activity and over activity, galactorrhoea, hirsuitism , polycystic ovarian disease and premenstrual syndrome
Menopause:
The resident must have extensive knowledge of the changes associated with menopause and aging, and be able to provide appropriate periodic assessment and management including hormonal and non-hormonal modalities.
Human Sexuality:
The resident must have the ability to identify problems related to sexual dysfunction including dyspareunia, vaginismus, inhibited sexual desire and anorgasmia, and be able to initiate management and/or referral.
Family Planning:
The resident must have an extensive knowledge of methods of contraception including mechanisms of action, indications, contraindications, and possible complications. He/she must be able to inform women of options available to them and provide any required service (such as counseling in contraception, prescription of oral and injectable contraceptives, insertion of intrauterine device, and sterilization or refer appropriately to meet the patient’s needs.
Infertility:
The resident must have an extensive knowledge of factors contributing to infertility, enabling him/her to diagnose, evaluate and manage the major causes. He/she will be able to utilize and interpret the tests and procedures commonly used in diagnosis , such as hormonal evaluation, semen analysis, basal body temperature charting, ovulation prediction, endometrial biopsy, hysterosalpingography and endoscopy. The resident will be aware of the effectiveness, and complications of current standard treatments as well as appropriate indications for subspecialty referral. The resident must have the necessary knowledge for diagnosis and management of ovulatory disorders. He/she must have an extensive knowledge for situations requiring simpler regimens such as clomiphene citrate and progestogens and a working knowledge for more complex regimens utilizing GnRH analogues and gonadotrophins as well as laparoscopic ovarian drilling. The resident must have a working knowledge of the surgical techniques used in treating tubal and pelvic causes of infertility, including pelvic adhesions, endometriosis, tubal obstruction, and uterine malformation. The resident must have a working knowledge of the assisted reproductive technologies currently available, including appropriate indications for referral
Pregnancy Loss:
The resident must have extensive knowledge of pathophysiology, investigation, diagnosis, and treatment in spontaneous abortion, ectopic pregnancy, and recurrent pregnancy loss.
Gynaecologic Infections:
The resident must have extensive knowledge of pathophysiology, investigation, diagnosis, and treatment in vaginal and vulvar infections, sexually transmitted diseases, gynecologic aspects of HIV and pelvic inflammatory disease.
Breast conditions:
The resident must have a working knowledge of the pathophysiology, diagnosis, and management of benign breast disease, screening, and referral for breast cancer, and the effect of breast cancer and its therapies on the reproductive system.
Urogynaecology:
The resident must have extensive knowledge of the underlying physiology, pathophysiology, investigations, diagnosis, medical and surgical treatment in the areas of lower urinary tract and pelvic floor disorders.
Other Non-Malignant Gynaecologic Conditions:
The resident must have extensive knowledge of the underlying physiology, pathophysiology, investigations, diagnosis, medical and surgical treatment in the areas of Uterine Fibroids, pelvic support defects , ovarian cysts, acute and chronic pelvic pain, endometriosis, abnormal uterine bleeding, and vulval pain and dermatoses.
General Gynaecologic Surgery:
The resident must have extensive knowledge of the indications for and be skilled in the performance of common gynaecological procedures including vulval, vaginal and cervical surgery for benign conditions, hysterectomy (abdominal and vaginal), myomectomy, adnexal surgery, abdominal exploration, omentectomy, identification of operative complications, paracentesis, anterior and posterior colporrhaphy and evacuation of the pregnant uterus. He/she must be able to assist procedures such as pelvic node sampling, retroperitoneal exploration, surgery for urinary incontinence & repair of urinary/rectal fistulae. The resident must be able to discuss with the patient the risks, benefits, and complications of any surgical treatment, as well as non-surgical treatment alternatives.
Laparoscopic and Hysteroscopic Surgery
Endoscopic Surgery:
The resident must have extensive knowledge of the indications for and be skilled in diagnostic laparoscopy, tubal patency test, laparoscopic sterilization and needle aspiration of simple cysts. He/she must be able to assist procedures such as ovarian biopsy, lysis of adhesions, laser or diathermy treatment of endometriosis (stage 1 and 2), linear salpingotomy or salpingectomy for ectopic pregnancy, salpingo-oophorectomy and ovarian cystectomy.
Hysteroscopic Surgery:
The resident must have extensive knowledge of the indications for and be highly skilled in hysteroscopy for the purpose of diagnosis and be able to assist simple hysteroscopic procedures such as treatment of intrauterine synechiae, simple polyp removal, removal of IUCD, and endometrial ablation. The resident will require a working knowledge of more advanced laparoscopic and hysteroscopic techniques. He/she should know the indications for and limitations of laparoscopically assisted vaginal hysterectomy in comparison with vaginal and abdominal hysterectomy.
Pre-operative and Postoperative Patient Care:
The resident must have the extensive knowledge and skills necessary to provide appropriate preoperative and postoperative care, including recognition and assessment of perioperative risk factors, provision of nutritional support, manage fluid and electrolyte balance, promotion of wound healing and management of medical and surgical complications. He/she will be able to perform Cardio Pulmonary Resuscitation.
Preinvasive and Malignant Gynaecological Disease:
Risk Factors:
The resident must have extensive knowledge of known risk factors for gynaecologic malignancy and of pre-malignant gynaecologic conditions.
Screening:
The resident must have extensive knowledge of the current guidelines and indications for screening for cervical, endometrial and ovarian cancer, and an understanding of the reliability of current screening methods.
Colposcopy:
The resident will have a working knowledge of colposcopic technique and interpretation, the indications for and limitations of the procedure, and indications for referral for colposcopic assessment.
Vulvar/Vaginal Neoplasia:
The resident will have the working knowledge and skills for diagnosis and staging, and for appropriate referral for treatment.
Cervical Neoplasia:
The resident will have the working knowledge and skills for the management of benign and preinvasive lesions of the cervix using techniques such as LEEP, laser, cryotherapy and cone biopsy. He/she will have a working knowledge of diagnosis, staging and appropriate surgical management (simple or radical hysterectomy) for cervical carcinoma. He/she will be able to refer appropriately to radical surgery, radiotherapy and/or adjuvant therapy.
Endometrial and Uterine Cancer:
The resident must have the extensive knowledge for diagnosis, staging and appropriate use of simple hysterectomy and bilateral salpingo-oophorectomy in the management of endometrial and uterine cancer. He/she will refer appropriately for more extensive surgery, radiation, and systemic therapy.
Ovarian and Tubal Cancer:
The resident must have the working knowledge and skills for diagnosis, and for appropriate referral for surgical staging, radiation chemotherapy, and other treatment modalities. He/she must be familiar with the techniques of hysterectomy, salpingo-oophorectomy, omentectomy and debulking in this context.
Gestational Trophoblastic Disease:
The resident will have the working knowledge and skills necessary for diagnosis, primary intervention, and follow-up. He/she will be able to carry out appropriate metastatic workup and distinguish low and high-risk disease with appropriate referral for further assessment and treatment
Adjuvant Cancer Therapies:
The resident will have a working knowledge of the principles and complications of adjuvant therapy, including an understanding of the indications for consultation with appropriate specialists. This will be achieved by attendance at multidisciplinary Tumor Boards and by observing external beam and Brachytherapy treatment.
Palliative Care:
The resident will have a working knowledge of palliation in incurable gynecologic disease, including the social and ethical implications of the various options.
Medical and Surgical Disease:
The resident will have a working knowledge of the important medical and surgical disorders which may have an effect on or be affected by the female reproductive system.
