Teaching psychosomatic obstetrics and gynaecology

Gynaecologists and obstetricians are confronted with many tasks that require biopsychosocial competence, as explained in Chapter 2. Care for patients with unexplained physical symptoms, and patients with chronic incurable diseases, in various phases of their lives, require patient education, health promotion, counselling, and management of psychosocial problems. To obtain this competency, a curriculum is needed, which, besides gynaecology and obstetrics, includes elements of psychology, psycho-social medicine, and psychiatry, adapted to the specific needs of gynaecologists and obstetricians in their everyday work. A basic part of Chapter 2 shows the curriculum consists of teaching the knowledge, and skills derived from communication theory and practice including physician, and patient-centred communication with active listening, responding to emotions and information exchange as well as breaking bad news, risk-counselling, and shared decision-making. Building on these skills, trainees are introduced into the biopsychosocial process of diagnosis, establishing a 9-field comprehensive work-up using the ABCDEFG guideline (Affect, Behaviour, Conflict, Distress, Early life Experiences, False beliefs, Generalised frustration). The therapeutic interventions are based on a working alliance between the physician and the patient, and are taught as basic elements, which have to be combined according to the individual patient and the presenting situation. The overall technique for gynaecologists and obstetricians can be summarised as supportive counselling/psychotherapy. This includes elements such as catharsis, clarifying conflicts and conflict resolution, cognitive reframing, insight and understanding, stress reduction techniques, and helping in behavioural change (CCRISH).