OB/Gyn Pearls: A student guide

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OB/Gyn Pearls A student guide
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Objectives

• General knowledge
• What you can expect from the residents
• What we expect from you
• How to shine on each service
• Transitions between services
• Miscellaneous pearls and helpful hints
• Alphabet soup

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General Issues

• Get the most out of the rotation
• You may have no interest in OB/GYN, but learning
  as much as you can will make you a better doctor
• You will treat women

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General Pearls

• Know why were doing what were doing
• Meet the patient, learn her history, read about
  the disease process before surgery
• In the OR
• Get involved learn how to position the patient,
  help move the patient, help clean up the patient,
  etc.
• Be the first in the OR to help with setup and the
  last to gown
• Take ownership of your patients
• Watch for lab results, vitals, new information

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General Pearls

• Emails are sent out over the weekend prior and
  give updates for what cases are going on and for
  staff coverage
• Use them to help look up patients and prepare for
  the week ahead
• Check your system list on the day prior to the
  rotation to see if there are patients who need
  rounded on in the morning
• Check out with the students from the previous
  week on Friday for GYN and GYN ONC

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General Pearls

• Please round on patients and have notes done at
  least 15 minutes prior to rounds
• Send them to most senior level resident
• This way we have time to look at them and give
  you suggestions for presenting
• We want you to look good!

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MD Interaction Room

• Reserved for those on LD
• Students on other services should refrain from
  using this room (please use other library,
  Sorrell Center, cafeteria,etc.)
• It is ok to store your things in there, but keep
  in mind that OB rounds are from 7-8 AM DO NOT
  interrupt rounds

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Labor and Delivery UNMC

• What to expect
• Rounds at 7am (8am on weekends)
• Scheduled cesarean sections or IOLs, labors
• Postpartum tubal ligations
• Outpatients (gt20weeks with OB complaints)
• Circumcisions
• In general, the more available and involved a
  student is, the more you get to do

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Labor and Delivery UNMC

• What we expect from you
• Round on the postpartum patients
• Divide the patients with your classmates
• Bring up any questions or concerns PRIOR to
  rounds
• Present your patients at rounds
• Speak up if you saw the patient
• Practice before you present
• Divide the laboring patients
• Meet her in between cervical exams, learn her
  history, discuss plan with resident
• Fill out a blue card afterwards (no
  abbreviations)

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Labor and Delivery UNMC

• What we expect from you
• C-section patients
• Meet the patient
• Be ready to help
• Be ready to tie suture, staple, and sew
• Fill out a blue card
• See the patient 4 hrs after surgery and write a
  post-op note
• Short progress note, share

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Labor and Delivery UNMC

• Mag Notes
• All patients on mag get notes at least three
  times per day 0600, 1400, 2200
• Students should write the 1400 and 2200 notes
• Short progress note, share
• See example on gray card

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Labor and Delivery UNMC

• If you feel like you are stuck in the interaction
  room
• Watch the monitors
• You can figure out when someone is pushing, a new
  patient arrives, or a patient is having decels
• Follow the intern on the floor
• You can always ask one of us "Can I come with
  you?"
• If you feel like you don't know what it going on
  with your patient, read through progress notes in
  the chart or ask a resident

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Labor and Delivery UNMC

• Dont!
• Walk into a room when a patient you havent met
  is delivering
• Stay in the interaction room all day
• Write your notes late or after a resident
• Do an invasive exam on a patient without the
  resident present

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Labor and Delivery Methodist

• Morning rounds at 8 am.
• SOAP notes on antepartum patients done before
  rounds and sent to perinate resident
• Round with MFM resident and staff
• After rounds, get the list of laboring patients
  from the charge nurse
• Coordinate with the OB resident (usually one
  student OR resident per delivery, unless MFM pt)
• Meet the patients and nurses
• Stay involved and visible (aka nurses station)
• If the nurses cant find you, they wont come
  looking for you

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Labor and Delivery Methodist

• During the day
• Check on antepartum pts throughout the day (F/U
  labs, US, etc.)
• Labor pts checked q2-3hrs by nurses, keep up to
  date on how the pts are progressing
• Be on the lookout for sections scheduled in the
  afternoon or that get added on
• Assist resident with any new admissions

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Gyn Onc

• What to expect
• OR cases for suspected or known cancer
• Uterine, cervical, ovarian, vulvar, etc
• Many patients will be receiving chemotherapy
  and/or radiation
• Clinic

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Gyn Onc

• Daily rounds in am and pm
• Time TBD
• Throughout the day, read the nursing notes and
  notes from consulting services on your patient
  (VS, I/O tab)
• Monday Surgery with Remmenga (wear scrubs)
• Tuesday Surgery with Rodabaugh (wear scrubs)
• Wed, Thurs, Fri clinic (dress clothes)
• See the return patients, check out with resident,
  then check out with attending
• Go with the resident to see the new patients

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Benign Gyn Surg

• What to expect
• OR cases for benign disease
• Hysterectomies, ablations, DCs, etc
• ER consults throughout the day
• Gyn Chief Clinic (Wed afternoons)
• Clinic Add-ons

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Benign Gyn Surg

• Monday, Tuesday, Thursday (wear scrubs)
• am hospital rounds, OR cases
• Wednesday (dress clothes)
• pre-op conference at 7am, am rounds, Education,
  pm Chief clinic
• Friday (wear scrubs)
• am rounds
• Students present a 10-15 min gyn topic (one page
  handout) Please have topics picked by Tues am of
  GYN week
• Ask your residents for help with an idea

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OR Etiquette

• Discuss amongst your fellow students who will
  scrub for each case
• Throw your gloves and gown
• Write your name on the white board in the OR
• Scrub as long as the most senior person scrubs,
  and use whatever they are using
• Dont grab anything from the mayo stand
• Be prepared to retract, cut suture, and sew

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General Knowledge Scrubbing

• Traditional Scrub
• Wet hands/forearms
• Clean nails using enclosed nail pick.
• Scrub nails, fingers, hands, wrists, arms.
• Important aspect is total contact time with soap
• Rinse so that dirty water doesn't drip down to
  your fingers
• Avagard is an acceptable alternative
• Be sure Avagard dries before gloving
• Directions on the bottle

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Staff Clinics

• What to expect
• Variety of patients with OB or GYN concerns
• Ask attending about how/when they want notes
  written
• Get focused history and check fundal height and
  get heart tones on ROBs
• Take focused history with NOB and GYN patients,
  wait on the exam until the physician gets there

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What to Expect From Your Residents

• Teaching
• We will pass on the basics of OB/GYN with a focus
  on likely shelf questions
• Maximize your educational opportunities
• We will get you involved with high-yield cases
• No busywork
• Things we ask you to do are important for patient
  care
• Address your concerns
• If you are having trouble, let us know

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How to be a successful student

• Phrases for students
• What can I do to help?
• What should I read about for tomorrow?
• Ask questions as they come up
• It is easier to learn and remember a concept when
  you can associate it with a patient
• Remember there is a proper time and place for
  questions if your resident is busy
• Treat the rotation as a job interview
• Put out your best effort and you will be rewarded
  with a better experience and a greater increase
  in knowledge

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How to be a successful student

• Communicate with your residents
• Text, email for any non-immediate concerns
• Page only if necessary
• Dont ask to go to sleep or be sent home
• We realize the days are long
• Theres always something you can learn

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Gs Ps

• G gravida (number of pregnancies)
• P para (number of deliveries)
• A abortus (number of abortions/ectopics)
• G_TPAL
• Gravida, term, preterm, abortus, living children
• Ex G3 P1112
• Ex G3 P1012

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Sample presentations

• OB
• 23 yo G1P0 PPD 1 from SVD at 39w1d. Pregnancy
  complicated by history of IUGR. She is doing
  well. Minimal lochia, breastfeeding, pain well
  controlled.
• Only pertinent vitals, if normal, say WNL
• Exam findings Fundal height
• A/P repeat the above opening sentences. Comment
  on Rh and rubella status, method of feeding for
  infant, and method of birth control

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Sample presentation

• OB (Methodist)
• 23 yo G2P0010 at 31w6d, admitted on 5/1 for PTL.
  Pregnancy complicated by history of cervical
  insufficiency with delivery at 18 weeks. Denies
  CTX/LOF/VB. Reports FM.
• PPROM Denies abdominal pain, fevers/chills.
• Preeclampsia Denies HA/vision changes/SOB/CP/RUQ
  pain

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Sample presentation

• GYN ONC and GYN
• 23 yo female, POD 1 TAH/BSO for Grade 1
  endometrial cancer. Pain well controlled on PCA,
  tolerating po intake, foley in place, has not
  ambulated yet.
• Vital signs WNL (do not say stable)
• Full exam, look at incision(s)
• Comment on Is and Os
• Labs (pertinents only)

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Sample presentations

• GYN ONC and GYN
• Repeat your initial statement for assessment of
  the patient
• Plan Postoperative goals, then list accordingly
  to other health issues they may have
• If ONC patient, is their pathology back yet? Are
  there plans for chemo/radiation?

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Alphabet Soup

• CTX contractions
• LOF loss of fluid
• VB vaginal bleeding
• TAH total abdominal hysterectomy
• TVH total vaginal hysterectomy
• BSO bilateral salpingoophrectomy
• LAVH laparoscopic assisted vaginal hysterectomy
• LVH laparoscopic vaginal hysterectomy
• PTL preterm labor
• SROM spontaneous rupture of membranes
• PROM premature rupture of membranes
• PPROM prolonged premature rupture of membranes

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Alphabet Soup

• GDMA1 gestational diabetes mellitus, diet
  controlled
• GDMA2 gestational diabetes mellitus, controlled
  with meds
• ROB return ob visit
• NOB new ob visit
• s/p status post
• h/o history of
• IOL induction of labor
• PNV prenatal vitamin
• TVT transvaginal tape

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Alphabet Soup

• SVD spontaneous rupture of membranes (sometimes
  NSVD normal spontaneous vaginal delivery)
• PLTCS primary low transverse c-section
• RLTCS repeat low transverse c-cestion
• PPTL post partum tubal ligation
• BTL bilateral tubal ligation
• LVAVD low vacuum assisted vaginal delivery
• OVAVD outlet vacuum assisted vaginal delivery
• LFAVD low forceps assisted vaginal delivery
• OFVAD outlet forceps assited vaginal delivery

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Have fun!

• Key concepts
• Get involved 
• Read about the patients 
• Find ways to be helpful 
• Approach the residents if you are having
  problems 

• Show students how to add the service lists in
  Epic
• Clinic, Gyn and Onc

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