Attachment 1 - GTA MUTA Statement of Work.pdf

GTA/MUTA Teaching Associates

STATEMENT OF WORK

Description:

The Integrated Clinical Skills (ICS) (School of Medicine) course and three Graduate School of Nursing courses: Advanced Health Assessment, Advanced Diagnosis and Management in Adult Primary Care and Essentials of Gynecologic Health, all include direct student-”patient” physical examination encounters. To provide the initial training of the male genitourinary examination, female breast and pelvic examination, the Uniformed Services University of the Health Sciences (USUHS) requires the participation of trained teaching associates. These individuals will serve as both the subjects of the examination and the instructor regarding technique and overall approach. Teaching associates must have appropriate training/experience in both examination and educational techniques to convey the required curriculum. All sessions are conducted at the Forest Glen Simulation Center located on the Walter Reed Annex in Silver Spring, Maryland. The contractor must be able to provide an onsite monitor/administrator for each session and teaching associate transportation to and from that facility on specified dates and times.

Period of Performance:

The anticipated Period of Performance for this Blanket Purchase Agreement (BPA) is May 1, 2024 through April 30, 2029. Specific Periods of Performance will be defined in the Individual Call Orders.

Tasks:

The following tasks/descriptions include all the types of courses that may be ordered under individual Call Orders:

Services include:

1. Student-to-teaching associate ratio of no more than (model) 4:1 (except on noted dates; see below).

2. Model demonstration of the male genitalia examination including inspection and palpation of the inguinal area, penis, scrotum and its contents, as well as evaluation for suspected inguinal hernia.

3. Model demonstration of the male rectal and prostate examination including inspection and palpation of the anus, rectum, and prostate.

4. Individual student practicum on examination of the male genitalia and rectum.

5. Sessions include didactics and practicum on proper draping techniques and attention to patient privacy.

6. The contractor will provide necessary supplies for each session (note: there is no capacity for on-site storage of supplies).

7. The contractor will provide services within the time limit specified (session times cannot be extended; awardee must supply adequate staffing to complete the session within the presented timeframe).

8. The contractor will inform teaching associates that a valid driver’s license and proof of insurance is required to drive a vehicle onto the Forest Glen military installation.

The contractor will also inform teaching associates that all vehicles entering the installation are subject to random vehicle inspections.

9. The contractor will provide additional training sessions at no additional expense should students have insufficient time to practice all designated skills due to contractor or teaching associate error, or failure to follow the prescribed time guidelines in the statement of work.

MALE GENITO-RECTAL EXAMINATION SEQUENCE

Duration of Exercise:

● 1.25 hour session for a group of 2 learners;

● 1.5 hour session for a group of 3 learners;

● 1.75 hour session for a group of 4 learners.

Time breakdown: student tasks outlined below. Patient is in room, gowned, and sexual history has been taken. Exam will proceed in context of a complete physical Preliminary (GTA time: 5 minutes)

● Teaching associate didactics & discussion time - 25 min;

● Student examination practice - 20-25 min per student (up to 4)

● 15 - 45 minutes between sets;

1. Knocks and waits for recognition, introduces self to patient, addresses patient by surname.

2. Explains purpose and main steps of examination.

3. Offers patient opportunity to void to decrease risk of discomfort during exam.

4. Invites patient to ask questions at any time during the examination.

5. Washes hands in presence of patient before beginning examination and puts on clean gloves.

6. States that universal precautions will be used during the examination.

7. Addresses issue of potential sexual stimulation (ONLY if it occurs).

8. Discusses draping principles (balance between sensitivity to privacy versus adequate exposure).

Abdominal/Genital Examination:

1. Percusses upper limit of bladder (symphysis pubis to umbilicus).

2. Re-drapes lower abdomen and exposes genitalia.

3. Palpates inguinal lymph nodes.

4. Inspects pubic area and scrotum.

5. Palpates shaft of penis including both corpora cavernosa and corpus spongiosum

6. Inspects and palpates the glans penis. Inspects under the coronal ridge

(retracting prepuce or foreskin if present). Spreads urethral meatus then compresses gently to check for discharge.

7. Palpates the scrotum and its contents. Checks for nodules, tenderness, etc. Notes any evidence of swelling.

8. Isolates and palpates each testis (immobilize within scrotum).

9. Locates and palpates each epididymis.

10. Identifies each spermatic cord.

11. Palpates each cord between thumb and fingers from the testis to superficial inguinal ring.

Hernia Examination:

1. Observes scrotum with patient in upright position. If any change is noted, re-palpates and transilluminates.

2. Checks for direct inguinal hernia (fingers flattened over inguinal area).

Increases intra-abdominal pressure by asking patient to bear down or cough.

3. Checks for indirect inguinal hernia (index finger in inguinal canal).

Increases intra-abdominal pressure by asking patient to bear down or cough.

Rectal Examination (upright and lateral decubitus positions):

1. Asks patient which position they prefer (upright or lateral decubitus position)

2. Inspects anus, sacrococcygeal and perineal regions, checking for abnormalities such as nodules, fissures,inflammation, rashes, etc.

3. Alerts patient that the examination is about to begin.

4. After placing lubricant on finger, exerts pressure anteriorly over external sphincter with pad of index finger.

5. Asks patient to bear down, pauses for sphincter to relax, and gently inserts finger into anus, aiming toward umbilicus.

6. Palpates prostate, left and right lobes, and median sulcus.

7. Palpates remaining surface of rectum, including right lateral, posterior and left lateral areas, by rotating finger through an arc (if necessary reassure patient about normalcy of flatulence or urination).

8. Explains to patient that the examination is over and that the student will be leaving the room while the patient cleans up and dresses.

Female Breast and Pelvic Examination (Graduate School of Nursing) Female Breast and Pelvic Examination (ICS Course) – (SCHOOL OF MEDICINE)

Services include:

1. Student-to-teaching associate of no more than (model) 4:1 (except on noted dates, see below).

2. Model demonstration of the pelvic examination of both external and internal genitalia, including the speculum and bimanual examination.

3. Individual student practicum on pelvic examination.

4. Model demonstration of breast examination with emphasis on the general approach, inspection, palpation, and lymph node and axillary examination.

5. Sessions include didactics and practicum on proper draping techniques and attention to patient privacy.

6. Contractor provides necessary supplies for each session (note: there is no capacity for on-site storage of supplies).

7. Contractor provides services within the time limit specified (session times cannot be extended; awardee must supply adequate staffing to complete the session within the presented timeframe).

8. Contractor will inform teaching associates that a valid driver’s license and proof of insurance is required to drive a vehicle onto the Forest Glen military installation.

Contractor will also inform teaching associates that all vehicles entering the installation are subject to random vehicle inspections.

9. Contractor provides additional training sessions at no additional expense should students have insufficient time to practice all designated skills due to contractor or teaching associate error, or failure to follow the prescribed time guidelines in the statement of work.

BREAST AND PELVIC EXAMINATION SEQUENCE

Duration of Session:

● 1.5 hour session for a group of 2 learners;

● 2.0 hour session for a group of 3 learners;

● 2.5 hour session for a group of 4 learners.

Time Breakdown: Patient is in room, gowned, sexual history has been taken.

Exam will proceed in context of a complete physical; student tasks outlined below.

Breast Examination Preparation (2 min/pair):

● Teaching Associate didactics & discussion time - 30 min;

● Student examination practice - 30 min per student (up to 4)

● 15 - 45 minutes between sets;

1. Knocks and waits for recognition, introduces self to patient and addresses patient by surname.

2. Explains purpose and main steps of the examination.

3. Invites patient to ask questions at any time during the examination.

4. Checks all equipment for examination including drape (gloves may be needed for lactating patient).

5. Uses universal precautions and washes hands in presence of patient before beginning examination.

6. Discuss current recommendations for age and periodicity of mammogram.

Breast Visual Examination (3 min/pair):

1. Student instructed to look for symmetry, masses, lesions, skin changes, dimpling, peau d' orange, scars, bruises, etc.

2. Exposes both breasts completely (shoulders at the same level).

3. Visually inspects both breasts in seated position.

4. Visually inspects both breasts with hands on hips and asks patient to raise shoulders and squeeze shoulder and chest muscles.

5. Visually inspects both breasts with patient leaning forward. (Advises patient that hand mirror can be used at home.)

6. Visually inspects both breasts with arms above head.

Breast Examination (15 min/pair):

1. Palpates patient's right axilla in patient seated position:

2. Examiner uses left hand to examine patient's right axilla and palpates: deep central axillary area, lateral lymph nodes, medial axillary area, pectoral lymph nodes, and subscapular lymph nodes.

3. Palpates patient's left axilla in patient seated position:

4. Uses right hand to examine patient's left axilla and palpates: deep central axillary area, lateral lymph nodes, medial axillary area, pectoral lymph nodes, and subscapular lymph nodes.

5. Palpates patient's right and left breast in lying position:

6. Explains and demonstrates technique while examining patient. Repeats thorough examination of entire right breast using three degrees of pressure and methodical path with patient supine. Note: In patients, B cup and larger, left side lying position moving both shoulders on table or a pillow can be used to bring breast tissue toward the midline for examination of the lateral aspect. Supine position required for examining medial aspect.

7. If discharge has been noted in seated exam or reported by patient, attempt to locate source of discharge by palpation/stripping of quadrants of areola then breast.

8. Reiterates importance of, clinical exam, and mammogram as appropriate.

Establishes date of clinical exams with patient.

Pelvic Examination (External Genital Examination):

1. Assists patient in positioning herself (lithotomy position) and encourages and assists patient.

2. Inquires that the patient is comfortable.

3. Washes hands and puts on clean gloves (double gloves on dominant hand).

4. Faces patient's perineum, while sitting on chair, illuminates perineum with light source.

5. Alerts patient verbally that the examination is about to begin (examiner must establish tactile signal with hand as well).

6. Visually examines and palpates mons pubis/area of hairline and pubic area. Note pattern of hair growth.

7. Visually examines and palpates labia majora/outer folds and labia minora/inner folds.

8. Retracts prepuce/covering and visually examines clitoris.

9. Visually examines urethral meatus/opening to urethra, and introitus/opening to vagina, followed by palpation of Skene's glands, Bartholin's glands, and perineum.

Speculum Examination:

1. Washes hands and re-gloves if necessary.

2. Chooses the appropriate speculum, checks it (both mechanically and to make sure that it is not too cold) and shows it to the patient.

3. Alerts patient that speculum examination is about to begin.

4. Separates labia minora with forefinger and thumb of one gloved hand.

5. Holds speculum, at a 45 degree angle, with other hand and introduces it into vaginal introitus keeping it away from urethral meatus area.

6. Inserts speculum slowly into vagina along posterior vaginal wall, depressing perineal body, and rotates it to a flat position.

7. Opens speculum after inserting it fully; exposes cervix and tightens screw on speculum.

8. Cervical inspection: observes cervical size, color, and outer os configuration and notes any erosion, cyst, polyp, tumor, eversion, etc. (Note: Pap smear protocol would take place here).

9. Releases screws while holding bills open; removes speculum slightly until free of cervix and closes speculum partially.

10. Vaginal inspection: rotates speculum while removing to observe anterior and posterior vaginal walls, noting vaginal rugae, bleeding, ulcer and/or tumor; also noting discharge including amount, character and color, if any.

11. Allows speculum to close completely as it is removed.

Bimanual Vaginoabdominal Examination:

1. Applies lubricant to fore and middle finger of gloved hand.

2. Alerts patient that bimanual examination is about to begin.

3. Introduces distal segment of middle and fore fingers (with palm facing sideways) into vagina, uses pubococcygeal relaxation technique by pressing down on the perineal body.

4. Inserts both fingers slightly into vagina and turns hand to palm up position;

hyperextends thumb and flexes fourth and fifth fingers towards the palm.

5. Palpates vaginal rugae; checks for depth, deformity, scarring, cyst, etc.

6. Palpates cervical size, direction, configuration, consistency and tenderness.

7. Asks patient to take a deep breath and then relax her abdominal muscles with other hand on abdomen placed below umbilicus.

8. Palpates uterine body between vaginal hand and abdominal hand; notes uterine position, size, configuration, mobility, consistency, and sensitivity.

9. Moves vaginal fingers into fornix and abdominal hand to lower quadrants of abdomen.

Attempts to palpate both ovaries and parametrial tissues. Notes thickness of parametrial tissues and whether there are any pelvic masses.

Bimanual Rectovaginal Examination:

1. Withdraws fore and middle fingers from vagina, re-gloves and applies lubricant to fore and middle fingers.

2. Alerts patient that examination is about to begin.

3. Introduces middle finger into rectum and fore finger into vagina.

4. Uses anal sphincter relaxation technique by asking patient to bear down as middle finger is inserted into rectum.

5. Repeats the palpation and characterization of the cervix, uterus, ovaries, and parametrial tissues from the posterior position.

6. Palpates posterior pelvic wall with rectal finger.

7. Palpates rectovaginal septum between fingers while withdrawing forefinger from the vagina and middle finger from the rectum.

8. Withdraws fingers(see #7 above) in a single smooth and deliberate movement..

9. Asks patient to meet in office or exam room after dressing to discuss the examination findings.

10. In meeting, reiterates importance of clinical exam, mammogram, pelvic exam, and pap smear. Note: Be prepared to explain that flatulence, discharge, involuntary urination, bleeding or leakage of fecal matter may occur after exam.