Intro to Reproduction: Clinical skills

• This presentation offers an introduction to reproductive health, delivered by Anita L. Nelson, MD, from Western University of Health Sciences on January 31, 2025.
• Anita L. Nelson is a Professor of Obstetrics & Gynecology at Western University of Health Sciences and Professor Emeritus at UCLA's David Geffen School of Medicine.

Conflict of Interest Disclosure

• Anita L. Nelson has grants/research support from Daré Bioscience, Viatris Pharmaceuticals Inc, Organon & Co, Sebela Pharmaceuticals, and Sumitomo Pharma America (previously Mayne Pharma).
• She receives honoraria/speaker bureau fees from Sumitomo Pharma America and Organon & Co.
• She is a consultant/advisor for Bayer, Exeltis USA, Inc, Natural Cycles, Sumitomo Pharma America, and Myovant.

Status of Women's Care in the US

• US women experience the highest rate of maternal mortality among 11 developed countries.
• African American women in the U.S. have maternal mortality rates three times higher than Caucasian women.
• Women in the U.S. report the least positive experiences with their healthcare system compared to other developed nations.
• US women face the greatest burden of chronic illness.
• They have the highest rates of skipping health care due to cost and difficulty affording it.
• Only approximately one-quarter of women aged 18-64 rate their quality of medical care as excellent or very good.

International Comparison of Maternal Mortality

• The US has a higher maternal mortality ratio compared to other wealthy nations.
• The US maternal mortality ratio is 14 maternal deaths per 100,000 live births among women ages 15-49.
• Canada reports 7, the UK reports 9, Sweden, Norway, and Switzerland report 5, Germany reports 6, France reports 8

Approaches to Meet Reproductive Health Needs

• Evidence-based practice of clinical medicine is essential.
• Individualized care should be provided in the context of osteopathic medicine.
• Other needs include population medicine and public health approaches to enhance health.
• Smoking cessation and preconception folate intake are important.

Issues in Reproductive Health

• Reproductive health, particularly OB-GYN, is a highly impactful specialty.
• It encompasses individual, familial, social, and environmental impacts across generations.
• Attitudes are shaped by cultural, religious, societal, property-related, and historical influences, often conflicting with scientific facts.
• Views of women as merely a "vessel" for the man's "seed" persist.
• Contraception was illegal in many states until the 1960s.
• Reproductive health presents some of the most complex ethical issues in medicine, like end-of-life decisions and defining independent life.
• Conflicts arise between autonomy and beneficence, especially in regards to a woman's wellbeing versus that of the fetus.
• Differing fertility desires of men and women and cultural definitions of sex, gender, and acceptable sexual behaviors contribute to these ethical challenges.
• There is widespread ignorance about the "facts of life."
• Erroneous beliefs contribute to the demand for frequent Pap smears and mammograms.
• Opposition to contraception arises from misinformation about when pregnancy is established.
• Lack of preconception care and prenatal vaccination uptake are also significant issues.

Course Overview

• The course provides some of the most meaningful learning experiences
• The course will enable students to provide scientifically correct information about reproduction.
• Students will learn to conduct informed discussions with patients to help them make informed decisions.
• The course prepares students for examinations at the end of the second year and for clinical rotations in the third year.
• Clinical rotations in the third year includes caring for women in OB-GYN and primary care settings.

Course Teaching Approaches

• Teaching methods include pre-recorded lectures, live Zoom lectures, live Zoom wrap-up sessions, live Zoom quiz reviews, and virtual breast pathology sessions.

General Organization of Course

• The course covers the embryology of the reproductive system and relevant anatomy.
• It addresses the male reproductive system, including anatomy, histology, physiology, and pathology.
• Clinical issues discussed are erectile dysfunction, prostatic hypertrophy, prostate carcinoma, male infertility, acute pain syndromes, infection, and sexual dysfunction.
• The female reproductive system is examined, focusing on anatomy, histology, physiology, and pathology.
• Microbiology related to sexually transmitted infections (STIs) is included.
• The course reviews clinical abnormalities of the menstrual cycle, including amenorrhea, infrequent bleeding, PCOS, heavy bleeding, and dysmenorrhea.
• Chronic pelvic pain and acute pelvic pain are addressed, along with GYN malignancies.
• GYN malignancies topics include screening, clinical presentation, differential diagnoses, staging, and treatments.
• The course also covers STDs, pelvic relaxation, female incontinence, sexual dysfunction, intimate partner violence, and the clinical implications of gender identities.
• The course includes pharmacology of estrogen/progestins and androgens/antiandrogens.
• Imaging modalities in Obstetrics and Gynecology will be reviewed.
• Genetics in carcinoma and fetal issues will be discussed
• STDs, pelvic relaxation, female incontinence, sexual dysfunction, intimate partner violence, and the clinical implications of gender identities are covered.
• It als covers obstetrics, including the physiology of fertilization and implantation.
• Physiology of maternal adaptation to pregnancy, delivery and postpartum along with fetal development are discussed
• Genetics, obstetrics clinical issues and first trimester bleeding are reviewed, too.
• There is also a section on pharmacology of medications in pregnancy
• The curriculum addresses complicated obstetrics and the impacts of maternal diseases and fetal abnormalities on pregnancy.
• It also covers other pregnancy-related complications and those related to delivery and postpartum.

Study Resources

• Suggested resources include lectures and accompanying notes
• Hatcher and Moore's "Essentials of Obstetrics and Gynecology" (6th ed.).
• ACOG Practice Bulletins and Committee Opinions are recommended.
• American Cancer Society Guidelines should be reviewed
• Accessing virtual learning for breast pathology is also recommended
• Online resources such as Perinatology.com and GLOWM are also good study resources
• Online resources/apps include CDC STD Treatment Guidelines (2021), CDC US Medical Eligibility Criteria for Contraception (2024), CDC Selected Practice Guidelines for Contraception (2024) and National Cancer Institute websites-breast cancer risk estimator are good sources
• Lectures from previous courses, including those on medical genetics and microbiology, are relevant.
• Surgical topics and the basics of respiratory, cardiac, hematologic, and GI functioning are important for understanding changes during pregnancy.

Review Opportunities

• Review sessions are held each week, linking basic science insights to clinical cases.
• Office hour sessions are available, some in-person.
• Additional review sessions will be held the last week.
• There will be opportunities to review practice questions for each topic in clinical repro.

Other Resources

• Stanford Medicine 25 with Dr. Paula Hillard offers resources.
• "Essentials of Clinical Breast Exam," from the Department of Health Services (Ahmad Abushandab 8/13/2017) is good reference.

Essential Elements to Cover Studying Clinical Topics

• Definition of the condition
• Prevalence/incidence
• Subgroup differences and risk factors
• Recommended screening programs
• Clinical presentations (symptoms and physical findings)
• Significant laboratory or imaging findings
• To cover differential diagnoses
• The natural history of a condition with or without treatment
• Treatment options and patient education/counseling messages
• How test questions will be asked so studying is focused and efficient

This course equips students with both scientific knowledge and practical skills for future patient interactions and clinical rotations. It focuses on developing diagnostic and treatment abilities. The course uses live sessions to enhance learning.