What you need to know about the OBGYN rotation

My pearls to help you be successful on the OBGYN clerkship & Shelf exam

Day 1: Approach the OBGYN physician with caution

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Most docs in the OB field are generalized to be “catty”, which of course isn’t true everywhere. But if you think about it—the long hours, being on call, constantly feeling like you’re on demand–you can imagine how that can wear on your attitude some days. So, careful as you come in with your beaming smile and radiant energy because you may not be met with the same thing. You’re likely coming off of a full nights sleep while your doc or resident was on call last night. So, use your social cues and gage the situation. Look for ways to help your people out or help the staff to do anything that makes the day run smoother. The staff will love you, and your attending will notice how much they love you.

It’s not all about the deliveries!

The first thing people say to me when I tell them I’m on OBGYN is so you’re delivering lots of babies huh? Of course delivering babies is a big part of the field (especially financially), but as a student if you go into the rotation thinking you’re only going to be popping babies out left and right, you’ll be highly disappointed. And there is so much to learn in those 12-24 hours leading up to the delivery–managing the patients labor, tracking the rate of cervical dilations, monitoring the status of the fetus, making sure mom is comfortable and gets her epidural on time, etc. The birth itself is a bloody climax to it all. So whenever you spend your time on L&D, I advise you to work closely with & learn from the nurses (or possibly junior residents) who are likely the ones keeping a close eye on everything. In my experience working in a smaller town, the nurses manage the patients all the way until about 60 seconds before the baby is ready to see the world. So I really gained a TON of knowledge and clinical experience by following patients with the nurses, much of which helped me on the Shelf exam. And to answer the question, yes I caught my fair share of babies.

You need to know ASEPSIS

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OBGYN is a surgical specialty and you spend quite a bit of your time in the operating room (at least I did). Pay special attention to your ASEPSIS training and if you aren’t getting it right before the rotation, watch some YouTube videos to help you refresh. Save yourself the embarrassment & potential scolding depending on where you rotate. I think the most common way you’d mess up (from personal experience and from what I’ve been told) is moving the surgical light with your sterile hands, so be extra careful there. Luckily I rotated at a site where the staff and doctors were chill and didn’t take pleasure in making med students cry, so when I messed up it wasn’t the end of the world.

On surgery days, learn as much about the patients as possible

Watching/assisting with procedures is awesome, but unfortunately won’t get you very far in the numbers game as a third year medical student. Take time to read each patients chart before the surgery in order to understand how they got to this point. Then go ask them questions if you can before they get all doped up. How old are they? What were their major symptoms? What things did they try before hand? If you’re doing an operative laparoscopy (op-lap), think about some things you might see based on the patients symptoms. Especially cases like dilation & curettages, LEEP and cone biopsies–learning about the patients getting these procedures can help you in your studies when a clinical vignette is asking you about the infamous “next step in management.”

SHELF advice–The name of the game is management and risk factors

What is the diagnosis? What is the next step in management? What is the greatest risk factor for this patients condition? are a few of the most common question stems you will encounter in your shelf prep. So start early nailing these things down as you study different conditions. If I could go back, I would have kept a few sheets of paper where I drew out flow charts for the management of different conditions. It gets so confusing when you follow different protocol based on age or weeks gestation or stage of cancer or grade of lesion. I found myself second guessing a lot of those types of things, even on my exam.

 math study learning exam studying GIFThe resources I used were the Beckman’s textbook, Online MedEd, UWise, UWorld, PreTest, and I read some of Case Files in the last weeks. Each of those resources were solid, but honestly PreTest really wasn’t doing it for me like it did during Pediatrics. Like in Peds, I watched all of the OME videos up front and took digital notes on them as my foundation. As I did questions and learned more, I added those notes into the structure I already had. Our school had a reading schedule for us to get through the Beckman’s text along with the associated APGO YouTube videos and UWise quizzes. I was able to keep up with that consistently. I did PreTest in the first 3 weeks by waking up early in the morning or doing questions at night when I finished the readings and Uwise. But like I sad, it’s really not something to be pressed about. I did UWorld in the 4th and 5th week and did NBMEs/UWise comprehensive exams in the last week. Lastly, you want to always have something on you to study at all times. There is down time on L&D and in between surgeries that you can use to get some of your work done, especially if you have long hours.

Nearing the end of the rotation, I had this unsettling feeling in me that no matter how much I studied, I would still be iffy on those management questions. I just felt like there was no way for me to just memorize it all (I’m horrible at memorizing things if you didn’t know). I could only really remember the things that related to patients that I worked with. That’s why I said if I could go back I’d have created something as I went and used that to review/memorize in crunch time. But hey, I did my best, which is all I can ask of myself, so we’ll see how those results come out!

I hope this is helpful to someone. If you’ve been through it and have other things to add about OBGYN, feel free to drop them in the comments!

Also, S U B S C R I B E !

New rotation, new location–one week down!

Update on OB, life, and embarrassing moments from the week

First week of OB has been awesome! It started out with me being in the wrong place for orientation, which is exactly the type of thing that I would do. People think I’m really smart but in reality I don’t have much common sense. Everything ended up working out though of course. Anyways, being in a rural area as the only student with my preceptor and no residents means that I get to see all the patients and scrub in/assist with all the surgeries. I work with different preceptors throughout my time here which I personally enjoy because I learn even more. And I live right across from the hospital and 2 mins from the surgery center/clinic, which is so great for my sleep, and car. And there’s free breakfast and lunch in the doctors lounge, which I have access to! So I can’t complain.

My first day was GYN clinic which was full of women young and old with all sorts of things going on. From annual physical exams to possible ectopic pregnancies to infertility, I met so many school requirements in just one day. Coincidentally, I watched my preceptor insert an IUD (intrauterine device for contraception) in clinic, and after we finished she trained me on inserting it using a model. Then the next day I was working with a different preceptor doing GYN surgery and there’s a woman also getting the same IUD (under anesthesia)! Literally my the doctor just gave me the IUD and said “OK you’re gonna put this in.” I was praising God in my head that I had just learned about it the day before so I was able to do it with confidence. I worked with the same physician the rest of the week and not only do I scrub in each time, but she lets me operate the camera when she’s doing laparoscopies and she even let me do part (a very small part, she’s not crazy) of a D&C (dilation and curettage). Anything I want to do I just ask! Thursday morning I was in L&D (labor & delivery). I was in my first C-section and all I can say is WOW. I was just blown away. I might have even forgotten to blink. It was weird though because we were talking to mom casually meanwhile I’m looking at her insides. I was thinking if only you knew what was going on on the other side of this drape… The rest of that day was OB clinic which was pretty un-stimulating for the most part bc it’s just monthly check ups and labs. The girl we were supposed to deliver from L&D decided that her cervix wasn’t going to dilate till 8pm so I missed that chance. My preceptor just had me read and present all the fetal heart tracings so I got pretty good at those, and I watched ultrasounds, which I’ll eventually have to do as an assignment. Then Fridays are apparently office OR days so I was back there again–saw stage 4 endometriosis which was pretty gross and so cool at the same time, also sad bc it was preventing the patient from getting pregnant.

I’ve been able to stay on top of my studies without losing sleep also which I’m proud of. We have assigned readings, videos, and online quizzes to do and I also try to squeeze PreTest questions in as well. As for other parts of my life, I got 2 workouts in this week–we’ll shoot for 3 this week. I haven’t explored the city much outside of going out to dinner with my roomie. I got lots of great news this week including winning this scholarship I applied for back in June! And also, my birthday is coming up on Wednesday! So over the weekend I had a brunch with some of my college and med school friends and had so much fun! My parents also took me out for breakfast so I appreciated that very much.



All in all I’m having a blast to far, and I’m excited to see what this week has in store! Being me, I’ve already racked up my share of embarrassing moments in just 4 days and I’ll tell the top 3 stories for your entertainment pleasure…

Pass the Scissors:
So I’m with my preceptor the first day in the OR and the nurse tells me to get ready to pass the surgeon the scissors–simple enough. Up until this moment I had never passed a surgeon anything so I didn’t know there was a special format. So it took me like 3 repositions and the nurse kept saying “no not like that, turn it the other way”. I just felt like an idiot! Then after the procedure my preceptor showed me the proper way to pass instruments, and she was nice about it so I didn’t mind.

I got fully scrubbed in then I touched the overhead light without the sterile cover thing and then everyone just looked at me like yeeeeeeah you’re not touching anything this time.

A way with words:
This nurse in L&D was asking me about the size of a patient (who was having her c-section that morning) and I didn’t know exactly how to describe her. She specifically wanted to know about her body size. But what I said was she’s like your size…like with her arms and stuff. And honestly she did have similar body size as the nurse in terms of arms and shoulder breadth. But I quickly realized that I basically just told that nurse that she was the same size as a lady giving birth that morning. I think I severed any possibility of a future relationship with her.

Hope you enjoyed the read! If you did, take the next step and S U B S C R I B E today!

Have a wonderful week,