Audition Rotation #1: Ob/Gyn

Hi All!

I did my first audition rotation in Ob/Gyn at an AOA program in Michigan. This was a really insightful experience and I think it will serve as a good baseline for my future rotations. Here’s a quick summary of things I noticed/recommend:

  1. What can they do? This program produces AMAZING surgeons. I saw a fourth year resident do a full (open to close) c-section in 17 minutes, do a robotic hysterectomy in 45 minutes, and do a pelvic mass excision, exploratory laparotomy, and bilateral sapingooophorectomy as the lead surgeon. They start training on c-sections from day one and are incredible by their second year.
  2. Do they have someone looking over their shoulder or autonomy? Do they have a lot of guidance or are they left to hang dry? Look at the fourth year students–are they competent? The second years take call every other week for 24 hours at a time and attending s are not looking over their shoulders–they run the floor. By their third year, they are so knowledgeable.
  3. Are there other residency programs? It might be good to be unopposed for family medicine or to be in a place with other programs to meet more people and have friends outside of your residency program?
  4. How far along the accreditation process is this program? This hospital system is VERY on top of their accreditation for the ACGME merger.
  5. How on top of things is the program? They are VERY on top of administrative issues: their residents take boards during their third year, freeing up their fourth year to look for jobs and get cases.
  6. Do residents go into fellowships?
  7. Do residents have families? Kids?
  8. How do the residents gel with each other? What’s the vibe? Does it seem malignant? Do the residents seem jaded? how do they interact with med students? Other residents from different programs? Do you gel with them? Does your personality fit?
  9. How are the didactics? Resident led? Conferences? Michigan state DO programs all meet once a month and do a day of learning for the residents.Lots of conferences and education opportunities.
  10. How is the volume? Are residents getting the cases they need? The volume was not too crazy so there was time to learn. , but not too low… the residents still got their cases.
  11. How is the resident and attending relationship? The attendings were not mean or demeaning. They just helped the residents learn.
  12. Are their opportunities to learn? The attendings gave daily lectures to the med students.
  13. Do the residents close using staples or suture? It might be good to train with suture and get really good at it… you can always switch to staples later on.
  14. Are you doing a 2 or 4 week rotation?
    1. 2 week: 24 hour shift, 1 week Gyn, 1 week Ob, 1 presentation 1/2 day in clinic, we started everyday at 5:30 am (round on patients); on Gyn – go to surgeries (assigned); on Ob – watch the board, triage, c-sections, NSVDs, post partum patients
    2. 4 week: all of the above + 1 week nights, +1 week Gyn
  15. AOA vs ACGME: AOA programs are merging with ACGME programs, so it’s important to check that the program is on track to merge. Some programs have not been able to fulfill some of the ACGME requirements and are getting shut down. I would recommend doing a few AOA and a few ACGME rotations in order to compare the two.
  16. KIT: Keep in touch. Make at least one friend among the residents, which can be tough. Exchange numbers and message them every so often to check in and let them know how rotations are going/if they are still your first choice. This is especially important in AOA programs.
  17. Remember that you are ON when you are on your auditions. It was tough going from the west coast to the east coast and trying to adjust to the time change, but you have to do it and do it graciously. Wake up early, get ready, and go! Be there before the residents, see patients, and give a solid presentation (something I still struggle with). Stay late but go home when you are dismissed.
  18. Take time for yourself. Auditions are stressful. Take a night off, watch a movie, meditate, go for a walk, do Yoga, listen to music, talk to people you love.
  19. Location? What’s the location like? Will you be happy here? Are there things that you need that are close by? Do you like to hike? What about a temple nearby? Is the area diverse?
  20. Food? What’s the cafeteria like? Do residents get a stipend? is it only useful for the cafeteria or is money deposited in your pay check? Is it Vegetarian friendly food? Are there nice restaurants in the area?
  21. Do they offer classes on billing? Do they help you with loan management?

I didn’t give a full review/ name the program I went to as I am applying there, but it was a great learning experience. I learned a lot about myself as well. Anyhoo, hope this helps!

Good luck!!!!

Priya

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The Baby Dilemma

I’m never going to have children in my 20’s and it’s a weird thought.

After being consumed by discussions of pregnancies, viability, and infertility while on my OBGYN rotation, I’ve become all too aware of how lazy and out of commission my ovaries have been for the past 16+ years. Those white, round, probably sad, sacs of tissue that have been told to keep quiet and don’t disturb me until I’m ready, well they’re not going to wait forever… but they will be forced to wait another 3+ years.

I always presumed that I would never care or worry about getting pregnant and now I’m torn. It’s a pretty amazing and wonderful event to see a fully formed human be removed from a mass of hemorrhagic-appearing tissue and to see the joy that it brings to parents lives. And it’s not much of a stretch of the imagination for me to see myself enjoying the same privileges.

On the other hand, I love this career path that I’ve chosen and that I’ve dedicated my 20’s towards pursuing. I’m happy with the direction I’m going, and when I look at these other girls in their late 20’s enjoying the adventures of preggarsville, I think “one day, I too, will waddle like you for the same reason.”

Alright, enough personal lamenting, let’s talk Women’s Health. We have had some interesting cases in OB/GYN over the past six weeks:

  • Didelphys: double uterus, double vagina.
    • Yes, this is possible and easy to miss. It is quite rare though. Our patient presented w/ irregular bleeding and under initial speculum exam no blood could be seen in the vaginal canal or cervix. Upon removing and reinserting the speculum, he found another vaginal canal with bleeding present from the cervix. TWO vaginas! TWO cervixes and TWO uteruses! Pretty incredible.
  • Complications pertaining to moms recovering from Heroin addiction
  • C-section for baby in frank breech
    • When baby was removed from the uterus, she was peeing and pooping! It was almost cute.
  • Nexplanon & IUD inserts
  • Hysterectomy in a 25 yo female.
    • A tough decision for anyone, but being so young makes it all the more challenging.
  • Hormones for The Big M.
    • Menopause and bioidentical hormones are essential for healthful mental and physical aging. Women that are in menopause that take hormone replacement therapy see such a positive change in their cognition, energy level, and sometimes even their sex drive!
  • Catching boyfriends AND husbands cheating – all it takes is a pelvic exam, a PCR test, and your admission of guilt. Don’t cheat.

Okay, so pretty standard cases overall. Here is some great advice I’ve heard from my preceptor saying to his patients:

  • “Men always dribble before they shoot.” – on why the pullout method is not always effective birth control. 
  • “Take time for foreplay.” – self-explanatory. 
  • “If you’re not using birth control and not using condoms, you’re trying to get pregnant.” – Pregnancy 101 (he said this countless times to women who just did not understand how important birth control was for pregnancy prevention).
  • “A candle is always brightest when it’s alone.”

Boy, am I glad OBGYN is complete! It was a fun rotation with a couple of highlights, but I’m glad that the next pelvic exam I participate in will only be my own. 🙂 Next up: Pediatrics! (pretty appropriate).

 

Is this really what I want to do with the rest of my life?!

Hi All!

Hope you’re doing well!

Ob/Gyn was my third rotation here in Walla Walla and it’s been a very interesting experience. I walked into the rotation extremely unsure of myself, and in retrospect, I think I was having a mid-med school crisis. This was it. The big rotation. It was finally here, what I had thought I’d wanted to do since high school. I had built it up so much in my head and I was so afraid of failing, that I struggled so much in the beginning.

The docs that I worked with were two were male physicians, who had been doing this for a number of years and a female was fresh out of residency. One of the physicians challenged me a lot and I learned a ton. I felt like this was the rotation where I grew immensely.

Why it’s AWESOME: Lots of procedures (IUD, Nexplanon, C-Sections, Hysterectomies, Tubals, Cystectomies, etc.)

Why it’s TOUGH: High emotions, High stress, High risk!

There was one experience I would like to share with all of you. We were in the OR and I was assisting with a cystectomy. The procedure was laproscopic, though it did need a uterine manipulator. When the procedure was done, I got to close the laproscopic incisions and do the final speculum exam to check the cervix. Everything was going well; I was calm the whole time, sutured the incisions well, and found the cervix (yay!) no problem. It was then that the unthinkable happened. As I was unscrewing the speculum (it was one I had never used before) to take it out, and I went too far and dropped the screw in the bag of urine down below. It was terrible! I felt like such an idiot. We had to drain the urine and my preceptor had to reach in and grab the screw for me. 😦

But then I stopped to think about what had just happened, I kept calm and did not harm to the patient. My sutures and speculum exam were on par with what the physician wanted. That’s when I realized how much I enjoyed using my hands.

And as the weeks went on, things just got better. I got to help deliver over 7 babies vaginally, help with a ton of hysterectomies, c-sections, and other procedures. I got over the “eww” factor with time and was able to view everything I did as helping mom and baby!

So, maybe I do want to do this for the rest of my life. 🙂

 

 

Avoid pimping by your OBGYN

And suddenly you know. It’s time to start something new and trust the magic of beginnings – Eckhart Tolle

Most girls dream of their wedding day. Unlike most girls, I grew up dreaming of 3rd year rotation. Specifically, I dreamed of catching babies and experience what life would potentially be like as an OBGYN. Sometimes … well most of the time, life doesn’t pan out the way you dreamed them to be. Was I sad? Yes. Was I angry? Yes. Was I disappointed? oh HELL YES!! But I have learned that I can not let these things define me. Make the most of your experiences because they will only prepare you for the challenges in your future.

Below is another vlog update of everything that has happened since my 2 week rant and some question I was asked quite frequently on my OBGYN rotation. Hopefully the video can uncover some OBGYN knowledge you have buried under all that medical knowledge we obtained 1st and 2nd year. ENJOY!   

Othello, how do I say that in Spanish?

When life gives you lemons … fuck it, drink some tequila

Its been 2 weeks into my OBGYN rotation in Othello and I must say, it could be go much much … much better. But on the bright side, the water in the apartment gets hot very fast and the clinic has a free gym I could use! Well enjoy my little rant! As always, I will remind you that, there is a 2x speed option.

Cervix

Last week I finished 6 weeks of my first rotation of 3rd year: OBGYN.

It was more challenging yet invigorating and motivating than I imagined.

Let’s start at the weekend before my 1st day. After our orientation July 2, I made my way to Seattle for a surprise birthday party for one of my dear friends. His brilliantly talented girlfriend started his birthday toast with a story about her cat named Cervix.

This is Cervix.

IMG_4306

The story was endearing & heartfelt, but I didn’t realize until the following Monday that it also served as a prologue to my next 6 weeks and my quest to find the cervix. I’ll leave it up to you to refresh yourself on the anatomy, but I didn’t realize how something so easy to identify could be so challenging when baby’s head is smashing down on it. As a mother approaches term, the cervix flattens and softens, but it’s a small piece of anatomy and a small space – how hard would it be to navigate? This assumption was mistake #1. I felt nothing on my first few exams, but as I continued to be confused about what I was or wasn’t feeling, I quickly became frustrated. At one point, I don’t know what was harder – figuring out what I was feeling or trying to hide my confused face to the patient while I was doing the exam. I was unnecessarily hard on myself after several failed attempts, and it was easy to feel inadequate when the doctor, nurse and patient looked at me expectantly after finishing my exam, only for me to look sheepish and give the quick shake of the head no. The turning point started when a nurse dusted off the “vagina in a box” teaching tool.

Vag in a box

Not to mention the several very patient nurses coaching me through each exam – and of course, all the forgiving patients who encouraged me to basically stay the course during an exam until I found it. At about exam 25, I felt it more clearly (and more posteriorly) than I ever had and it’s been a relief for everyone since.

My preceptor was fantastic. On my 2nd day I scrubbed into an urgent c-section and also had a woman present in labor after a full day of seeing patients. Wanting to see the whole process, I stayed at  the hospital that evening to see all the steps leading up to the birth. At 2am, the nurse and I started a trial of pushing with the patient. As I held one of the legs, and the delivery was quickly nearing, the doctor walked in.  Having not yet seen him perform a delivery, I thought I would watch and assist however I could. Instead, he immediately told me to gown up and sit down. I was excitedly terrified – so focused, yet everything was a blur. He guided me through the entire thing and before I knew it, I delivered my first baby and tremulously (!) completed my first laceration repair. And the rotation didn’t slow down for the next 6 weeks. In total, I completed 15 vaginal deliveries and whatever repairs were necessary, and assisted with 10 c-sections with varying degrees of responsibility. It was intense. And I loved it.

It surprised me to have liked the gynecological aspect as much as I did – this specialty is much more than delivering babies. Women’s health is such a fundamental, yet understated, aspect of health & well-being. And it’s extremely vulnerable. I felt such a privilege to be a part of helping women with infertility to incontinence, and everything in between.

Some reflections & lessons learned from OB:

  • It’s easy to feel inadequate. I felt like an idiot ** A lot ** I had to keep reminding myself that not only was this my first in-depth exposure to OBGyn, but it was my first rotation EVER. And I’m a student, not a resident. It’s easy to think that it’s your job to advance your skill level to that of your preceptor and the nurses — especially with a specialty you love.  I was pushing myself hard to make sure it’s wasn’t just a “honeymoon” phase of ditching the classroom for clinicals. Regardless, I had to remind myself (& be reminded) those skills take years to evolve. And while it’s important to develop as many skills and learn as many things as I could, at the end of the day, I was still trying this specialty on to see if it fit me, and more importantly, I still had a shelf exam to pass at the end of the rotation, so I couldn’t get too bogged down in the “doing” of medicine.
  • Not every delivery is a feel good moment, and there is a lot of heartache that comes with this specialty. This hit me the most in the first week when immediately after I delivered a healthy baby girl, we went directly to the operating room to perform a D&C for a woman who had miscarried for the 3rd  time. The quick transition from the “high” after a healthy delivery to being present and comforting to a woman who was scared and sad, and delivering a baby that didn’t make it, was an important learning point that can’t be taught in the classroom. As challenging as it was, I walked away wanting to be there just as much for the woman who delivered the healthy baby as the one who was repeatedly experiencing unexpected loss.
  • The special moments in the Dr/patient relationship. Most c-sections I watched were planned and the women would receive spinal anesthesia after being moved to the operating room. It was here that I witnessed one of the most tender and compassionate moments between the surgeon and patient. Here is this woman, nervously excited for the delivery of her baby, being asked to sit hunched over her full term belly, perfectly still, for an uncomfortable procedure in a room full of surgical equipment and surrounded by gowned and masked people bustling about. The surgeon walks in and holds the woman’s hand as she folds over her belly while the anesthesia is placed. He stands close and almost instinctively, each woman would rest her head on his shoulder and he would quietly coach each of them through what they were feeling and provide encouragement and reassurance. And the whole room was quiet. It’s one of the most impactful displays of human connection that I have ever seen and I hope to provide that level of comfort and reassurance to my patients.

Overall, this was a phenomenal rotation and set the bar high for my clinical years. At the end of my first week, I was already feeling disappointment that I would only be doing this for 6 weeks. By the end of the 6th week, I was surprisingly sad that I wasn’t going to be doing this for the next 3 years. I think this is a good sign. We’ll see where the next rotation leads me.

-stacey