妇产科学实习大纲 一、实习时间： 共6周，其中妇科3周，产科3周 二、实习目的 1.在妇产科理论课及见习的基础上，通过实习，综合训陈实习医生运用所学的妇产科专业知识 与临床实际相结合，分析问题和解决问题的能力，能正确诊断和防治妇产科常见病。 2.培养实习医生严格的无菌观念，掌握正规的操作方法，培养和提高技术操作能力。 3.指导实习医生自学，培养他们钻研问题的习惯，提高分析问题、解决疑难问题的能力 4.培养实习医生组织管理及人际交流的能力，以正确的态度接待病人。 三实习要求： (一妇科方面 1.掌握妇科病历书写；掌握妇科盆腔检查法 一窥器、双合诊及三合诊检查，能正确辩认外 阴、阴道和宫颈是否正常，子宫的大小、位置、软硬度、活动度及有无压痛，双侧附件有无包块及 软硬度、活动度、与子宫的关系、有无压痛，官旁组织有无增厚、形状、软硬度及有无压痛，有无 包块，应注意其与子宫或盆壁的关系。 2.阴道清洁度的镜下检查：念珠菌、霉菌，滴虫的镜下检查。 3.了解卵巢功能及防癌检查、X线、腔镜、超声波检查的诊断意义。 4.掌握一些妇科常见病的诊断、治疗原则及预防，如各种流产，葡萄胎、子宫内膜异位征、功 能性子宫出血、闭经、痛经、炎症（阴道、宫颈，子宫及盆腔，、子宫脱垂、尿接、粪瘘、性传播疾 病、更年期综合征，女性生殖器官损伤等 5.对妇科急症如官外孕、卵巢囊肿蒂扭转、急性盆腔炎等能初步诊断及鉴别诊断。 6.进一步对妇科常见肿瘤如子宫肌瘤、卵巢肿瘤，子宫颈癌、子宫内膜癌、侵蚀性葡萄胎、绒 癌等提出早期诊断及处理原则。 7.参加门诊小手术，在带教医师指导下，能进行诊断性刮宫，输卵管通液、取宫颈息肉，阴道 冲洗、后穹窿穿刺等。 8.明确言颈癌的普查工作在临床工作中的重要价值，能正确采取宫颈涂片标本 (二)产科方面 1.掌握产科病历的书写；在熟悉妊娠期母体变化的基础上，正确诊断妊娠，宣传优生优育。① 初步掌握早期妊娠的诊断方法；②掌握产前检查和妊娠保健（包括妊娠时限、胎产式及胎方位诊断、 孕期保健常规检查内容及意义)；③掌握产科四步触诊、胎心听诊及骨盆外测量。 2.在带教医师指导下，能诊断妊娠期合并症及异常妊娠，并能提出诊治原则，如妊娠高血压综 合征、臀位、双胎、过期妊娠、羊水过多、羊水过少、前置胎盘、胎盘早期剥离、妊娠合并心脏 病、妊娠合并肝炎等。 3.能正确处理正常分娩三产程，并能及时发现异常情况向带教医师汇报。在其指导下给予正确 处理。 4.能正确鉴别新生儿是否正常。能独立进行新生儿体检，在带教医师指导下学会新生儿的抢 教。 5.参加产科危重病人的抢救。 6.进一步了解常见难产的处理原则及常见产科手术指征， 7.掌握产后出血及产褥感染等的处理原则侧。 8.掌握孕、产妇用药的特殊性
妇产科学实习大纲 一、实习时间： 共6周，其中妇科3周，产科3周。 二、实习目的 1．在妇产科理论课及见习的基础上，通过实习，综合训练实习医生运用所学的妇产科专业知识 与临床实际相结合，分析问题和解决问题的能力，能正确诊断和防治妇产科常见病。 2．培养实习医生严格的无菌观念，掌握正规的操作方法，培养和提高技术操作能力。 3．指导实习医生自学，培养他们钻研问题的习惯，提高分析问题、解决疑难问题的能力。 4．培养实习医生组织管理及人际交流的能力，以正确的态度接待病人。 三、实习要求； (一)妇科方面 1．掌握妇科病历书写；掌握妇科盆腔检查法——窥器、双合诊及三合诊检查，能正确辩认外 阴、阴道和宫颈是否正常，子宫的大小、位置、软硬度、活动度及有无压痛，双侧附件有无包块及 软硬度、活动度、与子宫的关系、有无压痛，宫旁组织有无增厚、形状、软硬度及有无压痛，有无 包块，应注意其与子宫或盆壁的关系。 2．阴道清洁度的镜下检查：念珠菌、霉菌，滴虫的镜下检查。 3．了解卵巢功能及防癌检查、X线、腔镜、超声波检查的诊断意义。 4．掌握一些妇科常见病的诊断、治疗原则及预防，如各种流产，葡萄胎、子宫内膜异位征、功 能性子宫出血、闭经、痛经、炎症(阴道、宫颈，子宫及盆腔)、子宫脱垂、尿瘘、粪瘘、性传播疾 病、更年期综合征，女性生殖器官损伤等。 5．对妇科急症如宫外孕、卵巢囊肿蒂扭转、急性盆腔炎等能初步诊断及鉴别诊断。 6．进一步对妇科常见肿瘤如子宫肌瘤、卵巢肿瘤，子宫颈癌、子宫内膜癌、侵蚀性葡萄胎、绒 癌等提出早期诊断及处理原则。 7．参加门诊小手术，在带教医师指导下，能进行诊断性刮宫，输卵管通液、取宫颈息肉，阴道 冲洗、后穹窿穿刺等。 8．明确宫颈癌的普查工作在临床工作中的重要价值，能正确采取宫颈涂片标本。 (二)产科方面 1．掌握产科病历的书写；在熟悉妊娠期母体变化的基础上，正确诊断妊娠，宣传优生优育。① 初步掌握早期妊娠的诊断方法；②掌握产前检查和妊娠保健(包括妊娠时限、胎产式及胎方位诊断、 孕期保健常规检查内容及意义）；③掌握产科四步触诊、胎心听诊及骨盆外测量。 2．在带教医师指导下，能诊断妊娠期合并症及异常妊娠，并能提出诊治原则，如妊娠高血压综 合征、臀位、双胎、过期妊娠、羊水过多、羊水过少、前置胎盘、胎盘早期剥离、妊娠合并心脏 病、妊娠合并肝炎等。 3．能正确处理正常分娩三产程，并能及时发现异常情况向带教医师汇报。在其指导下给予正确 处理。 4．能正确鉴别新生儿是否正常。能独立进行新生儿体检，在带教医师指导下学会新生儿的抢 救。 5．参加产科危重病人的抢救。 6．进一步了解常见难产的处理原则及常见产科手术指征。 7．掌握产后出血及产褥感染等的处理原则。 8．掌握孕、产妇用药的特殊性
9.技术操作：①学会肛查，观察产程.了解产程中先露进展，官口开大情况，骨盆初步测量： ②在带教医师指导下作产科的阴道检查，了解宫口情况，先露下降、有无骨盆狭窄、头盆关系、胎 位、是否破膜，如有阴道出血应注意官颈口附近有无海棉样胎盘组织；③能独立接正常产。了解会 阴保护要领，并能缝合会阴一Ⅱ裂伤；④能作产钳、胎吸、臀位助产及剖腹产等手术的第二助手及 腹部手术伤口缝合。 四、实习方法 1,熟悉妇产科病房规章制度和工作方法. 2.在带教医师指导下分管4张床位，完成日常医疗工作，包括接诊新病人，书写完整病历(24小 时内完成及各种记录（如病程记录，出院记录、病例讨论记录等），在上级医师指导下完成必要的手 术和诊疗技术操作，参加病房值班和重危病人的抢救，学习观察和处理病人，并应向护士学习护理 技术操作.每位实习医生平均每周至少完成1份病历，并由带教医师审核后签字。 3.门诊实习：在带教医师指导下，参加门诊诊疗工作，书写门诊病历，熟悉门诊用药，学会重 点查体.对常见病多发病能提出诊新和处理意见.参加门诊小手术。 五、妇产科专业特色及实习注意事项 1.妇产科全部病员均为女性，要求实习医生要特别严肃认真，工作细致，言语行动诚恳 2.男实习医生作妇科检查时，必须有指导医师或护士协同，不得单独进行。 3.产科常在深夜进行工作，如接生、手术等。要求实习医生认真耐心观察产程。 六、考核与鉴定方法 出科考试由出科考核小组进行，包括理论和技术操作。 Outline for Gynecology and Obstetrics 1.Duration Six weeks in all,during which 3 weeks is for Gynecology,3 weeks for Obstetrics. 2.Purposes I.Based on theories learnt in Gynecology and former learning on the job,train interns the abilities to analyze and solve practical problems encountered in practice.Besides.they are to learn how to diagnose,prevent,and treat commonly encountered diseases in Gynecology and Obstetrics. ll.Train interns to develop strict concept of asepsis,master correct manipulation,improve their operational ability. Ill.Instruct interns to leamn by themselves,foster habits to conduct research,improve their abilities to analyze and solve difficulties. IV.Foster intems to develop skills of management and social communication,train them to treat patients with proper attitudes. 3.Requirements On Gynecology I.Master the ability to write correct case history:master correct methods of gynecologic pelvioscopy.which includes speculum,bimanual examination,vagino-recto-abdominal examination;be able to correctly identify whether vulva,vagina,and uterine are normal or not;able to identify the size.position.flexibility.and mobility of uterus.as well as the presence of
9．技术操作：①学会肛查，观察产程．了解产程中先露进展，宫口开大情况，骨盆初步测量； ②在带教医师指导下作产科的阴道检查，了解宫口情况，先露下降、有无骨盆狭窄、头盆关系、胎 位、是否破膜，如有阴道出血应注意宫颈口附近有无海棉样胎盘组织；③能独立接正常产。了解会 阴保护要领，并能缝合会阴I—Ⅱ裂伤；④能作产钳、胎吸、臀位助产及剖腹产等手术的第二助手及 腹部手术伤口缝合。 四、实习方法 1．熟悉妇产科病房规章制度和工作方法。 2．在带教医师指导下分管4张床位，完成日常医疗工作，包括接诊新病人，书写完整病历(24小 时内完成)及各种记录(如病程记录，出院记录、病例讨论记录等)，在上级医师指导下完成必要的手 术和诊疗技术操作，参加病房值班和重危病人的抢救，学习观察和处理病人，并应向护士学习护理 技术操作．每位实习医生平均每周至少完成1份病历，并由带教医师审核后签字。 3．门诊实习：在带教医师指导下，参加门诊诊疗工作，书写门诊病历，熟悉门诊用药，学会重 点查体．对常见病多发病能提出诊断和处理意见．参加门诊小手术。 五、妇产科专业特色及实习注意事项 1．妇产科全部病员均为女性，要求实习医生要特别严肃认真，工作细致，言语行动诚恳。 2．男实习医生作妇科检查时，必须有指导医师或护士协同，不得单独进行。 3．产科常在深夜进行工作，如接生、手术等。要求实习医生认真耐心观察产程。 六、考核与鉴定方法 出科考试由出科考核小组进行，包括理论和技术操作。 Outline for Gynecology and Obstetrics 1. Duration Six weeks in all, during which 3 weeks is for Gynecology, 3 weeks for Obstetrics. 2. Purposes I. Based on theories learnt in Gynecology and former learning on the job, train interns the abilities to analyze and solve practical problems encountered in practice. Besides, they are to learn how to diagnose, prevent, and treat commonly encountered diseases in Gynecology and Obstetrics. II. Train interns to develop strict concept of asepsis, master correct manipulation, improve their operational ability. III. Instruct interns to learn by themselves, foster habits to conduct research, improve their abilities to analyze and solve difficulties. IV. Foster interns to develop skills of management and social communication, train them to treat patients with proper attitudes. 3. Requirements On Gynecology I. Master the ability to write correct case history; master correct methods of gynecologic pelvioscopy, which includes speculum, bimanual examination, vagino-recto-abdominal examination; be able to correctly identify whether vulva, vagina, and uterine are normal or not; able to identify the size, position, flexibility, and mobility of uterus, as well as the presence of
tenderness:able to identify the flexibility.mobility of appendages.its relation with uterus.as well as the presence of lump or tenderness;be able to identify the thickness,form,flexibility of tissues adjacent to the uterus,their relation with uterus or pelvic wall,as well as the presence of tenderness and lumps. Il.Master microscopy of the cleanness of the vagina,including the microscopy of Monilia,fungus trichomonad. Ill.Know functions of ovary,diagnostic significance of cancer prevention examination,X-ray uteroscopy,and ultrasonography. IV.Master the diagnosis,principles of therapy,and prevention of certain gynecologic diseases including varous forms of miscarriage,hydatid mole.endometriosis.metropathia hemorrhagica. amenorrhea,dysmenorrhea,vaginitis,cervicitis,uteritis,pelvitis,hysteroptosis,urinary fistula,fecal fistula,venereal disease,menopausal syndrome,injury of female genital organs,etc. V.Be able to make initial diagnosis and differential diagnosis of some gynecologic emergencies such as ectopic pregnancy,torsion of ovarian cyst,acute pelvic inflammation,etc. VI.Be able to make early diagnosis and principles of therapy of commonly encountered tumors such as hysteromyoma,oophoritic,carcinoma of uterine cervix,carcinoma of endometrium, invasive mole,choriocarcinoma,etc VIl.Participate in minor operations in the out-patient.Under instruction of tutors,perform uterine curettage,tubal patent test by liquid instillation,removal of cervical polyp,vaginal douche culdocentesis,etc. VIll.Comprehend the clinical significance of mass survey of carcinoma of uterine cervix.Able to take correctly sample cervical smear. On Obstetrics 1.Master correct method of writing case history:be familiar with maternal changes in pregnancy. correctly diagnose pregnancy,advocate aristogenesis. (1)Master correct methods of early pregnancy diagnosis; (2)Master correct methods of prenatal examination and pregnancy care,including diagnosis of trimester of pregnancy,lie of fetus,and fetal position,as well as contents and significance of antenatal care; (3)Master correct methods of obstetric 4-step auscultation,fetal heart auscultation,and external pelvimetry. II.With instruction of tutors,interns should be able to diagnose complication of pregnancy and abnormal pregnancy,and suggest principles of therapy,such as,pregnancy hypertension syndrome,breech delivery,twin birth,prolonged pregnancy,polyhydramnios,hypamnion,placenta previa,premature separation of placenta,pregnancy associated with cardiac disease and hepatitis Ill.Be able to manage the three stages of normal 'labor,to find out abnormal situations timely and report to the tutors and manage them correctly under instruction of tutors. IV.Be able to identify whether the newbom is healthy or not,able to conduct physical examination of newborn independently,and able to rescue the newborn under instruction of tutors. V.Participate in the rescue of seriously ill patients VI.Further understand principle of management of commonly encountered difficult labor and common obstetric operation indications VIl.Master the principles of management of postpartum hemorrhage,puerperal infection,etc
tenderness; able to identify the flexibility, mobility of appendages, its relation with uterus, as well as the presence of lump or tenderness; be able to identify the thickness, form, flexibility of tissues adjacent to the uterus, their relation with uterus or pelvic wall, as well as the presence of tenderness and lumps. II. Master microscopy of the cleanness of the vagina, including the microscopy of Monilia, fungus, trichomonad. III. Know functions of ovary, diagnostic significance of cancer prevention examination, X-ray, uteroscopy, and ultrasonography. IV. Master the diagnosis, principles of therapy, and prevention of certain gynecologic diseases, including various forms of miscarriage, hydatid mole, endometriosis, metropathia hemorrhagica, amenorrhea, dysmenorrhea, vaginitis, cervicitis, uteritis, pelvitis, hysteroptosis, urinary fistula, fecal fistula, venereal disease, menopausal syndrome, injury of female genital organs, etc. V. Be able to make initial diagnosis and differential diagnosis of some gynecologic emergencies, such as ectopic pregnancy, torsion of ovarian cyst, acute pelvic inflammation, etc. VI. Be able to make early diagnosis and principles of therapy of commonly encountered tumors, such as hysteromyoma, oophoritic, carcinoma of uterine cervix, carcinoma of endometrium, invasive mole, choriocarcinoma, etc. VII. Participate in minor operations in the out-patient. Under instruction of tutors, perform uterine curettage, tubal patent test by liquid instillation, removal of cervical polyp, vaginal douche, culdocentesis, etc. VIII. Comprehend the clinical significance of mass survey of carcinoma of uterine cervix. Able to take correctly sample cervical smear. On Obstetrics I. Master correct method of writing case history; be familiar with maternal changes in pregnancy, correctly diagnose pregnancy, advocate aristogenesis. (1) Master correct methods of early pregnancy diagnosis; (2) Master correct methods of prenatal examination and pregnancy care, including diagnosis of trimester of pregnancy, lie of fetus, and fetal position, as well as contents and significance of antenatal care; (3) Master correct methods of obstetric 4-step auscultation, fetal heart auscultation, and external pelvimetry. II. With instruction of tutors, interns should be able to diagnose complication of pregnancy and abnormal pregnancy, and suggest principles of therapy, such as, pregnancy hypertension syndrome, breech delivery, twin birth, prolonged pregnancy, polyhydramnios, hypamnion, placenta previa, premature separation of placenta, pregnancy associated with cardiac disease and hepatitis. III. Be able to manage the three stages of normal 'labor, to find out abnormal situations timely and report to the tutors and manage them correctly under instruction of tutors. IV. Be able to identify whether the newborn is healthy or not, able to conduct physical examination of newborn independently, and able to rescue the newborn under instruction of tutors. V. Participate in the rescue of seriously ill patients. VI. Further understand principle of management of commonly encountered difficult labor and common obstetric operation indications. VII. Master the principles of management of postpartum hemorrhage, puerperal infection, etc
W.Master the special characteristics of drugs used for pregnant women and parturients IX.Technical operations: (1)Master rectal touch and observe stages of labor,understand the process of presentation,the opening of orifice,initial measurement of pelvis; (2)Under instruction of tutors,perform obstetric vaginal examination,know about orifice of uterus descent of presentation.presence of contracted pelvis.cephalopelvic position.lie of fetus. rupture of membranes;if there is colporrhagia,pay attention to the presence of spongioid placenta tissue beside the orifice of uterus; (3)Be able to perform normal labor midwifery:understand main principle of protection of perineum,and can suture perineal I-lI laceration; (4)Be able to act as the second assistant in operations such as obstetric forces,application of vacuum extractor,assisted breech delivery.hysterectomy,and perform suture of abdominal operations 4.Methods 1.Familiar with the techniques,rules and regulations of the wards. ll.Under instruction of tutors,interns are to take charge of 4 beds,completing daily work(receiving new patients,writing complete case history within 24 hours).various records(record of duration of illness,discharge record,casuistic record),finishing necessary diagnostic and therapeutic operation,participating in ward duty and rescuing seriously ill patients,studying observation and management of cases,and studying nursing techniques and operations from nurses.Each interne should at least finish one case history each week,which is to be signed after being checked by the tutor. Ill.Participate in the work of out-patient department under instruction of tutors.Write out-patient case history,learn how to conduct physical examination,be familiar with drugs used in the out- patient department,be able to suggest diagnosis and management of commonly and frequently encountered diseases,and participate in minor operations of out-patient department. 5.Characteristics of Gynecology and Obstetrics,precautions in practice 1.Patients are all females,therefore,interns should be especially serious,careful,and sincere with patients. ll.When gynecologic examination is conducted by male intems,tutors or nurses must be present. The male interns must not conduct the examination alone. Ill.Obstetric work is always conducted late at night;therefore,interns must observe birth process attentively and patiently. 6.Appraisal and approval The appraisal team of the department conducts phase examinations,which will include theories,operation of clinical techniques and skills
W. Master the special characteristics of drugs used for pregnant women and parturients. IX. Technical operations: (1) Master rectal touch and observe stages of labor, understand the process of presentation, the opening of orifice, initial measurement of pelvis; (2) Under instruction of tutors, perform obstetric vaginal examination, know about orifice of uterus, descent of presentation, presence of contracted pelvis, cephalopelvic position, lie of fetus, rupture of membranes; if there is colporrhagia, pay attention to the presence of spongioid placenta tissue beside the orifice of uterus; (3) Be able to perform normal labor midwifery; understand main principle of protection of perineum, and can suture perineal I-II laceration; (4) Be able to act as the second assistant in operations such as obstetric forces, application of vacuum extractor, assisted breech delivery, hysterectomy, and perform suture of abdominal operations. 4. Methods I. Familiar with the techniques, rules and regulations of the wards. II. Under instruction of tutors, interns are to take charge of 4 beds, completing daily work (receiving new patients, writing complete case history within 24 hours), various records (record of duration of illness, discharge record, casuistic record), finishing necessary diagnostic and therapeutic operation, participating in ward duty and rescuing seriously ill patients, studying observation and management of cases, and studying nursing techniques and operations from nurses. Each interne should at least finish one case history each week, which is to be signed after being checked by the tutor. III. Participate in the work of out-patient department under instruction of tutors. Write out-patient case history, learn how to conduct physical examination, be familiar with drugs used in the outpatient department, be able to suggest diagnosis and management of commonly and frequently encountered diseases, and participate in minor operations of out-patient department. 5.Characteristics of Gynecology and Obstetrics, precautions in practice I. Patients are all females, therefore, interns should be especially serious, careful, and sincere with patients. II. When gynecologic examination is conducted by male interns, tutors or nurses must be present. The male interns must not conduct the examination alone. III. Obstetric work is always conducted late at night; therefore, interns must observe birth process attentively and patiently. 6. Appraisal and approval The appraisal team of the department conducts phase examinations, which will include theories, operation of clinical techniques and skills