- Length - 6 weeks
- 3 weeks of obstetrics
- 1 week morning shift (6 am - 2 pm)
- 1 week afternoon/evening shift (2 pm - 10 pm)
- 1 week either night float (10 pm - 6 am) or high-risk OB shadowing
- 3 weeks of gynecology
- 1 week gynecologic surgery
- 1 week gynecologic oncology
- 1 week clinic
- 3 weeks of obstetrics
- Lunchtime lectures 2-3 days each week
- Weekly didactics on Friday mornings
- 1 student presentation
So, as you've probably figured out by now, I started off third year on OB-GYN, which at my program is a 6-week-long rotation split into two halves [as detailed above]. I actually ended up with the "golden schedule" thanks to the alphabet, meaning that the order of my rotations corresponded almost exactly to the order of topics of discussion for lectures and didactics [normal OB --> abnormal OB --> gynecology --> infertility --> oncology --> office visits and wellness]. I started off on the obstetrics side of things; my very first day, after we wrapped up our orientation session, I got to scrub in on a C-section and play first assist to one of the private OBs who operates at our hospital. Seriously the coolest start to the rotation I could have ever asked for. L&D had different goings-on depending on which shift you were working: mornings involved seeing a couple of patients as part of pre-rounds and potentially contributing notes to the patient's chart, sitting through morning checkout, and then rounding with the day intern and the attending whereas the afternoon shift didn't involve any hospital "logistics" and instead focused on seeing patients who either came into the screening room or the EC [the two ERs] or who were admitted to the labor & delivery floor. C-sections and deliveries could happen at literally any time of day, although C-sections tended to be more common in the morning as most of the planned surgeries were scheduled for earlier in the day when things tended to be less busy. Night float was possibly my very favorite week of the whole rotation; the nurse midwife who normally covers the EC overnight was on vacation that week, so it was up to the intern and I to attend to all the patients instead, as well as our usual responsibility for the screening room and the patients on the floor.
Gyn surgery covers the EC during the day; the interns are tasked with responding to pages and seeing patients who present to the EC with gynecological or early pregnancy complaints in between cases in the OR. Mornings on the surgical services started off with pre-rounds; most days we usually proceeded down to the OR floor to see patients in pre-op and usually do at least one case before returning back upstairs to do actual rounds with the attending for the day. There's a lot of downtime in between cases, since almost all of the gyn procedures use the same room and we have to wait on it to be turned over after each case. Gyn surgery also involved colposcopy clinic on Monday afternoons and preop clinic on Thursday afternoons, whereas gyn oncology didn't include any clinic time. And then clinic itself is pretty self-explanatory. You're at a different site depending on the day of the week; most of our time is spent with the residents at their patient continuity clinic, but we also can spend time at the health department or a couple of other sites depending on scheduling. Continuity clinic covers a wide variety of things - standard obstetric visits, gyn complaints, well-woman visits, etc. The health department doesn't really provide OB services, but we did see patients for annual exams and abnormal pathology follow-ups in particular.
clerkship work hours
Labor & delivery was set up in three 8-hour shifts - 6am - 2pm; 2 pm - 10pm; 10pm - 6 am. L&D also included 16 hours of weekend call time, scheduling for which was randomly assigned based on your work schedule; your 16 hours were either split up between Friday night and Sunday morning, or scheduled all day Saturday from 6am-10pm.
Gyn surgery and Gyn oncology, both being surgical services, had variable start times and variable work hours depending on the number of cases we had on a given day and on the number of patients on the floor. I usually arrived around 6 am unless instructed otherwise, and got dismissed home most days sometime in the early afternoon.
Clinic hours are pretty standard business hours - 8 am until 3 or 4 pm, depending on location. My days at the resident continuity clinic were both half days, whereas I spent a full day with the doctor at the health department clinic.
- BABIES. Oh my god, there is nothing quite like being present when a new life enters the world. I found vaginal deliveries to be a lot more fun than sections, because the atmosphere is so different between the two settings, but either way the experience is magical. It took some effort for me not to start crying alongside the new parents and their family members. I ended up getting to do 3 vaginal deliveries [with my resident guiding my hands the whole time, thankfully] and so many C-sections I honestly lost count - it was definitely somewhere upwards of 10. I almost got two more deliveries, but end up being complicated by things like shoulder dystocia so I stepped aside to let the residents take over.
- I love women's health issues. I've been interested in pregnancy and lady parts and gynecologic stuff since I was way younger and actively concerned that being interested in female physiology made me weird. It was so fulfilling for me in so many ways to get some hands-on experience with this aspect of medicine; even beyond the pregnancy stuff, I loved getting to practice pelvic exams and wet preps and using a speculum [that cervix can definitely be a tricky little bugger!].
- And then babies again. Even outside of actual deliveries, it was just so much fun to get to talk to the expectant parents about their pregnancies. In clinic I got to use the Doppler to find fetal heart sounds [which definitely took some practice] and measure fundal heights and perform Leopolds and answer questions, and it all made me so happy. Getting to chat with patients is one of my very favorite parts of this job, and I can only imagine how much more fulfilling everything will be when I get to work with my own patients with whom I've gotten to know and develop relationships with over time. Just living the dream.
- We had a day on gyn oncology without any cases scheduled, so the resident let me and the fourth year student play with the Da Vinci robot while she worked on charting and paperwork. The robot comes loaded with a bunch of simulations and games to help you learn and practice how to operate the robot and manipulate the arms and the lights and all of the various parts. It definitely takes some getting used to! I found trying to suture to be incredibly difficult, but merely moving the graspers around proved pretty quick to get a feel for.
- Our gyn oncology attendings are awesome and actually seem to enjoy incorporating students into the team dynamics. They like to ask questions and engage the students, and they were also usually great about bringing us along as they ran around doing other tasks, like examining tissue samples with pathology or talking to family members post-procedure.
- We were given a scrub workshop on our very first day, as part of orientation, and it left me feeling a lot more confident about being in OR situations. I hadn't observed surgery or anything before, and as such I was unfamiliar with the setting and all of its various rules and intricacies, but the scrub techs we worked with were great at getting us acclimated to OR and teaching us what to do and what to expect. It makes me a little bit less afraid for my actual surgery rotation in the spring.
- I don't know how it works at other programs, but at mine the interns are specifically tasked with overseeing the medical students...which makes being the first group of the year particularly difficult, since the new interns are starting their academic year shortly after we start ours. Everyone's focus was on getting the new interns acclimated to their jobs and teaching them how everything works; as a result, we students definitely felt more than a bit ignored since our education was much lower priority [for good reason, but still].
- Building on that, because the interns themselves are new, they don't really have a good grasp on how to handle students. Like, I can recall a few specific instances in which I did something incorrectly without thinking about it - like copying down only the most recent set of vitals from the computer instead of the range from the past 24 hours - and being offered absolutely no feedback on having messed up something. There were so many times when we students would offer to do something to try to help out, only to be shut down and told by the interns that they would just take care of everything themselves.
- Surgery as a whole. Just ugh. I think this may partly be a reaction to butting heads with residents on my gyn surgery week - leaving me feeling pretty skittish about life - but the surgical side of things really just doesn't appeal to me. I'm sure things are better and more interesting as you get more involved, but as the student in the room who was largely being ignored in favor of explaining things to the interns, surgical cases just proved to be boring. It's quite difficult to see anything considering the size of the usual surgical field, scrubbing in to a procedure gets super tedious super quickly, and I'm entirely too lazy to want to stand around for hours at a time. End of story.
- I honestly have a lot of negative things to say about the gyn surgery aspect of the rotation, which I think is largely a reaction to how weird that whole week ended up. I also ended up receiving some negative feedback from one of the residents I worked with regarding my attitude that involved making up a story about how I pouted and refused to participate in writing patient notes because my feelings were hurt that my notes didn't count for anything...when in reality, I was never asked to contribute to seeing patients in the morning in any way, and I was explicitly discouraged from trying to contribute a note to patient charts. The whole experience left me feeling incredibly skittish towards the OB department and quite frankly the speciality as a whole; OB had previously been at the very top of my interests, but the way my clerkship ended has left a sour taste in my mouth.
Anyway. I could whine a lot about that surgery week and all the problems it ended up causing for me - largely because of hurt feelings, I will be the first to admit - but that's not really appropriate or professional. I've spoken with my clerkship director a few times on the matter and we're tentatively keeping an eye on the situation in case the discrepancy with my feedback progresses further. The funny thing is, Boyfriend had a terrible time on his OB rotation and had me feeling apprehensive about the clerkship since his class was full of stories about terrible treatment at the hands of the OB residents; I spent week marveling to him about how much nicer everyone was than I had expected, only to end up in a similar position completely unexpectedly. Go figure.
- UWorld question bank - obviously the holy grail of question banks. I went through all of the questions in the obstetrics and gynecology sections over the course of the rotation.
- Case Files Obstetrics & Gynecology
- Blueprints Obstetrics & Gynecology
- bought Case Files for myself and stole Blueprints from Colby, and I go back and forth on which one I liked better. Blueprints is set up in more of a traditional textbook format - chapters dedicated to specific topics with paragraphs and subsections and so on and so forth. Case Files, on the other hand, is exactly that - a bunch of sample patient cases covering specific topics. Like, one case might be on abnormal uterine bleeding, in which you would be provided with a patient vignette providing details on a fictional patient, followed by a couple of pages of background information on abnormal uterine bleeding - presentation, pathophysiology, diagnosis and treatment, etc. I guess you could say Blueprints is like larger bites of info where Case Files breaks things into smaller bites? For the most part they cover the same things, so it's mostly a matter of preference.
- First Aid for Obstetrics & Gynecology - I bought this to try it out since I'm a fan of the First Aid series of resources and saw that it was well reviewed on Amazon. I ended up not using it as much as I had intended, but I did find this to be helpful and concise for times when I wanted to quickly review a topic before TBL in the morning or something. Considering Case Files and Blueprints both are pretty word heavy, it was nice to have a text I could easily zip through at times.
- Beckmann, Obstetrics & Gynecology textbook - provided by the department for the duration of the rotation. Our lectures and assignments corresponded to particularly readings in the textbook, and the textbook itself corresponds to ACOG objectives for the clerkship.
- APGO uWISE questions - The OB-GYN department at my school has APGO membership and as a result we get access to the uWISE question bank for free; it proved quite handy to work through the questions, as some of our TBL quizzes included questions that were basically straight from uWISE. Plus, as usual, the more practice questions you do, the better prepared you usually end up being.
- NBME practice exams - $20 each, I think, and totally worth it. My classmates tried to do something goofy involving designating a specific person to buy each exam and then sharing screenshots of the questions in order to save money, but I preferred to skip the complicated maneuverings and just buy the exams for myself. NBME is a little frustrating in that your score report only allows you to view the questions that you missed [without providing the correct answers!]; I would appreciate being able to look through all the questions again after submitting a test, as I'm not always positive that my choice is correct in the first place.