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.