Rookie mistakes in OB/Gyn

[Cards21aceking]

For those of you who are have matched and/or begun your residency, what do you think are the most common mistakes that a 3rd year can make on his or her ob/gyn clerkship?

I have it as my first clerkship and I'm a bit anxious/nervous, so I was just wondering if anyone would be able to pass along any simple or not so simple advice that you either wish you had known or routinely pass along other underclassmen.

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[smq123]

For those of you who are have matched and/or begun your residency, what do you think are the most common mistakes that a 3rd year can make on his or her ob/gyn clerkship?

I have it as my first clerkship and I'm a bit anxious/nervous, so I was just wondering if anyone would be able to pass along any simple or not so simple advice that you either wish you had known or routinely pass along other underclassmen.

Not a 4th year, but I did do my ob/gyn rotation already:

• Don't expect people to tell you where to be. A lot of people think that their residents will page them when someone is about to deliver, but that's not always possible. Things on L&D move so quickly, and can happen so fast, that it's hard to remember to page someone else. Trying to figure out a way that you'll know when things are going on is something you need to do within the first day or so on Labor and Delivery.
• Before you start L&D, read up on how to interpret a fetal heart tracing - what is "reassuring"? What is a decel?
• On L&D and in clinic, whenever you see a pregnant woman, always, always, ALWAYS "wheel her out." Use the pregnancy wheel to figure out where she is in her pregnancy. Always, always, always. And, if possible, find out how the patient learned her estimated date of delivery - was it based on a first trimester ultrasound, last menstrual period, etc.
• Always, always, ALWAYS know a patient's "Gs & Ps" - how many kids has she had?
• Be flexible. On OB/gyn, since you're changing between clinic, L&D, and gyn surgery, things change fast.

Good luck, and enjoy the rotation!

 

[Cards21aceking]

This is great! I'm learning so much already!!!!

ALWAYS "wheel her out."

Is it sad that when I first read this I thought this was talking about taking her out in a wheelchair ....oh I have so much to learn.

 

[sunkists]

depending on the academic climate of your L&D floor, you might not want to be caught sitting down and reading (even if it's ob/gyn related). i was better off actively following around someone and asking a couple of decent questions here and there.

 

[smq123]

Is it sad that when I first read this I thought this was talking about taking her out in a wheelchair ....oh I have so much to learn.

No, it's not sad. When my resident first asked me, "Did you wheel her out," all she got was a deer-in-headlights look in response. "Whaaa...???"

I forgot one more thing. When a patient goes into labor, you can maximize your chances of doing stuff if you're prepared. As soon as someone is fully dilated, get a sterile gown, sterile gloves, plastic boot/shoe coverings, and a surgical mask ready, and set it all aside. (Obviously don't unwrap the sterile gown all the way just yet! But have it ready.) That way, you'll be gowned up and ready to go when the woman gets ready to deliver.

If the baby's head is starting to come out, and you're still struggling to get those plastic boot coverings on, there's no way that a resident is going to let you do anything. So be prepared!

 

[genome25]

try be in a good mood and always try to look interested! oh and smiles are contagious...even in ob/gyn

 

[Cards21aceking]

Man, you guys are amazing. I wish I could just start tomorrow. It's so hard getting through these last couple months of second year, and that little "quiz" at the end of the summer that my father likes to call U-Smile....gotta love Indian parents

 

[daisyduke]

Advice from a 2nd yr resident:
1. Be on time; actually, be early. It looks bad when the students are rolling in to the hospital after the junior residents have already started to see patients.
2. Jump in and start rounding on patients; definitely appropriate to ask to be assigned patients, but after the first day just get in there and start rounding. You don't need a personal invitation to see the patients. If you finish early, see an extra patient.
3. Ask and know your patient's OB and GYN related history!
4. Get a pregnancy wheel from somewhere and USE IT. Knowing your patient's G's P's, dating, how they are dated (LMP/sono/what trimester) will make you look smart.
5. Be on top of triage... beat your intern to the triage patients and get started. Try to learn the basics of what needs to be done to triage a patient and see if you can help your resident gather the supplies they need (portable light, culture swabs, sono, etc).
6. Introduce yourself to patients and get to know them; that way the patients see you as part of the team!
7. Review fetal heart monitoring strips frequently; report your findings to your residents. Follow patients on magnesium and write notes every 2-4 hours.
8. Pick a few patients to really get to know on L&D and ask to "sign out" these patients at board turn over... if you do a good job, you will look like a star!
9. For gyn or onc, get there BEFORE your junior residents and get started on your notes. It sucks to come in the earliest, but we have all done it.
10. Never leave pre-rounds when you are done writing your notes to go get breakfast while the junior residents scramble around to finish work and go hungry. That is just rude.
11. Speak up and present the patients you saw on rounds before the residents speak over you
12. Ask if you can help with writing the orders during rounds with the fellow or attending to help out the residents; also help with writing scripts or discharge instructions. You really don't need an MD to do that stuff and it REALLY helps your team out
13. Be interested, enthusiastic, tireless, and never leave before your team unless dismissed early! Remember, no matter how tired you are, the residents you are working with are much more tired!
14. The more you help, the more your residents will want to teach you and let you get involved with the hands-on, fun part of OB (deliver babies, close skin during surgery, do ultrasounds).

 

[Farmer Jane]

This is just a practical tip, but one I've found is appreciated: before you go to c-section, unless it's a crash one, go to the patient kitchen and chug a 4-oz cup of juice. The extra sugar will help prevent you from feeling light-headed during the procedure.

 

[smq123]

2. Jump in and start rounding on patients; definitely appropriate to ask to be assigned patients, but after the first day just get in there and start rounding. You don't need a personal invitation to see the patients. If you finish early, see an extra patient.

Definitely follow daisyduke's excellent advice!

But, if you finish early and decide to see an extra patient - BE EXTRA CAREFUL and make sure that another student on your team isn't following that patient! Double check your patient lists - somebody did that to me on gyn (he prerounded on my patient), and I almost keeled over when I opened the chart and saw his note. (I had been warned that I was going to present that patient to the PD that morning!) It was an accident, and he was an awesome teammate otherwise, but it made for a rough morning.

4. Get a pregnancy wheel from somewhere and USE IT. Knowing your patient's G's P's, dating, how they are dated (LMP/sono/what trimester) will make you look smart.

There are free "pregnancy wheel" programs for your PDA available online. I don't like these programs (and I hate lugging around my palm pilot with me around L&D), but a lot of people use them.

You can also print out pregnancy wheels from the internet - try googling "printable pregnancy wheel" or "printable gestational wheel" or something like that. You can then cut out the circles of paper, and attach them together in the middle with a brass brad. It won't be very sturdy, but if you decide to go into OB/gyn, you can get a plastic one later on.

 

[SippiGirl08]

There are free "pregnancy wheel" programs for your PDA available online. I don't like these programs (and I hate lugging around my palm pilot with me around L&D), but a lot of people use them.

You can also print out pregnancy wheels from the internet - try googling "printable pregnancy wheel" or "printable gestational wheel" or something like that. You can then cut out the circles of paper, and attach them together in the middle with a brass brad. It won't be very sturdy, but if you decide to go into OB/gyn, you can get a plastic one later on.

www.acog.org (or maybe it's www.apgo.org) will mail medical students a free pregnancy wheel.

 

[smq123]

www.acog.org (or maybe it's www.apgo.org) will mail medical students a free pregnancy wheel.

Wait, ACOG sent you one?

I asked them TWICE, and haven't gotten one yet. And I'm actually planning on going into OB/gyn!

 

[nykka3]

Wait, ACOG sent you one?

I asked them TWICE, and haven't gotten one yet. And I'm actually planning on going into OB/gyn!

aah.... so you have decided on obgyn?

 

[tiredmom]

Advice from an Intern:
1. Pay attention and be proactive - I can't possibly remember which student is following which patient in L&D or know their pager numbers - hover/make friends with the nurses, work out some system to know when your patient is starting to push. Be there when she starts to push, stay in the room and push with her. The families should know your name.
2. Beat me to the patients - I about fell out of my chair when a 3rd year student came out of a triage room to present to me - I usually have to give specific assignments. It was GREAT!
3. Realize when to ask a question. When I'm in the middle of trying to figure something out or I'm really busy, it's not a good time to clarify what cervical effacement means. I'll answer your questions, but you have to realize that I've got a ton of work to do too.
4. Get checkout from the off-going students when you switch rotations. Most Ob/Gyn clerkships are split between ob and gyn, so chat with your buddies to find out what your responsibilities are. You can't possibly realize how exhausting it is to give the same orientation every week (I sure didn't).
5. Act interested. If I have to come looking for you all the time, I'm much less inclined to work hard at teaching. If you're around and seem interested, we've got more opportunities to talk about topics. You have to remember, if it's easy for me to teach you, I'll teach all day... but if I have to make a conscious decision to either do one of the 15 things on my list of stuff I have to get done in the next 3 hours or to sit with you for 10 minutes to talk about something, the expendable thing is your teaching time. I know everybody doesn't want to be an ob/gyn when they grow up (why not, I can't fathom...JK ). I don't expect that. What I do expect is for you not to whine about it being boring or that you wish there were more traumas (actual comment by a student this year).
6. Have fun. It's a fun rotation where you learn a lot in a rather hands on manner. It's a nice mix of surgery and medicine. We tend to lean more towards surgery mindset... shorter notes, not a long differential. It's also an area that doesn't get duplicated much - and it's pretty straightforward information. Plus, delivering babies is pretty cool!
Good luck!

 

[daisyduke]

Definitely follow daisyduke's excellent advice!

But, if you finish early and decide to see an extra patient - BE EXTRA CAREFUL and make sure that another student on your team isn't following that patient! Double check your patient lists - somebody did that to me on gyn (he prerounded on my patient), and I almost keeled over when I opened the chart and saw his note. (I had been warned that I was going to present that patient to the PD that morning!) It was an accident, and he was an awesome teammate otherwise, but it made for a rough morning.

At my program we usually have one student on our team at a time, so they only follow a few patients on the service and the rest of the patients are not seen by any student. Of course if the patients are divided among several students, try not to step on your classmate's toes.... that is definitely not cool!

 

[smq123]

When doing triage on L&D, or seeing pregnant women in clinic, don't forget the "cardinal questions":

1) Is the baby moving?
2) Any vaginal bleeding?
3) Any loss of fluid - do you think your water broke?
4) Have you had any contractions?


Also ask, "Do you have any pain, changes in vision, chest palpitations? Are there any problems?" - never hurts to try and pick up pre-eclampsia/HELLP early.