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Mastering the surgical approaches to clinical problems within a field as broad such as obstetrics and gynecology is a formidable task. It requires drawing on a knowledge base, to procure and filter through the clinical and laboratory data, to develop a differential diagnosis, and finally to make a rational treatment plan. To gain these skills, the clinician is best guided and instructed by experienced teachers and accomplished surgeons, and inspired toward self-directed, diligent reading and practicing one's craft. Clearly, there is no replacement for experience at the bedside and the surgical suite. Unfortunately, younger physicians will not have encountered the diversity of clinical situations, or dealt with the more unusual surgical complications. Perhaps the best alternative is a carefully crafted patient case designed to stimulate the clinical and surgical approach and decision making. In an attempt to achieve that goal, we have constructed a collection of clinical vignettes to teach diagnostic, therapeutic, and surgical approaches relevant to obstetrics and gynecology. Most importantly, the explanations for the cases emphasize the underlying principles, rather than merely rote questions and answers.
This book is organized for versatility: It allows the physician "in a rush" to go quickly through the scenarios and check the corresponding answers, and it provides more detailed information for the clinician who wants thought-provoking explanations. The answers are arranged from simple to complex: a summary of the pertinent points, the bare answers, an analysis of the case, an approach to the topic, a comprehension test at the end for reinforcement and emphasis, and a list of resources for further reading. The clinical vignettes are purposely placed in random order to simulate the way that real patients present to the practitioner. A listing of cases is included in Section III. The information is presented with the degree of evidence of support. Several multiple-choice questions (MCQs) are included at the end of each case discussion (comprehension questions) to reinforce concepts or introduce related topics.
Each case is designed to simulate a patient encounter with open-ended questions. At times, the patient's complaint is different from the most concerning issue, and sometimes extraneous information is given. The answers are organized into four different parts:
1. Summary: The salient aspects of the case are identified, filtering out the extraneous information to identify the key issues(s).
2. A straightforward answer is given to each open-ended question, often with a differential diagnosis.
3. The analysis consists of two parts:
Objectives: A listing of the two or three main principles that are crucial for a practitioner to manage the patient. Again, the students are challenged to make educated "guesses" about the objectives of the case upon initial review of the case scenario, which helps to sharpen their clinical and analytical skills.
Considerations: A discussion of the relevant points and brief approach to the specific patient.
Approach to the Disease Process: It consists of two distinct parts:
Definitions: Terminology pertinent to the disease process.
Clinical Approach: A discussion of the approach to the clinical problem in general, including tables, figures, and algorithms.
Comprehension Questions: Each case contains several MCQs, which reinforce the material, or which introduce new and related concepts. Questions about material not found in the text will have explanations in the answers.
Clinical Pearls: Several clinically important points are reiterated as a summation of the text. This allows for easy review, such as before an examination.