Brigham and Women's Hospital Harvard Medical School

4th Year Information

Clinical Electives

The Department of Obstetrics and Gynecology at Brigham and Women’s Hospital offers challenging electives for interested fourth year medical students.  Course descriptions are listed below. 

To apply for fourth year electives please contact HMS Registrar:
Harvard Medical School
Office of the Registrar
Gordon Hall, Room 213
25 Shattuck Street
Boston, MA 02115
phone: (617) 432-1515
fax: (617) 432-0275
Email: registrar@hms.harvard.edu
Email: exclerks@hms.harvard.edu
Office Hours: Monday–Friday, 9am–5pm

Course Descriptions for BWH 4th Year Electives
OB510M.23 Maternal Fetal Medicine

Credits: 4.00 CREDITS (Clinical Elective)
Sites: BWH
Directors: Dr. Louise Wilkins-Haug
Prerequisites: HMS Principal Clinical Experience (Core Clinical Clerkships) or equivalent
Offered: Full time one month. Not offered in May.
Open to Exclerks: US/Canadian

Description:
During their rotation as subinterns on the MFM inpatient service, students actively admit and follow patients, participating in their procedures and deliveries.  The students are expected to be the physicians for their panel of patients under the supervision of the MFM fellows, a third year obstetrics resident and the attending perinatologist.  Formal structured teaching occurs during Wednesday didactic sessions, after morning rounds and during weekly perinatal conferences.  Students are expected to take night call, but the schedule is flexible.  Grading is based on evaluations from resident staff, fellows and divisional faculty.

Learning Goals:
Familiarity with the physiology and common pathophysiologies of pregnancy.
Familiarity with the diagnosis and treatment of the common antenatal complications of pregnancy including preeclampsia, preterm premature fetal membrane rupture, preterm labor, placental abruption, and fetal growth abnormalities.
Familiarity with the diagnosis and treatment of the common medical complications of pregnancy including pre-gestational diabetes, asthma, HIV, and maternal autoimmune complications.

Incorporation of Basic Science Content and Evidence-Based Medicine:
Basic science and evidence-based concepts, applicable to maternal fetal medicine, are incorporated primarily during daily teaching rounds and at at formal, weekly perinatal rounds and Ob Rounds.

Evaluation:
Observation and participation in clinics, labor & delivery, operating room, on the wards with specific attention to integrity, interpersonal skills, professionalism, communication skills, fund of knowledge, participation and attendance. Feedback from faculty, fellows, residents, nurses and other ancillary staff.

Grade Criteria:
Honors with Distinction:
Top 5%-10% of students who've rotated through the elective. Consistent high honors in all categories from all evaluators.
Honors:
80%-90% Consistent honors in all categories from all evaluators.
Pass:
50%-80% Consistent satisfactory in all categories from all evaluators.
Unsatisfactory:
Fails to meet the absolute minimum standards expected of a 4th year student with respect to integrity, interpersonal skills, professionalism, communication skills, fund of knowledge, participation and attendance.

OB507M.23 Family Planning

Credits: 4.00 CREDITS (Clinical Elective)
Sites: BWH
Directors: Dr. Deborah Anne Bartz
Offered: Full time every month. Not offered in May
Open to Exclerks: No (HMS only)

Description:
This course will expose the student to the range of clinical experiences and issues related to family planning, in order to provide a comprehensive knowledge base, an opportunity for skill development, and a context for clarification of values related to family planning. Seventy percent (7-half day sessions) of the student's time will be spent in family planning and gynecology clinics where she will gain exposure to abortion and contraceptive care. This clinical training will include exposure to abortion in a hospital setting and with community-based abortion providers, as well as time spent in outpatient gyn services within a community health center (CHC). By observing the full spectrum of family planning care delivery sites—from the integrated approach to primary prevention within the CHC medical home model to the tertiary care afforded to more complex cases in the hospital—the student will gain appreciation of the role of family planning in the full spectrum of women’s health. Across these settings, advanced instruction will be provided in patient counseling and health promotion related to reproductive decision-making.

Thirty percent of the student’s time (3 half day sessions) will be dedicated to didactics and research, including the 4 hours of regularly scheduled didactic time dedicated to the BWH-MGH combined ob/gyn residency and including the 2 hours of weekly seminar provided at BWH Family Planning Center. Didactic sessions will supplement the knowledge base built in prior core clerkships, covering issues rarely addressed elsewhere in the curriculum, including abortion, reproductive health policy, and domestic and global family planning concerns. Seminars will provide an opportunity for discussion and values clarification regarding family planning care provision. Students will be required to generate a substantive scholarly product on a topic of chosen interest and to prepare a presentation of this work to the family planning faculty and staff.

Learning Goals:
1) Experience clinical care in delivery of abortion and contraceptive services
2) Understand domestic and international family planning concerns including the epidemiology of unplanned pregnancy and the impact of reproductive health policy on quality of care
3) Understand the role of family planning as a component of primary prevention in the community-based medical home model
4) Understand the role of family planning, including abortion, in the full context of the health of reproductive age women (15-45)

Incorporation of Basic Science Content and Evidence-Based Medicine:
In addition to exposure to the evidence-based best clinical practices employed in the clinical context, students will be exposed to basic science and evidence-based medicine content through three primary channels:
1) readings in the written curriculum designed to accompany the course;
2) participation in ongoing resident lectures, family planning seminars, and family planning simulations scheduled concurrently with the student's time in
the course;
3) individual research mentored by family planning faculty.

Evaluation:
Students will be evaluated based on four criteria:
1) his/her performance in the clinical context of abortion care delivery;
2) his/her performance in the clinical context of contraceptive care delivery;
3) his/her performance in the clinical context of community-based outpatient gynecologic care;
4) the quality of his/her final scholarly product and accompanying presentation.

Students will be evaluated on the quality of clinical care delivery based on their demonstrated ability to perform the following tasks in the following
domains:

Interpersonal and Communication Skills
*Counsel patients regarding: Contraceptive options & First and second trimester abortion procedures
*Provide care to patients experiencing pregnancy loss in an emotionally sensitive manner
*Understand and acknowledge the complex reasons patients choose to terminate a pregnancy

Professionalism
*Understand the components of informed consent
*Demonstrate tolerance of value systems different than one’s own
*Demonstrate a commitment to patient confidentiality

Practice-Based Learning
*Use consultative services to improve patient care
*Analyze systems of care and discuss how they may influence quality of care

System-Based Practice
*Facilitate abortion and contraceptive services to young women
*Understand the global consequences of unsafe abortion
*Understand importance of operating procedures such as safety pause to minimize medical errors
*Increase understanding of operative planning in context of financial, insurance and social constraints

In evaluating the scholarly product, faculty will consider the extent to which the product is:
-fruitful for the advancement of basic science and/or grounded in the principles of evidence-based medicine;
-applicable in the field either immediately or at some future date as the
basis for a study design, grant proposal, or clinical protocol;
-demonstrative of either
1)in-depth knowledge of a clinical issue/question of timely relevance, or
2)in-depth exploration of the public health or epidemiological literature on a population health issue pertinent to family planning.

Grade Criteria:

Honors with Distinction:
The student demonstrates: 1) professionalism and empathy for all patients; 2) the highest commitment to delivering safe, efficient, and high-quality care for all patients and all presenting concerns; 3) significant improvement in clinical skills including the taking of history and physical; interpretation of ultrasound images and laboratory test results as applicable; surgical skills; 4) substantial mastery of resources for optimizing the management of care for women with complex medical needs, such as evidence-based contraceptive use guidelines. The student's scholarly product is of sufficient quality such that it may form the basis for a future grant proposal; manuscript targeting peer-reviewed publications; oral abstract and/or conference poster; grand rounds lecture; or be appropriate for another dissemination channel of scholarly significance.
Honors:
At a minimum, the student demonstrates: 1) professionalism and empathy for all patients; 2) the highest commitment to delivering safe, efficient, and high-quality care for all patients and all presenting concerns; 3) moderate improvement in clinical skills including the taking of history and physical; interpretation of ultrasound images and laboratory test results as applicable; surgical skills; 4) emerging mastery of resources for optimizing the management of care for women with complex medical needs, such as evidence-based contraceptive use guidelines. The student's scholarly product is of sufficient quality to demonstrate mastery of a subject area of clinical significance. It may form the basis for further research.
Pass:
At a minimum, the student demonstrates: 1) professionalism and empathy for all patients; 2) the highest commitment to delivering safe, efficient, and high-quality care for all patients and all presenting concerns; 3) limited improvement in clinical skills including the taking of history and physical; interpretation of ultrasound images and laboratory test results as applicable; surgical skills; 4) limited mastery of resources for optimizing the management of care for women with complex medical needs, such as evidence-based contraceptive use guidelines. The student's scholarly product is of high quality and may form the basis for future research.
Unsatisfactory:
The student demonstrates: 1) professionalism and empathy for most patients; 2) high commitment to delivering safe, efficient, and high-quality care for most patients and presenting concerns; 3) little or no improvement in clinical skills including the taking of history and physical; interpretation of ultrasound images and laboratory test results as applicable; or surgical skills; 4) little or no mastery of resources for optimizing the management of care for women with complex medical needs, such as evidence-based contraceptive use guidelines. The student's scholarly product is of moderate or poor quality.

OB505M.23 Gynecologic Oncology

Credits: 4.00 CREDITS (Clinical Elective)
Sites: BWH, DFCI
Directors: Dr. Ross Stuart Berkowitz
Prerequisites: HMS Principal Clinical Experience (Core Clinical Clerkships) or equivalent
Offered: Full time every month. Not offered in May
Open to Exclerks: US/Canadian

Description:
The course is designed to provide a sound background, relevant to neoplastic disease in general, in the early detection, diagnosis and management of gynecologic cancer.  Weekly clinics will be devoted to early detection of cervical neoplasia and the correlation of clinical cytologic and histologic findings.  Students will have an opportunity to actively participate in surgical, radiotherapeutic and chemotherapeutic management of individual patients.  Investigative aspects of anti-cancer pharmacology and immunology will be considered.

Learning Goals:
Learn the pathogenesis and prevention of precancerous and cancerous diseases of the female reproductive tract.
Learn diagnosis, management and follow-up of gynecologic cancers and their premalignant conditions.
Expose students to the operative management and the use of chemotherapy and radiation therapy in the management of gynecologic malignancy.
Expose students to developing concepts in the understanding of gynecologic malignancy and the development of novel therapies.

Incorporation of Basic Science Content and Evidence-Based Medicine:
Students are provided reference materials, including current articles that are related to the management and pathophysiology of gynecologic malignancy.  This material emphasizes the relationship between management and basic science and evidence-based medicine data.

Evaluation:
Observation and participation in clinics, operating room, on the wards and during informal presentations with specific attention to integrity, interpersonal skills, professionalism, communication skills, fund of knowledge, participation and attendance. Feedback from faculty, fellows, residents, nurses and other ancillary staff.

Grade Criteria:
Honors with Distinction:
Top 5%-10% of students who have rotated through the elective. Consistent high honors in all categories from all evaluators.
Honors:
Top 80%-90% of students who have rotated through the elective. Consistent honors in all categories from all evaluators.
Pass:
Top 50%-80% of students who have rotated through the elective. Consistent satisfactory in all categories from all evaluators.
Unsatisfactory:
Fails to meet the absolute minimum standards expected of a 4th year student with respect to integrity, interpersonal skills, professionalism, communication skills, fund on knowledge, participation and attendance.

OB506M.23 Fertility and Reproductive Endocrinology

Credits: 4.00 CREDITS (Clinical Elective)
Sites: BWH
Directors: Dr. Janis Heidi Fox
Prerequisites: HMS Principal Clinical Experience (Core Clinical Clerkships) or equivalent
Offered: Full time every month. Not offered in May
Open to Exclerks: US/Canadian

Description:
The course is designed to acquaint students with current concepts of infertility and management of interrelated reproductive endocrine problems and to familiarize them with laboratory techniques used in evaluating patients with such problems.  Students will observe the workup and care of fertility and endocrinology patients, as well as patients with recurrent miscarriage.  There is extensive exposure to surgical management of such patients, including minimally invasive surgery and robotic cases.  They will attend conferences and seminars related to these subjects.  Students will also have exposure to laboratory techniques used in the work up and treatment of such patients.  Exposure to assisted reproductive technologies in clinics and laboratories, and pediatric gynecology and endocrinology is also available and encouraged.

Learning Goals:
Acquaint students with current concepts of infertility and interrelated reproductive endocrine problems.
Familiarize students with laboratory techniques related to workup and treatment of above such patients.
Expose students to workup and care of fertility and endocrinology patients, including surgical management and assisted reproductive technologies.
Appreciate assisted reproductive endocrine and andrology laboratory techniques and processes.

Incorporation of Basic Science Content and Evidence-Based Medicine:
Students are exposed to reproductive endocrinology, andrology and IVF laboratory policies and procedures. Weekly conferences during which a variety articles related to REI are reviewed. Formal weekly conferences are held with invited experts presenting the most up to date advances in the field.

Evaluation:
Observation in clinics, operating room, on the wards and during formal, assigned presentation with specific attention to integrity, interpersonal skills, professionalism, communication skills, fund of knowledge, participation and attendance. Feedback from faculty, fellows, residents, nurses, laboratory techs and other ancillary staff. HMS evaluation forms will be utilized.

Grade Criteria:
Honors with Distinction:
Top 5%-10% of students who have rotated through the elective. Consistent high honors in all categories from all evaluators.
Honors:
Top 80%-90% of students who have rotated through the elective. Consistent honors in all categories from all evaluators.
Pass:
Top 50%-80% of students who have rotated through the elective. Consistent satisfactory in all categories from all evaluators.
Unsatisfactory:
Fails to meet the absolute minimum standards expected of a 4th year student with respect to integrity, interpersonal skills, professionalism, communication skills, fund on knowledge, participation and attendance.

SU520M.23 Sub-internship in Urogynecology

Credits: 4.00 CREDITS (Clinical Elective)
Directors: Dr. Abraham Nicholas Morse
Offered: Full time every month, except May.
Open to Exclerks: No (HMS only)

Description:
This course will expose the participant to all facets of urogynecology/pelvic floor dysfunction focusing on outpatient evaluation and surgical and non-surgical treatment of urinary incontinence, defecatory dysfunction and pelvic organ prolapse.  The current clinical science and basic science will be introduced where applicable.  The student will have the opportunity to participate with the Urogyn faculty in clinic and in the operating room at BWH and Faulkner Hospital.  There will be opportunities to observe urodynamic testing, cystoscopy and pelvic floor physical therapy.

Learning Goals:
1) Understand the epidemiology and the pathophysiology of female pelvic floor dysfunction.
2) Develop a systematic approach to the evaluation and management of urinary incontinence, pelvic organ prolapse and defecatory dysfunction in the outpatient setting.
3) Continue to improve skills for assisting in the operating room and for the perioperative management of urogyn/gyn surgical patients.

Incorporation of Basic Science Content and Evidence-Based Medicine:
Students will utilize Walters and Karram's Urogynecology as their primary text. This will supplemented with current literature on both basic science developments in urogynecology and the evidence base for current clinical practice.

Evaluation:
Students will have a written course description with objectives and evaluation criteria. They will be in communication with the course director on or before the first day to orient and answer any questions. They will meet with the course director at mid-clerkship for feedback on their performance up to that point. The course director will solicit comments from attendings, residents and ancillary staff who have worked with the student. At this time, they will also identify the topic of their presentation which will occur at the end of the rotation. At the end of the rotation they will meet with the course director for a final discussion and feedback. The course director will solicit comments from attendings, residents and ancillary staff who have worked with the student. Evaluation criteria will include History Taking Focused Physical Examination Fund of Knowledge Technical/Procedural Skills Clinical Eval & Management Skills Interpersonal Skills Presentation Skills Professionalism Cultural/Social/Systems Awareness Initiative and Desire to Learn.

Grade Criteria:
Honors with Distinction:
Consistently outstanding evaluations from evaluators in all areas
Honors:
Excellent evaluations from most or all evaluators in most or all areas
Pass:
Satisfactory performance on evaluations from most evaluators
Unsatisfactory:
Significant deficiencies and/or concerns in at least two areas from at least two evaluators

OB505M.18 Tumor Immunology in Gynecologic Malignancy

Credits: 4.00 CREDITS (Clinical Elective)
Sites: SWRL
Directors:  Dr. Ross Stuart Berkowitz
Prerequisites: HMS Principal Clinical Experience (Core Clinical Clerkships) or equivalent
Offered: Full time every month. Not offered in May
Open to Exclerks: No (HMS only)

Description:
This course is designed to provide research experience in molecular biology as it applies to gynecologic oncology.  The student will be assigned reading material and will be expected to participate in discussions on recent scientific concepts at weekly laboratory meetings.  Research in which the student may participate is centered on molecular biologic studies concerning the pathogenesis of gynecologic malignancy and, in particular, ovarian cancer.

Learning Goals:
Learn about the role of molecular biology in the understanding of the pathogenesis of gynecologic malignancy and, in particular, ovarian cancer.
Participate in molecular biologic experiments related to the understanding of the pathogenesis of gynecologic malignancy.
Learn developing concepts in molecular biology that may provide new insights in the understanding of the origins and biology of gynecologic malignancy.

Incorporation of Basic Science Content and Evidence-Based Medicine:
Students are provided reference materials, including current articles that are related to the management and pathophysiology of gynecologic malignancy. This material emphasizes the relationship between management and basic science and evidence-based medicine data.

Evaluation:
Students are evaluated by observing their participation in assigned projects and laboratory meetings.

Grade Criteria:
Honors with Distinction:
Top 5%-10% of students who have rotated through the elective. Consistent high honors in all categories from all evaluators.
Honors:
Top 80%-90% of students who have rotated through the elective. Consistent honors in all categories from all evaluators.
Pass:
Top 50%-80% of students who have rotated through the elective. Consistent satisfactory in all categories from all evaluators.
Unsatisfactory:
Fails to meet the absolute minimum standards expected of a 4th year student with respect to integrity, interpersonal skills, professionalism, communication skills, fund on knowledge, participation and attendance.