I loved my OBGYN rotation. I did 7 24-hour shifts over the span of three weeks!! It was so hands on and fun and happy (for the most part). My very first day I assisted on delivering twins via C-section, and did hands-over-hands to deliver 4 other vaginal births. I was on an adrenaline high to say the least. I also loved clinic, which is a first. I hated clinic for every other specialty so far. I don't think there was anything I didn't like about this rotation, other than the few fetal demises I saw, which is the reality of the profession.
For my rotation, and I think most hospitals, I rotated with my preceptor most weeks, but other weeks I worked with different providers for variety. His schedule would generally be 3 days of clinic, 1 day of surgery, 1-2 days on call (where we would still see clinic patients), and 1 day post call.
24-hour shift schedule: Quite variable depending on the shift
06:30-08:00: Read on patient charts, pre-round
08:00-09:00: Round with attending
09:00-16:00: Rotate between patients in clinic and L&D, maybe deliver a few babies!
16:00-17:00: Dinner
17:00-08:00: Watch the fetal heart strips for any category tracings, check on patients, chart, deliver some babies either NSVD or CS. Some days there would be back to back deliveries all nights, and others there would be plenty of down time. For the shifts with time in between, I would go to the sleep room and study, practice suturing or two hand ties, watch OnlineMedEd, do flashcards.
Surgeries/procedures performed:
Cesarean section
Laparoscopic hysterectomy
Vaginal hysterectomy
Robot-assisted (DaVinci) laparoscopic hysterectomy
Oophorectomy
Salpingectomy
Cervical cerclage
D&C
Endometrial ablation
Laparoscopic myomectomy
Tubal ligation
Laparoscopic procedures to remove cysts or for ovarian torsions
Repair for 2nd and 3rd degree tears in vaginal
Practice your one and two-hand ties! You will use them!
What to read up on before starting:
Fetal Heart Tracings: Category 1,2,3 acels decels (VEAL CHOP)
HPV and cancer screenings
Gestational hypertension vs. Pre-eclampsia vs. Eclampsia vs. HELLP
Abnormal Uterine Bleeding
I would listen to Pimped Podcast and watch the youtube playlist as early as possible
Read Pocket Pimped -- I got pimped on SO many of these questions
Resources:
High yield review (watch night before the exam)
ACOG Practice Bulletins
APGO Video Playlist
Red Book: Comprehensive Handbook OBGYN
Pimped Youtube Playlist (anatomy reviews, surgery reviews)
First Aid :Step 2 CK OBGYN Section or OBGYN First Aid Book
OnlineMedEd
FAVORITE RESOURCE: Podcast: Pimped OBGYN Podcast on Spotify
Apps:
Pimped App – Clinical questions to expect in the OR and on the wards
LactMed – medications safe in breastfeeding
ASCCP: Cervical cancer screening (costs money but worth it if you're going into women's health)
CDC STI guidelines
ACOG app
OB Wheel or dating
Uptodate
Epocrates
GoodRx
Labor and Delivery:
Important to ask for presenting:
Gs & Ps aka Gravity and Parity
Primes, multips
Gestational age Preterm vs term
Types of visits at clinic:
ROB (routine obstetric visits) ask about: fetal movement, abnormal discharge, bleeding, contractions, any new pains/symptoms/complaints. Take patient history, measure fundal heights, listen to heart sounds on the doppler, and shadow.
Pre-procedure patients
Annual exams
Birth control initiation (IUD or Nexplanon insertion or removal)
For Gyn appointments: ask about menopause, LMP, mammogram, sexual history, GU, and anything pertinent to CC
Tips and Tricks:
Practice your one and two-hand ties and have them down-- you will use them! I keep suture on my steering wheel and practice at stop lights on my way to and from the hospital.
If you're interested in women's health, I recommend staying at the hospital your entire 24 hour shift. You inevitably get to do and see more versus going home and getting called in. You can also offer to triage and check on patients for the doctor and have nurses call you with updates to practice presenting to your preceptor.
Sometimes OBGYNs don't want students to chart for them because of malpractice/legal stakes involved, so if a doc didn't want me to, I would ask to practice charting and have them review my note with me on things to improve.
Offer to push with patients! This really helps you to bond with mom and be more involved in deliveries.
Bring food and snacks with you because the days are long and sometimes you won't get a chance to go grab food. I would carry snacks in my coat pocket because being blow blood sugar before rushing into a surgery is no fun.
Practice everything as much as you can and ask the doctor to be hands on -- ask to do hand-over-hands for deliveries, manipulate the cervix during hysterectomies, measure fundal heights, find the heartbeat on the doppler, check dilation and effacement, do wellness exams and check cervix *with patient approval*
What to bring:
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