Mastering the cognitive knowledge within a field such as obstetrics and gynecology is a formidable task. It is even more difficult to draw on that knowledge, 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 student often learns best at the bedside, guided and instructed by experienced teachers, and inspired toward self-directed, diligent reading. Clearly, there is no replacement for education at the bedside. Unfortunately, clinical situations usually do not encompass the breadth of the specialty. Perhaps the best alternative is a carefully crafted patient case designed to stimulate the clinical approach and decision making. In an attempt to achieve that goal, we have constructed a collection of clinical vignettes to teach diagnostic and therapeutic approaches relevant to obstetrics and gynecology. Most importantly, the explanations for the cases emphasize the mechanisms and underlying principles, rather than merely rote questions and answers.

This book is organized for versatility: It allows the student “in a rush” to go quickly through the scenarios and check the corresponding answers, and it provides more detailed information for the student 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 have been arranged as obstetric in the first half and gynecologic in the second half, with related cases grouped together. Section III contains review questions designed to require higher level integration of information. Finally, we intentionally did not use a multiple-choice question (MCQ) format in our clinical case scenarios because clues (or distractions) are not available in the real world. Nevertheless, several MCQs are included at the end of each case discussion (Comprehension Questions) to reinforce concepts or introduce related topics.

HOW TO GET THE MOST OUT OF THIS BOOK

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:

CLINICAL CASE FORMAT: PART I

1. Summary: The salient aspects of the case are identified, filtering out the extraneous information. Students should formulate their summary from the case before looking at the answers. A comparison to the summation in the answer will help to improve their ability to focus on the important data, while appropriately discarding the irrelevant information—a fundamental skill in clinical problem solving.

2. A straightforward answer is given to each open-ended question.

3. The analysis of the case is composed of two parts:

   1. Objectives of the case: 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. The objectives are corelated to the AAMC Entrustable Professional Activities (EPA), which were developed in 2014 to provide expectations for both learners and teachers. They reflect 13 activities that all medical students should be able to perform upon entering residency (see Table 1).

   2. Considerations: A discussion of the relevant points and brief approach to the specific patient.

PART II

Approach to the disease process: This 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.

PART III

Comprehension questions: Each case contains several multiple-choice questions, which reinforce the material or introduce new and related concepts. Questions about material not found in the text will have explanations in the answers.

PART IV

Clinical pearls: Several clinically important points are reiterated as a summation of the text. This allows for easy review, such as before an examination.