Panda’s Quick n’ Dirty Guide to Third Year Rotations: Part 1

Obstetrics and Gynecology (OB/Gyn)

Your Real Responsibilities:
Nothing. You’re a student and you don’t count. Every medical student in the hospital could vanish and apart from less crowding on the elevators, nobody would notice.

Your Pretend Responsibilities:
Following pregnant woman pre-, ante-, and post-partum. Assisting in vaginal and Cesarean deliveries. Assisting in gynecological surgeries including hysterectomies, vulvecvtomies, and salpingectomies. Seeing patients in clinic with various gynecological problems who you will present to your attendings and residents. You will probably “shadow” a resident at first. Your level of independence will depend on the school, the attendings, and your level of interest.

Things You Should learn:
1. Pelvic Exams. Don’t be squeamish. They call it a bimanual for a reason. The first fifty you do all you’ll be able to say is that it’s warmer in there than outside but after a while you’ll get the hang of it.
2. Assessment of labor. Learn how to assess the cervix for dilation and effacement. Recognize the stages of labor and which stage the woman is in if you feel the baby’s ears while checking the cervix.
3. Recognizing common complications of pregnancy (placenta previa, accreta, malpresentation, pre-ecclampsia, etc), knowing who to call and what to do in the meantime.
4. Treatment of STDs.
5. Causes of abnormal vaginal bleeding and what to do about them.
6. Common gynecological malignancies.

Things That Will Suck:
1. The hours. The early, early hours. Best to just suck it up and go to bed early every night. Tivo American Idol if you must but it is not unusual to pre-round at 0500 on OB which means that unless you sleep in your clothes and don’t brush your teeth you will have to get up at hours that would make dairy farmers cringe.

2. Vaginal Discharge: Are you some kind of freak? How could anybody possibly enjoy looking at and smelling green frothy discharge pouring out of an orifice that would turn Puff Daddy gay if he were to merely gaze at it. I have seen some horrific sights in Gynecology clinic. Visions of terror that have made even hardened OB/Gyn residents recoil in horror while their less-seasoned colleagues wept and spread ashes on their faces. They don’t call it the whiff test for nothing.

3. OB/Gyn residents. I’m conflicted on this. They’re not necessarily malignant, just cliquish. Definitely cold towards medical students unless you really show an interest which, frankly, is hard to do if you’re not interested (obviously).

Cool Things About the Rotation:
1. Once you get past the feces, urine, smells, screaming, and other truly frightful aspects of childbirth which they don’t show on the Discovery Channel (but I don’t have HDTV) it is kind of cool. Everybody is usually pretty happy to see the baby, even mothers who you know will be going back to their crack pipe an hour after discharge. Hope springs eternal.

2. A good variety of things in one rotation, ranging from primary care to incredibly intricate oncological surgeries. If you don’t like looking at “wedding tackle” this is also your rotation. Plus, although there are exceptions, female patients are generally less nasty than men.

3. Clinic weeks: Generally, when you are on the outpatient part of your rotation the hours will be nine-to-five with no call.

Idiotic, like most medical student call. Still, take advantage of the opportunity to get more involved in deliveries at night when there are fewer people around and you have a better chance to assist in a C-section doing something more than holding a retractor. You will mostly do call in OB triage.

Slacking Potential:
Not so good. On clinic weeks you definitely have to be in clinic and it’s hard to stand around doing nothing in that kind of exposed environment. Still, you can work slow and “just miss” picking up a chart from the door of a new patient. Although I kind of liked OB/Gyn, I can understand completely how after a couple of “close encounters” one might decide that they have had enough.

On Obstetrics you will have to round and since OB is busy, they have very well organized rounds and morning reports. No getting out of it. If you don’t want to go to the OR you can probably hide-and-slide when you are on “Benign Gyn” or “Tumor Gyn” but you will get dragged into a certain number of C-sections even if you have sworn an oath to all of the pagan gods that you will cook and eat your own entrails before you would match into OB/Gyn.


What you will do an intern.