Reproductive Health

Heather Paladine, MD

• Let Dr. Paladine know if you are interested in email listservs on abortion care or transgender care

• What pregnancy tissue looks like before 10 weeks: https://www.theguardian.com/world/2022/oct/18/pregnancy-weeks-abortion-tissue

• AFP Adnexal Mass: https://www.aafp.org/pubs/afp/issues/2016/0415/p676.html

• TEACH abortion workbook (includes more information on counseling, medication and procedural abortion, ultrasound, miscarriage management, and incorporating abortion care into practice): https://pressbooks.pub/workbook/

• Online modules on transgender care: 

  • https://medicine.umich.edu/dept/obgyn/education/continuing-medical-education-cme/transgender-healthcare-curriculum

  • https://www.coursera.org/learn/transgender-medicine?action=enroll&authMode=signup

• AFP Mifepristone and Misoprostol for Early  Pregnancy Loss: https://www.aafp.org/pubs/afp/issues/2021/0415/p473.html

• NEJM Diagnostic Criteria for Early Pregnancy Failure: https://drive.google.com/file/d/1SW-bcEH6YpczD-CXJUnrvtijQ5Lv8apY/view?usp=sharing

• Dr. Paladine will get feedback from the other faculty you have worked with and submit a combined evaluation. This will include your completion of the educational activities. You will also receive a rotation evaluation in Medhub. This  will be compiled after six months to preserve anonymity and shared with the rotation faculty and PEC.

Goals and Objectives

Medical Knowledge

• Learn the foundation of medical knowledge for common issues related to reproductive health, including pregnancy options counseling, contraception, abnormal Pap management, and common gyn problems.

Patient Care

• Have a framework for providing informed consent for common procedures in Family Medicine.

• Be familiar with the steps for Nexplanon insertion/removal, IUD insertion/removal, and endometrial biopsy.

• Optional: Evaluate and counsel a patient for medication abortion.

System-based Practice

• Be familiar with the legislative restrictions on abortion care in the United States.

• Understand the topic of Reproductive Justice

Practice-based Learning and Improvement

• Demonstrate the use of point of care apps for contraception and abnormal Pap triage

• Demonstrate the use the AFP resources for common reproductive health topics

Interpersonal and Communication Skills

• Demonstrate use of patient-centered language and precepts of trauma-informed care when providing reproductive health care.

• Be able to conduct an options counseling discussion with a pregnant patient.

Professionalism

• Be on time and prepared for rotation activities.

• Complete the assigned readings for the rotation.

• Complete additional rotation assignments: values clarification discussion with Dr. Pilipenko and options counseling recording review with Dr. Paladine

Please review the orange schedule - there may be changes in your Farrell schedule based on room/preceptor availability. If you are out sick or otherwise need to miss a session, please let Dr. Paladine and the attending you are scheduled with know that you are out.

Gyn at Farrell - Dr. Swapna Nalgonda

• Focus on gyn patients. There may be a PGY1 resident as well who will see the OB patients.

Colposcopy - Dr. Yorgos Strangas

• This session is scheduled every other week. Make sure you have downloaded the ASCCP app prior to the session.

Early Options - Dr. Heather Paladine or Dr. Alice Beckman

• This session focuses on abortion and reproductive health care. Here is a reminder from PGY1 year of the preparation for this session: https://docs.google.com/document/d/1DQZmhzmXmN0PysoGA-LMRgjbiFHlESxVrbGfxvpJhto/edit?usp=sharing

• There may be a PGY1 resident, medical student, or FNP student. Be prepared to review the schedule and participate in the teaching of learners who are scheduled.

Family Planning 21 Audubon - Dr. Annie Fu or Dr. Erica Levi

• This session is scheduled all day Friday but please check the online schedule to confirm: columbiaobgyn-pac.qgenda.com Family Planning is listed under FPP.

Urology/Men's Reproductive Health - Dr. Joseph Alukal

• Herbert Irving 11th floor from  1-5pm.  You will do one session on a  Tuesday afternoon during your rotation instead of a session with Dr. Nalgonda. This is general on the third week of the rotation. You should email Dr. Alukal at the start of the rotation to confirm, and you can go on a different Tuesday if he isn't available: jpa2148@cumc.columbia.edu

Additional meetings - these will be arranged via email:

• Meeting during the first week of the rotation with Dr. Paladine to discuss goals and objectives.

• Meeting with Dr. Pilipenko to review values clarification exercise.

• You should record (sound only) a patient during the first three weeks of the rotation and meet with Dr. Paladine during the final week of the rotation to review.  Ideally you would record a pregnancy options counseling session, but any patient visit related to reproductive health is fine.

Rotation Schedule 

Preparation for the rotation: Please download the following apps:

• CDC Contraception app: https://www.cdc.gov/reproductivehealth/contraception/mmwr/mec/summary.html

• ASCCP app (submit to Diana Suarez for reimbursement: 

This rotation has four different core topics to review during self study time. You should plan to complete one topic each week and be prepared to discuss during Early Options time. There are also optional topics listed below.  You can switch the order of the weeks, but please make sure to complete all of the topics.

Here is a reminder from last year about some of the logistics for the Early Options session. If you did not watch the video about Reproductive Justice, please do that before the first session: https://docs.google.com/document/d/1DQZmhzmXmN0PysoGA-LMRgjbiFHlESxVrbGfxvpJhto/edit?usp=sharing

Week One: Medication abortion or Pregnancy Options Counseling

• One hour online module to review medication abortion: https://abortionpillcme.teachtraining.org 

• Interactive medication abortion case (approximately one hour): https://rhedi.org/medication-abortion-interactive-case/

Alternative: If you do not want to be involved with providing medication abortion, focus on patient counseling:

• Pregnancy options counseling information and cases: https://docs.google.com/document/d/19ypTqq_II8LF55zcggYrMB8zN-EihZsXcIzL2cHAKqw/edit?usp=sharing

• RHAP info on language in the exam room: https://www.reproductiveaccess.org/2012/10/language-in-the-exam-room/

• RHEDI video on non-directive counseling (10 minute): https://www.innovating-education.org/2017/03/teach-non-directive-counseling/

• RHAP framework for options counseling: https://www.reproductiveaccess.org/wp-content/uploads/2014/12/counseling_amb_pat.pdf

Week Two: Abnormal Pap Management, HPV, and Colposcopy

• AFP Colposcopy: https://www.aafp.org/pubs/afp/issues/2020/0701/p39.html  and direct link 

• ASCCP Colposcopy Standards: https://drive.google.com/file/d/1pxPeIkGI4e9gmHSbhBacOu2BdUmGcIHa/view?usp=drive_link 

• Colposcopy: Slides on the procedure slides on the procedure

• Colposcopy: Slides on the abnormal transformation zone

• Video on how to use the ASCCP app (30 minutes): https://www.youtube.com/watch?v=AEEmCMZTb5E&feature=youtu.be&fbclid=IwAR36e9reqImV95iGA3eRYqVLabXdRUR8n4MYJMR-cTFHrvZnbZy5-kwBe0I

Week Three: Contraception

• 90 minute online module to review contraception: https://beyondthepill.ucsf.edu/self-paced-training

• AFP Evidence-based Contraception: https://www.aafp.org/pubs/afp/issues/2022/0900/contraception.html

• AFP Difficult LARC Insertions and Removals: https://www.aafp.org/pubs/afp/issues/2018/0901/p304.html

Week Four: General Gyn Topics

• AFP Chronic Pelvic Pain: https://www.aafp.org/pubs/afp/issues/2016/0301/p380.html

• AFP PCOS: https://www.aafp.org/pubs/afp/issues/2023/0300/polycystic-ovary-syndrome.html

• AFP Endometriosis: https://www.aafp.org/pubs/afp/issues/2022/1000/endometriosis.html

• AFP Abnormal Uterine Bleeding: https://www.aafp.org/pubs/afp/issues/2019/0401/p435.html

• AFP Managing Menopausal Symptoms: https://www.aafp.org/pubs/afp/issues/2023/0700/menopausal-symptoms.html

• AFP Endometrial Biopsy: https://www.aafp.org/pubs/afp/issues/2020/0501/p551.html

• ACOG Postmenopausal Bleeding and TVUS: https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2018/05/the-role-of-transvaginal-ultrasonography-in-evaluating-the-endometrium-of-women-with-postmenopausal-bleeding