My pearls to help you be successful on the OBGYN clerkship & Shelf exam
Day 1: Approach the OBGYN physician with caution
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
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.
The 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 !