Obstetrics and Gynecology Advice
So I finished my Ob/Gyn rotation last week, and here’s some take aways that I found valuable. Take this with a grain of salt. I’m just a wee third year medical student:
Before the Rotation:
1. I studied a few things beforehand, and several residents/attendings said that it showed during the first couple of weeks of the rotation. Know fetal heart tracing basics and why they happen (baseline HR, variability, accels, decels). Know what G’s and P’s are (TPAL!). Review pre-eclampsia. You’ll learn more about this on the rotation, but if you’re at a larger urban hospital like I am, you’ll see a lot of this.
2. Watch a video of a baby being born and a c-section if you have no idea what you’re getting yourself into. If you haven’t taken surgery yet, and really want to be prepared, watch a video of a subcuticular suture. I closed more skin on this rotation than I did on general surgery.
3. Sleep and grocery shop because lol who knows when you’ll get the chance later.
Labor and Delivery
1. Follow your residents EVERYWHERE. You will get left behind if you don’t.
2. Offer to get an H&P on as many triage patients as you can, especially if it’s a labor rule-out. At my hospital, we weren’t allowed to go into rooms of laboring patients we hadn’t met before. So try to meet as many as you can, so you can get more deliveries! Don’t just expect to be handed deliveries. You have to earn it.
3. Ask to do as much as you can. Whether it’s cervix checks or presentation ultrasounds, there’s lots of smaller hands-on stuff that the resident can do in a few seconds and will forget to include you on if you don’t ask.
4. Some people might not agree with me on this, but if you’re interested in Ob/Gyn and have to do night shifts, don’t sleep if you can help it. See above, if you are asleep, there are tons of small things the residents do throughout the night that they won’t wake you up for. Also, there were a couple of times people rolled in by ambulance at 10cm and pushed a baby out in a few minutes. You don’t want to miss this. Be included in as much as you can! Plus, you can always study during slower nights.
5. C-sections are so much fun! Wear the knee high boots, and grab that suction because you’re going to need it. Eat something beforehand and don’t forget to bend your knees.
6. You’ll see lots of body fluids. Practice your poker face and don’t scowl when things get weird.
1. Don’t forget the OB and GYN histories. For OB, get the full G’s and P’s. Don’t forget to ask about miscarriages and abortions. Ask about any pregnancy complications (i.e. hypertension, diabetes, preterm delivery) and mode of delivery. For GYN, ask about last menstrual period, how heavy they are, how regular they are, and how long they last. Then, ask about birth control/condom usage, history of STI’s (list them off because sometimes people don’t know), and pap smears (any abnormal ones?). Finally, ask about sexual activity (men/women/both, multiple partners, etc.). This seems like a lot to ask, but if you don’t ask, many people won’t tell!
2. Be comfortable with speculum exams. For God’s sake, don’t tell patients to “spread your legs”. Ask them to let their knees fall to the sides. Tell them to expect your touch and downward pressure. Insert the speculum ALL the way and open, the cervix will 9 times out of 10 pop into view from there. Make sure you close the speculum while taking it out.
3. Know what tests need to be ordered when for each OB visit throughout pregnancy. Know the types of spontaneous abortions and what can be expectantly managed. Know the work up for infertility. Know when colposcopy and LEEP are generally indicated. Know when endometrial biopsies are indicated.
4. Talk to every patient about birth control if they aren’t already on it and aren’t trying to get pregnant! Maybe this is something I’m just passionate about, but no one is going to fault you if during your presentation for a patient with a vulvar lesion or vaginal discharge you say “…oh by the way, she’s interested in trying a Nexplanon”.
1. I only had a week of this but know your anatomy. Know layers of the abdominal wall, parts of the fallopian tube, and uterine ligaments.
2. Fibroids and abnormal uterine bleeding. Learn this. Know the types of fibroids and when you treat abnormal uterine bleeding with surgery.
3. Sleeping patients are the best time to practice speculum and bimanual exams.
1. I don’t know my score yet, but I studied sooo much for this one. I read BluePrints, did all the UWise/UWorld questions x1, and all the questions I got wrong x1.
2. Honestly, I love the ACOG committee opinions and practice bulletins. Ask your resident to use their account if you don’t have one. If you only choose a couple to read, the hypertension/pre-eclampsia and gestational diabetes ones are great.
3. Just work hard, and it will all be ok! After taking the shelf, I realized that I saw so many of the clinical vignettes in real life, which was pretty cool.
4. Some things I wish I studied more were STI’s and antibiotics, breast disease, and stages of labor.
I probably have a lot more advice, so if you have questions, just ask! These are just some things that helped me along the way.