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Private Parts and Pregnant Ladies: OB/GYN Clerkship

February 14, 2018

 Some of the Team! 

 

 Incredibly grateful for these two and all they taught me! 

 

 

Private Parts and Pregnant Ladies.  

 

I had never thought that I would have been so excited for this rotation.  I had never thought that I would have actually considered this as a future career.  I distinctly remembering at my Ob/gyn appointment before I left for clinical rotations and we were talking about medical school and of course she asked me if I knew what I wanted to go into.  At that point, I was pretty set on Primary Care either through Internal Medicine or Family Medicine and then focusing in on Preventive Medicine or Geriatrics. And because I had been working in the medical field for a few years before starting medical school, I felt that my prior experiences allowed me to say that with a degree of certainty. Of course, I was wrong.  My Ob then began to tell me of how she also thought that she would never see herself loving OB and she always thought she wanted to be a pediatrician. In my mind I thought, "Well, that will never be me because I know what I want".  But as you all know, my life was rocked by my surgical rotation. I fell in love with the OR (Operating Room) and knew that my future in medicine would end up being in that room on a consistent basis. To me, it was a complete shock because I had already carved out this little nice niche of an outpatient life and future for myself, so as I began to admit to myself that I wanted to operate, it was a lot to take in.  Nevertheless, I knew that I still had a tremendous passion for primary care.  I am the definition of a people person, so continuity of care and having patients that I get to see year after year was so important to me and my future practice of medicine.  Of course, in most surgical specialities or in general surgery, you do not get that.  The one main exception is Colorectal Surgery which is what I really loved, but for the vast majority, you operate, you fix, you follow up and you will likely never see that patient again. I was unsure if I was built for that as a physician. So, when I realized that Ob/Gyn was the perfect mix of both being able to operate and being a primary care physician, I was intrigued but also annoyed that I had been so wrong in determining the my future path as a physician. I was reluctant to commit to OB/Gyn until I actually had my rotation because that would have just been silly, but it was my hope that after completing that rotation, I would know how I would spend the rest of my life. 

 

My OB/Gyn Clerkship was split into 4 weeks outpatient and 2 weeks inpatient.  One of the great things about my school and the track that I am in is that we can place requests for certain preceptors/attendings for some of our rotations.  For inpatient, I was told that I "had to" request one particular doctor because the experience was so great. For outpatient, I was told that if I wanted a super hands on experience where you get to do everything, request another office. Sign.Me.Up. 

 

My outpatient experience was everything that I wanted and probably a little bit more.  Although the office did have its issues (as most do), I was allowed to do just about anything and everything when it came to the care of our patients.  In the beginning it was definitely a little overwhelming because my Nurse Practitioners literally expected me to jump in and start doing pap smears the first day and the only experience I actually had performing one was during our intro to clinical rotations course on a practice dummy. So needless to say, I spent that first day just observing the pap smears, the technique, how to actually find that sneaky cervix and really trying to understand the anatomy of the vagina, cervix, uterus and ovaries.  Along with performing probably close to if not more than 100 pap smears in my 4+ weeks in the office, I also learned how to take care of obstetric patients which included but was not limited to auscultating for fetal heart sounds with the doppler, distinguishing the baby's heart beat from the mom from the placenta (IT IS SO HARD), performing the leopold maneuvers, educating, educating and more educating and so so much more.  I found that I loved doing both. I loved the well woman visits because it provided me the ability to build rapport with my patients and establish a certain continuity of care that I was so desperately seeking.  I loved obstetric visits because it was truly amazing to see these women week after week and feel like you were literally growing with them.  It gave me the same continuity of care but on a different spectrum.  During rotations, Ob/Gyn is probably the main clerkship that allows you to actually be able to follow up with patients week after week.  It was through this experience that I was reassured that just as much as I love the OR, I love truly knowing my patients. 

 

My time on inpatient was sadly too short. As I have previously alluded to, I was SO looking forward to getting back into the OR and sadly, that never happened.  My inpatient rotation was slightly overloaded with students so we had to split our days and the biggest thing you learn in OB is that babies come when babies want to come.  Of course C-sections get scheduled but unfortunately, I did not get the luck of the draw in that regard and never actually got back into the OR. I, however, did get into the L&D suite and it was AMAZING. You know how there are two people in this world: The first is the one who sees a live birth and passes out and the second is someone who sees a live birth and is ready to see about 10 more and I guess there is also a third, someone who sees a live birth and does not pass out but has absolutely no desire to see another one. I am easily #2. It was one of the most powerful, nerve-wracking, emotional, exhilarating and beautiful things I have ever seen or been apart of.  I felt extremely fortunate and blessed to be guided and taught by an OB/Gyn who has been doing this for almost 40 years and has delivered almost 3000 babies, so to observe him remain so patient and caring but also focused and intentional was truly remarkable.  Seeing a whole new human begin his existence is so hard to put into words. Even without having seen a C-Section or scrubbing in for a hysterectomy or myomectomy or any of the gynecologic surgeries that I am very interested in-- I now know that if I can just help assist in God's handiwork and help bring life into the world every day, I will live a life full of content. 

 

This is a long post because if you have not figured it out by now, I have decided to apply and go into OB/Gyn. I have been somewhat reluctant on whether I should make this statement because once it is out there, it is out there for good and there are no take backs ;-), but after a lot of prayer, pro/con lists and reflection, I know it is the right fit.  It probably was not until my last week in clinic when I had at least 3 of my patients request for me to be their Ob/Gyn (and yes, I ALWAYS introduce myself as a student), that I felt so at peace and sure that this was the specialty for me.  Additionally, because of the tremendous teaching and hands one experience I received, I felt ready for Ob/Gyn intern year (well, more or less). I never ever EVER thought that I would want to or elect to spend half of my days staring at vaginas and being able to detect a BV infection within 0.5 seconds of starting an exam, or how much I would enjoy educating girls that are 15 to women who are 65 on their sexual health, or how amazing it would feel to provide biopsy results that a patient does not have cancer, or dealing with the hard stuff of telling a patient that their baby has a chromosomal abnormality, or that a patient has high grade dysplasia or woman that their fetus is not viable.   In the most recent episode of Grey's anatomy (yes I still watch and I secretly but not so secretly LOVE it), Arizona was distraught by the death of her patient due to HELLP syndrome which spurred her to look at Maternal Mortality in the US. I was literally applauding and yelling with her because Maternal Mortality rates in the US is the highest out of all developed countries and is a major public health and medical concern right now. But for me as I was yelling at the TV screen as every normal person does, it felt natural to be so impassioned by this Ob/Gyn issue. It felt natural that I want to help be the solution. 

 

I could say so much more but this post is already long and I have yet to talk about resources for studying. But I have a feeling that I will have more to say about Ob in the upcoming future. 

 

SHELF RESOURCES 

 

BOOKS 

"Your" dedicated CK Study Book (MTB, First AID CK, Step Up) 

 

As with family medicine, I recommend that you read the Obstetrics and Gynecology chapters for part of your studying. They are always a pretty easy read chock full of the high yield material and I find that if you highlight and annotate now, you do not have to do it in the future when it is time for dedicated Step 2 CK studying. Win. Win. 

 

Case Files 

Did not use it. Did not buy it. Did well on shelf without it. However, I do have friends that did use it and they found it helpful. 

 

First AID for the OB/Gyn Clerkship 

This is a book that I wish I bought the hard copy and started reading it day 1 of my rotation. I started to read a PDF version I had probably 4 weeks into my rotation and immediately regretted not starting it sooner.  It pretty much all the information you need to do well both on shelf but also on the wards and in clinic. It goes into detail about the anatomy and of course there are pictures which I think is integral to gaining a full understanding of the material even if you do not see it in "real life". 

 

Apps

 

Sadly, I do not have any must use apps for you guys for this particular rotation except for Up to Date. Always use up to date.

 

QUESTIONS 

 

UWORLD 

No explanation necessary. Do your UWORLD questions. 

 

ACOG/APGO 

Our school (and I know that many other schools) provide free access to the Association of Professors of Gynecology and Obstetrics QBANK which is CLUTCH. There are about 400 questions on the site and it is broken down by specific topics in gynecology and obstetrics which allows for more targeted studying. Similar in quality to the ABFM App in reference to Family Med, if you have access to APGO for Ob/Gyn, doing these questions is a MUST because they are extremely relevant and similar to the types of questions you will see on Shelf. 

 

NBMEs 

Do your NBMEs. It's like drinking your morning coffee. You can choose to not to but you will be flubbing around like a fish out of water if you don't. 

 

OTHERS 

 

Online MedEd 

You already know Dr. Williams is bae so there is not much more to say other than watch your MedEd. 

 

General Pieces of Advice for Ob/Gyn: For those who have no interest in Ob/Gyn just remember that this is the only experience that you will have when it comes to gynecologic and obstetric care and if you ever find yourself in a situation that you need to deliver a baby on the side of the highway (because that ALWAYS happens in real life), then you should have a vague idea of what you are doing. So take in the whole experience because it will just make you a better clinician in the long run.

 

Thank you for reading this 2000 word essay, if you have made it this far. I am actually writing this 2.5 weeks into my LAST rotation, so up next will be Psychiatry and then Peds in a few weeks. The LAST year of Med School is almost here! ALL.THE.FEELS. 

 

Kar 

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