OB-GYN Clerkship Tips: At your cervix

Emile here! With Ob-Gyn all finished up, I wanted to take some time to talk about my experience and share some tips for how to approach Ob-Gyn. Our program’s Ob-Gyn clerkship is 6 weeks long with the breakdown of 1 week obstetrics (labor and delivery), 1 week of nights L &D, 1 week of gynecology, 2 weeks of ambulatory/outpatient clinic and the final week is examinations and lectures leading up to the shelf exam. The hours are much longer than Family Medicine or Psychiatry and I got my first taste of surgery during this rotation. Ob-Gyn encompasses all of women’s health from screening guidelines, contraception, fertility issues, pregnancy and prenatal/antenatal/postpartum care, gynecologic oncology, and all other diseases that women face. Here are some important points to mention:

  1. You get a wonderful balance of inpatient/hospitalist and outpatient/continuity medicine. While Ob-Gyn has a lot of procedural medicine, there is a lot of continuity of care and long term management in care. Ob-Gyn’s are able to build strong relationships with their patients and even help their patients begin their families.
  2. You also get a great blend of both diagnostic medicine and procedural medicine. For people who feel that they “love everything” this is a great rotation/career choice. Ob-gyn’s do a lot of rounding, patient care management, disease work-up, and take extensive histories similar to what an internist would do BUT they also do a lot of procedures: (c-section, biopsies, hysterectomies, ablations, robot assisted laparoscopies, dilation and curettage, etc.)
  3. There are a lot of great subspecialties within OB-GYN for those who really want to master something specific. There are fellowships in Maternal Fetal Medicine (MFM) for high risk pregnancies, Reproductive Endocrinology and Infertility (REI), Gynecologic Oncology (medical and surgical management of endometrial, cervical, and uterine cancers), Gynecologic Urology (Uro-Gyn deals with incompetence, pelvic reconstruction), and others.

Overall, Ob-Gyn has a lot of learning opportunities for third year students regardless of interests. My role mainly consisted of taking histories and doing physicals, helping with deliveries, scrubbing into procedures (c-section and gynecologic surgeries), and doing magnesium checks for mom’s on Magnesium Sulfate for seizure prophylaxis.

Be aware that differences between hospitals and hospital systems make these tips applicable to some more than others. Use common sense and evaluate appropriate times to utilize these tips. These experiences and opinions are our own and do not represent the views of the hospital where we rotate.

Things to consider purchasing before you start:

  1. Perfect H & P: This was a total lifesaver during OB-GYN as it saved me a ton of time at the clinic. Everything is laid out and organized, the review of systems is all there, and when you precept to your resident/attending you’ll have more flow and structure in your presentations.
  2. Maxwell’s Quick Medical Reference
  3. Reflex Hammer. This came in handy for doing magnesium checks and testing Mom’s reflexes to assess for hyporeflexia. Click here to see the one I bought on amazon.

General Tips:

  1. Walk in with a smile, be kind, and be respectful. Women’s health is extremely private and intimate topic and this rotation really teaches you the importance of being non-judgemental, being approachable, and being trustworthy. Your patients will be more likely to open up to you and discuss their health concerns if you show genuine interest and build strong rapport and trust. Having a child is an emotional experience so be mindful of that when you meet your patients.
  2. Prepare the night before by reading up on whatever procedures you’re going to see the next day AND read up on each of the patients you’re going to see.  Know what the indication is for the surgery the patient is receiving and what the risk factors or alternative treatment options might be. You may see a variety of surgical tools used on Gyn (truclear, novasure, myasure, etc.) so I would recommend looking them up on youtube before you go in. If you’re going to see a TAH-BSO (total abdominal hysterectomy-bilateral salpingo-oopherectomy) or cesarian section, take a look at this link before the procedure.
  3. Know how to tie square knots! You might get the opportunity to help close up a c-section. I practiced on everything (shoe laces, knot board, string) so once you get the basics make sure to practice with two sets of wet gloves because that’ll be the best simulation of the real thing. Click here to view a link to a video I found helpful.
  4. Read as many ACOG Practice Bulletin Posts as you can! The most important ones are post-partum hemorrhage, induction of labor, fetal heart tracings, evaluation of adnexal masses. At the end of each bulletin is a review of the guidelines and level of recommendation. You can get a free membership through your institution.
  5. For antenatal care, know which weeks to order what testing and whether or not its screening or diagnostic. For example, first trimester screen (wk 10-13), Chorionic villous sampling (after wk 10), amniocentesis (wk 15-20), glucose tolerance test (wk 24-28), group B strep test (wk 35-37), etc.
  6. Ob-Gyn is its own language and there are a lot of abbreviations and acronyms used. The first week or so felt like I was in my first week of spanish 1 from high school. Take some time at the beginning of the rotation to learn all the little abbreviations and acronyms- it will go a long way in helping you adjust to the fast-paced rotation!

Study Resources:

I’ve learned that STEP 2 style questions are much more of “what is the next best step in management?” instead of “what is the diagnosis?” My biggest piece of advice is to create working algorithms for how to approach clinical different presentations and use that to answer questions. It takes the guess work out of trying to decide what test you should order, because honestly they all sound right. Biggest algorithms to know 1. management of amenorrhea (rule out pregnancy first!!), 2. management of abnormal uterine bleeding (if they’re peri/post-menopausal get a biopsy to rule out cancer) 3. management of adnexal masses 4. management of PPROM 5. management of preterm labor 6. management of post-partum hemorrhage. Online Med Ed has some great algorithms to follow.

  1. Online Medical Education (OME) Videos (Obstetrics and Gynecology 6 week schedule).

This is where I would start. There are roughly 40 videos for OME and they are free for medical students. Dr. Dustyn Williams does an incredible job of helping you recognize, manage, and treat diseases in a very systematic and well organized manner. I would also recommend reviewing these videos closer to your exam and writing out some of the algorithms and charts.

  1. UWORLD:

The #goat. Amazing questions that have so much learning packed into each one. Take your time with these and read through all the explanations. There are 285 questions and I started them during my third week of Ob-Gyn. There is also a new flashcard feature so you can use those beautiful images and charts to quiz yourself.

  1. American Professors of Gynecology and Obstetrics (APGO) videos + uWISE modules (Free):

These APGO videos are absolute gold. They have great visuals, are backed by APGO, they have 10 question blocks tied to each video called uWISE (which is required through our school), and they’re honestly fun to watch. I would recommend watching these leisurely throughout the rotation and revisiting them closer to the shelf.

  1. Obstetrics and Gynecology- Beckmann, 7th Edition:

I wasn’t able to finish the entire book but I got through a good chunk of it and thought it was a great resource with solid, reliable information. I also referenced it if I had any questions or confusion about a topic. Click here is the link:

  1. Firecracker- Ob-Gyn Clerkship ($249)

I didn’t really use Firecracker for M1/M2 year but its been a great resource during clerkships. Purchasing and using Firecracker is a commitment (and why I placed it at the end of this discussion). What a lot of people don’t know is that there is a firecracker section for Family Medicine (outside of the USMLE STEP 2 CK section). Its a little hidden but it covers topics from other question banks. If you’re a firecracker person, these are great for helping you on the boards (Shelf) and the wards (i.e. getting pimped). There is also a 110 question practice shelf exam that I did the day before the exam that I felt helped a lot.

In a nutshell: 1. Online Medical Education, 2. UWORLD, 3. APGO videos + uWISE 4. Beckmann Textbook 5. Firecracker 

If you have any questions, don’t hesitate to shoot us a message on our Instagram page. Feel free to comment with any of your tips you learned on your family medicine rotation in the comments below!

Be aware that differences between hospitals and hospital systems make these tips applicable to some more than others. Use common sense and evaluate appropriate times to utilize these tips. These experiences and opinions are our own and do not represent the views of the hospital where we rotate.

 

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