Ooooh Obstetrics and Gynaecology….. The main goal of third year medical school is to gather the basic skills to become a physician and show you what you might like to pursue post grad. For me this will not be OBGYN haha. Even though I didn’t enjoy this area of medicine, doesn’t mean I didn’t learn some very valuable skills. Also, seeing a baby being born for the first time was pretty amazing. So here are some tips on what it’s like and how to go about acing your OBGYN rotation ;).

What is Obstetrics and Gynaecology?

OBGYN is classified into two different areas that focus on the female reproductive system. Obstetrics deals with the care of pregnant women, the baby, labour and delivery and the immediate postnatal period. Gynaecology on the other hand, deals with the female reproductive tract relating to any other issue. This includes the vagina, cervix, uterus, fallopian tubes and ovaries. Clinic visits may include but are not limited to cervical screening, contraceptive counciling, and minor procedures. Both obstetrics and gynaecology involve a surgical aspect to them as well. This includes procedures such as C sections, tubal ligation, hysterectomies, oophorectomy, salphingectomy, and cone biopsies. Over all, OBGYN covers everything pertaining to female reproductive health.

Goals and Objectives

My OBGYN rotation was divided into 2 weeks OB, 2 weeks clinic and 2 weeks GYN. During the obstetric portion of my rotation, I was helping to deliver babies both vaginally and via C section. We were also responsible for ER admissions pertaining to problems such as pre-term birth, vaginal bleeding in pregnancy, spontaneous abortion and pre-eclampsia. Since we do not get training in this area during the first two years of medical school, the main objective here is to learn… and learn quickly. This was the first time I saw a baby being delivered, and also the first time I learned how to scrub into a surgery. Everything is very new, so I would suggest trying to find a good academic resource (we will go over this in a bit). Also, practice makes perfect when trying to navigate the operating room haha. Try not to touch anything until you have a hang of whats going on, or someone asks you ;).

The clinic weeks were a lot slower then the 5am-7pm days of OB. This dealt with any outpatient problems related to OB and GYN. I also had minimal previous training in the area of women’s health, and really appreciate the skills I developed here in clinic. I think one of the main goals for a budding physician is to be comfortable examining and understanding any part of the human body. Including vaginal exams, which can be uncomfortable for the patient. This is a good area to get comfortable preforming these physical exams and understanding the variety of women’s health needs. It is also a prime time to understand pre-natal screening and testing. Besides that, I tried to uses the rest of clinic days to study.

I had the gynaecology part of my rotation last. Your time here is mainly consumed with gynaecological surgeries. I did a few hysterectomies, tubal ligations, salphingoophorectomies ect. My best advice here would be to try to see the same surgery in multiple different ways. For example view a hysterectomy openly, laprascopic and robotic. This will give you a good idea of the anatomy, how different surgeons go about it and different techniques used for surgery. Be warned though, OBGYN surgeries tend to be kinda long, on average I was in there 3-4 hrs every surgery. Make sure you eat something before going in, try to move your legs once and a while and pee before hand. That way you won’t pee yourself and pass out 😉 lol.

Path to Success

I found that I had a lot more time to study in OBGYN then in Internal. Maybe it was the fact that I focused more on clinical work then studying in Internal Medicine or maybe because I was not very fond of this rotation that the pendulum swung the other way. I dedicated a lot of time to studying in OB, and that is probably why it was my highest shelf grade to date. Try to use your down time between cases or on clinic week to study. I used U world and finished all the questions. I also read an entire text book “Obstetrics and Gynaecology Seventh ed.”. I would say that this book is a little overboard on what you need to know, but it deffinently reflected in my grades. Other then that, I did the practice NBME OBGYN exams. These three resources were over all complete.

On the Floor

Unlike internal medicine, you are not able to do a lot of independent work in OBGYN. I would still focus on taking a thorough history, and use this time to understand the important aspects of an obstetric and gynaecological interview. There are a lot of other questions that are pertinent to interviewing a patient in this setting. Other then this I tried to use my time understanding fetal heart rate monitoring, the stages of labour, obstetric complications and why a procedure is being done. You can also follow up on your patients the next day after a C section during rounds. This adds to continuity of care, and its always fun to see the baby you helped deliver :).

Call Schedule

I’m going to warn you now, the call schedule for OB is pretty brutal. This is the first rotation where I had to learn how to switch between normal day shifts and night calls. Before, I had done a week of night call continuously, switching days and nights. Flipping back and forth between day and night is harder, because you don’t have a constant schedule. Everyone goes about this differently, but if you have a night call that blends into a day shift, try to wake up for a bit in the middle of the day post call. This makes me tired enough to go back to sleep in order to wake up the next day. I also experienced my first 24 hr call in OB, and I’m deffienetly not a fan. This was a 24 hr long shift 7am – 7am with no sleep in-between. I don’t have much advice for this other then just get through it and try not to have a car accident driving home the next day. Honestly I felt really out of it post call, and don’t understand how anyone could do that on the regular. As you can tell I was not a fan of the call schedule for this rotation, but we all have to get through it ;).

Shelf Exam

I found the OBGYN shelf to be the easiest yet, although I’m not sure you should take my word for it haha. Lot’s of other people thought it was very difficult, maybe this is due to the book that I read to prep. I found OBGYN questions to be entirely different then the regular Step 2 format, this is probably due to the nature of the content. Try to get used to the different language that they use, for example G2P11001… and you can get through the exam questions quicker. They also like to focus on medical algorithms, for example working up a breast mass in a woman under 30 years of age is entirely different then that of a woman that is 55. Screening is another area that is really important for this shelf, I would know cervical and prenatal screening inside and out :).

What I would do differently

I feel like I kind of hid this rotation. Don’t get me wrong I was still an active participant in the clinical events, but I felt really disconnected. Maybe it was because I had thrown myself into Internal so hard, and felt like I needed to focus on my academic side more during OB. Or maybe it was because I’m just not that fond of delivering babies (I know its weird ok lol). I don’t know if I would change anything that I did in this rotation, but I was still struggling to find a good balance of clinical vs academic work. This time the pendulum swung the other way. I did learn some very valuable skills though, and I am now pretty confident working in a sensitive area of women’s health.

My Thoughts

Overall, I did not enjoy OBGYN. This had nothing to do with the quality of education, the department was superb and I had exposure to many different pathologies. It’s just I wasn’t a fan, and I think thats ok. I’m going to extrapolate here from the great Forest Gump, “third year is like a box of chocolates, you never know what your gonna get” haha. Sometimes you need to see what you don’t like in order to realize your path is in another direction. So even though I will not be pursuing OBGYN I am glad for the experience and my new found skills that I can take forward with me into future rotations.

As for now I am still in my surgery rotation and I will be flying home to Maui in one week! I am very excited, and ready to hit the beach, scuba dive and have a Mai Tie :). Coming up I have a blog about Christmas time in New York City, and how beautiful it is during this season. Till then, stay warm everyone!

Cheers,

Jackie.