BGDA StudentGuide 2015 Final-2

MFAC1521 - Beginnings, Growth
and Development A
Student Guide 2015
Session 1: TP 2, 2015
Contents
WELCOME ............................................................................................................................................ 4
A note on feedback................................................................................................................................4
Material required for SG sessions .........................................................................................................4
Staff Involved in the Course...................................................................................................................5
GENERAL INFORMATION ...................................................................................................................... 6
Course themes .......................................................................................................................................6
Aims of the course .................................................................................................................................6
Timetable ...............................................................................................................................................6
Resources ..............................................................................................................................................6
Evaluation ..............................................................................................................................................6
Scenario group session preparation ......................................................................................................7
Clinical sessions .....................................................................................................................................7
Course overview ....................................................................................................................................7
SCENARIO 1: TEENAGE PREGNANCY ..................................................................................................... 8
Schedule ................................................................................................................................................8
Overview ................................................................................................................................................9
SGS 1: Considering the Teenage Pregnancy scenario and the science of pregnancy ........................10
SGS 2: Social and cultural issues affecting Deborah and Jessica .........................................................20
SGS 3: Anatomy and physiology of reproduction ................................................................................24
SGS 4: The menstrual cycle and fertility awareness ............................................................................35
SGS 5: Common complaints in pregnancy: A word from the experts ...............................................47
SGS 6: Vaginal Delivery versus Caesarean Section ..............................................................................55
SCENARIO 2: TWO NEW MOTHERS ..................................................................................................... 62
Schedule ..............................................................................................................................................62
Overview ..............................................................................................................................................63
SGS 7: Consider the Two New Mothers scenario; Overview of Diabetes Mellitus and Gestational
Diabetes ..............................................................................................................................................64
SGS 8: Newborn screening ..................................................................................................................68
SGS 9: Cervical neoplasia-clinical application ......................................................................................74
SGS 10: Two Peas in a Pod? ................................................................................................................78
SCENARIO 3: INFERTILITY ................................................................................................................... 79
Schedule ..............................................................................................................................................79
Overview ..............................................................................................................................................80
SGS 11: Considering the Infertility scenario; Project Presentations ..................................................81
SGS 12: Autonomic pharmacology ......................................................................................................82
SGS 13: Pelvic inflammatory disease and its complications ................................................................87
Beginnings Growth and Development A

Student Guide Session 1: TP2, 2015
Page 2
ASSESSMENT ...................................................................................................................................... 89
Assessment overview .......................................................................................................................... 89
Attendance .......................................................................................................................................... 89
Academic honesty and plagiarism ....................................................................................................... 90
Assignments and projects offered in BGD A 2015 .............................................................................. 90
Compulsory registration of assignment and project choice ............................................................... 91
Due dates for submission of project reports and assignments ........................................................... 91
Assignment 1: Growing a heart ........................................................................................................... 92
Assignment 2: Male Contraception ..................................................................................................... 94
Assignment 3: Should Australian babies have the Guthrie Heel Prick Test to screen for Congenital
Primary Hypothyroidism? ................................................................................................................... 96
Assignment 4: Changes to cervical screening in Australia - HPV DNA testing versus Pap test ........... 99
Project 1: Ethics of in vitro fertilisation (IVF) ..................................................................................... 102
Project 2: Understanding the Teenage Pregnancy Scenario ............................................................. 105
Project 3: Female Infertility ............................................................................................................... 108
Project 4: PID - The Play .................................................................................................................... 110

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Welcome
Welcome to Beginnings, Growth and Development A!
The Beginnings, Growth and Development courses in Phase One have been designed to help you gain an
understanding of the particular health issues that arise during conception, pregnancy and childhood.
In BGD A there are three scenarios, focusing mainly on the course themes of conception, pregnancy and birth,
with a minor emphasis on some issues related to the course themes of childhood growth and development,
sexuality and nutrition.
The first scenario considers the issues facing two pregnant teenage girls. The focus here is on normal pregnancy
and on the medical, social and cultural issues facing these girls. The second scenario involves two new mothers
and traces their experiences, with a focus on screening issues. The third scenario involves a couple who are
having difficulty conceiving a baby.
This course will be your first opportunity to put into practice the learning skills you were introduced to in
Foundations, and to begin to build on the basic knowledge gained in all disciplines there. We have a range of
activities planned for scenario group sessions to complement and add to the lecture and practical class
schedule and other components of the program.
This is the fifth time that BGD A has run exclusively for Year 1 students. If you are finding the material
challenging or the course structure bewildering, remember to seek help early. The convenors and your
facilitators, lecturers and second year colleagues, and importantly your fellow Year 1 students, are all
important sources of information and advice.
Most importantly, we hope that you enjoy the course!
A note on feedback
We regularly seek feedback and have taken note of feedback from the BGD A course in previous years in
making changes to the course. These include:
Improvements to team and individual quiz session in week 6 to provide progressive assessment and
immediate feedback to students.
Clinical application scenario group sessions (9 and 13) which give you the opportunity to apply the
knowledge you have gained in lectures and practicals to a clinical problem.
Maintaining the new lectures on cardiac embryology, anatomy of the pelvis and issues surrounding
teenage pregnancy which were added in 2011.
Separation of histology of the male and female reproductive tract into two lectures.
Major improvements to SGS 2.
Please note that we try as much as possible to:
o timetable course activities in a coherent, logical sequence. If a lecture, tutorial etc is presented out of
sequence it is because lecture staff or the required teaching spaces were unavailable at the desired
time.
o provide time off for a lunch break. Unfortunately sometimes the limited time availability of teaching
spaces prevents this for some groups.
o link learning activities closely with the scenarios.
o provide you with feedback on your progress. We have asked facilitators to give you feedback on your
progress within their scenario groups. Remember also that your peers are an excellent source of
feedback on your progress.
Material required for SG sessions

Many scenario group sessions rely on worksheets or information contained in this guide. It is your
responsibility to bring a printed or electronic copy of the relevant section of the guide to your scenario group
sessions. You should also ensure that you have completed any pre-reading or other preparation that has been
set prior to attending the session.

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Staff Involved in the Course

The members of the Design and Implementation Group hope that you find this course stimulating and
interesting and wish you well in your studies in BGD A and beyond.
Course convenor
Co-Convenor
Dr Karen Gibson
Department of Physiology
School of Medical Sciences
Phone: 9385 3650
Email: k.gibson@unsw.edu.au
Dr Nicole Marden
Department of Physiology
School of Medical Sciences
Phone: 02 9385 3601
Email: n.marden@unsw.edu.au
Beginnings, Growth and Development Design Group
Karen Gibson
Christine van Vliet
Lulu Liu
Nalini Pather
Kerrie Arnhold
Rachel Thompson
Rose Leotrini
Paul Waters
With special thanks to

Gary Velan (online assessment)
Suzanne Mobbs
Elena Mankovskaia (timetabling)
Chinthaka Balasooriya
Melissa Haswell-Elkins
The many other individuals, including teachers, health professionals, patients and administrative staff who
have contributed to course development.
Other contacts
Ethics and legal aspects
Dr Adi Torda
E: a.torda@unsw.edu.au
Campus and Hospital Clinical skills
Dr Silas Taylor
E: silas.taylor@unsw.edu.au
Quality of Medical Practice
Dr Rachel Thompson
E: rachelt@unsw.edu.au
T: 02 9385 8038
Student support
UNSW Counselling Service: https://www.counselling.unsw.edu.au/
Medicine Education & Student Office, Ground Floor, Wallace Wurth Building, Kensington
Elena Mankovskaia
HelpLine
x51008
x58795
Administration Manager
Moodle; eMed Map

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General information
Course themes
The four themes for the Beginnings, Growth and Development domain are:
Conception, pregnancy and birth

Childhood growth and development
Puberty, adolescence, sexuality and relationships
Nutrition, growth and body image
BGD A emphasises the first of these themes but includes material relevant to all four. The last three themes
are the focus of BGD B.
Aims of the course

The three scenarios focus on a range of issues surrounding conception, pregnancy, birth and the care of
neonates. They aim to stimulate student interest in:
The medical sciences that inform medical practice in the area of obstetrics and gynaecology, especially in
relation to conception, pregnancy, and birth
Embryology and fetal development.
Biochemistry, molecular biology and genetics
Reproductive physiology and anatomy
Microbiology of infection
Pathology of inflammation and cervical cancer
Pharmacology of the autonomic nervous system and reproduction
Impact of history, culture and socioeconomic status on reproductive health, especially on Indigenous
reproductive health, and on access to health care.
Maternal responsibility, including contraception and pregnancy planning, nutrition and drug taking.
Screening, both antenatal and newborn, including the physiological, genetic and clinical issues.
The notion of rights and duties, especially in relation to reproduction.
Communication issues, including dealing with ambiguous test results, giving advice and gaining consent.
The psychological impact of pregnancy and infertility on women and on couples.
Timetable
Consult the eMed Timetable for the details of session dates, times and locations.
Resources
Resources relevant to the course can be accessed on the eMed Map and on the Beginnings, Growth and
Development A UNSW Moodle site.
Evaluation
Periodically student evaluative feedback on both courses and teaching is gathered. The UNSW Course and
Teaching Evaluation and Improvement (CATEI) processes are used along with student focus groups, student
forums, and at times additional evaluation and improvement instruments developed in consultation with the
Faculty of Medicine's Program Evaluation and Improvement Group. Student feedback is taken seriously, and as
discussed above continual improvements are made to the course based in part on such feedback.
Significant changes to the course will be communicated to subsequent cohorts of students taking the course
through inclusion of information in student course guides, and in presentations by course convenors.
Evaluation activities across the Faculty are strongly linked to improvements and ensuring support for learning
and teaching activities for both students and staff.

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Scenario group session preparation

Please note the following scenario group sessions have essential readings or other tasks to be completed
before the session. These sessions will not make much sense to students and they wont be able to fully
participate unless they have done this reading. Pre-reading is detailed in Moodle.
Week
1
Session
Activity
SGS 1
SGS 2
Pre-reading
SGS 3
Bring anatomy and physiology

notes
SGS 4
3
SGS 5
Group presentations, student

lead activity
SGS 6
Pre-reading
SGS 7
Pre-reading +/or team

presentations
SGS 8
Pre-reading
SGS 9
Pre-reading and video. Bring

cervix lecture notes
SGS 10
Pre-reading
Public holiday
SGS 11
SGS12
7
SGS13
Project presentations
Do hexamethonium man.
Bring pharmacology notes
P4 presentations. View video.
Bring microbiology lecture
notes
Clinical sessions
Students should consult eMed Timetable for details of their clinical sessions.
Course overview
Further details on each activity, including detailed capability references, suggested readings and websites, and
information on relevant disciplines, are contained in the eMed Map at http://emed.med.unsw.edu.au

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Scenario 1: Teenage pregnancy

Schedule
Please refer to the eMed Timetable for dates, times and locations of learning activities
Learning Activity
Principal Teacher
Scenario Plenary 1: Teenage Pregnancy
Gibson, Karen &

Marden, Nicole
Lecture 1: Pregnant at 15
Vollmer-Conna, Ute
Campus Clinical Skills Session 1: Basic information and skills
Taylor, Silas
Tutorial 1: Contraception
Vollmer-Conna, Ute
Scenario Group Session 1: Considering the 'Teenage Pregnancy' scenario and

the science of pregnancy
Gibson, Karen
Lecture 2: Anatomical framework of the pelvis Lecture
Hardman, Craig
Lecture 3: Female Reproductive Tract Histology
De Permentier, Patrick
Lecture 4: Aboriginal/rural reproductive health issues
Haswell-Elkins, Melissa
Lecture 5: Physiology of male reproduction
Lewis, Trevor
Scenario Group Session 2: Social and cultural issues affecting Deborah and
Jessica
Gibson, Karen
Science Practical 1: Histology of the female reproductive tract
Lecture 6: Physiology of female reproduction
Lewis, Trevor
Lecture 7: Development of the embryo/fetus 1
Hill, Mark
Science Practical 2: Anatomical framework of the pelvis prac
Hardman, Craig
Lecture 8: Maternal Physiology
Gibson, Karen
Lecture 9: Gene Function 1: Replication & Transcription
Lutze-Mann, Louise
Science Practical 3: Embryology fertilization
Hill, Mark
Scenario Group Session 3: Anatomy and physiology of reproduction
Gibson, Karen
Hospital Clinical Skills Session 1: Presenting symptoms and skin lesions
Taylor, Silas
Lecture 10: Fertilisation and implantation
Costello, Michael
Lecture 11: Gene Function 2: Translation
Lutze-Mann, Louise
Lecture 12: Female reproductive tract anatomy
Hardman, Craig
Lecture 13: PCR and individual variation
Lutze-Mann, Louise
Science Practical 4: Female reproductive system anatomy
Hardman, Craig
Scenario Group Session 4: The menstrual cycle and fertility awareness
Gibson, Karen
Lecture 14: Development of the embryo/fetus 2
Hill, Mark
Lecture 15: DNA damage, repair and mutation
Lutze-Mann, Louise
Science Practical 5: Polymerase Chain Reaction (PCR)
Lutze-Mann, Louise
Lecture 16: Development of the nervous system
Tancred, Elizabeth
Lecture 17: Ethics: Ethical issues in human reproduction
Torda, Adrienne
Tutorial 2: Ethics 1: Reproductive technologies, designer babies and human

rights
Torda, Adrienne

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Learning Activity
Principal Teacher
Campus Clinical Skills Session 2: Considerations for you as a doctor
Taylor, Silas
Science Practical 6: Embryology: implantation to 8 weeks
Hill, Mark
Scenario Group Session 5: Common complaints in pregnancy: 'A word from

experts'
Gibson, Karen
Lecture 18: Male Reproductive Tract Anatomy
Hardman, Craig
Lecture 19: Cardiac Embryology
Pather, Nalini
Lecture 20: QMP: Critical Appraisal and Bias 1
Thompson, Rachel
Lecture 21: Male Reproductive Tract Histology
de Permentier, Patrick
Scenario Group Session 6: Vaginal Delivery versus Caesarian Section
Gibson, Karen
Lecture 22: Pathology of the female reproductive tract
Van Vliet, Christine
Lecture 23: QMP: Critical Appraisal and Bias 2
Thompson, Rachel
Science Practical 7: Male reproductive system anatomy
Hardman, Craig
Science Practical 8: Female reproductive hormones and their effects
Ulman, Lesley
Online Activity 1: QMP Online Tutorial 4: Critical appraisal
Thompson, Rachel
Online Activity 2: QMP Online Tutorial 5: Bias - the biggest enemy
Thompson, Rachel
Note: This schedule is subject to change. It only shows the first instance of any one activity. Refer to the eMed
Timetable system and email updates sent to your UNSW email account for accurate times and locations.
Overview
This scenario addresses the question: What inhibits, and what enhances, healthy outcomes in pregnancy?
It will examine the basic science surrounding a healthy pregnancy such as:
Anatomy and physiology of reproduction and development, including conception and implantation
Embryology
Cellular mechanisms in reproduction and development, including genetics and biochemistry
It will also explore a range of issues including:
Impact of the social determinants of health particularly history, culture, geography, socio-economic
status and politics on indigenous and rural reproductive health
Maternal responsibility, including nutrition and drug taking
Access to health care, including options for care, choices in reproduction (termination, adoption etc.)
and equity issues
Contraception and pregnancy planning
Description
The scenario is about two pregnant 15 year old girls. Deborah is an Aboriginal girl living in western Sydney as
part of an urban Aboriginal community. She is 22 weeks pregnant and attends an Aboriginal Medical Centre.
Doctors are worried because her fetus may be small for her apparent dates. Jessica is an Anglo-Celtic girl living
in a small country town and is in year 9 at the local high school. She is worried that she is pregnant because her
period is two weeks overdue.

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SGS 1: Considering the Teenage Pregnancy scenario and the science of

pregnancy
Aims
This session aims to help students to contextualise some of the learning that will occur during this course by
reflecting on the issues raised by the stories of Deborah and Jessica in the Teenage pregnancy scenario. In
order to achieve these aims, the students should:
Consider the course themes and objectives

Think about and explore the issues raised in the scenario plenary
List learning goals that they want to pursue individually or as a group
During this session students will also consider the assignment and project options.
Time will also be allocated for introductions.
This scenario group session will lay the foundation for students to identify and explore the basic science
associated with changes during pregnancy, including the anatomy, histology and physiology of the reproductive
system and the development of the embryo and fetus.
Key concepts:
Social and cultural determinants of health in pregnancy (including access to health care and family and
community support). What social and cultural factors support or detract from a good pregnancy outcome?
Medical sciences related to conception and pregnancy. What are the biological changes that occur in
pregnancy? What inhibits a good pregnancy outcome?
Anatomy and physiology of reproduction and development, including conception and implantation
Embryology
Cellular mechanisms in reproduction and development, including genetics and biochemistry
Process:
Activities
1. Introducing yourself and setting ground rules
2. Explore the scenario plenary and video and identify key issues
3. Review the project and assignment options
4. Program 2 from the Human Body series: An Everyday Miracle
5. Preparation for SGS 2
1. Introducing yourself and setting ground rules

2. Explore the scenario plenary videos and identify key issues
Age of consent for sexual interactions. Updated information about Age of Consent laws in Australia can be
found at https://www3.aifs.gov.au/cfca/publications/age-consent-laws
Age of consent for medical treatment, A copy of the policy directive from NSW Health can be found at
http://www.health.nsw.gov.au/policies/PD/2005/PD2005_406.html
3. Review the project and assignment options
th
Registration for Project 4: PID the play (quota of 8) must be made by 4pm Friday 8 May 2015 (week 1). No
more than 1 group per SG group may do this project.
th
Registrations for all assignments and projects except project 4 must be made by 4 pm, Friday 15 May, 2015
(week 2).

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4. Program 2 from the Human Body series: An Everyday Miracle

5. Preparation for SGS 2: Research task
In SGS 2 we will consider some of the social and cultural issues raised by the cases of Deborah and Jessica.
All students should undertake the pre-reading on Moodle.
Pre-reading for SGS 2
Cass, A., Lowell, A., Christie, M., Snelling, P.L. et al. (2002) Sharing the true stories: improving
communication between Aboriginal patients and healthcare workers. Medical Journal of Australia.
176(10), 466-470.
https://www.mja.com.au/journal/2002/176/10/sharing-true-stories-improving-communication-betweenaboriginal-patients-and?0=ip_login_no_cache%3Df6804f1f6fa98a417485fab807bad057
Quine, S., Bernard, D., Booth, M., Kang, M., Usherwood, T., Alperstein, G. & Bennett, D. (2003) Health and
access issues among Australian adolescents: a rural-urban comparison. Rural and Remote Health Journal.
http://www.rrh.org.au/articles/subviewnew.asp?ArticleID=245
Notes below by Dennis McDermott, Professor Lisa Jackson Pulver and A/Prof Melissa Haswell-Elkins
Background information on Aboriginal & Torres Strait Islander Health.
The following notes have been generously provided by Dennis McDermott who assisted with the
development of the Indigenous health and rural health component in this course when it first ran in 2004.
Professor Lisa Jackson Pulver updated the notes in 2010. Further updates were done by A/Prof Melissa
Haswell-Elkins in 2015.
Aboriginal and Torres Strait Islander health in general
The lecture provided you with a snapshot of Aboriginal and Torres Strait Islander health and some revealing
international comparisons. It then went beyond the what of bare statistics, however, to build your
understanding of the how and why of poor Indigenous health status. Now, most challengingly, we will
attempt to draw out the skills and strategies that might help improve Indigenous health. Enhancing your
capacity to deliver health interventions that are culturally and contextually appropriate has relevance for your
effective work with, not only, Aboriginal and Torres Strait Islander Australians, but also with a range of
marginalised populations, even beyond Australia. You may even find a holistic approach beneficial with
everyone you work with.
Through specifically addressing the health status of Aboriginal and Torres Strait Islander Australians, you will
build your knowledge concerning definitions of health, the effectiveness of the Australian health care system
and the ways in which the social determinants of health operate. You will also increase your awareness of how
you can work to reduce health inequalities and enhance both health and broader wellbeing.
The Social determinants of health
The determinants of health are all the factors that influence health status. They include income and social
status, social support networks, education, employment and working conditions, physical and social
environments, access to nature and outdoor recreational activities, biology and genetic endowment, personal
health practices and coping skills, child development, health services, gender and culture. These factors are
inter-related.
Persistent differentials in health and socio-economic status are deeply embedded in the social and political
context that characterised early stages of colonisation when structural determinants of health and wellbeing
were changed. These persist today in many forms.
Government was established by arbitrary decree in Australia cementing in place new structural social
determinants, diminishing the influence traditional strategies had on intermediate determinants brought about
by land alienation and new, exclusive forms of education traditional knowledge was no longer sufficient to
meet the challenges to health in a cash economy.
There is evidence that over the past thirty years progress has been made to improve the social determinants of
health, however, on many indicators, our health now remains unacceptably lower and at levels experienced
Page 11
nearly a century ago by our non-Indigenous peers. The influence that structural determinants have on
inequities cannot be addressed without fundamental changes to the consequences of a history of colonisation.
Restoring access to the cultural and social facilities that maintain social capital will do much to maintain
resilience that is a defining character of all Aboriginal and Torres Strait Islander peoples. Provision of resources
sufficient to complete this transition in our own terms will encourage autonomy and therefore the opportunity
own and solve emerging problems along the way. This cannot be undertaken without the help and support of
the rest of society and without the shared wisdom that arises from a problem shared and understood.
The Socioeconomic Environment
Income, Income Distribution and Social Status: Research indicates that income and social status is the single
most important determinant of health. Studies show that health status improves at each step up the income
and social hierarchy. In addition, societies which are reasonably prosperous and have an equitable distribution
of wealth have the healthiest populations, regardless of the amount they spend on health care.
Social Support Networks: Better health is associated with support from families, friends and communities.
Some studies conclude that the health effect of social relationships may be as important as established risk
factors such as smoking, obesity, high blood pressure and a sedentary lifestyle.
Additional cultural determinants: Extended families and communities play a central role in Aboriginal and
Torres Strait Islander peoples lives and connection many families continue to seek healing from the impact of
the Stolen Generations and other government policies that broke these connections.
Education: Health status improves with level of education and literacy, including self-ratings of positive health
or indicators of poor health such as activity limitation or lost work days. Education increases opportunities for
income and job security, and provides people with a sense of control over life circumstances key factors that
influence health. There are many models of culturally competent educational practice that have been shown to
enhance educations outcome. These require commitment and continuity of support by education systems and
staff.
Employment and Working Conditions: People who have more control over their work circumstances and fewer
stress-related demands on the job are healthier. Workplace hazards and injuries are significant causes of health
problems. Moreover, unemployment is associated with poorer health.
Social Environments: Societal values and rules affect the health and well-being of individuals and populations.
Social stability, recognition of diversity, safety, good human relationships and community cohesiveness provide
a supportive social environment which mitigates risks to optimal health.
Physical Environment
Physical factors in the natural environment such as air, water and soil quality are key influences on health.
Factors in the human-built environment such as housing, workplace safety, community and road design are
also important factors.
Additional cultural determinants: Access to and caring for Land and traditional country play an enormous role
in enabling and maintaining physical, spiritual, social and emotional wellbeing and cultural identity of many
Aboriginal and Torres Strait Islander Australians.
Healthy Child Development
The effect of prenatal and early childhood experiences on health in later life, well-being, coping skills and
competence is very powerful. For example, a low birth weight links with health and social problems throughout
the lifespan. In addition, mothers at each step up the income scale have children with higher birth weights, on
average, than those on the step below.
Additional cultural determinants: Family and social support and cultural connections and mentoring contribute
to healthy pregnancies and confidence and skills in parenting young children.
Personal Health Practices
Personal practices such as smoking, use of alcohol and other drugs, healthy eating, physical activity, and other
behaviours often reflect unmet needs for support and healing, and in turn affect family and child health and
wellbeing.
Individual Capacity and Coping Skills
Social environments that enable and support social and emotional wellbeing that motivates healthy choices
and lifestyles, as well as peoples knowledge, intentions, behaviours and coping skills for dealing with life in
healthy ways, are key influences on health.
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Biology and Genetic Endowment

The basic biology and organic make-up of the human body are fundamental determinants of health. Inherited
predispositions influence the ways individuals are affected by particular diseases or health challenges.
Health Services
Health services, especially those designed to maintain and promote health, prevent disease and injury, and
restore health, contribute to population health.
Cultural determinants: Consider the differences in definition and approach of health for Aboriginal and Torres
Strait Islander Australians from the one that health services operationalize and the need for cultural safety and
competence in service delivery.
Aboriginal perinatal health
The text below, taken from a 4 page flyer on Aboriginal Perinatal Health from the NSW Health website is a good
starting point for the issues raised for Deborah in this scenario.
http://www.kidsfamilies.health.nsw.gov.au/media/200323/abl_perinatalflyer.pdf
The full report on Aboriginal perinatal health is also available for down load at:
http://www.kidsfamilies.health.nsw.gov.au/media/199837/abl_peri.pdf
The four major points the flyer emphasizes are:
1.Under-utilisation of health services
2.Young adolescent birth rate
3.Lack of empowerment (lack of control over life events)
4.Social, economic and political factors affecting woman (and families).
These points provide a succinct framework for addressing the students questions. The challenge is to evoke
students' understanding of how these factors (the interaction of history, geography, socio-economic status,
politics, etc., that are referred to in the Deborah and Jessica lecture scenarios) actually come about which
includes dealing with student lack of information and persistent stereotypes how they play out in everyday
Aboriginal lives (including negative or ineffective interactions with health services) and how they might be
remedied.
The NSW Aboriginal Perinatal Health Report (2003) was commissioned to identify the risk factors associated
with Aboriginal perinatal mortality and provide a strategic framework to improve Aboriginal maternal and
infant health in NSW. Findings of the NSW Aboriginal Perinatal Health Report:
The health problem
Perinatal mortality (20 weeks gestation to 28 days after birth) is a key indicator of a populations health status
and is affected by the standard of living and the level of health care provided.
In 2000 there were 2,122 births to Aboriginal women in NSW (2.4% of all births) and 38 perinatal deaths, giving
an Aboriginal perinatal mortality rate of 17.9 per 1,000.This is almost twice the NSW non-Aboriginal rate of
9.7.In the same year the percentage of low birth weight Aboriginal babies was 11.9%.This was almost twice the
non-Aboriginal rate of 6.4%.
Low birth weight (less than 2,500gm) due to preterm birth or intra-uterine growth retardation is a key risk
factor for perinatal mortality and morbidity. The risk factors associated with low birth weight are complex and
exacerbated by the poor health status of many Aboriginal women.

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The NSW Aboriginal Perinatal Health Report identified four risk factors associated with poor birthweight:
1. Under-utilisation of antenatal services
Regular antenatal care which begins early in pregnancy is vitally important in monitoring pregnancy. Due to
problems with access and cultural appropriateness of many services, in 2000, 22.4% of Aboriginal women
presented after 20 weeks gestation for their first antenatal visit. This compares with 13% of non-Aboriginal
women. Often these women are the most vulnerable and in need, for example, young adolescent mothers, IV
drug users and victims of family violence.
2. Young adolescent birth rate
In 2000, 21.8% of Aboriginal births were to adolescent mothers (12-19 years).This was almost four times the
non-Aboriginal rate of 4.5%. Adolescent mothers have an increased risk of premature births and low birth
weight babies and infants who die during the first year of life. Studies indicate that the risks of preterm birth
and neonatal mortality are higher among younger adolescents (13-15) than those aged 16-17.
3. Lack of empowerment
(lack of control over life events) Aboriginal people define health as not just the physical well-being but the
social, emotional and cultural well-being of the whole community (National Aboriginal Health Strategy, 1989).
Aboriginal women identify low-self esteem and stress as two issues of most concern. The disempowerment
experienced by many Aboriginal women (and their families) stems from a combination of historical and social
factors.
Because of the disharmony evident in many communities, Aboriginal women can be victims of abuse and
violence. Low self-esteem is associated with the high rate of Aboriginal young teenage pregnancy and
behavioural risk factors, such as smoking and drug and alcohol use during pregnancy.
Smoking is the number one preventable risk factor for low birth weight babies and in 2000, 55.9% of Aboriginal
women in NSW smoked during pregnancy. This was over three times the non-Aboriginal rate of l7.4% (NSW
Department of Health, 2001).
4. Social, economic and political factors affecting Aboriginal women (and families)
Poverty and low educational levels are the most powerful predictors of poor health status and Aboriginal
Australians continue to suffer extreme disadvantage in these areas.
The poor reproductive health of many Aboriginal women and the high number of at-risk pregnancies can be
associated with the poverty, alienation and social disruption evident in many Aboriginal communities.
How to improve Aboriginal maternal and infant health
Due to the complex mix of social, behavioural and medical risk factors contributing to perinatal mortality, long
term strategies are needed to improve the delivery of appropriate maternal health services and improve the
health and wellbeing of Aboriginal women. What is needed:
1. A collaborative, multi-faceted approach between NSW Health, Aboriginal Community Controlled Health
Services and allied agencies to improve health service delivery.
2. A primary health care approach which provides community based services but importantly, looks beyond the
health sector and the medical causes of illness to:
improve the educational status of Aboriginal people
increase employment levels in Aboriginal communities.
NSW Aboriginal Maternal and Infant Health Strategy
To improve the health of Aboriginal mothers and babies, NSW Health provided recurrent funds of $1.5 million
in December 2000 to implement the NSW Aboriginal Maternal and Infant Health Strategy.
The Strategy uses a primary health care approach where Aboriginal women are cared for in community settings
by teams of midwives, Aboriginal health workers/health education officers and medical practitioners.
NSW Health also provided funds of $300,000 in 2002 to four metropolitan Area Health Services for Aboriginal
maternal and infant health initiatives.
Page 14
Policy Context
The Aboriginal Maternal and Infant Health Strategy encompasses the:
NSW Framework for Maternity Services (2000)
NSW Aboriginal Health Strategic Plan(1999)
Evaluation of the Alternative Birthing Services Program for Aboriginal Women(1998)
The aims of the Strategy align with the Families First early intervention and prevention strategies which assist
families requiring additional support.
The components of the Aboriginal Maternal and Infant Health Strategy are threefold:
1. Primary Health Care programs
2. a Training and Support Program
3. an evaluation strategy
1. Primary Health Care (PHC) programs Six rural and remote Area Health Services receive recurrent funds to
provide targeted PHC programs for Aboriginal women and their babies. The programs are located in Moree,
Broken Hill, Dubbo, Orange, Taree, Coffs Harbour and Newcastle.
The program components are:
a midwife
an Aboriginal maternal and child health worker
GP services
a vehicle
goods and services
training and support
community consultation
peer education.
The Aboriginal health worker provides the critical link to the Aboriginal community.
The PHC programs are specially designed to meet the needs of Aboriginal women during the antenatal and
postnatal period
Teams of midwives and Aboriginal health workers work together with GPs and specialists to provide
community based care; antenatal and postnatal education; social and emotional support and referral to
community services. The teams also provide outreach and home visiting services and transport.
Several factors are central to the effectiveness of the PHC model:
Partnerships between mainstream health services, Aboriginal Community Controlled Health Services and
allied agencies
Infra-structure and organisational support for the midwife/Aboriginal health worker teams from mainstream
maternity units and obstetric and medical staff
The development of trusting relationships between the teams and Aboriginal women and their families
The participation of Aboriginal women in the implementation and evaluation process.
Community development
To promote community development and increase Aboriginal ownership at a local level, each program has
established an Aboriginal Womens Reference Group. These groups steer program development and plan
initiatives to improve the health and wellbeing of Aboriginal families.
Aboriginal Womens Reference Groups and Peer Education Programs for Aboriginal women provide the
mechanism for Aboriginal women to become empowered by:
increasing their knowledge on womens health issues
becoming community educators
developing preventative health initiatives
gaining planning and evaluation skills
establishing community groups.

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2. Training and Support program

To improve recruitment and retention, particularly in rural and remote areas, the Strategy funds Northern
Sydney Area Health Service to provide a statewide Training and Support Program for midwives and Aboriginal
health workers who provide services for Aboriginal mothers and babies.
Two of the key objectives of this program are to provide a professional and peer support network and develop
an accredited maternal health training program for Aboriginal health workers, which will articulate to
midwifery training.
3. Evaluation Strategy A three-year evaluation commenced in February 2002 to evaluate the implementation
of the Strategy and determine the Strategys effectiveness in improving health outcomes for Aboriginal
mothers and infants.
Aboriginal Maternal and Infant Health Strategy organisational structure
The organisational structure of the Strategy consists of:
i. Implementation Group with representatives from NSW Health, the seven AHSs funded by the Strategy
and the Aboriginal maternal health programs funded by the Alternative Birthing Services Program.
ii. Advisory Group with representatives from NSW Health, Royal Australian and New Zealand College of
Obstetricians and Gynaecologists, College of GPs, Families First, Midwives Association, Aboriginal Health
and Medical Research Council and the Strategys Implementation Group.
Goals for the Aboriginal Maternal and Infant Health Strategy
In the short term, the Strategy aims to ensure that all Aboriginal women are provided with comprehensive
antenatal and postnatal care. In particular, it aims to ensure that women are seen early in pregnancy and
receive regular visits appropriate to the period of gestation and any associated medical condition. This is
particularly important for women with high risk pregnancies.
In the long term, the aim of the Strategy is to decrease the number of high risk pregnancies in the Aboriginal
community by working in partnership with Area Health Service Health Promotion and Drug and Alcohol Units,
Aboriginal Community Controlled Health Services and allied health services to develop innovative preventative
health strategies.
Where to from here?
Healthy Aboriginal mothers and babies is a fundamental prerequisite for Aboriginal children gaining a healthy
start in life.
By utilising a primary health care approach which simultaneously addresses health service delivery and the
broad social factors affecting Aboriginal communities, it is possible to achieve significant long term
improvements in Aboriginal maternal and infant health.
NSW Health, Aboriginal Community Controlled Health Services, the NGO sector and agencies outside health
need to work in partnership to improve the social determinants which affect the health and wellbeing of
Aboriginal families. For example, as part of the Aboriginal Maternal and Infant Health Strategy, NSW Health
funded resilience building programs with Aboriginal youth to increase school retention and enable youth to
develop the skills and self-confidence necessary to make healthy life choices.
The term Aboriginal is used in this report to refer to both Aboriginal and Torres Strait Islander people.
NSW Department of Health 2003
Further reading
Queensland Government (Department of Aboriginal and Torres Strait Islander Policy and Development,
nd
DATSIPD). (2000). The Aboriginal and Torres Strait Islander Womens Task Force on Violence Report (2
ed.). Brisbane.
Atkinson, J. (2002). Trauma Trails: Recreating Song Lines, The Transgenerational Effects of Trauma in
Indigenous Communities. North Melbourne: Spinifex.

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Websites
Site Name: Australian Indigenous Health InfoNet
Hosted By: Edith Cowan University
Website Address: http://www.healthinfonet.ecu.edu.au
Summary: Presented by the Australian Indigenous HealthInfoNet for the purpose of disseminating Indigenous
health information, free of charge, for the benefit of the public. This website provides an extensive amount of
Aboriginal and Torres Strait Islander health and cultural information. There are extensive links to related
websites, publications and articles.
Site Name: Australian Institute of Aboriginal and Torres Strait Islander Studies
Hosted By: Australian Government http://www.aiatsis.gov.au/
Summary: AIATSIS is an independent Commonwealth Government statutory authority devoted to Aboriginal
and Torres Strait Islander studies. It is Australia's premier institution for information about the cultures and
lifestyles of Aboriginal and Torres Strait Islander peoples. This site has a large library catalogue and is eminently
useful for exploring cultural awareness issues.
Site Name: Muru Marri home page
Hosted By: University of New South Wales
Website Address: http://sphcm.med.unsw.edu.au/centres-units/muru-marri
Summary: The home page of the Faculty of Medicines Muru Marri Unit. Hosts information about the activities
of the Unit,
Discussion of cultural competence in healthcare
What can health services do?
One of the most powerful measures available to health services is to review the way they provide services to
Aboriginal and Torres Strait Islander people. Following Harts Inverse Care Law, the dictum of welsh medico
Tudor Hart that those with the greatest health need access services least a similar trend amongst Indigenous
Australians who are, on average, three times sicker than their non-Indigenous compatriots would not be
unexpected. In fact, the reluctance to access health services, sometimes (jokingly) referred to as Aboriginal
peoples high tolerance of pain, has been developed from generations of racism, systemic discrimination, child
removal and official neglect. Past government and institutional practices have resulted in such lingering
mistrust that, as one young Aboriginal woman reported a couple of years ago:
They (her cousins) dont want to ask for help they find it difficult a lot of them dont want to ask white
people for help. (Source: The Australian, 2.01.02)
Obviously, any moves, in collaboration with Indigenous organizations, to make services more Koori-friendly (or
more Murri or Nyoongah-friendly: depending whether you live in SE Australia, Queensland or Western
Australia) would assist in improving service utilisation. There are four specific sets of factors that must be
addressed to improve a populations access to health services:
Geographic (rural, remote and outer urban)
Socio-economic (particularly the cost sometimes hidden of services and prescribed treatments)
Waiting times and reception experiences
Conscious and unconscious barriers (including cultural and language)
So, a service could work upstream to overcome transport barriers by considering the validity of a home
visitation service. It could find innovative ways to provide expensive medications or counselling programmes,
or it could train and appoint some Aboriginal front-of-house staff.
A service could consider an integrated approach to providing their services that recognises the transcultural
encounter thats taking place. One element for which many training programmes have been run in Australia
over recent decades is to raise the cultural awareness of service providers. Another is to develop
practitioners cultural competence. One of the most-telling measures, though, is for a service to thoroughly
review just how safe the Indigenous patient or client feels to be themselves, when dealing with a doctor,
nurse or allied health practitioner. Such an approach, called cultural safety, also tries to minimise the power
imbalance between (say) doctor and patient as well as encouraging practitioners to be aware of the own
cultural beliefs and approaches that they bring to the encounter. Finally, the concept of cultural ease suggests

Page 17
that one can work more effectively when you incorporate appropriate Aboriginal protocols and ways into your
practice.
(You may care to enhance the depth of your understanding of what a practitioner can do, by conducting an
Internet search for articles and conference presentations by Dr. Melanie Tervalon. You might find her notion of
cultural humility helpful. Shes an Afro-American paediatrician and medical educator from the University of
California in San Francisco, with a strong reputation in this field. I suggest such search terms as Melanie
Tervalon cultural humility University California will return enough to explore the concept.)
The four approaches that make up an integrated approach appear to be less separate, in practice, than they
first appear in description. For example, although cultural safety would appear to be the dominant model in
Aotearoa / New Zealand one prominent Maori health researcher, Dr. Papaarangi Reid, goes so far as to say
its all about cultural safety Professor Mason Durie, an eminent Maori psychiatrist, holds that there is an
important, even mandatory, role amongst health professionals that is centred on cultural competence. For
him, cultural competence is about:
Skills and relationship
The capacity of the worker to improve the patient / clients health status
Interpreting culture into the health context
Maximising the gains from the health intervention
Another dimension to the doctor-patient relationship
Towards an Integrated Model
The jury is still out on which combination of the models weve been discussing is the most useful in both
advancing Indigenous Australian engagement and retention in treatment, and receptiveness to health
promotion. Some combination of the four dimensions of awareness (knowledge of local culture), safety
(power relationships and cultural self-reflection), competence (practitioner attitude and skill) and ease in
incorporating appropriate parts of the patients preferred ways of interacting, would seem a necessary starting
point.
Figure I, sets out such an integrated model.
Figure I
Recent British work on clinical competence
talks of the need to move beyond a
simplistic, check-list approach, something
that occurs in some North American moves
to quantify practitioner ability. If Mason
Durie is right, we are actually looking at a
meta-skill, perhaps one calling upon our
whole personhood, not just the professional
layer, to implement. From the perspective
of the individual health professional then
whether you are working clinically,
administratively, academically or through
health promotion at the population health
level looking for a personal integration of
the skills of cultural competence will make your work with Aboriginal and Torres Strait Islander people easier,
as well as more effective, in reducing the inequity and unsustainably damaging status of Indigenous health.
Below, Ive listed eight attributes of core relevance to becoming culturally-competent health professional:
Eight simple (sort of) ways to be effective through cultural competence
1. Know yourself. An Anglo-Australian author recently described Australians of English (he emphasised not
British) heritage as this countrys invisible ethnics. Ally this notion to the growing worldwide interest in
Whiteness studies and we can find support for the strategy that if we want to work successfully across the
cultural divide, the logical starting point is not some designated other, but ourselves. I suggest that if we
examine our own cultural heritage, worldview, beliefs and practices, that provides the best possible start to

Page 18
being able to work effectively with another person, one whose apprehension of the world is from a different
angle, one who sees the world through a different lens.
2. Know appropriate aspects of a persons culture and context. Beware of the trap of believing you have to be
a card-carrying anthropologist. With over 200 (at least) distinct cultural and linguistic groupings in pre-invasion
Australia, you could not possibly be across all of them. Rather, it would seem better to focus on knowing
sufficient pertinent information about the group at hand to begin work with them as a skilled professional who
is, yet, able to acknowledge their own status as a humble, cultural novice.
3. Offer respect. Sounds simple, and is. Real respect is tangible to the patient / client / community youre
working with: without it, people will vote with their feet.
4. Build trust. The Social Justice Report 1998, of the Acting Aboriginal and Torres Strait Islander Social Justice
Commissioner, compiled a year after the release of the Bringing Them Home report into the Stolen
Generations (and taking note of the full range of reactions to that report), concludes, tellingly, that:
The Indigenous sense of injustice is so deeply inscribed that it appears to form an expectation of injustice. (p. 19)
I suggest that although the level of mistrust of the system, the welfare and authority is profound in
Indigenous Australia, genuine non-patronising willingness to let the person in front of you take the time they
need to become comfortable with you, or your service, will pay dividends in terms of the retention of those
people in, and the attraction of others into, the offered treatment or health promotion initiative.
5. Be transparent. Indigenous people arent so much impressed by your credentials (though, obviously, your
level of clinical competence is crucial) as by your willingness to let people see who you are as a human being.
You can be a thoroughgoing professional, and maintain the necessary professional boundaries, even as you
take off the metaphorical white-coat.
6. Collaborate. Youre not alone. There are Aboriginal Liaison Officers, Aboriginal Health Workers, a whole
Aboriginal Community Controlled Health Sector with a number of crucial peak bodies, such as NACCHO and the
AH&MRC, as well as the Aboriginal Health Branch of the NSW Dept. of Health, OATSIH and AIDA. Use your
colleagues, their skills and resources.
7. Advocate. Individual people and communities may have a jaundiced understanding of, and lack of comfort in
using, seemingly straightforward parts of the health, welfare or governmental system that professionals take
for granted. Their sense of ease may have been severely compromised by past educational barriers impacting
on literacy and ease with technology or, perhaps, by cultural differences or individual experience of racism or
systemic discrimination. Going the extra mile for someone: perhaps to write a letter or make a phone call to a
service or bureaucrat naturally, using your professional judgement as to what would be genuinely beneficial
in each case, and why has a potential to improve that persons health outcome that is capable of surprising
the professional.
At times, advocacy may even call for a personally challenging and difficult political stance. The driving
momentum in such a case is the desire to secure the optimum clinical outcome called-for under our
obligation of duty of care or the truly-equitable outcome integral to our population health praxis.
8. Think holistically. Not just the person, but also the person in the context of their extended family, their
neighbourhood, income level and personal and community history. Do they worry that the DoCS worker to
whom youve referred them might take their child away? Can they afford the prescribed medications, or the
lifestyle choice to eat properly? Whats the level of violence or racism like down their way? What
personal and cultural resilience can they call on, or have judiciously enhanced by appropriate measures?
Thinking holistically makes your interventions significantly more likely to be effective.

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SGS 2: Social and cultural issues affecting Deborah and Jessica

Aims:
This session aims to help the group to explore and understand the social and cultural issues that might impact
on the pregnancies of Deborah and Jessica, in particular, issues related to Indigenous health and rural health.
During this session, the students will also choose their assignments and projects for this course.
Key concepts:
What social and cultural factors may influence the outcome of pregnancy?
Social determinants of health in pregnancy
The relationship between late presentation and access to services and their cultural appropriateness and
safety for Aboriginal and Torres Strait Islander peoples and their families
Particular relevance of Stolen Generations issues: impact of history, and socio economic status on
reproductive health
The impact of culture on todays Aboriginal and Torres Strait populations
Rural health care and access issues; family and community support; choice; lack of anonymity/privacy; role
of the rural GP; and rural culture
Maternal responsibility, including nutrition, smoking, alcohol use and drug taking
Process:
Activities
1. Review the social and cultural issues facing Deborah and Jessica using the
Ecological Model of Health and possible solutions
2. Indigenous health questions
3. DVD: Who Do You Think You Are: Michael OLoughlin
4. Project and assignment choices
5. Materials needed for SGS 3
1. Review the social and cultural issues facing Deborah and Jessica using the Ecological model of Health and
the possible solutions
Students will be familiar with the Ecological model of Health from Foundations. This creates a good framework
for summarising and comparing the social and cultural issues facing Deborah and Jessica.
Ecological model of Health

Page 20
Factor
Innate
Deborah
Jessica
Individual behaviour
Social, family and

community networks
Living and working

conditions
Broad social,
economic, cultural,
physical
environmental
conditions and govt
policies
1b. How may Aboriginal and Torres Strait Islander health be improved?
1c. How may rural health be improved?

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2. Indigenous health questions

These questions give a brief overview of some health statistics and address some stereotypes.
Q. 1 How do you think Aboriginal Australia would define health?
Q. 2 What is the median age of death for Indigenous males in Australia (median: 50% of cases above, 50%
below)?
48.5-58.5
overall 54 years
Q. 3 Is this different from the non-Indignenous Australian male population?
20> younger than other Australians

78.5 years
Q. 4 What is the median age of death for Indigenous females in Australia?
58 years
avg. 61 year
Q.6 Is there a difference between the frequency of maternal deaths among Aboriginal and Torres Strait
Islander women and other Australian women?
20> younger than other aust females

71.4-85.5 avg 84.7
Q.7 What percentage of Aboriginal and Torres Strait Islander Australians currently drink alcohol? What
percentage exceed the current lifetime risk and single occasional risk guidelines?
NOTE: 2009 NHMRC guidelines for reducing risk do not distinguish between males and females.
Guideline 1: lifetime risk - no more than 2 standard drinks a day
Guideline 2: Single occasional risk no more than 4 standard drinks on a single occasion
10% of maternal deaths were aboriginal
Q.8 What percentage of non-Indigenous Australians exceed current lifetime risk and single occasional risk
guidelines?
72% consumed
Lifetime: 18%
Male: 26%
Female: 10%
Single occasional risk: 54%

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Q. 9 Which state has the largest Aboriginal and Torres Strait Islander population?
New South Wales
3% of Australians are Aboriginals
Q.10 What are the 5 leading causes of Indigenous mortality?
Circulatory System - 24%

Neoplasia - 20%
External - 15% e.g. suicide rate, drunken violence
Q. 11 How many Aboriginal or Torres Strait Islander doctors are there?
120 - 200 Aboriginal medical trainees
Q. 12 How many Indigenous doctors do we need to bring numbers, per head of population, up to the level of
non-Indigenous Australia?
1000 nationwide
3. DVD: Who Do You Think You Are: Michael OLoughlin
In order to understand the present you need to understand the past. By exploring Michael OLoughlins (former
Sydney Swans AFL player) family history the impact of colonisation by the British on Indigenous Australians is
revealed.
4. Project and assignment choices

5. Materials needed for SGS 3
Students are to bring basic anatomy and physiology textbooks, and lecture notes on the anatomy and
physiology of male and female reproduction to SGS 3.

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SGS 3: Anatomy and physiology of reproduction

Aim:
The main activity in this session is designed to reinforce basic anatomy and physiology of the reproductive
system in males and females. Students will also discuss the estimation of delivery dates.
Key concepts:
Male reproduction anatomy, actions of testosterone, control of spermatogenesis and testosterone

secretion
Female reproduction anatomy, control of reproductive cycle, follicular phase of cycle, luteal phase of
cycle, actions of estrogen
Estimated date of delivery
Process:
Activities
1. Anatomy and physiology of reproduction
1a. Introduction
1b. Working on allocated question
1c. Presenting answers to the scenario group
2. Pregnancy wheels and estimating dates of delivery
1. Antomy and Physiology of reproduction
1a. Introduction
There are three different questions in the worksheet. Students should attempt to answer the questions using
their lecture material and textbooks.
1b. Working on allocated questions
Students will have about 45 minutes in total in which to research and answer the questions and to get the
answer to their allocated question in a format that they will present to the rest of the group.
1c. Presenting answers to the scenario group

Page 24
WORKSHEET WITH ANSWERS

QUESTION 1
Q1a. Name the structures indicated on the diagrams below (unlabelled version in the student worksheet).

Page 25
Q1b. Match the following

epididymis
Sertoli cells
Leydig cells
urethra
rete testes
testis
i.
site for storage and maturation of sperm.
ii.
nurture sperm.
iii.
produce testosterone.
iv.
contains small, mucus-secreting glands.
v.
is the site of spermatogenesis.
vi.
structures into which the seminiferous tubules drain.
Q1c. What do the secretions from the following structures contain and what are the functions of these
substances? Approximately what percentage of semen volume does each accessory gland contribute?
i. seminal vesicles
ii.
prostate

Page 26
iii. bulbourethral glands
QUESTION 2
Q2a.
i) Using a flow diagram, describe the control of spermatogenesis and testosterone secretion. You must
be able to take the class through this diagram step by step

Page 27
ii)
Indicate what occurs to this feedback system if there is an excess of testosterone.
iii)
Indicate what may happen to the feedback if there is damage to the testes and spermatogenesis is
decreased.
Q2b i) Where is testosterone produced in the human male?
ii) Some of the actions of testosterone and its two active metabolites (estradiol and 5-dihydrotestosterone,
DHT) are listed in the table below. Match these with the hormone responsible.
Action
Embryonic sexual differentation
Pubertal changes:
Beard growth
Prostatic enlargement
Enlargement of the penis and seminal vesicles
Stimulation of sebaceous gland activity at
puberty (causing acne)
Enlargement of the larynx
Spermatogenesis
Skeletal muscle growth
Accumulation of abdominal visceral fat
Fusion of epiphysial plates (growth plates) in long bones
Haematopoiesis
Suppression of gonadotropin secretion
Libido

Page 28
Hormone
QUESTION 3
Q3a. Complete the following diagram of events occurring during a 28 day menstrual cycle to show:
i) Plasma hormone levels throughout the cycle (Graph A: estrogen, progesterone, LH and FSH; Graph B:
inhibin A and inhibin B)
ii) The names of the 2 ovarian structures circled
iii) The names of the ovarian and uterine cycle phases
iv) The secretion at X and the structures at Y

Page 29
Q3b. i) Explain the rise in estrogen levels during the first half of the cycle. What cells produce estrogen and
where does its precursor come from? Use diagrams of the follicular cells and of the feedback system from your
lecture to aid your explanation.

Page 30
Q3b ii) Why does the dramatic mid-cycle spike in LH and FSH occur?
Q3b iii) What structure and cell type produce progesterone and estrogen during the second half of the cycle?
2. Calculating the estimated date of delivery (EDD)

Online pregnancy wheel is available at:
http://www.hpwh.com.au/gestation-wheel.html or http://www.premierus.com/dynamic-pregnancy-wheel
A. Why is it important to estimate delivery dates?
B. How is the EDD calculated and what information would you need from a pregnant woman to calculate her
EDD? How accurate is this estimate?
C. You calculate a patients EDD to be the 20th October 2015. You then find that her menstrual cycle is
usually 35 days long. How will you adjust your estimate?
D. Use the pregnancy wheels to work out the expected date of delivery if the patients last menstrual period
th
was on the 4 March 2015.
3. Research tasks for SGS 5

SGS 5 will focus on the basic science underlying common discomforts experienced in a normal healthy
pregnancy. Students are to divide into groups of 3-4 and each group is to choose one of the four topics below
to research before the next session (references relating to each of these topics are on UNSW Moodle, and they
will also have a lecture on Maternal Physiology in Week 2). Students will need to prepare a presentation for
SGS 5 in which they act as the expert to answer questions posed by pregnant patients. For each topic, quotes
are provided which come from pregnant women with no underlying pathology, i.e. they are describing normal
changes in pregnancy. Concentrate your research on:
how the normal physiological and/or anatomical changes in pregnancy lead to each maternal
discomfort
how common these complaints are in pregnancy
how they might be managed

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Topic 1:
Topic 2:
Topic 3:
Topic 4:
heartburn; constipation; nausea and vomiting

increased urinary frequency; nocturia; altered thermoregulation; hair growth during pregnancy and
post partum hair loss
dependent oedema; varicosities; haemorrhoids; dizziness/fainting
breathlessness (dyspnoea); anaemia; lower back pain; pubic symphysis pain
Presentation length: About 20-25 minutes per group is available in SGS 5, but this should include time for
discussion and clarification. Therefore students should aim for presentations that are around 10-15 minutes.
Students need to think about how they can order their information and convey it effectively (and that is not
just by cramming in facts and talking quickly). The important thing is that the other scenario group members
gain a good understanding of what is being presented. It is not necessary to use Powerpoint. Some groups like
to do a role play where the experts are the doctor and those asking the questions are the patient.
GROUP 1
Im 15 weeks pregnant and my digestion seems to be going haywire. I cant eat very much before Im full,
then it seems to take forever to go through my system. Im constipated, and lately Ive been getting
heartburn. And Im still getting morning sickness I throw up a couple of times a week. It doesnt just
happen in the morning either.
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
What is heartburn?
Is it common? Why do I have it?
Is there anything that I can do about it?
It feels as if my stomach has shrunk is that right?
Why am I constipated?
Is it bad for the baby?
What can I do about it?
Why do I feel so nauseous?
Its called morning sickness but I feel sick at any time of the day. Is that normal?
The nausea and vomiting seem to be lasting a long time with me is that normal?
Will the vomiting hurt the baby?
Will I feel this bad during my next pregnancy?
What can I do to try to reduce the nausea?
Suggested Readings
nd
Blackburn, S.T. (2003). Maternal, Fetal, & Neonatal Physiology: A Clinical Perspective (2 ed., pp.412-426).
Saunders, St Louis, MO. [available in Moodle]
Quinlan, J.D. and Hill, D.A. (2003). Nausea and vomiting of pregnancy. American Family Physician 68:121128. http://www.aafp.org/afp/2003/0701/p121.html
GROUP 2
Im 13 weeks pregnant with my first baby. I have to get up twice now in the night to empty my bladder. I
seem to be going to the loo more often during the day as well.
1.
2.
3.
4.
5.
Why do I need to make so many trips to the toilet? I seem to spend most of my life emptying my bladder.
Is it common?
Ive been like this for a few months now but my baby couldnt have been pressing on my bladder back
thenis it that my bladder is smaller now? Or it it that Im making more urine?
Im waking up at least 3 times during the night needing to wee why is that?
What can I do about it should I try to drink less water?
I normally get cold hands and feet in winter, but Im pregnant this year and theyve been quite warm.
Actually since Ive been pregnant I havent felt the cold as much as usual.
6.
7.
Why can I tolerate the cold more easily?

Why are my hands and feet so warm?

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Ive noticed that Im not losing much hair at all since Ive been pregnant a little used to come out onto my
brush or when I washed my hair but hardly any does now. My friend told me that her hair came out in
handfuls after she had her baby.
8.
9.
Why am I not losing as much hair as normal?

Will my hair get back to normal after I have the baby?
Suggested Readings
nd
Blackburn, S.T. (2003). Maternal, Fetal, & Neonatal Physiology: A Clinical Perspective (2 ed.,). Saunders, St
Louis, MO. [available in Moodle]
pp. 370-383
pp. 521 & 524
pp. 707-708
GROUP 3
Im 28 weeks pregnant and lately Ive been having trouble fitting into my shoes my ankles and feet are
swollen. Its more noticeable if Ive been on my feet for a while.
1.
2.
Why are my ankles and feet so swollen?

My mum got varicose veins when she was pregnant with me. Now Ive got them, at 34 weeks, and I have
haemorrhoids as well. Im hoping theyll go away after I have the baby.
3.
4.
5.
6.
7.
8.
What are varicose veins?

Why have I developed them?
What can be done about them?
Will they go away after I have the baby?
What are haemorrhoids?
Why do I have them?
Im 34 weeks pregnant and fainted the other day. The bus was late, and as I was standing there waiting for
it I passed out. Ive also noticed for a while now that I get dizzy if I try to get out of bed quickly. Its also
pretty uncomfortable lying flat on my back now.
9. Why did I faint at the bus stop?
10. Why do I feel so dizzy when I get out of bed quickly?
11. A few visits ago you said that I should try not to sleep flat on my back why is that?
12. How does the blood get back to my heart when Im lying down if the major blood vessel is being closed off
by the baby?
Suggested Readings
nd
Blackburn, S.T. (2003). Maternal, Fetal, & Neonatal Physiology: A Clinical Perspective (2 ed). Saunders, St
pp. 255-267
pp. 381-382
p.425
p.520
GROUP 4
Im 16 weeks pregnant and Ive been really tired and breathless. My obstetrician just told me that Im
anaemic. I dont really understand it: my sister is due in a few weeks and is short of breath too, but her
doctor says shes not anaemic. A friend of mine said that her haemoglobin levels went down when she was
pregnant, but her doctor told her that it was normal and nothing to worry about. Im confused.

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1.
2.
3.
4.
5.
What is anaemia?
Why do I have it?
What effects will it have on my baby?
If Im iron deficient does that mean my baby is too?
How did I get anaemic when Im not even losing any blood? I thought that periods were the reason why
women had problems with anaemia more often than men.
6. Why have I been feeling a little out of breath?
7. Why would my sister be breathless if shes not anaemic?
8. Why did my friends haemoglobin level fall? Why was that considered normal when I have to get
treatment for anaemia?
9. What can I do to fix the anaemia?
10. Ive been told to take folate along with my iron supplement why is that?
My lower back has been sore since a couple of months into my pregnancy. Now Im 35 weeks and my pubic
bone is aching its incredibly painful, especially when I walk. If I sleep with a pillow between my legs it
helps.
11. Why is my back so sore? I got the backache well before I was even showing, so it cant all be because of
the weight of the baby.
12. Why is my pubic bone hurting so much?
13. What can be done for my pubic pain?
Suggested Readings
nd
Blackburn, S.T. (2003). Maternal, Fetal, & Neonatal Physiology: A Clinical Perspective (2 ed). Saunders, St
o pp. 213-227
o pp. 317-318
o pp. 547-548
o pp.553-554
Leadbetter, R.E., Mawer, D. and Lindow, S.W. (2004). Symphysis pubis dysfunction: a review of the
literature. Journal of Maternal Fetal and Neonatal Medicine, 16, 349-354.

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SGS 4: The menstrual cycle and fertility awareness

Aims:
This small group session aims to make students aware of the natural signs and symptoms which can be used to
indicate the most fertile and relatively infertile phases of a womans menstrual cycle. Note that this
information can be used by couples either to increase the likelihood of a successful pregnancy or to avoid
pregnancy. The use of these indicators to avoid pregnancy is the basis of Natural Family Planning (NFP).
Key concepts:
What fertility awareness involves and how it is used

Relevant features of male and female fertility
Changes that occur under the influence of estrogen and progesterone
Monitoring physiological indicators of fertility
Completion of a symptothermal chart
The advantages and disadvantages of NFP
Effectiveness of NFP
Using the indicators of fertility to plan or avoid a pregnancy
Process:
Activities
1. Introduction
2. Worksheet
A. Understanding the basics of natural family planning
B. Completion of a sympto-thermal chart
C. Discussion of advantages, disadvantages and effectiveness of NFP
D. Discussion of two scenarios
3. Progress reports for projects and assignments
4. Preparation for SGS 5 (peer teaching activity)
1. Introduction
When NFP is used to avoid pregnancy, couples avoid intercourse during the days of a womans cycle when she
is fertile. A variation of NFP is the Fertility Awareness Method (FAM) in which couples use contraceptive
methods (usually barriers) during the identified at-risk days. This session does not seek to advocate the use of
NFP as a reliable contraceptive, but NFP is a very useful way to introduce students to fertility signs.
2. Worksheet
Students should spend this session working through the worksheet.
The worksheets require students to think about:
1. The relevant features of male and female fertility.
2. The monitoring of physiological changes in the menstrual cycle.
3. Planning and avoiding pregnancy.
4. The advantages and disadvantages of NFP.
Worksheet: The menstrual cycle and fertility awareness
A. UNDERSTANDING THE BASICS OF NATURAL FAMILY PLANNING
Natural methods of family planning use fertility awareness to identify the fertile and infertile phases of a
womans menstrual cycle. This involves observing the natural signs and symptoms or clinical indicators of
fertility.
Fertility awareness involves
Understanding basic information about fertility and reproduction.
Identifying the signs and symptoms of ovulation during the womans menstrual cycle.
Applying this information to oneself, discussing it with a partner, and with health professionals.

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Uses of fertility awareness

Helping to conceive: Fertility awareness can help couples to maximise their chances of conception, by
recognising signs of ovulation and optimising the timing of intercourse.
Helping to avoid pregnancy: Couples can also learn to identify the fertile and infertile phases of the cycle and
to abstain from intercourse during the fertile phase if pregnancy is to be avoided.
Several techniques have been developed to identify fertile days. These include the calendar or rhythm method,
standard days method using cycling beads (particularly useful for women in areas of the world with low
literacy), basal body temperature method and the Billings technique (using changes in cervical/vaginal
secretions that reflect the hormonal swings of the menstrual cycle). The most effective technique is the
symptothermal technique. This method requires observation of more than one clinical indicator of fertility
(usually a combination of waking temperature and cervical mucus) and may add other potential signs and
symptoms to detect ovulation like cervical signs, and minor indicators of fertility (see below). This ensures the
highest degree of effectiveness in avoiding pregnancy.
When motivated couples are taught by experienced teachers, natural methods can be up to 98% effective.
(Range 85-98% effective Family Planning Association 1995; www.fertilityuk.org
)
Pertinent features of male and female reproductive physiology
To avoid or achieve a pregnancy, you need to be aware of some of the pertinent features of the male and
female reproductive tracts.
Question: What is the main difference between men and women in terms of fertility?
Features of MALE fertility pertinent to NFP:
Features of FEMALE fertility pertinent to NFP:

Cycles vary in length from 23 days or less in a short cycle, to over 35 days in a long cycle. Few women have an
absolutely regular menstrual cycle, and a variation of up to 7 days is perfectly normal. For convenience, we will
use an average length cycle of 28 days. The reproductive cycle may be conveniently divided into two phases the phase before ovulation (pre-ovulatory or follicular) and the phase after ovulation (post-ovulatory or luteal).
Pre-ovulatory phase / follicular phase - controlled by FSH and estrogen

FSH (follicle-stimulating hormone) is secreted by the anterior pituitary gland and stimulates follicular growth
and development. These developing follicles produce increasing amounts of estrogen.

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List the changes that occur to the following parameters as the estrogen levels rise approaching ovulation.
The endometrium (lining of the uterus)
The cervix
Cervical mucus
The temperature
When the increase in estrogen levels becomes high enough, the anterior pituitary gland is stimulated to release
a surge of
___________
___________
, which leads to ovulation within 36 hours. The
most mature follicle ruptures and releases the ovum.
Post-ovulatory phase / luteal phase - controlled by progesterone
Following ovulation, luteinising hormone or LH causes the ruptured follicle to develop into the corpus luteum
which produces both progesterone and estrogen.
List the changes that occur to the following parameters under the influence of progesterone.
The endometrium (lining of the uterus)
The cervix
Cervical mucus
The temperature
The corpus luteum remains for around ________________

___________ , then it regresses; the level of
progesterone falls; the temperature drops; and the endometrium disintegrates, so completing the cycle.

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Changes During the Fertility Cycle

(adapted from http://www.fertilityuk.org/nfps20.html#physiologyslug)
The vertical dotted line indicates ovulation.

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The cyclic phases of fertility and infertility
The fertility cycle figure illustrates an average fertility cycle of 28 days.

The first day of menstruation is day
____
of the cycle. Subsequent days are numbered up to but not
including the first day of the next menstrual period. A number of infertile days follow menstruation this is the
______ _________
relatively infertile phase. The fertile phase occurs either side of ovulation. The first sign
of cervical mucus designates the onset of the
________
phase, because sperm can survive in fertile mucus
for 3-5 days awaiting ovulation. After ovulation, time must be allowed for
days) and the possibility of a
_________
___________
______
occurring within 24 hours. The post-ovulatory
infertile phase is confirmed by a combination of _____________ and
__________
three days after ovulation. This phase lasts until the onset of the next
____________
__________
_______ (about 2
_________ about
______ . The
_______________ infertile phase is the most effective in avoiding pregnancy.
Using the diagram below and the subsequent text, students should learn that cycles vary in length and that
the post-ovulatory phase remains fairly constant but the pre-ovulatory phase may be variable in length.
Variations in cycle length
The post-ovulatory phase or interval between ovulation and the next menstrual period remains fairly constant around 14 days. As cycles vary greatly in length, it follows that the interval between menstruation and
ovulation (pre-ovulatory phase) must constitute the variable part of the cycle.

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In a short cycle of 21 days, ovulation will occur around day 7 and there will be no pre-ovulatory infertile days. A
normal length cycle (around 28 days) will have a few pre-ovulatory relatively infertile days and a long cycle (for
example 35 days) where ovulation does not occur until around day 21, will have many pre-ovulatory relatively
infertile days.
MONITORING PHYSIOLOGICAL CHANGES
A woman learns to monitor her fertility cycle subjectively by observing physiological changes, using a
combination of indicators of fertility that reflect changes in the ovarian hormone levels and fertility status.
Indicators of fertility
1. The waking temperature
When should temperature be taken?
What type of thermometers are used?
What site should be used?

Where should these temperatures be recorded?
What confirms ovulation?
What indicates the onset of the post-ovulatory infertile phase?
How does temperature help to indicate the onset of the fertile phase?
2. Cervical mucus changes

Cervical mucus changes are observed at the vulva (vaginal entrance) and are recorded at the end of each day.
Mucus changes can also be observed at the cervix - mucus may appear here one day before its appearance at
the vulva. Developing awareness of cervical mucus changes takes time and persistence. These changes may
be masked by seminal fluid, spermicide or vaginal infections, so it is vital that a woman receives adequate
teaching and support to monitor this sign.
Cervical dryness is an indicator of which phase?

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What does a sensation of moistness or dampness indicate?
What does a sensation of wetness, slipperiness and the presence of transparent, slippery, stretchy mucus
indicate?
Peak day is the last day of highly fertile-type mucus recognised retrospectively (coincides closely with
ovulation). Following peak day there is a rapid return to dryness until the next menstruation.
3. Changes in the cervix
Detecting cervical changes can give additional information and is particularly useful for women with very long
cycles, during breast-feeding or pre-menopausally. However, it is something that women and even clinicians
find very difficult to assess and its usefulness is therefore doubtful. The first change in the cervix is frequently
noted one or two days prior to changes in cervical mucus, and can give a very early warning of approaching
fertility.
A low (i.e. closer to the vagina; can be more easily reached), long, tilted, firm, closed, dry cervix indicates
A high, short, straight, soft, open, wet cervix indicates
4. Recording cycle length

How is cycle length measured?
If using the calendar or rhythm method alone, how is the fertile period calculated?
5. Minor indicators of fertility.

These are the least reliable indicators but may be useful for some women to confirm other observations.
Ovulation or Mittelschmerz pain
Breast symptoms
Increase in libido
6.
What factors might affect the cycle or disturb recordings?

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B. COMPLETION OF A SYMPTO-THERMAL CHART

Students should now work in pairs to complete a sympto-thermal chart using the data given below (chart on
next page) then answer the following questions.
Temperature recordings
Day 1
Day 2
Day 3
Day 4
Day 5
Day 6
Day 7
Day 8
Day 9
Day 10
Day 11
Day 12
Day 13
Day 14
Day 15
36.8C
36.7C
36.6C
36.7C
36.6C
36.7C
36.7C
36.6C
36.6C
36.7C
36.7C
36.6C
36.6C
36.7C
36.6C
Day 16
Day 17
Day 18
Day 19
Day 20
Day 21
Day 22
Day 23
Day 24
Day 25
Day 26
Day 27
Day 28
Day 29
Day 30
36.6C
36.9C
37C
36.9C
36.9C
37C
36.9C
37C
36.9C
36.9C
36.8C
36.9C
36.8C
36.8C
36.5C
Cervical Secretions
Day 1 - Day 5
Day 6 - Day 9
Day 10 - Day 13
Day 14 - Day 16
Day 17 - Day 19
Day 20 Day 29
Day 30
period
dry, no secretions
thick, cloudy, sticky mucus
wet, slippery, transparent and stretchy mucus
thick, cloudy, sticky mucus
dry, no secretions
period
Cervix
Day 6 Day 11
Day 12 Day 17
low, firm, closed

high, soft, open
Shortest cycle in last 6 cycles = 28 days

Other facts: Patient experienced some abdominal pain on day 16

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Complete the sympto-thermal chart to show correlation between all indicators of fertility

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1.
On what day has ovulation occurred?
2.
Which day marks the start of the fertile phase? Explain how you arrived at this conclusion.
3.
Which day is peak mucus day?
4.
Which day confirms the post-ovulatory infertile phase? Until when does this phase last?
C. DISCUSSION OF ADVANTAGES, DISADVANTAGES AND EFFECTIVENESS OF NFP

Advantages of NFP
Disadvantages of NFP

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General Effectiveness of Natural Family Planning

A couples motivation has a crucial influence on the effectiveness of a number of methods of family planning.
The first years use always carries the highest risk of unplanned pregnancy due to the time taken for a couple to
learn to use the method effectively.
A high degree of motivation is essential if a couple are to use natural methods of family planning successfully.
They should both be in accord about their goals of family spacing or limiting. It is interesting to note that the
family-spacers, those who plan more children but at a later date, are less effective in preventing pregnancy.
They are prepared to take risks; whereas family limiters, those who have completed their family, are more
conscientious and determined, and more successful in preventing pregnancy.
The effectiveness of any form of family planning depends on the method being well taught, well understood
and well applied, but this is of particular importance for natural family planning. With experience, the symptothermal method is a highly effective method. Advances in teaching techniques and use of multiple index
methods have considerably reduced the unplanned pregnancy rate among NFP users. The method is however
unforgiving of imperfect use.
Several studies of the sympto-thermal method reported a user effectiveness rate of 98% if used correctly.
However, perfect use is difficult to achieve. The table below shows more realistic figures.
TABLE : Typical and perfect use failure rates (percentage of women experiencing an accidental pregnancy)
during the first year of use of a contraceptive method
Typical use
Perfect use
No method
85
85
Withdrawal
22
Methods based on fertility awareness
24
35
Diaphragm with spermicide
12
Condom
18
Intrauterine device (IUD)
2
b
0.8
0.6
0.3
Depo-Provera
0.2
Nuva-Ring
0.3
Implanon
0.05
0.05
Female sterilisation
0.5
0.5
Male sterilisation
0.15
0.10
Combined pill
(a) ovulation (cervical mucus) and standard days methods for determining abstinence
(b) 0.2% for the Mirena progesterone-releasing IUD
(c) or progestogen-only pill
Source: Trussell J. Contraceptive efficacy. In: Hatcher RA, Trussell J, Nelson AL, Cates W, Kowal D, Policar M.
Contraceptive technology: twentieth revised edition. New York: Ardent Media, 2011. Available at
www.glowm.com/index.html?p=glowm.cml/section_view&articleid=374
Note:
1. Pregnancy rates during perfect use reflect how effective methods can be in preventing pregnancy when
used consistently and correctly according to instructions.
2. Pregnancy rates during typical use reflect how effective methods are for the average person who does not
always use methods correctly and consistently.
3. Pregnancy rates during typical use of adherence-dependent methods generally vary widely for different
groups using the same method, primarily due to difference in the propensity to use the method correctly.

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D. DISCUSSION OF TWO SCENARIOS

Scenario 1
Sarah and Jason have been married for three years and have avoided pregnancy by the successful use of a
contraceptive. Sarah is now approaching 30 and the couple have decided they are ready to start a family.
Provide them with a brief summary of how they can use indicators of fertility to maximise their chances of
achieving a pregnancy. How can they use Sarahs temperature as an indication of whether or not a
pregnancy has been achieved?
Scenario 2
Sue, 25 years old and Pete, 30 years old, will be married in 6 weeks time. They do not wish to start a family
for a few years and for religious reasons do not wish to use any means of contraception.
Provide for them a brief summary of how they can use indicators of fertility to give them their best chance of
avoiding a pregnancy. During which phase should they avoid intercourse and during which phase are they
safest and why? What factors would you make them aware of which may affect the cycle or disturb the
recordings?
3. Progress reports for projects and assignments

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SGS 5: Common complaints in pregnancy: A word from the experts

Aims:
This session is designed to examine the science underlying some of the common, normal discomforts
experienced by pregnant women. In SGS 3, the students were divided into 4 groups (3-4 per group). Each
group chose a topic area covering one or more of these maternal complaints, and was asked to research their
physiological basis and management. In this session, they will act as the experts to present the answers to
questions posed by women affected by these discomforts.
There is also time set aside at the end of the session for peer-teaching activities. Those groups doing the
Understanding the Teenage Pregnancy Scenario project can run a student-led review of the learning issues
associated with this scenario. Some facilitators also organise student-led quizzes periodically through the
course and could use the remainder of the session for this purpose instead.
Key concepts:
This session addresses the following issues:
The normal physiological changes that occur in women during pregnancy.
Common maternal complaints during pregnancy, their physiological basis and management.
Process:
Activities
1.
Introduction
2.
A Word From the Experts
3.
Peer teaching session
4.
Progress reports for projects and assignments
5.
Preparation for SGS6
1. Introduction
2. A Word from the Experts

GROUP 1
Im 15 weeks pregnant and my digestion seems to be going haywire. I cant eat very much before Im full,
then it seems to take forever to go through my system. Im constipated, and lately Ive been getting
heartburn. And Im still getting morning sickness I throw up a couple of times a week. It doesnt just
happen in the morning either.
1.
What is heartburn?
2.
Is it common? Why do I have it?

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3.
Is there anything that I can do about it?
4.
It feels as if my stomach has shrunk is that right?
5.
Why am I constipated?
6.
Is it bad for the baby?
7.
8.
Why do I feel so nauseous?
9.
Its called morning sickness but I feel sick at any time of the day. Is that normal?
10. The nausea and vomiting seem to be lasting a long time with me is that normal?

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11. Will the vomiting hurt the baby?
12. Will I feel this bad during my next pregnancy?
13. What can I do to try to reduce the nausea?
GROUP 2
Im 13 weeks pregnant with my first baby. I have to get up twice now in the night to empty my bladder. I
seem to be going to the loo more often during the day as well.
1. Why do I need to make so many trips to the toilet? I seem to spend most of my life emptying my
bladder.
2. Is it common?
3. Ive been like this for a few months now but my baby couldnt have been pressing on my bladder back
then Is it that my bladder is smaller now? Or is it that Im making more urine?
4. Im waking up at least 3 times during the night needing to wee why is that?
5. What can I do about it should I try to drink less water?

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I normally get cold hands and feet in winter, but Im pregnant this year and theyve been quite warm.
Actually since Ive been pregnant I havent felt the cold as much as usual.
6. Why can I tolerate the cold more easily?
7. Why are my hands and feet so warm?
Ive noticed that Im not losing much hair at all since Ive been pregnant a little used to come out onto my
brush or when I washed my hair but hardly any does now. My friend told me that her hair came out in
handfuls after she had her baby.
8. Why am I not losing as much hair as normal?
9. Will my hair get back to normal after I have the baby?
GROUP 3
Im 28 weeks pregnant and lately Ive been having trouble fitting into my shoes my ankles and feet are
swollen. Its more noticeable if Ive been on my feet for a while.
1.
Why are my ankles and feet so swollen?
2.

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My mum got varicose veins when she was pregnant with me. Now Ive got them, at 34 weeks, and I have
haemorrhoids as well. Im hoping theyll go away after I have the baby.
3.
What are varicose veins?
4.
Why have I developed them?
5.
What can be done about them?
6.
Will they go away after I have the baby?
7.
What are haemorrhoids?
8.
Why do I have them?
Im 34 weeks pregnant and fainted the other day. The bus was late, and as I was standing there waiting for
it I passed out. Ive also noticed for a while now that I get dizzy if I try to get out of bed quickly. Its also
pretty uncomfortable lying flat on my back now.
9.
Why did I faint at the bus stop?
10. Why do I feel so dizzy when I get out of bed quickly?
11. A few visits ago you said that I should try not to sleep flat on my back why is that?
12. How does the blood get back to my heart when Im lying down if the major blood vessel is being
closed off by the baby?

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GROUP 4
Im 16 weeks pregnant and Ive been really tired and breathless. My obstetrician just told me that Im
anaemic. I dont really understand it: My sister is due in a few weeks and is short of breath too, but her
doctor says shes not anaemic. A friend of mine said that her haemoglobin levels went down when she was
pregnant, but her doctor told her that it was normal and nothing to worry about. Im confused.
1.
What is anaemia?
2.
Why do I have it?
3.
What effects will it have on my baby?
4.
If Im iron deficient does that mean my baby is too?
5.
How did I get anaemic when Im not even losing any blood? I thought that periods were the reason
why women had problems with anaemia more often than men.
6.
Why have I been feeling a little out of breath?
7.
Why would my sister be breathless if shes not anaemic?
8.
Why did my friends haemoglobin level fall? Why was that considered normal when I have to get
treatment for anaemia?

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9.
What can I do to fix the anaemia?
10. Ive been told to take folate along with my iron supplement why is that?
My lower back has been sore since a couple of months into my pregnancy. Now Im 35 weeks and my pubic
bone is aching its incredibly painful, especially when I walk. If I sleep with a pillow between my legs it
helps.
11. Why is my back so sore? I got the backache well before I was even showing, so it cant all be because
of the weight of the baby.
12. Why is my pubic bone hurting so much?
13. What can be done for my pubic pain?
3. Student led activity

Option 1 Reviewing learning issues of this scenario
Option 2 Student led quiz
4. Progress report for projects and assignments
Students to discuss progress on the assignments and projects.
5. Preparation for SGS6
All students should read:
The Royal Australian College of Obstetricians and Gynaecologists (2013). College Statement C-Obs 37. Delivery
of the Fetus at Caesarean section and College Statement C-Obs 39. Caesarean Delivery on Maternal Request
http://www.ranzcog.edu.au/college-statements-guidelines.html
Students should note down any advantages or disadvantages of vaginal delivery or caesarean section which are
described in the article they read. The information will be collated during SGS 6. Students may like to also
consider the source of the article and whether they detect any bias on the part of the author.

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Articles for pre-reading

1. Buhimischi, C.S. and Buhimischi, I.A. (2006). Advantages of Vaginal Delivery. Clinical Obstetrics and
Gynaecology, 49 (1), 167-183.
2. Zelop, C. and Heffner, L.J. (2004). The Downside of Cesarean Delivery: Short-and Long-Term
Complications. Clinical Obstetrics and Gynaecology, 47 (2), 386-393.
3. Sakala, C. (2006). Vaginal or Cesarian birth? A systematic review to determine what is at stake for
mothers and babies. www.childbirthconnection.org/article.asp?ck=10271&ClickedLink=200&area=2
4. Lamaze International: Elective Cesarean Surgery Versus Planned Vaginal Birth: What are the
consequences?
http://www.sciencebasedbirth.com/WebPublishing_05/ASPO_elect_cs_consequences_06.pdf
5. Crowther, C.A., et al. (2012) Planned Vaginal Birth or Elective Repeat Caesarean: Patient Preference
Restricted Cohort with Nested Randomised Trial. PLoS Med 9(3): e1001192.
http://www.plosmedicine.org/article/info%3Adoi%2F10.1371%2Fjournal.pmed.1001192
6. Shub, A., Williamson K., Saunders L, McCarthy E.A. (2012). Do primigravidae and their carers have a
realistic expectation of uncomplicated labour and delivery? Australian and New Zealand Journal of
Obstetrics and Gynaecology, 52(1), 73-77.
http://onlinelibrary.wiley.com/doi/10.1111/j.1479-828X.2011.01396.x/full
7. Neu, J. and Rushing J. (2011). Cesarean versus Vaginal Delivery: Long term infant outcomes and the
Hygiene Hypothesis. Clinics in Perinatology, 38(2), 321-331.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3110651/
8. Barrett J.F.R. et al. (2013). A randomized trial of planned caesarean or vaginal delivery for twin
pregnancy. New England Journal of Medicine, 369, 1295-1305.
http://www.nejm.org/doi/full/10.1056/NEJMoa1214939

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SGS 6: Vaginal Delivery versus Caesarean Section

Aims:
This session aims to help students to:
Gain an overview of a normal vaginal delivery and a caesarean section
Understand some of the advantages and disadvantages of vaginal delivery and caesarean section
Key concepts:
Normal vaginal delivery

Normal caesarean section
Advantages and disadvantages of vaginal delivery and caesarean section
Process:
Activities
1. Introduction
2. Videos of vaginal delivery and caesarean section delivery
3. Discussion of medical indications for caesarean section delivery
4. Generating a list of the advantages and disadvantages of vaginal delivery vs
caesarean section
5. Statistics for mode of delivery in Australia and comparison with other countries
1. Introduction
Overview of the video being presented.
2. Viewing footage of a vaginal delivery and a caesarean section
View videos and take notes.
3. Indications for having a caesarean section delivery
Discuss the following:

(a) What are the major medical reasons for planning delivery by caesarean section?

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(b) Why would a woman having a vaginal delivery have an emergency caesarean section?
4. List advantages and disadvantages of vaginal delivery and caesarean section

Each student should have developed a partial list based on the articles they read for pre-reading. Work with the
group as a whole to generate 4 lists
1. advantages of vaginal delivery,
2. disadvantages of vaginal delivery,
3. advantages of caesarean section,
4. disadvantages of caesarean section.
Advantages of vaginal delivery
Disadvantages of vaginal delivery
Advantages of caesarean section
Disadvantages of caesarean section

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5. Statistics for mode of delivery in Australia and world wide

AIHW, Hilder, L., Zhichao, Z., Parker, M. Jahan, S. and Chambers, G.M. 2014. Australia's mothers and babies
2012. Perinatal statistics series no. 30. Cat. no. PER 69. Canberra: AIHW.
www.aihw.gov.au/publication-detail/?id=60129550033
i)
Comment on the relative proportions of the different birth methods in Australia in 2012.

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ii)
How have the rates of caesarean section and instrumental deliveries changed over the last 10 years?
iii)
How do maternal age and hospital sector impact on this data?

Page 58

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iv) How do Australian statistics compare with those of other countries?
http://www.oecd-ilibrary.org/sites/health_glance-2011en/04/09/index.html?itemId=/content/chapter/health_glance-2011-37-en
Interested students may like to look at the data tables provided in Gibbons, L. et al. The Global numbers and
costs of additionally needed and unnecessary caesarean sections performed per year: Overuse as a Barrier to
Universal Coverage.World Health Report (2010) Background Paper 30.
http://www.who.int/healthsystems/topics/financing/healthreport/30C-sectioncosts.pdf
In SGS 7, students in Teams 1 and 2 will present an overview of diabetes mellitus to provide a background for
the activity on gestational diabetes. This is an exercise in peer teaching and your peers will benefit from clear
simple explanations of the basic biochemistry and physiology of glycaemic control. Students in Team 3 will act
as an Expert panel to answer questions resulting from the case study which will be studied in SGS7.

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Team 1:
1. Explain how the body normally regulates blood glucose.
2. What happens to this mechanism in diabetes mellitus?
3. Differentiate between Type I and Type II diabetes.
4. What are the causes of Type I and Type II diabetes?
5. What is the incidence of diabetes in Australia?
Most information can be found in standard textbooks, but the following resources may be helpful for some of
the questions.
Diabetes Australia website
http://www.diabetesaustralia.com.au/
McElduff A. (2013). Non-type 1, Non-type 2 diabetes: whats in a name? Australian Prescriber 36:196-8.
http://www.australianprescriber.com/magazine/36/6/196/8
Team 2:
6. How is diabetes diagnosed?
7. Can diabetes be prevented?
8. What are the associated complications or risks of diabetes?
9. Does pre-existing diabetes pose any risk in pregnancy?
Most information can be found in standard textbooks, but the following resources may be helpful for some of
the questions.
RACGP Clinical guidelines for diagnosis of diabetes
http://www.racgp.org.au/your-practice/guidelines/diabetes/3-screening,-risk-assessment,-case-findingand-diagnosis/34-diagnosis-of-diabetes/
DEmden, M. (2014). Glycated haemoglobin for the diagnosis of diabetes. Australian Prescriber 37, 98-100.
http://www.australianprescriber.com/magazine/37/3/article/1507.pdf
Team 3
Students in this team should reseach gestational diabetes by reading the following articles available in Moodle.
In SGS7 they will be expected to form an expert panel and answer questions which will posed by Teams 1 and
2 after reading the relevant case study.
Australasian Diabetes in Pregnancy Society (ADIPS) Consensus Guidelines for the Testing and Diagnosis of
Gestational Diabetes Mellitus in Australia. (Version 2: 3 May 2013)
http://www.adips.org/information-for-health-care-providers-approved.asp
Gestational diabetes: Q and A. MyDr from MIMS
http://www.mydr.com.au/default.asp?article=2456
Diabetes gestational. Better Health Channel
http://www.betterhealth.vic.gov.au/BHCV2/bhcarticles.nsf/pages/Gestational_diabetes?OpenDocument

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Scenario 2: Two New Mothers

Schedule
Learning Activity
Principal Teacher
Scenario Plenary 2: Two New Mothers
Mowat, David
Lecture 24: Introductory Genetics
Waters, Paul
Tutorial 3: Embryology Tutorial
Hill, Mark
Scenario Group Session 7: Consider the 'Two new mothers' scenario; Overview
of DM and Gestational Diabetes
Pather, Nalini
Science Practical 9: How to be critical in a world full of 'evidence'
Thompson, Rachel
Hospital Clinical Skills Session 2: The psychosocial history and examining

lumps/bumps & ulcers
Taylor, Silas
Lecture 25: Screening Basics
Adelstein, Barbara-Ann
Lecture 26: Newborn screening
Wiley, Veronica
Science Practical 10: Histology of the male reproductive tract
Lecture 27: Growth and differentiation of cells
Whitaker, Noel
Lecture 28: The cervix in health and disease
Scenario Group Session 8: Newborn Screening
Lecture 29: Mechanisms of Inheritance
Waters, Paul
Lecture 30: Enzymes, vitamins and cofactors
Le Bard, Rebecca
Lecture 31: Population Genetics
Waters, Paul
Lecture 32: Initiation of labour at term and before term
Gibson, Karen
Science Practical 11: Chromosome analysis and population genetics
Lutze-Mann, Louise
Lecture 33: Prepregnancy counselling and screening: Integrated Prenatal Care
Welsh, Alec
Lecture 34: Prenatal Screening Tests
Welsh, Alec
Campus Clinical Skills Session 3: What it means to the patient
Taylor, Silas
Tutorial 4: QMP Screening Tutorial
Thompson, Rachel
Scenario Group Session 9: Cervical neoplasia-clinical application
Science Practical 12: Embryology: embryo to fetus
Hill, Mark
Lecture 35: Genetic prediction and diagnosis
Chung, Clara
Lecture 36: Folate metabolism
Le Bard, Rebecca
Lecture 37: Infection Screening in Pregnancy
Rawlinson, William
Lecture 38: Cholinergic mechanisms 1
Liu, Lu
Scenario Group Session 10: Two Peas in a Pod?
Gibson, Karen
Lecture 39: Cholinergic Mechanisms 2
Liu, Lu
Lecture 40: Fetal Physiology
Gibson, Karen
Science Practical 13: Autonomic Pharmacology
Liu, Lu
Lecture 41: Adaptation of the newborn to extra-uterine life
Gibson, Karen
Lecture 42: Sexually transmitted diseases
To be confirmed

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Overview
In this scenario the focus is on the later stages of pregnancy and on neonates. It supports the Domain themes:
Conception, pregnancy and birth and Nutrition, growth and body image.
The scenario aims to stimulate interest in the following topics:
Anatomy and physiology of labour, and of fetal and newborn development in term and pre-term
delivery.
Factors influencing maternal and perinatal outcomes.
Development of the respiratory system and relevance to management of preterm infants.
Screening, both antenatal and newborn, including the physiological, genetic and clinical issues.
Communicating ambiguous test results, and issues in giving advice and gaining consent.
The implications of obtaining genetic information on an individual, the family and society.
Description
Two new mothers become friends at antenatal classes. Yasmine is expecting her first baby, who is born preterm. Katrina is expecting her second child and goes on to have a normal pregnancy and full term delivery. The
child undergoes the normal postnatal screens and returns a positive result on the newborn screening test for
cystic fibrosis.

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SGS 7: Consider the Two New Mothers scenario; Overview of Diabetes

Mellitus and Gestational Diabetes
Aims:
The first part of this session explores the issues raised by the scenario.
The aim is to encourage students to contextualise what they are learning in this course by:
thinking about and further exploring the learning issues raised by the scenario
list learning goals that they want to pursue individually or as a group
looking over the scheduled learning activities and assessments to identify how these relate to the scenario
and to their learning goals.
In the latter part of the session, after an initial discussion on diabetes mellitus, a case study of gestational
diabetes will be presented and students will address some of the questions a patient diagnosed with
gestational diabetes might ask.
Key concepts:
The major issues concerning gestational diabetes addressed in this session: definition, causes, risk factors,
diagnosis, long-term prognosis, effects on fetus and infant, treatment.
Process:
Activities
1. Explore plenary, identify key issues and review scheduled learning
activites
2. Discussion on diabetes mellitus
3. Case study on gestational diabetes and generation of questions
4. Panel discussion
1. Explore plenary video, identify key issues and review scheduled learning activities
2. Peer teaching on diabetes mellitus

Most cases of diabetes mellitus fall into three broad categories: Type I, Type 2 and gestational diabetes.
Students are to present an overview of diabetes mellitus focussing on Type I and Type 2 diabetes (homework
from SG6) answering the following questions:
Team 1:
1. Explain how the body normally regulates blood glucose.
2.
What happens to this mechanism in diabetes mellitus?

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3.
Differentiate between Type 1 and Type 2 diabetes.
4.
What are the causes of Type 1 and Type 2 diabetes?
5.
What is the incidence of diabetes in Australia?
Team 2:
6. How is diabetes diagnosed?
7.
Can diabetes be prevented?
8.
What are the associated complications or risks of diabetes?

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9.
Does pre-existing diabetes pose any risk in pregnancy?
3. Case study and generation of questions on gestational diabetes

CASE STUDY
A 34-year-old Australian Aboriginal woman who is in her second pregnancy and has had one live birth and no
abortions is seen for prenatal care at 24 weeks gestation. Her height is 1.7m and her weight is 98kg (prepregnancy weight was 89kg). Her blood pressure is 130/80 mmHg. Uterine size is appropriate for gestational
age. The patient's past obstetric history includes the spontaneous vaginal delivery of a 4.3kg male infant at 40
weeks gestation, 8 years ago. The patient reports that the child is doing well. Her family history reveals that her
mother has type 2 diabetes mellitus.
Because of her history this patient is at high risk for gestational diabetes. She was provided instructions to
prepare for an oral glucose tolerance test (OGTT) which was booked for 4 days time. After a check of her
compliance with the preparation for test, the glucose tolerance test results were reviewed and showed a
fasting glucose of 6.1 mmol/l and a 2 hour value of 9.4 mmol/l. Gestational diabetes was diagnosed.
CASE STUDY OUTCOME
The patient was taught home glucose monitoring the next day and instructed in healthy eating and gentle
exercise regimens. The recommendations included eating 3 meals and 3 snacks per day that each included
some low glycaemic index carbohydrate. When reviewed 1 week later, well over 20% of her glucose values
were above target even though she had been strict with her diet and exercise regimen. Because of this she was
commenced on insulin therapy. The targets for both the diet therapy and the subsequent insulin therapy were
a fasting value of <5.0 mmol/l and <6.7 mmol/l at 2 hours after eating. Because insulin resistance and hence
insulin requirements steadily increase in the second trimester, her insulin levels were increased each week by
about 10% in anticipation of the glucose rises. With this regimen she rarely recorded a glucose value out of
range, except when she ate out. At 34 weeks gestation when insulin requirements are known to plateau she
ceased having insulin levels increased.
At 28 weeks, the patient was instructed in daily fetal movement counting to assess fetal well-being, and at 32
weeks gestation fetal heart rate testing with non-stress tests was begun twice weekly. An ultrasound
examination at 37 weeks revealed the fetus to be growing normally with an estimated weight of 3.2kg. At 39
weeks, the patient started spontaneous labour and underwent the vaginal delivery of a 3.7kg boy. The infant
was evaluated for but did not demonstrate hypoglycemia or any other problems.
Six weeks after delivery, the patient returned to the clinic for an evaluation of her glucose tolerance. Her
fasting plasma glucose was 7.1mmol/l. She returned the next day, and a repeat fasting plasma glucose was
7.3mmol/l. Given these findings, the diagnosis of diabetes mellitus was made, and a 75-g OGTT test was not
needed.
4. Panel discussion
Students in Team 3 should form an expert panel providing answers drawn from their homework readings for
the questions posed by the patient teams (Teams 1 and 2).

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Research tasks
TASK 1. Research on newborn screening
Group 1. phenylketonuria (PKU)
Group 2. congenital hypothyroidism (CH)
Group 3. galactosaemia
Each group should research the following information and fill out their column in the blank table (available in
SGS 8):
incidence
number per year in NSW
carrier frequency
genetic basis
disease mechanism
clinical effects
what is measured in the initial newborn screen? (the method used eg tandem mass spectrometry is not
necessary)
the sensitivity of the newborn screen
intervention available
outcome of the condition (following intervention).
The Sydney Childrens Hospital Network website is a recommended resource
http://www.schn.health.nsw.gov.au/health-professionals/statewide-laboratory-services/nsw-newbornscreening-programme/disorders-we-test
Click on the disorder of interest.
TASK 2. All students.
Research on cystic fibrosis
We will also be looking at cystic fibrosis in a little more depth in SGS 8. Students should read the following as
preparation for this exercise.
The Sydney Childrens Hospital Network website
http://www.schn.health.nsw.gov.au/health-professionals/statewide-laboratory-services/nsw-newbornscreening-programme/disorders-we-test
Click on Cystic fibrosis.
NSW Newborn Screening Programme, Information for parents/Carers for Cystic Fibrosis
http://www.schn.health.nsw.gov.au/files/attachments/cystic_fibrosis.pdf
Ciske, D. et al. (2001). Genetic counselling and neonatal screening for cystic fibrosis: an assessment of the
communication process. Pediatrics, 107 (4), 699-705.
http://pediatrics.aappublications.org/content/107/4/699
This background reading should help students to address most of the following questions and to start to think
about how test results might be communicated to parents.
1.
2.
3.
4.
5.
6.
What causes cystic fibrosis?

How common is the condition?
Which populations are more prone to getting cystic fibrosis?
What are the main clinical features of cystic fibrosis?
What tests are carried out on the Guthrie card blood to screen for and diagnose cystic fibrosis?
How is the sweat test performed? What does this test measure and why does it increase in cystic fibrosis?
For interested students, the following chapter provides more detailed information about this condition
Boucher R.C. (2012). Chapter 259. Cystic Fibrosis. In D.L. Longo, A.S. Fauci, D.L. Kasper, S.L. Hauser, J.L.
Jameson, J. Loscalzo (Eds), Harrison's Principles of Internal Medicine, 18e. Retrieved April 30, 2013 from
http://er.library.unsw.edu.au/er/cgibin/eraccess.cgi?url=http://www.accessmedicine.com/content.aspx?aid=9128393

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SGS 8: Newborn screening

Aims:
To look at newborn screening as an example of population screening and gain an overview of four
conditions that are currently screened for.
To work through a flow chart for cystic fibrosis screening in order to examine screening issues and the
implications of genetic information.
Key concepts:
The implications of a screening test on a population, health resources, the implication of genetic
information for the baby and his or her parents.
Screening tests for phenylketonuria, congenital hypothyroidism, galactosaemia and cystic fibrosis and
some features of these conditions.
Screening criteria what makes a condition worth screening for?
Process:
Activity
1. Collation of newborn screening research
2. Cystic fibrosis questions
3. Screening worksheet
4. Summary of session
1. Collation of newborn screening research

This exercise is aimed to encourage students to think about why newborns might be screened. (How severe is
the disease? What are the consequences if not detected early? Are suitable tests available? Suitable
treatments? etc.)
Newborn Screening Table
PKU
Incidence
No. per year NSW
Carrier frequency
Genetic basis
Disease mechanism

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CH
Galactosaemia
PKU
CH
Galactosaemia
Clinical effects
What is measured
in the initial
Newborn Screen?
Sensitivity
Intervention
Outcome
2. Cystic fibrosis questions

1.
What causes cystic fibrosis?
2.
How common is the condition?
3.
Which populations are more prone to getting cystic fibrosis?
4.
What are the main clinical features of cystic fibrosis?

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5.
What tests are carried out on the Guthrie card blood to screen for and diagnose cystic fibrosis?
6.
How is the sweat test performed? What does this test measure and why does it increase in cystic
fibrosis?
3. Screening worksheet
What is baby Callums risk of having cystic fibrosis?
You are Katrinas GP. Katrina telephones you stating that the hospital has contacted her and asked her to
bring baby Callum in for a sweat test. The hospital stated that he may have cystic fibrosis. She is very
concerned wants to know how likely is it that Callum has cystic fibrosis.
Questions:
1. What is the best study design to determine the accuracy of a test?
2. What is the best study design to evaluate a screening program?
3. The table below compares the test to a gold standard. Fill the appropriate boxes with the following: True
positive (TP), True negative (TN), False positive (FP), and False negative (FN)
Gold Standard
Disease
Yes
Diagnostic Test
Positive
Negative
TOTAL

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No
TOTAL
4. How do you calculate the positive predictive value of the test (PPV)? How do you interpret the PPV?
5. How do you calculate the negative predictive value of the test (NPV)? How do you interpret the NPV?
6. How do you calculate the sensitivity of the test? How do you interpret the sensitivity? How do you
calculate FN rate? How do you interpret FN rate?
7. How do you calculate the specificity of the test? How do you interpret the specificity? How do you
calculate FP rate? How do you interpret FP rate?
8. Using the information given below complete the following table.

1. The number of births in NSW/ACT is 100,000 per year
2. The incidence of CF is 1 in 2500
3. CF newborn screening misses 4 cases of CF per year
4. CF newborn screening detects 48 false positive cases per year
Gold Standard
Cystic fibrosis (CF)
Yes
No
CF newborn
screening
IRT/DNA test
TOTAL
Positive
Negative
TOTAL

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9. Using the information given in the table above calculate the following for the CF newborn screening test
(IRT/DNA) and provide an explanation of what your findings mean:
a)
Positive predictive value (PPV)
b) Negative predictive value (NPV)
c)
Sensitivity and FN rate
d) Specificity and FP rate
10. As Katrinas GP what advice would you give her regarding baby Callums risk of CF?
4. Summary of session
Students are to bring lecture notes from The Cervix in Health and Disease
All student are to view and read the following prior to SGS 9
Melbourne Sexual Health Centre, Taking a PAP test (video).
http://mshc.org.au/HealthProfessional/OnlineEducation/MSHCClinicalVideos/TakingaPAPtest/tabid/541/D
efault.aspx#.VTlRcULNZE4
Douglass Hanly Moir, Recommendations for changes to cervical screening in 2017
http://www.dhm.com.au/media/21965083/nationalcervicalscreeningprogramrenewal_gynaepath_a4_mar
2015_web.pdf
Cancer Council Australia, National Cancer Prevention Policy: Cervical Cancer Screening
http://wiki.cancer.org.au/policy/Cervical_cancer/Screening.

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Page 73
SGS 9: Cervical neoplasia-clinical application

Aims
To develop an understanding of the aetiology and pathogenesis of cervical neoplasia

To apply this understanding to a clinical problem
Key concepts
National Cervical Screening Program

Human Papilloma Virus
The PAP test (smear)
Transformation zone
Low and high grade squamous intraepithelial lesions (LSIL and HSIL)
Colposcopy and biopsy
Cervical intraepithelial neoplasia (CIN1,2 and 3)
Cervical carcinoma
Process
Activities
1. Introduction & clinical problem
2. Patient assessment and management
3. Social and cultural issues
4. Teamwork Transformers
5. Effective communication & ethical & legal
6. Reflection - identify take home messages
1. Introduction & clinical problem (ppt)
This SGS will deal with HPV infection, cervical screening, cervical cytology and squamous intraepithelial lesions
(LSIL and HSIL), cervical histology and cervical intraepithelial neoplasia (CIN 1,2 & 3) and cervical carcinoma. It
begins by discussing a clinical problem.
Clinical problem: Michelle, a 38 year old Aboriginal woman presents with post-coital (after sexual
intercourse) vaginal bleeding (PCB). Her last pap smear was 6 years ago which was normal.
2. Patient assessment and management (ppt)
As a group discuss possible answers to the questions below.
a. List possible causes for her post-coital bleeding (PCB)
b. What investigations would you perform?

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Causes of PCB
Importance
Investigations
3. Social and cultural (ppt)

As a group discuss possible answers to the questions below. Students who have just submitted assignment 4
Changes to cervical screening can lead this discussion):
a.
How often should women have Pap tests?
b. Should women who have never had sexual intercourse have Pap tests?
c.
What percentage of women participate in cervical screening?
d. If Michelles pap smear showed FIG 1 (ppt) what action should be taken?
e.
If Michelles pap smear showed FIG 2 (ppt) what action should be taken?
f. Michelles pap smear showed HSIL. She saw a gynaecologist who performed colposcopy and took a
biopsy. What does her biopsy show (FIG 3)?
g. What barriers may have prevented Michelle from having pap smears? What strategies may overcome
these barriers?

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Barriers
Strategies
Patient
GP
Economic
Access
Cultural
h. What are the proposed changes to cervical screening in 2017? How might these changes help over
come the barriers?
4. Teamwork Transformers
Students will be divided into 2 teams Team 2 MUST have 7 STUDENTS. Assign a leader for Team 2.

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5. Effective communication/ethical and legal

Students to read the following article available on Moodle under Learning materials for SGS 9.
The Telegraph 24/12/2010 Cancer sufferer sues hospital over missed diagnosis (online)
http://www.telegraph.co.uk/health/healthnews/7756681/Cancer-sufferer-sues-hospital-over-misseddiagnosis.html
Discuss the following
a. How accurate are pap smears?
b. Do you think this woman would be suing if she had been informed an error had been made?
c.
Who is responsible for this error?
6. Reflection

Students are to pre read the following article on Moodle:
Van Jaarsveld, C.H.M., Llewellyn, C.H. et al (2012). Are my twins identical: parent may be misinformed by
prenatal scan observations? BJOG 119: 517-518

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SGS 10: Two Peas in a Pod?

Aims:
This session sees students working through a clinical problem, using their knowledge of reproductive
physiology and biochemistry.
Process:
Activities
1. Two Peas in a Pod?
a) Case
b) Video The Stuart Twins (at least Part 2)
2. Preparation for SGS 11 and TIQ session
1. Two Peas in a Pod?

Reminder project presentations
Time has been set aside in SGS11 for presentation of projects (and assignments if students wish to do this).
Recommended timing for presentations: 15 minutes presentation; 5 minutes questions/feedback
Generic criteria for giving feedback on oral presentations
Students should allocate an F, P-, P or P+ for each of the following criteria, with justification.
Explanation of project Project aim, methods and findings were clearly explained; findings are based on
the evidence available; methodology is appropriate and adequate for the task.
Presentation Oral presentation was clear, well structured and easily understood; Timing was controlled
so that most aspects were covered; Audio visual aids or handouts were clear, well structured and easy to
read.
Understanding Project team appeared to have a good understanding of the topic; able to answer
audience questions.
Stimulating learning Presentation was interesting; significant issues and unanswered questions were
highlighted; the audience should be able to learn a lot from this presentation and be stimulated to find out
more about the topic.

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Scenario 3: Infertility
Schedule
Learning Activity
Principal Teacher
Scenario Plenary 3: Infertility
Chapman, Michael
Lecture 43: Many fertilized eggs do not lead to a baby
Chapman, Michael
Science Practical 14: Fetal membranes and placenta
Hill, Mark
Hospital Clinical Skills Session 3: Eliciting a full medical history and

summarising
Taylor, Silas
Lecture 44: Microbiology of Pelvic Inflammatory Disease (PID)
To be confirmed
Lecture 45: Maternal and Perinatal mortality
Welsh, Alec
Scenario Group Session 11: Consider the 'Infertility' scenario; Project

Presentations
Lecture 46: Adrenergic Mechanisms 1
Finch, Angela
Lecture 47: Adrenergic Mechanisms 2
Finch, Angela
Science Practical 15: Organisms in PID
Mitchell, Hazel
Science Practical 16: Phenylketonuria - PKU
Lutze-Mann, Louise
Lecture 48: Chronic inflammation
Kumar, Rakesh
Lecture 49: Ethics: human rights
Torda, Adrienne
Tutorial 5: Ethics 2: Is termination of pregancy a right?
Torda, Adrienne
Scenario Group Session 12: Autonomic pharmacology
Liu, Lu
Science Practical 17: Healing and Chronic Inflammation
Velan, Gary & Kumar,

Rakesh
Lecture 50: TIQ 1 - Cervical neoplasia-clinical application
Lecture 51: TIQ 2 - PID and its complications-clinical application
Lecture 52: Male sexuality
Lowy, Michael
Lecture 53: Female Sexuality
King, Rosie
Scenario Group Session 13: Pelvic inflammatory disease &its complicationsclinical application
Lecture 54: Fertility and Fecundity
Sacks, Gavin
Lecture 55: Reproductive Pharmacology
Finch, Angela
Lecture 56: An Infertile Couple
Sacks, Gavin

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Overview
This scenario focuses on a couple who have been so far unsuccessful in conceiving a child. They are seen
discussing the issues with their GP and undergoing a series of tests.
The scenario supports the course themes of 'conception, pregnancy and birth, and it aims to stimulate interest
in a range of topics including:
Anatomy and histology of the cervix.
Molecular, cellular and microbiological causes of infertility.
Counselling and screening.
The psychological impact of infertility on women and on couples.
Description
38 year old Nadia migrated to Australia 2 years ago. She has recently married Bruce, and has been trying to get
pregnant (unsuccessfully) for the last 12 months. She has a history of pelvic inflammatory disease in her late
teens and had an ectopic pregnancy while in Romania. Nadia had a pap-smear 5 years ago consistent with CIN2
changes and this was followed by a biopsy and treatment. Subsequent pap-smears have been normal. She and
Bruce are referred to a fertility clinic.

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SGS 11: Considering the Infertility scenario; Project Presentations

Aims:
This session will begin with an exploration of the issues raised in the Infertility scenario. The aim is to
encourage students to:
think about and explore the issues raised by the scenario
list learning goals that they want to pursue individually or as a group
look over the scheduled learning activities and assessments to identify how these relate to the
scenario and to their learning goals.
The remainder of the session is devoted to Project Presentations.
Process:
Activities
2. Project Presentations; feedback and discussion
3. Preparation for SG12
2. Project Presentations s
3. Preparation for SG12

Prior to SGS 12 students need to complete The Hexamethonium Man which can be found on Moodle.
Students are to bring their lecture notes on Cholinergics 1 & 2 and Adrenergics 1& 2 to SG12.

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SGS 12: Autonomic pharmacology

Aims:
The aim of this session is for students to:
understand the structure of the autonomic nervous system;
study some of the chemical mediators of the autonomic nervous system;
identify and classify receptors in cholinergic and adrenergic transmission;
understand the effects on effector organs;
help students to apply this knowledge to relevant cases.
The autonomic nervous system innervates the heart, blood vessels, glands and many other visceral organs that
contain smooth muscle. Studies on the autonomic nervous system have resulted in the classification of its
receptors and many major types of drug action. In this session students will work through a number of cases
involving drugs that affect or have side effects mediated by the autonomic nervous system. Students have had
4 lectures on autonomic pharmacology.
Key concepts:
Autonomic nervous system, muscarinic, nicotinic and adrenergic receptors, effect of blockade/stimulation of
these receptors, agonist, antagonist.
Process:
Activity
1. Autonomic pharmacology questions and answers
1. Autonomic pharmacology questions and answers
Student should bring their microbiology lecture notes to SGS 13. Students should also view the following video.
Melbourne Sexual Health Centre, Laboratory diagnosis of Sexually Transmissible Infections
http://mshc.org.au/HealthProfessional/OnlineEducation/MSHCClinicalVideos/LaboratoryDiagnosisofSTIs/t
abid/390/Default.aspx#.VTlqeULNZE4
Autonomic Pharmacology Questions and answers
Cholinergic Questions
Case 1
A 45 year old woman is brought to the hospital due to increasing muscle weakness, and severe urinary and
faecal incontinence.
On examination: The patient is drooling, diaphoretic and her pupils are constricted. She is dyspnoeic and has
difficulty in carrying out a conversation. Bilateral lung wheezes are heard on auscultation. Her heart rate is slow
but maintains a regular rhythm.
Vital signs are as shown below.
On review of her medical history you learn that the patient suffers from myasthenia gravis and is being treated
with neostigmine.
Vital Signs
Heart rate
Blood pressure
Respiratory rate
50 beats/min
130/88 mm Hg
24 breaths/min
Temperature
Pupil diameter
Pupillary light reflex
37 C
2 mm
Absent

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Bradycardia (normal in adults is 6080)

Normal
Rapid (normal resting rate 12-20)
Normal
Constricted (under normal conditions, the pupil dilates in
the dark and constricts in light. When constricted, pupillary
diameter is about 3-4 mm, and the dark-adapted pupil can
vary from 5 to 9 mm.)
Terminology:
Incontinence: involuntary loss of urine (urinary incontinence) or stool (faecal incontinence).
Drooling (salivary incontinence): saliva flows outside the mouth due to excess production of saliva
Diaphoretic: profuse sweating
Dyspnoeic: laboured or difficult breathing
A. What is myasthenia gravis?
B. What is neostigmine? What is its mechanism of action in the treatment of myasthenia gravis?
C. The patient has a neostigmine overdose. Explain each of the signs and symptoms presented by the
patient. In your discussion be sure to explain the structure of the cholinergic nervous system and what
normally happens in each tissue and what type of receptors are involved.

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D. How do you manage this patient?
Case 2
An 8 year old boy presents to the hospital with somnolence, slurred speech, and combative behaviour. He tells
you that he has eaten some small seeds he collected from the garden. On examination: His skin is warm and
dry, and his mucous membranes are dry. His pupils are dilated and not reactive. He is running a high
temperature and has a rapid heart beat.
Vital signs are as shown below.
Vital Signs
Heart rate
Blood pressure
Respiratory Rate
Temperature
Pupil diameter
Pupillary reflex
140 beats/min
100/60 mmHg
22 breaths/min
39 C
9 mm
Absent
Tachycardia (normal in children under 10 is 70-120)

Normal
Slightly rapid
Fever
Dilated
A. What is your provisional diagnosis?
B. What receptors are implicated in each of the symptoms presented by this boy? In your discussion be
sure to explain the underlying mechanisms.
C. How do you manage this patient?

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Case 3
Julie is a 45 year old woman who is obese (body mass index (BMI) of 35) and has type II diabetes. She comes to
see you, her GP, following an overnight fast as she is going to have her blood glucose levels checked. During
her consultation she tells you that she is having trouble sleeping and feels like her heart is racing. She also tells
you that she is taking a Chinese herbal medicine called ma huang to help her lose weight. She has been taking
two capsules twice a day (twice the recommended dosage). Each capsule contains approximately 25 mg of
ephedrine. You check her vitals (noted below)
Vital Signs
Heart rate
Blood pressure
Blood glucose
Pupil diameter
100 beats/min
150/95 mmHg
8.3 mmol/L
8 mm and do not respond
to increases of ambient
illumination
Tachycardia (normal in adults is 6080)

Hypertensive
Hyperglycaemic (normal fasting 3.5-6 mmol/L).
Dilated. Under normal conditions, the pupil gets wider
in the dark and narrower in light. When narrow, the
diameter is about 3-4 mm, and the dark-adapted pupil
can vary from 5 to 9 mm.
A. Describe the mechanism of action of ephedrine (a diagram may be used).
B. Which of the changes induced by ephedrine may aid in weight loss?
C. The activation of which receptors could account for each of Julies adverse reactions (insomnia,
hypertension, tachycardia, hyperglycaemia and pupil dilation)? In your discussion be sure to explain
the underlying mechanisms of action in each tissue/organ. Include in your answer the adrenoceptor
subtype that is mediating each side effect.

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Case 4
George is a 75 year old male. When he was in his early fifties his GP regularly monitored his blood pressure as it
had been elevated for some time. He tried to lose weight and exercise to reduce his cardiovascular risks,
however his blood pressure was still elevated so his GP prescribed a -blocker (-adrenoceptor antagonist).
Georges blood pressure has been well controlled by the -blocker medication over the past 20 years. George
has mild asthma that is triggered when he exercises.
Vital Signs
Heart rate
Blood pressure
Respiratory rate
Temperature
70 beats/min
130/88 mmHg
15 breaths/min
37 C
Normal (adults is 6080 bpm)

Normotensive
Normal
Normal
A.
Describe the mechanism by which a adrenergic antagonist will lower blood pressure.
B.
How will the -blocker affect Georges heart rate at rest and when he exercises?
C. Which -adrenergic antagonist, metoprolol or propranolol, would be the best treatment for
Georges hypertension? Provide a reason for your choice.
D.
What side effects might George experience from taking the -adrenergic antagonist you chose
above?

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SGS 13: Pelvic inflammatory disease and its complications

Aims
To provide an understanding of pelvic inflammatory disease and its complications

To provide an opportunity for feedback to the course designers and to the facilitator.
Key concepts:
Chronic inflammation, pelvic inflammatory disease, Neisseria gonorrhoeae, Chlamydia trachomatas, ectopic
pregnancy, addressing learning issues from scenario and course.
Process
Activities
1. PID-The play
2. Diagnosis of common infections and STIs
3. Quiz ppt
4. Evaluation
1. PID The play
2.
Diagnosis of common infections and STIs
2a. Complete the tables below.

VAGINA: Infectious vulvovaginitis
Candidiasis
Bacterial vaginosis
Trichomoniasis
Organisms
Pathophysiology
Discharge
Other
Signs and symptoms
pH
Saline wetmount

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CERVIX AND EXTERNAL GENITALIA

Organism/
morphology
Signs and symptoms
Investigations
Prevention
Gonococcal
urethritis/cervicitis
Non-gonococcal
urethritis/cervicitis
HPV
Genital herpes
Infectious syphilis
2b. What is the difference between endometritis and endometriosis?
3. Quiz ppt
4. Evaluation
Students are to complete facilitator (Form C) CATEI evaluation forms. Thank you!!
Instructions for students:
1. Log into myUNSW (https://my.unsw.edu.au/ ) or Google myUNSW
2. Click on the CATEI icon (top left hand corner)
3. Select Evaluate Tutor
4. Select Choose and select the correct SG Facilitator and SG time
5. Complete the evaluation form and submit.
TIP: For iPhone users, turn the phone to landscape to see the form more easily.
Thank you for your feedback in BGD A 2015! We wish you all the very best for your future careers!

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Assessment
Assessment overview
Assessment in this course involves an assignment, a group project, a course examination and attendance
requirements.
You must complete one group project and one assignment from the set list. Successful completion of the
assignment and project work is necessary before your exam results will be released.
You are reminded that questions relating to the tutorials and scenario group sessions may be included in the
end-of-course examination.
Refer to the Phase 1 guide and Medicine Program website for information on the format of the end-of-course
examination and for detailed progression rules.
A formative online assessment will also be available.
While your final result for the course will largely be determined by your performance in the end-of-course
examination, the assignment and project work is also an important component of the assessment for the
course. The graded assignments and projects will form part of the portfolio examination at the end of your
second year, where they will be used as evidence of your achievement in each of the capabilities.
Attendance
You are expected to attend all classes and it is to your advantage to do so.
Although 100% attendance is normally expected, to allow for illness or misadventure minimum attendance
requirements of 80% have been set for activities in this course. Therefore students must:
attend at least 80% of scenario group sessions; AND
attend at least 80% of hospital and campus clinical skills sessions and ethics tutorials; AND
attend at least 80% of science practical classes.
Tutors will keep attendance records in scenario group sessions, hospital clinical skills sessions, campus clinical
skills sessions, ethics tutorials and science practical classes.
If you fail to comply with the above attendance requirements, the Faculty has the right to refuse to allow you
to sit the end-of-course examination. As a result, an Unsatisfactory Fail (UF) will be recorded as your result for
the course.
All applications for exemption from attendance at forthcoming classes of any kind must be made as outlined in
the Faculty policy on extra-curricular activities affecting attendance in MBBS and BMed/MD Program.
(http://med.unsw.edu.au/sites/default/files/_local_upload/others/Extra-curriculActivitiesPolicy2013.pdf)
In the case of illness or of absence for some other unavoidable cause, you may be excused by the Registrar for
non-attendance at classes for a period of not more than one month or, on the recommendation of the Dean,
for a longer period.
Where required, explanations of absences from classes should be delivered to the Medicine Education and
Student Office and include medical certificates, where applicable. Medical certificates should NOT be given to
teaching staff.
It is your responsibility to frequently check your official student email account and the timetable for assigned
classes and any changes. Ignorance of classes, which are scheduled in the timetable, is not an acceptable
excuse for non-attendance.

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You can only attend classes to which you are allocated. You may not attend practicals or other classes at
different times to your timetable. Tutors may ask you to leave if you are not in your allocated class.
You are expected to be punctual in attendance at all classes.
Academic honesty and plagiarism

Students should be familiar with the UNSW Student Conduct Policy and the policies relating to code of conduct
particularly relating to academic misconduct and plagiarism
https://student.unsw.edu.au/conduct
The Faculty of Medicine regards the maintenance of academic integrity by staff and students as a matter of the
highest priority. The Faculty participates in the Universitys use of the similarity detection software Turnitin.
Students work submitted to the eMed Portfolio system will be compared to other items in the eMed system, to
material on the Internet, electronic publications and to items in the Turnitin database.
You can check your own assignments and projects against Turnitin before you submit it to eMed Portfolio by
using the link in the Moodle module for this course located under Assessment Activities.
The Learning Centre website is main repository for resources for staff and students on plagiarism and academic
honesty. These resources are located at: http://www.student.unsw.edu.au/plagiarism
Assignments and projects offered in BGD A 2015

There is a discussion board open for each assignment and project in Moodle.
Assignments
Title
A1
Growing a heart
A2
Male Contraception
A3
Should Australian babies have the Guthrie

Heel Prick Test to screen for Congenital
Primary Hypothyroidism?
Changes to cervical screening in Australia HPV DNA testing versus Pap test
A4
Focus Capabilities
Using Basic and Clinical Sciences
Patient Assessment and Management
Social and Cultural Aspects of Health and Disease

Self-directed Learning and Critical Evaluation
Focus Capabilities
Ethics and Legal Responsibilities
Self-Directed Learning and Critical Evaluation
Teamwork

Teamwork
Projects
P1
P2
P3
P4
Title
Ethics of in vitro fertilisation (IVF)
Understanding the Teenage Pregnancy
Scenario
Female Infertility
PID - The Play
(Quota 8 groups, only one per Scenario
Group)
Please note that project groups will be expected to report to their scenario group in scenario group session 11,
and that all members of the group will be expected to answer questions from the group and the facilitator on
the presentation.
Capabilities
Please refer to the 2015 Program Guide for details about generic capabilities.

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Word count
The word count for assignments and projects includes all the text in the report, apart from the cover page and
the reference list. Assignments are up to 2000 words and projects up to 2500 words, unless there is an explicit
exception for any individual assignment or project.
You should format your report in accordance with the specification on the Medicine program website, and
include a word count. Ensure that you carefully reference your written work using the UNSW Medicine
referencing style (APA). (http://web.med.unsw.edu.au/infoskills/apa/apa.html)
Please refer to the Medicine program website for penalties that will be applied to reports that exceed the
maximum length:
http://medprogram.med.unsw.edu.au/assignments-and-projects-phase-1#tab-303400342
Asking for help
Each assignment and project has a discussion board on Moodle, please post any questions you may have here.
Think before you post! With a little extra thought, can you answer this question yourself or by discussing it with
your colleagues? For all general questions related to assignments and projects such as word limits, report
requirements and submissions, please contact Dr Karen Gibson (k.gibson@unsw.edu.au) or Dr Nicole Marden
(n.marden@unsw.edu.au).
Compulsory registration of assignment and project choice
th
Students wishing to complete Project 4 should register their choice by 4 pm Friday, 8 May, 2015 (Week 1). As
this project has a quota, you will receive an email to notify you whether you may proceed with this choice. All
projects and assignment choices except Project 4 must be registered via eMed Registrations (MyPreferences
th
submenu) by 4pm, Friday 15 May, 2015 (Week 2). You are encouraged to choose your assignment early and
begin work on this in Week 1.
Registration of assignments and projects is compulsory. Your assessment task may not be marked if you have
failed to register it and you may be given a maximum grade of P- for your generic Self Direction and Critical
Evaluation capability.
Only one student from your project group should register in eMed on behalf of the group. While you need to
finalise the composition of your group by the end of week 2, the formal declaration of group membership only
occurs at the time of group submission into eMed Portfolio.
Due dates for submission of project reports and assignments
Submission of Assignments
9am, Monday 1 June 2015
Submission of Project reports and any supporting evidence
9am, Monday 15 June 2015
Submission to eMed
Information on submitting assessments to eMed is available at:
https://medprogram.med.unsw.edu.au/emed-portfolio
Please refer to the Medicine Program website for penalties that you will incur if you submit after the due dates.
https://medprogram.med.unsw.edu.au/penalties
If there are extenuating circumstances that prevent you from meeting the due date for submission, contact the
course convenor before the due date to request an extension. In most cases a medical certificate or a similar
level of documentation will be required. Since assignments and projects are due on Monday at 9 am, requests
for extensions should be submitted by 3 pm on the previous Friday. An exception may be made for an incident
or misadventure during that weekend. Students experiencing ongoing issues must apply earlier.

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Assignment 1: Growing a heart

Graduate Capabilities assessed in this assignment
The report will also be assessed for each of the generic capabilities (effective communication, self direction and
critical evaluation and development as a reflective practitioner).
Aims
The cardiovascular system is the first functioning system in the embryonic period of development. This
assignment will facilitate an understanding of the critical time points in the development of the cardiovascular
system. You will also gain an appreciation for the formation of the four chambered heart and associated septal
abnormalities.
Course themes and related learning activities
This assignment relates to the course theme: Conception, pregnancy and birth.
Task description
1. The assignment requires that you research the development of the cardiovascular system and thereafter
prepare a report on cardiovascular development which should include:
a. a timeline for the development of the cardiovascular system
b. a description of how a four chambered heart forms from the right and left heart tubes
c. an overview of septal defects, clearly showing where relevant, their location in the septum
2.
Then, using what you have learnt above:

a. describe the Tetralogy of Fallot (include its incidence, anatomic abnormalities and
pathophysiology)
b. discuss the assessment and management of a patient with a Tetralogy of Fallot.
Time allocation guide

Week 1 and 2
Research development of the cardiovascular system
Week 3
Research congenital abnormalities of the cardiovascular system including Tetralogy of Fallot.
Week 4
Research the assessment and management of a patient with Tetralogy of Fallot. Draft report.
Week 5
Submit the final report to eMed with no track changes.
Report requirements
The report should be a maximum of 2000 words. Include a reflective component.
include a word count on the title page (refer to word count guidelines see link below).
Ensure that you carefully reference your work. Please refer to the Medicine program website for penalties that
will be applied to reports that exceed the maximum length.
Assessment criteria
For a P grade, the written report should meet the following criteria:
Focus Capability 1: Using Basic and Clinical Sciences
Clearly describes the process of cardiac septation (1.1.1Explains mechanisms that maintain a state of
health)
Demonstrates an understanding of septal defects and its consequences (1.1.2 Recognises health
problems and relates normal structure and function to abnormalities)
Demonstrates an understanding of the complexity of a Tetralogy of Fallot (1.1.3 Describes the pathophysiological process of health problems and can explain their basis at the whole person, organ
system, cellular and molecular levels.)

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Focus Capability 2: Patient Assessment and Management

Demonstrates an understanding of the definitive diagnosis and management options of a patient with
Tetralogy of Fallot. (1.3.8 Applies clinical reasoning relevant health scenarios, including the identification
of key features and clinical patterns. 1.3.9 Articulates a general strategy of management).
In addition to the focus capabilities listed above, the generic capabilities (Effective communication, Self
direction and critical evaluation and Reflection) will be assessed using the generic criteria for assignments listed
in the Program guide.
References
1. Online Resources
UNSW Embryology Homepage: http://embryology.med.unsw.edu.au/
UNSW Cardiac Embryology Homepage:
http://php.med.unsw.edu.au/embryology/index.php?title=Cardiac_Embryology
Emedicinehealth - http://www.emedicinehealth.com/tetralogy_of_fallot/article_em.htm
American Heart organisation - http://www.americanheart.org/presenter.jhtml?identifier=11071
NIH Heart Lung and Blood institute - http://www.nhlbi.nih.gov/health/dci/Diseases/tof/tof_what.html
Development - http://dev.biologists.org/
Developmental Dynamics - http://www3.interscience.wiley.com/cgibin/jhome/38417
Birth Defects Research Part A: Clinical and Molecular Teratology
http://www3.interscience.wiley.com/cgi-bin/jhome/102526943
Birth Defects Research Part B: Developmental and Reproductive Toxicology http://www3.interscience.wiley.com/cgi-bin/jhome/102527215
2. Textbooks
Moore, K.L., Persuad, T.V.N., Torchia & M.G. (2013). The Developing Human: clinically oriented embryology
(9th ed.). Philadelphia: Saunders.
th
Schoenwolf, G.C., Bleyl, S., Brauer, P., and Francis-West, P. (2014) Larsens Human Embryology. (5 ed.).
Churchil Livingston.
Sadler, T.W. (2014) Langman's Medical Embryology. (13th ed.).Wolters Kluwer.
Contact:
A discussion regarding this assignment is available through Moodle.

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Assignment 2: Male Contraception

Graduate capabilities assessed in this project
The report will also be assessed for each of the generic capabilities for assignment (Effective Communication,
Self-directed Learning and Critical Evaluation, and Reflection).
Aims
High rates of contraceptive discontinuation or noncompliance are responsible for about 50% of unintended
pregnancies. Currently available birth control methods for men are vasectomy and condoms, both of which
have disadvantages. Although vasectomy is effective, it is a permanent and largely irreversible method. As
many as 84% of couples do not like to use condoms due to various reasons. Clearly, reversible and reliable
long-term male contraceptive methods which can be simply administered would meet a big need for many
men and women. The aims of this assignment are:
1. to develop a better understanding of how male hormonal contraceptives work
2. to explore the main hurdles in the development of male contraceptives
3. to gain a better appreciation of the importance of medication compliance
This assignment relates to the Beginnings Growth and Development course themes:
Conception, pregnancy and birth and
Puberty, adolescence, sexuality and relationships.
Task description
1.
2.
3.
4.
Describe the male reproductive system and how it is regulated hormonally. Discuss the basis for a
hormonal approach to male contraception from a pharmacological perspective.
Male contraceptives have been developed for a few decades, and none is available to date. Identify the
main hurdles in the development of male contraceptives; why it is so close yet so far from being attainable.
Review the routes of administration of male hormonal contraceptives and identify the most convenient
way for contraceptive administration which may result in better compliance.
Discontinuation and noncompliance account for a high rate of unintended pregnancy, which causes health,
social, and financial problems and many other negative impacts. Develop strategies for improving
contraceptive compliance in general.
Time allocation guide:

Weeks 1 & 2
Weeks 3
Week 4
Week 5
Background reading and research

Continue research, linking together the main concepts and outlining your discussion. Begin
drafting responses to each of the tasks.
Prepare final report
Submit the final report to eMed with no track changes.
Report requirements
The report should be a maximum of 2000 words, including a reflective component.

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Assessment criteria
Demonstrates an understanding of the physiology and hormonal regulation of the male reproductive
system. (1.1.1 Explains mechanisms that maintain a state of health)
Demonstrates knowledge of what kinds of new hormonal contraceptives are currently under development,
and at what stages of development (e.g. pre-clinical, clinical trials etc). (1.1.4 Identifies the components of
basic/medical science that are necessary to understand a scenario that has not been studied, locates
relevant information.)
Identifies main issues that hinder the development of male contraceptives. (1.1.4 Identifies the
components of basic/medical science that are necessary to understand a scenario that has not been
studied, locates relevant information.)
Focus Capability 2: Patient Assessment and Management

Uses clinical trial data to describe possible routes of administration of male hormonal contraceptives and
their effectiveness in the control of pregnancy. (1.3.8 Applies clinical reasoning to relevant health
scenarios, including the identification of key features and clinical patterns)
Poor compliance with medication regimens is common and reaches an epidemic proportion, probably with
no exceptions for contraceptive uses. Develops some strategies which may be useful in improving
compliance and reducing unintended pregnancies (e.g education and simple ways of administering
medications etc) (1.3.3 Understands patients should share decision-making and planning of their
treatment including communication of risk and benefit of management options.)
direction and critical evaluation and Reflection) will be assessed using the generic criteria for assignments listed
in the Program guide.
References
These listed references can be used for background reading on the topic. Students should also carry out their
own research of the published literature
Amory, J.K., Page, S.T. and Bremner, W.J. (2006) Drug insight: Recent advances in male hormonal
contraception. Nat Clin Pract Endocrinol Metab. 2:32-41.
Liu. P.Y., Swerdloff, R.S. and Wang, C. (2010). Recent methodological advances in male hormonal
contraception. Contraception. 82:471-475.
Contact:

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Assignment 3: Should Australian babies have the Guthrie Heel Prick Test to
screen for Congenital Primary Hypothyroidism?
Graduate Capabilities assessed in this project
The report will also be assessed for each of the generic capabilities (Effective Communication, Self-Directed
Learning and Critical Evaluation, and Development as a Reflective Practitioner).
Aims
Your task here is to investigate the science and justification behind the heel prick neonatal screening test
(Guthrie card) to screen for Congenital Primary Hypothyroidism (herein after called the CH / Guthrie test).
1. For the first part of the assignment you will investigate both the science behind the condition and how the
neonatal screening tests for this work.
2. For the second part of the assignment you will investigate and evaluate the CH / Guthrie test using the
specific screening criteria recommended.
This assignment relates to the course theme of Childhood, growth & development, and relates to the content
area of newborn screening. This topic is introduced in Scenario 2: Two New Mothers, in the NSW Newborn
Screening lecture, the QMP lectures on Screening Tests (week 4), and in the QMP tutorial on screening (week 6
but available online). In week 4, SGS 8 has an activity on the Guthrie newborn screening.
Task description
Task 1:
Discuss the basic and clinical science underlying the disease of Congenital Primary Hypothyroidism and the
associated neonatal (Guthrie) screening test, as described below:
a) Briefly describe the condition, referring to the basic and clinical science underlying the disorder. This
should cover the relevant basic epidemiology, clinical presentation, physiology, biochemistry,
anatomy, pathology and genetic heredity of the disorder as relevant.
b) Describe in detail the process for the neonatal screening test in NSW, specifically the CH/ Guthrie.
c) Using the information from a) and b) above, outline the scientific basis (i.e. the principles) for the
relevant test(s) used for the neonatal CH / Guthrie screening test in NSW (e.g. physiological,
biochemical, genetic etc. as relevant), thus revealing how the screening test detects the disease in
question. Write a discussion on which specific aspects of the condition allows for this particular
screening test, demonstrating how the test relates to the condition.
d) We suggest that you use a table or a flow diagram to summarise or illustrate the testing process and/
or the science behind.
Task 2:
Looking at the CH/ Guthrie neonatal screening test as it is used in NSW, evaluate the screening test as
shown below, writing up your evaluation as part two of the overall report.
By examining the general principles that are used to design any healthcare screening test make an
appraisal of how justifiable and how effective you think this screening test is for the NSW, Australian
population.
a) Firstly, you should examine the UK National Screening Committee (NSC) criteria (reference given
below) and decide which of these criteria for screening are relevant to the CH/ Guthrie test.
b) Next, referring to the epidemiology of the disease as discussed earlier for Task 1 and using the
relevant criteria from part a) above, you should evaluate this test as fully as possible. There may be
criteria that you may not be able to answer in-depth but that you should make an attempt at (e.g.
opportunity cost) by carrying out further research. Addressing each criterion as a bullet point or set
out within a large table is acceptable, but each criterion should be addressed, even if it is to state that
it is not relevant and why it is not.
c) Finally, once again using current available NSW figures for the condition and the CH / Guthrie test,
demonstrate how you would interpret a positive and a negative result. Write explicitly about how you
might convey these results to the parents of a baby who has been tested using the neonatal screening
process. You should refer to the sensitivity, specificity, PPV, NPV of the test as relevant. For this task
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you will need to estimate and discuss the probabilities involved (see SGS 8 and the online screening
tutorials for direction on this).
Task 3:
List your references carefully as a separate list at the end using the APA reference style. (See websites in
reference section at end for some important tips and advice on style).
Write a summary of the search strategies that you used for this report in table form (using appropriate
column headings such as search engine, search terms, search limits, number of hits, useful articles, basic
appraisal, etc.). Append this to the full report as an appendix (not as a supporting file). There is no word
count for this appendix but keep it brief and succinct.
Note it is advisable to use Medline for your initial searches. When you search the internet (e.g. for NSW
screening info and current NSW prevalence figures), use the browsers advanced search format for a more
focused search.
Check out the Information Skills Tutorials before you start! http://web.med.unsw.edu.au/infoskills/
Week 1-2:
Review the tasks. Commence literature searches for and begin to answer Task 1. Research the BGDA screening
lectures/ online tutorials and the UK screening criteria that you will use for evaluation.
Weeks 2-3:
Read and analyse the information found. Write report for Task 1. Start searching for, collecting and analysing
information about the screening test for Task 2. Draft the Search Strategy table for Task 3.
Weeks 4-5:
Write up Task 2 and compile it carefully together with your writing for Task 1 into a proper report. Reflect on
the process and write a short reflection. Check your citation and reference list. Complete the Search Strategy
table and compile the appendix. Proof read the full report for submission. Submit the final report to eMed with
no track changes.
Report requirements
Reports should be a maximum of 2000 words in total excluding the appendix and should be formatted in
accordance with the specification on the Medicine program website, and include a word count on the title
page. Ensure that you carefully reference your work using the UNSW Medicine referencing style (APA). Please
refer to the Medicine program website for penalties that will be applied to reports that exceed the maximum
length: http://medprogram.med.unsw.edu.au/assignments-and-projects-phase-1#tab-303400342
You will need to research and report comprehensively on:
1. The basic and clinical science behind Congenital Primary Hypothyroidism and its Guthrie screening test
(around 700-800 words)
2. Critical evaluation of the use of CH/Guthrie screening test in NSW, and interpretation and presentation of
possible screening results (around 800-900 words)
3. Include a reflection on your work and your findings (around 400-500 words).
4. You should include a short appendix to the report showing a summary table of your search strategies and
information sources (max. 3 pages)
Assessment Criteria
For a P grade, the written report and any supporting file should meet the following criteria:
Discusses the condition of Congenital Primary Hypothyroidism referring to the basic and clinical science
underlying the disease (1.1.3 Describes the patho-physiological process of health problems and can
explain their basis at the whole person, organ system, cellular and molecular levels).
Explains how the CH / Guthrie test detects this condition by outlining the scientific principles behind the
test; discuss which specific aspects of the condition allows for this particular screening test, demonstrating
how the test relates to the condition. (1.1.4 Identifies the components of basic/ medical science that

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are necessary to understand a scenario that has not been studied, locates relevant information and
interprets the scenario when the relevant information is available).
Focus Capability 2: Social and Cultural Aspects of Health and Disease
Indicates comprehension of screening by discussing the principles of screening as they relate to the CH/
Guthrie test. (1.2.9 Distinguishes between surveillance and screening and can describe the principles of
screening, including characteristics and impact of tests).
Critically evaluates the effectiveness of the CH / Guthrie test against established criteria for the NSW,
Australian population using basic knowledge of the condition. Makes a final recommendation with
explanations as to whether this test should be recommended for every newborn baby in NSW, Australia.
(1.2.9 Distinguishes between surveillance and screening and can describe the principles of screening,
including characteristics and impact of tests).
Demonstrates knowledge of how to interpret a positive and negative result from this specific Guthrie test
and briefly discusses the issues to be considered when conveying these results to the parents of a child.
(1.2.9 Distinguishes between surveillance and screening and can describe the principles of screening,
including characteristics and impact of tests).
Learning and Critical Evaluation, and Development as a Reflective Practitioner).
NOTE: The search table will be assessed within the generic capability, Self-Directed Learning and Critical
Evaluation
References
Comprehensive relevant references are available in the eMed system MAP for this years learning activities on
screening. Also you might find it useful to access the MAP Archive and listen to the 2014 BGDA lectures on
screening (which you will be able to attend live this year, but in week 4).
QMP online tutorials on screening are available and will be helpful:
Phase 1: Screening Tests: the Basics (which is the basis of the week 5 tutorial):
http://web.med.unsw.edu.au/QMP/QMPBGDA_2008/BGDA_Basics.htm
Phase 2: Screening and Diagnostic Tests:
http://web.med.unsw.edu.au/QMP/SH_P2_Screening/P2SH_About.html
NSW Newborn Screening Programme (The Sydney Childrens Hospital Network)
http://www.schn.health.nsw.gov.au/health-professionals/statewide-laboratory-services/nsw-newbornscreening-programme
Criteria for Evaluation of a Screening Test
UK National Screening Committee. (2010). Criteria for appraising the viability, effectiveness and
appropriateness of a screening programme. National Health Service: UK. Accessed on 08.04.15 at:
http://www.screening.nhs.uk/criteria
UNSW Medicine APA Reference Guide:
http://info.library.unsw.edu.au/biomed/skills/direct/Info_Skills_Docs/apa/apa1.htm
APA referencing site:
http://www.apastyle.org/
Learning centre APA ref site and access to more on in-text citation:
https://student.unsw.edu.au/american-psychological-association-apa-referencing-system
Contact:

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Assignment 4: Changes to cervical screening in Australia - HPV DNA testing

versus Pap test
Graduate capabilities assessed in this assignment
Self-directed Learning and Critical Evaluation
The report will also be assessed for each of the generic capabilities (Effective communication, Self-direction
and critical evaluation, and Development as a reflective practitioner).
In the renewal for the National Cervical Screening Program (NCSP), the Medical Services Advisory Committee
(MSAC) has recommended that HPV DNA testing replace the Pap test as the primary screening method.
Why?
Aims
To understand the pathogenesis of cervical cancer

To describe the current and proposed changes to cervical screening in Australia
To investigate the sensitivity, specificity, positive predictive values (PPV) and negative predictive values
(NPV) for HPV DNA testing compared to Pap tests
To evaluate the benefits and risks (ie pros and cons) of cervical screening using HPV DNA testing compared
to the Pap test
Summarise why the Medical Services Advisory Committee (MSAC) has recommended that HPV DNA testing
replace the Pap test as the primary screening method in the National Cervical Screening Program (NCSP)

This assignment relates to the course theme of conception, pregnancy and birth.
Task description
In this assignment you will prepare a report which:
1. Explains the role of human papillomavirus (HPV) infection in the pathogenesis of cervical cancer.
2. Describes and compares the different methods used to detect HPV infection of the cervix: pap test
(cytology), liquid based cytology, HPV DNA testing, and colposcopy and biopsy (histology). Includes a
description of reporting of HPV infected lesions in cytology (LSIL, HSIL) and histology (CIN I, CIN II, CIN III)
using the Australian Modified Bethesda System (AMBS 2004).
3. Briefly describes the current and proposed changes to cervical screening in Australia.
4. Interprets and compares the sensitivity, specificity, positive predictive values (PPV) and negative predictive
values (NPV) for HPV DNA testing and Pap tests in detecting high grade lesions (CIN2/3) and/or cervical
cancer.
5. Evaluates the benefits and risks (ie pros and cons) of cervical screening using HPV DNA testing compared to
the Pap test
6. Summarises and draws reasoned conclusions about why the Medical Services Advisory Committee (MSAC)
has recommended that HPV DNA testing replace the Pap test as the primary screening method in the
National Cervical Screening Program (NCSP) in Australia.
Suggested time allocation:
Week 1: PLAN see Hints for Assignment and Project writing in Moodle under Assessment activities
Create and save the following as A4 First Draft Report Plan before you have done any research. (submit
this as part of your appendix)
1. For each task under the Assessment criteria, list your ideas as dot points. Identify what you do and
dont know.
2. a. Create a table (shown below) to summarise the sensitivity, specificity, positive predictive values
(PPV) and negative predictive values (NPV) for HPV DNA testing compared to Pap tests. Comparison to
include at least 2 studies but no more than five.

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Specify high grade lesion

or cancer
Sensitivity
Specificity
PPV
NPV
HPV DNA test
Pap test
Research study
b. Create a table (shown below) to summarise the benefits and risk of HPV DNA testing compared to
Pap tests.
Benefits/Pros
Risks/Cons
HPV DNA testing
Pap tests
3.
4.
Identify the KEY TOPIC areas and keywords (search terms)

Draw up the report plan in Hints for Assignment and Project writing in Moodle under Assessment
Activities and put your dot points under each heading (Introduction, Body: paragraph 1, paragraph 2
etc and Conclusion)
Week 2: RESEARCH
Read the articles referenced below
Perform your own literature search using your keywords. Read your articles
You are NOT required to include your Medline search strategy
Week 3: SYNTHESIZE As you do your research your report plan will evolve. Save your final version A4 Final
Draft Report Plan (submit this as part of your appendix)
Week 4: WRITE Write your report. Use the APA guidelines for your references.
Week 5 EDIT Edit and remove track changes and submit final version to eMed.
Report requirements
The report should be a maximum of 2000 words. This word count does not include your appendix. Include a
word count and a reflective component. Refer to the program guide for details of penalties which apply to
excess length.
include a word count on the title page (refer to word count guidelines - see below). Ensure that you carefully
reference your work. Please refer to the Medicine program website for penalties that will be applied to reports
that exceed the maximum length.
Assessment criteria
For a P grade, the written report and the resource should meet the following criteria:
Explains the role of human papillomavirus (HPV) infection in the pathogenesis of cervical cancer (1.1.3
Describes the pathophysiological process of health problems and can explain their basis at the whole
person, organ system, cellular and molecular levels.)
Describes and compares the different methods used to detect HPV infection of the cervix: pap test
(cytology), liquid based cytology, HPV DNA testing, and colposcopy and biopsy (histology). Includes a
description of reporting of HPV infected lesions in cytology (LSIL, HSIL) and histology (CIN I, CIN II, CIN III)
using the Australian Modified Bethesda System (AMBS 2004).
(1.1.2 Recognizes health problems and relates normal structure and function to abnormalities.)
Briefly describes the current and proposed changes to cervical screening in Australia

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Focus Capability 2: Self-directed learning and critical evaluation

Interprets and compares the sensitivity, specificity, positive predictive values (PPV) and negative predictive
values (NPV) for HPV DNA testing and Pap tests in detecting high grade lesions (CIN2/3) and/or cervical
cancer. Comparison to include at least 2 studies but no more than five. (1.6.5 Demonstrates an
understanding of basic statistical principles and ability in handling and presenting quantitative
information appropriately.)
Critically evaluates the benefits and risks (i.e. pros and cons) of cervical screening using HPV DNA testing
compared to the Pap test (1.6.5 Demonstrates an understanding of basic statistical principles and ability
in handling and presenting quantitative information appropriately.)
Summarises and draws reasoned conclusions about why the Medical Services Advisory Committee (MSAC)
has recommended that HPV DNA testing replace the Pap test as the primary screening method in the
National Cervical Screening Program (NCSP) in Australia
The generic capabilities (Effective communication, Self direction and critical evaluation and Development as a
reflective practitioner) will be assessed using the generic criteria listed in the Program guide.
For the Generic capability: Development as a reflective practitioner
This section comes after your main report and is included in the word count.
Reflect on what you have learnt during this assignment by comparing your first and final Draft Report Plans
Discuss how the approach to completing the report could be improved.
As an appendix (which is not included in the word count) submit your first and final Draft Report Plans.
References:
These listed references should be used for background reading on the topic. Students should also carry out
their own research of the published literature.
Kumar, V., Abbas, A.K., Aster, J.C. (2012). Chapters 5 and 18 in Robbins Basic Pathology (9th ed. pp 182187, 202 & pp 685-688,). Philadelphia, PA:Elsevier Saunders.
Kumar, V., Abbas, A.K. and Aster, J.C. (2015). Chapters 7 & 22 in Robbins and Cotran Pathologic Basis of
th
Disease. (9 ed. Pp292-296, 326-327, 1002-1007) Philadelphia, PA:Elsevier Saunders.
DoHA. National Cervical Screening Program: NCSP Policies.
http://www.cancerscreening.gov.au/internet/screening/publishing.nsf/Content/cervical-screening-1
Dillner,. et al. (2008). Long term predictive values of cytology and human papillomavirus testing in cervical
cancer screening: joint European cohort study. BMJ 377:a1754.
Mayrand, M.H., et al. (2007) Group CCCSTS: Human papillomavirus DNA versus Papanicolaou screening
tests for cervical cancer. New England Journal of Medicine 357(16):1579-1588.
Ronco, G., et al. (2014) Efficacy of HPV-based screening for prevention of invasive cervical cancer: followup of four European randomised controlled trials. Lancet 383:524-532.
Medical Services Advisory Committee, Standing Committee on Screening. Application no. 1276 renewal
of the National Cervical Screening Program. (accessed April 2015).
[PDF MSAC Outcomes on the Medical Services Advisory Committee website]
Melbourne Sexual Health Centre, Taking a PAP test (video).
http://mshc.org.au/HealthProfessional/OnlineEducation/MSHCClinicalVideos/TakingaPAPtest/tabid/541/D
efault.aspx#.VTlRcULNZE4
Cancer Council Australia, National Cancer Prevention Policy: Cervical Cancer Screening
http://wiki.cancer.org.au/policy/Cervical_cancer/Screening
Douglass Hanly Moir, Recommendations for changes to cervical screening in 2017
http://www.dhm.com.au/media/21965083/nationalcervicalscreeningprogramrenewal_gynaepath_a4_mar
2015_web.pdf
Contact:

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Project 1: Ethics of in vitro fertilisation (IVF)

This project is suitable for 4-6 students.
Ethics and Legal Responsibilities
The report will also be assessed for each of the generic capabilities for projects (Effective Communication, Selfdirected Learning and Critical Evaluation, and Teamwork).
Aims
To outline the ethical and legal issues involved in the clinical scenario described below. You also need to
explore how these issues may be influenced by cultural and social factors.
This assignment relates to the ethical aspects of the course theme of conception, pregnancy and birth.
Task description
1.
Consider the following scenario:

A 42 year-old woman approaches her doctor stating she wants to have a baby before her biological
clock runs out and that she wants to do this using donor sperm and in vitro fertilisation (IVF).
She has recently separated from a long-term partner and is currently single;
Although she had been trying to conceive for several years (prior to her recent separation) she has
never been pregnant;
She owns a successful small business and is financially independent.
2.
Investigate the eligibility criteria that apply to those seeking IVF in Australia. Are there national, state
determined or local criteria? What is the current availability of medicare rebates for IVF?
3.
As a group decide on 2 ethical issues related to the scenario that you will research in further detail. (Note
there are a lot more than 2 potential issues but you will only be required to discuss those you have
selected).
4.
Think about some of the cultural/social issues that affect IVF.
Write a 2500-word report that discusses the following issues/questions:

1. Describe the eligibility criteria for IVF and the medicare funding available for IVF in Australia.
2.
Discuss each of the two ethical issues that you have decided to focus on. Discuss each issue in depth using
both your own research and the ethics wheel. Describe the nature of the issue or dilemma in ethical terms.
Your discussion should include the following:
An analysis of the dilemma identified, using at least one of the ethics perspectives, e.g. human rights,
principles based ethics, public health, feminist ethics.
A discussion about how using the selected ethical framework would argue the case for, or against a
particular action in relation to the dilemma.
Remember that these perspectives are not searching for the best answer, rather they are useful
frameworks used to analyse the problems.
3.
Discuss the ethical dilemmas that your group has chosen and the different personal viewpoints, ethical
perspectives and conclusions of group members in relation to it. Discuss some of the cultural origins of
these different personal viewpoints. If you all have the same opinion, then discuss a different attitude. For
the generic teamwork capability you might like to consider how any differences of opinion were dealt with
as a result of discussions between group members. What impact did these differences have on the group
process?

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Weeks 2-4
Research the basic procedures involved in IVF, eligibility criteria, Medicare funding for IVF and
identify ethical aspects. Research each of the perspectives and responses to the problems
Weeks 3-4
Meet to discuss these and clarify any overlap or confusion. Begin drafting responses to each of
the tasks.
Weeks 4-6
Prepare group presentation and edit report.
Week 6
Final edit taking into account any feedback from your presentation. (Have you addressed the
assessment criteria?)
Week 7
Submit the correct and final version to eMed with no track changes.
Report requirements
Word limit of 2500 words. Include a component evaluating your groups teamwork.
include a word count on the title page (refer to word count guidelines - see below).
Assessment criteria
Focus Capability 1: Ethics and Legal Responsibilities
1. Critically analyses the ethical issues raised using the ethical perspectives selected from the ethics wheel.
(1.7.4 Identifies and discusses the ethical aspects of scenarios and other experiences; 1.7.6 Understands
and can discuss a number of different ethical perspectives).
2. Explores differences of opinion between group members in relation to the ethical dilemmas. (1.7.3
Identifies and discusses ethical issues interactions between fellow students, with staff and with patients)
3. Describes differences in views about ethical aspects based on differing perspectives within the group.
(1.7.1 Explores the psychological, social and cultural determinants of ones own values and can discuss
the relevance and appropriateness of person values in clinical medicine)
Focus Capability 2: Social and Cultural Aspects of Health
1. Explores the sociocultural factors underpinning subjective considerations around health care issues and
that shape the decisions, actions and practices undertaken to address them. (1.2.1. Identifies
environmental, psychological, social and cultural issues which contribute to health problems in a
scenario)
2. Demonstrates understanding of the eligibility criteria and medicare funding for IVF. (1.2.5 Understands
equity and its implications for health care delivery for individual and population based approaches; 1.2.6
Describes the basic structure of the health care system)
The generic capabilities (Effective Communication, Self-directed Learning and Critical Evaluation and
Teamwork) will be assessed using the generic criteria for group projects listed in the Program guide.
References
1.
2.
3.
4.
McNeill, P., Torda, A., Little, J.M. & Hewson, L. (2004). Ethics Wheel. University of New South Wales.
(Available from the General Resources section on Moodle.
Lowe, M., Kerridge, I & Stewart, C. (2009) Ethics and Law for the Health Professions. (3rd ed.) Federation
Press
Chapman, E. (2002). The Social and Ethical Implications of Changing Medical Technologies: The Views of
People Living with Genetic Conditions. J Health Psychology, 7: 195 -206
Stainton, T. (2003). Identity, difference and the ethical politics of prenatal testing. Journal of Intellectual
Disability Research, 47: 533539.

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5.
6.
Garcia, E., Timmermaans, D.R.M. and Van Leeuwen, E. (2008). The impact of ethical beliefs on decisions
about prenatal screening tests: Searching for justification. Social Sciences & Medicine. 66(3), 753-764.
Teamwork for Group projects - Please refer to this webpage for resources to help you meet the
requirements for the generic Teamwork capability:
https://medprogram.med.unsw.edu.au/teamwork-group-projects
Please note that you will be expected to source references outside of this list and these are simply to provide a
starting point for your research. Clearly there are many ideas and approaches that could potentially be
discussed.
Contact:

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Project 2: Understanding the Teenage Pregnancy Scenario

This project is suitable for 4-6 students
Self-Directed Learning and Critical Evaluation
Teamwork
Learning and Critical Evaluation and Teamwork).
Aims
1.
2.
3.
To develop a deep understanding of the learning issues that arise from the Teenage Pregnancy scenario
To develop skills in optimally utilising the learning opportunities that are available in Phase 1
To develop skills in self-directed learning and collaborative learning (teamwork)

This project relates to the course theme of conception, pregnancy and birth.
Task description
1.
2.
3.
You are expected to take a systematic approach to addressing the learning issues that arise from the
Teenage Pregnancy scenario. You should:
Generate a concept map of the learning issues that arise from the Teenage Pregnancy scenario. Ensure
that all capabilities are covered, and the links between capabilities are highlighted.
Identify ways to address (follow up and understand) the learning issues through timetabled and/or
self-directed learning activities. You may choose a method that involves all project group members
working on all learning issues OR a method of dividing up the learning issues amongst project group
members and engaging in peer teaching that ensures that all project group members learn all the
material.
Keep a reflective diary of how the above learning activities helped your project group to better understand
the identified learning issues.
Work with your project group and scenario group to ensure that your developing understanding of the
learning issues is shared amongst your project and scenario group peers.
Conduct peer teaching sessions in order to ensure that all project group members share what they
learn and develop their understanding to the best possible level. You should use a range of peer
teaching strategies that may include presentations by individual members, group discussions of
complex content, peer run quizzes, or any other methods that help you support each other.
Regularly conduct brief peer-teaching sessions for your scenario group. These sessions would be based
on your learning of the relevant learning issues (above) and would highlight how lectures, practicals
and tutorials contribute towards understanding these learning issues. (For example, use five minutes
of a scenario session to recap the lectures, pracs, tutes and other activities that took place during the
preceding week, discuss how they relate to the learning issues, how they helped clarify questions that
the group had, and identify aspects that require further exploration through self-directed activities.
Alternatively, you may use a weekly email to achieve this). Make an attempt to clearly and concisely
communicate with the group, and ensure that each member of your project group gets an opportunity
to do this at least once.
Develop a mechanism to gather evidence of the effectiveness of your peer teaching. This could take
the form of peer or facilitator feedback from your scenario group, subsequent to your peerteaching/emails to the group. You are free to use this or any other method that helps to evaluate the
effectiveness of the peer-teaching methods of each member of your project group. It is re-iterated
that you must ensure that all project group members develop a sound understanding of all learning
issues and are confident in handling questions.
Keep a diary of how your project group worked together to achieve the objectives of the project.
Please try to maintain accurate records that will help you to identify both strengths and areas for
improvement in your teamwork. Use this diary when analysing the effectiveness of your teamwork.
Please note that facilitators will not be able to allocate large amounts of time during SGS for peer-teaching.
The most that you may be able to negotiate with your facilitator might be 5-10 mins at the end of some SG
sessions, and this is only if time is available after completion of scheduled SGS activities.
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In previous years, many student groups have arranged with their SG colleagues to conduct peer-teaching
either immediately before or after SG sessions. Alternatively, you can share your content via group email,
and use 5-10 min to clarify/expand upon the email content.
Report requirements
Your report should be 2500 words and should include:
1. A concept map of the learning issues identified by the group, highlighting inter-relationships between
them (categorised by capability). From this, select 4-6 learning issues as examples that best represent the
key issues related to the scenario (you should try to use examples from 4-6 capabilities not including SDL
and TW). Include a discussion of how your project group undertook further learning in relation to the 4-6
selected learning issues through scheduled and/or self-directed learning activities. The concept map does
not count towards your word count. However, please note that the concept map should be concise, and it
should not be used as a strategy for including additional text.
2.
A section that reflects on how your group worked together as a team. This section should:
a. Discuss how your project group collaborated to ensure that all group members achieved a sound
understanding of the learning issues. This should include a discussion of the peer teaching strategies
used by your group and the extent to which these strategies were effective.
b. A discussion of how your project group collaborated with your scenario group to integrate material
learnt through various scheduled and self-directed learning activities.
These sections (a & b) should be supported by evidence, which may take the form of self-assessments,
peer or facilitator comments, or any other evidence that the group may have generated.
Please include a separate teamwork reflection analysing your project groups behaviour and the contributions
made by each member of your project group. The analysis should be undertaken from the perspective of a
relevant theoretical model. (Select from: https://medprogram.med.unsw.edu.au/teamwork-group-projects)
Identify three strengths in the approach your group adopted, and identify three ways in which you could
improve the process if you were to engage in a similar collaborative activity in the future. (This section will help
you meet some of the requirements for the generic Teamwork capability.)
include a word count on the title page (refer to word count guidelines - see link below).
Assessment criteria
Focus Capability 1: Self-Directed Learning and Critical Evaluation
1. Identifies questions and learning issues arising from the scenario (categorised by capabilities), and
generates a concept map that highlights the links between these learning issues. (1.6.1 Identifies
questions and learning issues arising from scenario sessions and other teaching activities.)
2. Demonstrates ability to select 4-6 key learning issues (from the above) that address the major aspects of
the scenario. (1.6.1 Identifies questions and learning issues arising from scenario sessions and other
teaching activities.)
3. Using an appropriate level of content detail, demonstrates how various learning activities contributed to
the development of the groups understanding of these learning issues. (1.6.1 Engages in appropriate
activities to address identified needs.)

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Focus Capability 2: Teamwork

1. Develops appropriate methods of peer teaching. Discusses the effectiveness of the methods of peer
teaching that were used by the group. Identifies strengths and areas for improvement. (1.5.1 Discusses
differences in contribution styles and identifies contributions in terms of task focused behaviour, group
support behaviour, non-productive behaviour; 1.5.4 Monitors roles and contributions of group work, the
learning environment and group process.)
2. Provides evidence of helping the wider scenario group to better understand the relevant learning issues,
their inter-relationships, and how various learning activities contributed towards these. Uses an
appropriate method to gather this evidence. (1.5.3 Analyses and evaluates own roles and contributions
to group work using own observations and feedback from others.)
The generic capabilities (Effective Communication, Self-Directed Learning and Critical Evaluation and
Teamwork) will be assessed using the generic criteria listed in the Program guide.
In meeting the generic Teamwork capability requirements, you should evaluate how effectively the project
group worked as a team and analyse the role of each project group member using an appropriate theoretical
framework from the Teamwork for Group projects webpage:
Please ensure that you refer to the generic capability criteria and address these criteria which include providing
documentation of team meetings, evaluation of group process and reflection on features that enhanced or
impeded group process.
References
Teamwork
World Health Organization (2010). Topic 4: Being an effective team player. WHO Patient Safety Curriculum
Guide.
http://www.who.int/patientsafety/education/curriculum/who_mc_topic-4.pdf
Glynn, L., Macfarlane, A., Kelly, M., Cantillon P. and Murphy, A. (2006). Helping each other to learn a
process evaluation of peer assisted learning. BMC Medical Education 6: 18.
Marks, M.A., Mathieu, J.E. and Zaccaro, S.J. (2001). A temporally based framework and taxonomy of team
processes. The Academy of Management Review 26: 356-76.
requirements for the generic Teamwork capability: https://medprogram.med.unsw.edu.au/teamworkgroup-projects
Concept maps
Laight, D. W. (2006). Attitudes to concept maps as a teaching/learning activity in undergraduate health
professional education: influence of preferred approach to learning. Medical Teacher, 28(2), e64-e67.
Novak, J. D., & Caas, A. J. (2008). The Theory Underlying Concept Maps and How to Construct and Use
Them. Technical Report IHMC CmapTools 2006-01 Rev 01-2008, Florida Institute for Human and Machine
Cognition. Available at:
http://cmap.ihmc.us/Publications/ResearchPapers/TheoryUnderlyingConceptMaps.pdf.
Contact:
A discussion regarding this project is available through Moodle.

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Project 3: Female Infertility

This project is suitable for 4 - 6 students.
The report will also be assessed for each of the generic capabilities for projects (Effective Communication, Selfdirected Learning and Critical Evaluation, and Teamwork).
Aims
Preconception health and lifestyle plays an important role in female fertility. In this project you will examine
the impact of lifestyle on female reproductive health and fertility.
The broad aims of this project are for you to:
1. Develop an understanding of the impact of lifestyle factors on female fertility.
2. Examine the social and cultural aspects of both of these lifestyle factors.
3. Use your knowledge of the above to devise a list of important issues that would need to be considered
when designing a public health campaign to raise awareness and provide advice to women regarding
the effects of one of these lifestyle factors on their fertility.
This assignment relates to the Beginnings Growth and Development course theme: Conception, pregnancy and
birth.
Task description
Your group is to consider the impact on female fertility of BOTH:
Obesity
Cigarette smoking
1.
2.
3.
4.
Search the scientific literature to identify the potential impact of both of these factors on various aspects
of female reproductive health (e.g. fertility, health during pregnancy and pregnancy outcomes e.g. risk of
miscarriage). Examine the science underlying these effects in detail. Is there evidence that these effects
are reversible? Are they permanent?
Consider the social and cultural issues relating, in women aged from ~20 to 50 years of age in Australia, to:
a. Attitudes and prevalence of each of these factors
b. Attitudes towards female fertility
c. Willingness to access health services in general, and present with a problem relating to infertility
specifically. Is there also evidence for a cultural difference between women from different social and
cultural backgrounds regarding willingness to access health services?
Choose either obesity or cigarette smoking and develop a list of key issues for a public health campaign to
educate women in this age group about the risks of your chosen lifestyle factor to their reproductive
potential. In developing this list you should incorporate your consideration of sociocultural factors above.
You may wish to draw on programs that already exist, although these may not have been designed to
target female reproductive health specifically.
Write a report (maximum 2500 words) that:
a. Describes the potential impact of both of these lifestyle factors on fertility in women, and explains
the science underlying these effects;
b. Discusses the sociocultural issues outlined in Task 2, and possible implications these might have for a
public health campaign;
c. Presents and justifies the issues that your group have decided are important to inform a public
health campaign targeting your chosen lifestyle factor. You are not required to produce such a
campaign but it you are encouraged to include in your report some simplified diagrams and
explanations for key concepts.

Weeks 1 & 2
Weeks 3 & 4
Carry out research required for Task 1 and draft this section of the report.
Complete tasks 2 and 3 and draft this section of the report.

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Weeks 5 & 6
Week 7
Prepare group presentation and edit report.

Final edit of your report, taking into account any feedback from your presentation (Have you
answered the assessment criteria?). Submit the correct and final version to eMed with no
track changes.
Report requirements
Word limit of 2500 words. Include a component evaluating your groups teamwork.
include a word count on the title page (refer to word count guidelines - see below).
Assessment criteria
1.
2.
Accurately describes the potential impact of both obesity and cigarette smoking on female fertility. (1.1.2
Recognises health problems and relates normal structure and function to abnormalities)
Demonstrates an understanding of the pathophysiological mechanisms underlying the effects of both of
these lifestyle factors on female fertility. (1.1.3. Describes the pathophysiological process of health
problems)
Focus Capability 2: Social and Cultural Aspects of Health and Disease

1. Describes social and/or cultural factors which may be associated with obesity and cigarette smoking in
women. (1.2.1 Identifies environmental, psychological, social and cultural issues which contribute to
health problems in a scenario (eg sexuality, stress, family relationships, risky behaviours)).
2. Presents and justifies important issues for a public health campaign aimed at informing women of the
effect of either obesity or cigarette smoking on their fertility. (1.2.8 Describes primary, secondary and
tertiary approaches to disease prevention and health improvement).
The generic capabilities (Effective communication, Self direction and critical evaluation and Teamwork) will be
assessed using the generic criteria for group projects listed in the Program guide.
References
These listed references should be used for background reading on the topic. Students should also carry out
their own research of the published literature.
1. Metwally, M., Li, T.C. and Ledger, W.L. (2007). The impact of obesity on female reproductive function.
Obesity Reviews 8: 515-523
2. Zain, M.M. and Norman, R. J. (2008) Impact of obesity on female fertility and fertility treatment. Womens
Health 4(2): 183-194.
3. Brewer, C.J. and Balen, A.H. (2010). The adverse effects of obesity on conception and implantation.
Reproduction 140: 347-364.
4. ASRM Practice Committee (2008) Smoking and infertility. Fertility and Sterility 90(Suppl 3): S254-S259.
5. Dechanet, C., etal. (2011). Effects of cigarette smoking on reproduction. Human Reproduction Update
17(1): 76-95.
6. Teamwork for Group projects - Please refer to this webpage for resources to help you meet the
Contact:

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Project 4: PID - The Play

A Pretty Important Drama, not to be missed!
This project is suitable for 4-6 students. Only one group per SG may select this project. This project has a quota
of 8 groups. Groups must register by 4pm Friday 8th May 2015. Students will receive an email to confirm
whether they can complete this project by 4pm Tuesday 12th May 2015.
Teamwork
Learning and Critical Evaluation and Teamwork).
TASK: You are invited to write and perform a play about pelvic inflammatory disease (PID) and ectopic
pregnancy. A Pretty Important Drama/Diagnosis, not to be missed! It is a tale of sperm meets ovum,
fertilisation takes place, however tragedy ensues due to complications of inflammation as a result of a
Neisseria Gonorrhoeae infection.
Aims
1.
2.
3.
4.
5.
Develop an understanding of the cellular basis of acute and chronic inflammation based on the basic and
clinical science information acquired in Foundations and BGDA courses.
Develop an understanding of the pathogenesis and complications of pelvic inflammatory disease (PID)
based on the basic and clinical science information acquired in the BGDA course.
Write and perform a play describing the pathogenesis of PID, concentrating on the cellular basis of acute
and chronic inflammation
Develop an appreciation of what is required for teamwork to be effective
Reflect on teamwork skills

This project relates to the course theme of conception, pregnancy and birth.
Task description
In this project you will prepare a report which contains:
1.
A report giving a basic outline of the following disease processes based on the relevant basic and clinical
sciences information gained in the Foundations and BGDA course (lectures, scenario group sessions,
practicals and tutorials)
a. Acute inflammation
b. Chronic inflammation
c. Pathogenesis of PID
d. Ectopic pregnancy as a complication of PID
2.
A clinical application table summarising how your lecture, scenario group session, practical and tutorial
information has assisted your understanding of the above disease processes. An example of a clinical
application table is shown below. You may modify this table.
Course information
BGDA: Histology of
the female
reproductive tract
3.
Source
Lect and Prac
Relevant information
Team should give a brief
description of the histology of
the fallopian tube
Clinical application to PID

PID causes inflammation of the
fallopian tube (salpingitis)
A script for a 5-10 minute play utilising the information you have gained from Foundations and BGDA with
the following acts: (submitted as an appendix)

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Setting:
Fallopian tube
o ACT ONE: Neisseria Gonorrhoeae infection-Our story begins with the entry of Neisseria
Gonorrhoeae into the host via the vagina where it ascends to the fallopian tube
o ACT TWO: Acute inflammatory response-vascular changes
o ACT THREE: Recruitment of neutrophils
o ACT FOUR: Recruitment of macrophages
o ACT FIVE: Chronic inflammation and sequelae
o ACT SIX: Fertilisation and ectopic pregnancy
o THE END
Actors (or props): Neisseria Gonorrhoeae
Fallopian tube epithelial cells
Venular endothelial cells
Neutrophils
Macrophages
Lymphocytes, plasma cells, fibroblasts
Ovum
Sperm
Narrator
The team must write, direct and act in the play. The team may invite other members of their scenario
group (including their facilitator) to act in the play.
Briefly mention some of the main inflammatory mediators (eg IL 1, TNF) in your play however concentrate
mainly on the role of the cells.
4.
A performance: You will give a trial performance of your play in SGS 11 to your scenario group. In SGS 13
you will perform your play in front of your colleagues from other scenario groups and a pathology lecturer
who will assess your teams performance.
5.
A plan: Using Sarkisian Working in Groups. A note to faculty and a quick guide for students (see
reference section), develop a plan for working in a team on this project. Submit this plan as an appendix to
your project report (an appendix does not contribute to your word count). Your plan must include the
following:
o List of goals and the tasks required to achieve these goals
o Allocation of roles
o How the tasks are allocated amongst team members
o A timeline with suggested check points for stages of work to be complete.
o A diary of meeting dates
o How the team was organised. Who was the team leader/director or was this responsibility
shared?
6.
Problem solving: Discuss what is required for an effective team at the end of your report.

Weeks 1
Weeks 2 & 3
Weeks 4 & 5
Week 6
Plan: Develop a plan and timeline for working in a team on this project
Research:
b. Chronic inflammation
c. Pathogenesis of PID
d. Ectopic pregnancy as a complication of PID
Write report, construct clinical application table, write script
SGS 11: Practice performance
Final edit your report, taking into account any feedback from your presentation (Have you
answered the assessment criteria?).

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Week 7
Submit the final version to eMed after removing track changes. Use APA guidelines for your
references
SGS 13: PID-The Play performance!!
Report requirements
The report should be a maximum of 2500 words including text in tables, but exclusive of figure legends and
references. Include a reflective component on your groups teamwork.
Assessment criteria
1. Report: Gives a brief description of the following disease processes based on the course information from
Foundations and BGDA. (1.1.2 Recognises health problems and relates normal structure and function to
abnormalities, 1.1.3 Describes the pathophysiological process of health problems and can explain their
basis at the whole person, organ system, cellular and molecular levels.)
b. Chronic inflammation and sequelae
c. Pelvic inflammatory disease
d. Ectopic pregnancy
2. Clinical application table: Summarises this information in the form of a table. (1.1.2 Recognises health
problems and relates normal structure and function to abnormalities, 1.1.3 Describes the pathophysiological process of health problems and can explain their basis at the whole person, organ system,
cellular and molecular levels.)
3. Script: Writes a script with six acts, which accurately describes the roles of cells in the pathogenesis of PID
and ectopic pregnancy utilising the information gained from their coursework. (1.1.2 Recognises health
problems and relates normal structure and function to abnormalities, 1.1.3 Describes the pathophysiological process of health problems and can explain their basis at the whole person, organ system,
cellular and molecular levels, 1.1.4 Identifies the components of basic/ medical science that are
necessary to understand a scenario that has not been studied, locates relevant information and
interprets the scenario when the relevant information is available.)
Focus Capability 2: Teamwork
1. Plan: Develops a plan for working in a team (submitted as an appendix) (1.5.1 Identifies different purposes
of group work, analyses how well groups work, discusses differences in contribution styles and identifies
contributions in terms of task focused behaviour, group support behaviour, non- productive behaviour. )
2. Problem solves: Discusses and reflects on what is required for a cohesive and effective team (1.5.2 Gives
feedback on group roles and contributions constructively and respectfully, receives feedback openly and
non- defensively, 1.5.3 Analyses and evaluates own roles and contributions to group work using own
observations and feedback from others.)
3. Performance: Creates an entertaining play which demonstrates creativity through the use of costumes and
props as well as factual accuracy. It is no longer than 15 minutes. Students demonstrate cohesion during
the performance of their play in SGS 13. (1.5.4 Monitors roles and contributions to group work, the
learning environment and group process, communicates concerns appropriately and acts to ensure
effective group process.)
direction and critical evaluation and Teamwork) will be assessed using the generic criteria for group projects
listed in the Program guide.

Page 112
References
The majority of information for this project will come from your BGDA and Foundations courses.
Inflammation, PID and ectopic pregnancy
Kumar, V., Abbas, A.K., Aster, J.C. (2012). Chapters 2 and 8 in Robbins Basic Pathology (9th ed., pp. 29-44,
53-56, p695.). Philadelphia, PA:Elsevier Saunders.
Kumar, V., Abbas, A.K., Fausto, N. and Aster, J.C. (2010). Chapter 22 in Robbins and Cotran Pathologic Basis
th
of Disease. (8 ed., pp1009-1010, 1053-1054.). Philadelphia, PA:Elsevier Saunders.
Medzhitov, R. (2010). Inflammation 2010: New adventures of an old flame. Cell 140:771-776
Westrom, L. and Wolner-Hanssen, P. (1993) Pathogenesis of pelvic inflammatory disease. Genitourinary
Medicine 69(1):9-17
Teamwork
Sarkisian, E. Working in groups; A note to faculty and a quick guide for students. Derek Bok Centre for
Teaching and learning, Harvard University
http://isites.harvard.edu/fs/html/icb.topic58474/wigintro.html
An example on how to reference a lecture:
Hawkins, N. (2011, March 1). The disciplines of medicine. Lecture presented for the MFAC1501 Foundations
course in Medicine, University of New South Wales, Sydney, NSW.
In text citation (Hawkins, 2011)
Contact:

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MFAC1521 - Beginnings, Growth

Beginnings Growth and Development A

Beginnings Growth and Development A

Material required for SG sessions

Beginnings Growth and Development A

Staff Involved in the Course

Beginnings, Growth and Development Design Group

With special thanks to

Beginnings Growth and Development A

Conception, pregnancy and birth

Aims of the course

Beginnings Growth and Development A

Scenario group session preparation

Bring anatomy and physiology

Group presentations, student

Pre-reading +/or team

Pre-reading and video. Bring

Beginnings Growth and Development A

Scenario 1: Teenage pregnancy

Scenario Plenary 1: Teenage Pregnancy

Gibson, Karen &

Campus Clinical Skills Session 1: Basic information and skills

Scenario Group Session 1: Considering the 'Teenage Pregnancy' scenario and

Lecture 2: Anatomical framework of the pelvis Lecture

Lecture 3: Female Reproductive Tract Histology

Lecture 4: Aboriginal/rural reproductive health issues

Lecture 5: Physiology of male reproduction

Science Practical 1: Histology of the female reproductive tract

Lecture 6: Physiology of female reproduction

Lecture 7: Development of the embryo/fetus 1

Science Practical 2: Anatomical framework of the pelvis prac

Lecture 8: Maternal Physiology

Lecture 9: Gene Function 1: Replication & Transcription

Science Practical 3: Embryology fertilization

Scenario Group Session 3: Anatomy and physiology of reproduction

Hospital Clinical Skills Session 1: Presenting symptoms and skin lesions

Lecture 10: Fertilisation and implantation

Lecture 11: Gene Function 2: Translation

Lecture 12: Female reproductive tract anatomy

Lecture 13: PCR and individual variation

Science Practical 4: Female reproductive system anatomy

Scenario Group Session 4: The menstrual cycle and fertility awareness

Lecture 14: Development of the embryo/fetus 2

Lecture 15: DNA damage, repair and mutation

Science Practical 5: Polymerase Chain Reaction (PCR)

Lecture 16: Development of the nervous system

Lecture 17: Ethics: Ethical issues in human reproduction

Tutorial 2: Ethics 1: Reproductive technologies, designer babies and human

Beginnings Growth and Development A

Campus Clinical Skills Session 2: Considerations for you as a doctor

Science Practical 6: Embryology: implantation to 8 weeks

Scenario Group Session 5: Common complaints in pregnancy: 'A word from

Lecture 18: Male Reproductive Tract Anatomy

Lecture 19: Cardiac Embryology

Lecture 20: QMP: Critical Appraisal and Bias 1

Lecture 21: Male Reproductive Tract Histology

Scenario Group Session 6: Vaginal Delivery versus Caesarian Section

Lecture 22: Pathology of the female reproductive tract

Van Vliet, Christine

Lecture 23: QMP: Critical Appraisal and Bias 2

Science Practical 7: Male reproductive system anatomy

Science Practical 8: Female reproductive hormones and their effects

Online Activity 1: QMP Online Tutorial 4: Critical appraisal

Online Activity 2: QMP Online Tutorial 5: Bias - the biggest enemy