Monthly Archives: October 2014

Post-OBGYN Rotation Update: On Studying and the Shelf

Because it’s late I’ll keep this part of the update short.  I will say that the shelf exam was pretty hard for me; there is a heavy focus on screening guidelines which are difficult to keep up with sometimes.  And there are a number of diagnoses that sound similar but have subtle differences in presentation, which makes choosing the right answer difficult sometimes.  I survived though–had enough time to get through everything.

Here are the resources I used.  I’m (finally) learning that a heavier focus on questions is more helpful for grasping concepts than passively reading.

  • Casefiles: I like this series a bunch, but using it first before going through a more comprehensive reference was probably not the best idea
  • First Aid: I can get through FA more quickly than Blueprints (prose = snooze fest), but I’m not sure if one was more thorough than another for this rotation
  • UWorld: Hands down, necessary for every rotation.  Not more I can say here, because I’ve already said it in other posts
  • UWise: Through the school, we got free access to this expansive set of questions provided by the Association of Professors of Gynecology and Obstetrics.  Absolutely useful
  • I wanted to be super ambitious and finish Blueprints, Kaplan, and Pretest, but I didn’t get to any of these.  I used BP as a reference book sometimes when working on assignments for clinic, but that was about all I got to do.

Well, that’s about it!  Other updates: we had College Cup this weekend!  My College came in 2nd place this year, but we put in a ton of effort despite half of the med school having taken a shelf exam the morning that the Cup started.  This year, I competed in the Hula Hoop Relay, Spirit Showdown (dancing), Board Games (specifically Twister), and Trivia, in addition to doing vocals for the Chapman College’s opening song and screaming my head off for my College whenever I possibly could.  I’m exhausted beyond belief, but it was so worth it.  And now it’s back to real life…my last clerkship is internal medicine, which I start Monday.

Post-OBGYN Rotation Update: Clinic

For my last two weeks, I spent several half days at Vanderbilt’s One Hundred Oaks outpatient facility.  During OBGYN orientation, we were given tips for how to prepare for clinic; we were told that an “honors” amount of work involved printing patient summaries from the medical record, determining why they were being seen that day, and coming up with a plan for their visit.  So even though clinic visits didn’t start until 8am, I often got to campus at 6am to look up patients (10-12 per half day usually) before catching the shuttle to OHO.

Clinics were usually extremely busy, even when only a fraction of patients showed up; this happened more frequently than I expected it to.  Over the course of the two weeks, I worked with a number of providers–nurse practitioners, attending physicians, residents, midwives–for various types of clinic visits, such as urogynecology, genetic counseling, colposcopy, routine prenatal care (with individual patients and groups of patients and their partners as part of a program called Expect with Me), and annual well-woman checkups.  During these visits, I had varying amounts of responsibility depending on whom I was working with and how busy their clinic was.  For some visits, I simply shadowed the provider.  During others, I gave patients printed information about contraception options, performed supervised pelvic exams, estimated fetal growth by measuring fundal height (how high the uterus has gotten), or listened to fetal heart tones using a doppler ultrasound device.

The attending that I worked the most with gave me lots of responsibility in clinic.  I just shadowed her on the first half day.  The next day, she allowed me to start placing the speculum for pelvic exams and trying to find fundal heights and babies’ heartbeats.  Eventually, she allowed me to take histories on new gynecology patients while she saw others, in an effort to not get too behind on a busy clinic day.  Once, she let me take a history and do a physical exam on a return obstetrics patient–completely unsupervised–and present the patient to her before we both went back into the exam room.  She even let me remove an IUD (intrauterine device, a form of contraception) from another patient; afterward, she told me that she’d never let a medical student do this before.  In addition to all of this, she still found time to teach me on various topics that would likely show up on the shelf exam.

Usually I’m a bit nervous about having a lot of responsibility for patients.  I entered into this clinic setting in a similar fashion.  However, by the end of this two weeks, I realized I had gained a great deal of confidence in my ability to see patients effectively.  I hope that this confidence grows as I continue to treat patients in the future.

Post-OBGYN Rotation Update: Elective (Palliative Care)

My third two-week block was a bit different, as I transitioned from inpatient OBGYN to Palliative Care (PC).  I knew very little about PC before this elective; I knew that teams often consulted them to talk to patients with particularly difficult diagnoses, and that they were the people who managed getting some terminally ill patients into hospice.  I learned that the role of PC in the hospital is three-fold: symptom management, goals of care discussions of various caliber, and hospice referral.

I worked at Vanderbilt Hospital (VUH) and at the TN Valley VA hospital down the street.  At VUH, there is a PC consult service and an inpatient PC unit.  I got to spend time on both services, shadowing the providers and learning so much from them in the process.  They taught me about how to manage pain with various opioids, how to deliver bad news to patients and family, how to discuss goals of care and advance directives (not the same thing), and how to conduct family meetings.  The family meetings were especially interesting–we were present for a particularly difficult one that included members of the primary team as well as the ethics board, whom I’d never been able to work with before.  The VA’s PC service was a bit slower than VUH’s, but I still feel like I had a very robust experience and learned quite a bit about the important role of PC.  In addition, I got to know the team quite well; I helped them celebrate one of the attendings’ birthdays and found out that the PC social worker there had gone to my grandfather’s church while he was still pastoring in New York!

The attendings I spent time with at both hospitals were phenomenal.  Their bedside manner, their way of coping with difficult situations, even their sense of humor…all of it is something I want to emulate.  One of the attendings sat down with me and gave me some great encouragement, reminding me that I am meant to be here even when I feel like the opposite is true.  She also put me in touch with some child psychiatrists, so I can learn about what they do and why they do it in the near future.

On my last day of the elective, I shadowed a Child Life specialist.  Child Life finds creative ways to make being in the hospital or having a family member in the hospital easier for kids.  This can involve playing games with them, leaving them toys to entertain themselves, using puppets to teach them about aspects of their care…the possibilities are really endless.  I helped build a Lego tower for a boy who had been badly burned, talked to an adult patient followed by PC about meaningful gifts he could send to his grandchildren (such as “fingerprint jewelry” which is a fantastic idea), and “shopped” Child Life’s personal “toy store” (they probably had a different name for it, but I don’t remember what it was).  I didn’t know Child Life existed before spending time on PC, but if you ask me, these people work absolute magic.

PC has to be the most emotionally taxing service at the hospital.  I asked about the coping strategies of many of the people I worked with and was encouraged by their willingness to advocate for self-care.  I’m not absolutely certain about what I want to do with my life, but it has to be something that allows me to make myself more of a priority than it is right now.

 

Post-OBGYN Rotation Update: Labor and Delivery

Next was the infamous L&D service.  We each worked 4 12-hour day shifts and 3 12-hour night shifts, taking care of laboring patients on the floor, checking medication levels for the residents, and scrubbing in on vaginal deliveries and c-sections (both of which culminated in “catching a baby” if the med student was lucky).  On the day shift, students also rounded with the Maternal Fetal Medicine team which is responsible for managing the care of patients whose pregnancies were complicated by preterm labor, gestational diabetes, and other medical problems.

This was a tricky service in the sense that it was sometimes hard to be fully involved, especially during the daytime.  Some residents allowed med students to do periodic “mag checks” on patients being managed for high blood pressure, or let them check the patient’s cervix for level of dilation…others didn’t.  In addition, it was easy for medical students to miss important events just because there wasn’t a good place to stand that wasn’t in the way of the housestaff and nurses.  Even the course directors referred to the workroom in the back as a “black hole” where med students were often forgotten about…at least until the residents started typing their notes there during some of the night shifts.

Despite these setbacks, I had a great time on the service once I got used to the general flow of things.  I even liked the 6pm – 6am night shift more than i thought i would; it wasn’t too hard to readjust my sleep schedule, and I always shared the shift with a classmate or two (one girl even introduced me to the cheap but delicious white chocolate caramel cappuccino from the hospital cafeteria one night).  I didn’t get to “catch a baby” during a vaginal delivery, but I did deliver a few placentas and encourage a patient or two during labor–of course, I also witnessed the first moments of some beautiful babies.  And I got to see the organized chaos that is a stat c-section.  I didn’t even have time to scrub in; the baby was out in half an hour tops.  And most of the residents and attendings I worked with tried to take time out to teach us students about a topic that was applicable to both the shelf exam and the wards.

The highlight of the rotation by far was when I got to scrub in for the c-section of a patient I’d seen during a direct observation session a few weeks before.  When I went into her room to greet her before the operation, her face lit up, and she introduced me to her entire family as “the med student I was telling you all about.”  during the operation, the resident let me deliver her baby, guiding my hands through the process.  I probably won’t forget that patient or that experience any time soon.

Post-OBGYN Rotation Update: Benign Gyn

I started the rotation on “benign gyn,” an inpatient surgical service which dealt with every gyn issue that was not related to some sort of cancer.  There were typically 3-5 students with the team at any given time, so sometimes there weren’t enough OR cases or patients in-house so that everyone could do something each day.  But we made the best of it.  The cases I did get to see were really interesting.  I saw a number of urogynecology cases that served as treatment for organ prolapse or urinary incontinence; some minor operations that allowed for sampling of the patient’s uterus to get more information about a possible cause of her symptoms (abnormal bleeding, infertility, pain, etc); and a few sterilization procedures such as salpingectomies (removal of the Fallopian tubes).  I saw a few patients on consults with the 2nd year resident and learned about how to work up things like abnormally heavy bleeding in the ED.  I also developed pretty good rapport with some of my patients, even coming back on the morning after my official last day on the service to pre-round on one of them for continuity’s sake (I think the team was impressed that I did that!).  Most patients were discharged within a few days of their operations, but there were a handful who stuck around due to complications of surgery, such as infections or constipation; we got to know those patients well.

The great thing about this part of the rotation is that the housestaff spent time giving us tips on how to do well in the OR–how to read up on the patients and the cases, proper etiquette, etc.  To be honest, I wish I’d had OBGYN before surgery, even though I originally chose to put surgery first; I received preparation during the former that I saw neither hide nor hair of in the latter.   The great thing about this part of the rotation is that the housestaff spent time giving us tips on how to do well in the OR–how to read up on the patients and the cases, proper etiquette, etc.  To be honest, I wish I’d had OBGYN before surgery, even though I originally chose to put surgery first; I received preparation during the former that I saw neither hide nor hair of in the latter.

Post-OBGYN Rotation Update: Intro

Hey everyone!

I’ve just finished up another shelf exam, so it’s time for another update! I’ve been on OBGYN + a 2-week elective for the past 8 weeks, and I can honestly say that I enjoyed my time on this rotation. Students spent 2 weeks each in clinic, on an inpatient gynecologic surgery service (either gyn oncology or “benign gyn”), and labor and delivery (day and night shifts).  Each service was filled with opportunities to see diverse patient populations and learn about different aspects of OBGYN.  I don’t think I want to do this as a career, but I may have learned more here than on any other rotation due to how well it was organized and the volume of patients that we saw.

This was also the 2nd years’ first rotation!  Because 2 classes of med students were on the wards at the same time, there were a total of 42 students on OBGYN.  The teams were large to accommodate there being so many of us, but it worked well.  My 3rd year classmates and I did our best to gently welcome our younger counterparts to this exciting part of medical school.