My second rotation was in Obstetrics and Gynecology at QHC. I have say it was nice to have my second rotation in a hospital that I was already familiar with. Although I had to adjust to a new service, the overall adjustment was much less jarring. Like my pediatrics rotation, my ob/gyn rotation was broken up into three components: labor and delivery, gynecology, and clinic. The major difference aside from a different patient population (women as opposed to children) was that during this rotation I primarily worked with and reported to residents rather than attending physicians. The residents themselves were exceptionally busy and generally exhausted which presented challenges in terms of temperament and willingness to teach. While in pediatrics the attendings would take time after many of the cases, particularly if they were interesting, to question me about relevant information and point out what they themselves found to be most important in diagnostic studies or as a list of differentials. That did not occur during my ob/gyn rotation except for my two weeks in clinic when I was working with PAs or when I worked nights with one particular resident. Instead I had to find new ways to interact and learn from those I was working with. I found myself asking a lot more questions this rotation and found that as long as the questions were well thought out and relevant to the patient none of the residents minded giving me their perspective. The experience was certainly different, but overall positive and one that I learned a great deal from – especially how to work well with over-worked residents – which will be especially beneficial as I move into my emergency medicine and surgery rotations where I will be reporting mainly to residents.

My first week of rotation was spent in labor and delivery, something I was excited about – who doesn’t want to be a part of a birth?I was also excited to get my hands dirty so to speak and get some procedures under my belt as I didn’t have much opportunity to build up my procedural skills in peds. The only difficult part of L&D is that it is either feast or famine, some days there is so much going on it makes your head spin and then there are two or three days where nothing happens. I was in my first vaginal birth on my first day, for the most part all vaginal births are done by the residents and how much you get to do varies by which resident is delivering. Generally, the students will get the umbilical cord gases (much harder than it sounds, that thing is slippery) and deliver the placenta which can also be a bit of scary process as you want to make sure you don’t leave any part of the placenta behind as retained placenta is one of the causes of postpartum hemorrhage. I know that I am generally a confident person, but during births both vaginal or by c-section, I would have so much adrenaline pumping that my hands would become shaky and my concentration would fly out of the window. By my fourth birth I started using a tactic to clam myself down just before going into a birth – it is generally a chaotic scene with nurses and resident running into the room, downing a gloving as quickly as possible, and setting up the patient. Just before entering the room I would pause close my eyes for a minute, take five deep breathes and center myself. That small pause worked wonders, I entered the room as myself rather than a clumsy student who had no idea what was going on. I was able to be more present and learn more from the births and had better interactions with the patients.

I took that same approach and applied it to my week in gyn which is basically all surgical. I found that I scrubbed in to more procedures simply because I asked about the schedule at the start of each day. I know we are told to take initiative, but I feel like I was rewarded far more in this rotation by doing so because if you didn’t basically jump up and down in front of the resident’s faces you would get passed by for opportunities.

My favorite part of the rotation was my time in clinic – don’t get me wrong the gyn surgeries were some of the most fascinating things I have seen, but interacting with patients in clinic was what I liked best. The ob patients were generally happy, if a little uncomfortable and while each gyn visit had its own basic layout there was always something a little bit different about each one. Not surprisingly, I really enjoyed the gyn component overall and am definitely keeping it in the back of my mind as I move through rotations. I have always gravitated to women’s health, but I also know that I am a person who enjoys procedures and the OR and have known that gyn provides a good opportunity for both. What I was most surprised about during this rotation is just how much I enjoyed the clinic. I got to help with some minor procedures and did more paps and breast exams than I can count, but I really felt fulfilled at the end of each day. All of the days were good days and I really enjoyed getting to see the patients as well as the continuity of care. I saw a couple of ob patients during both of my weeks in clinic and then got to be at one of their deliveries, that was a pretty cool feeling.

I am still working on developing my differentials, which with a more specialized service I found to be a little easier, but gyn patients have medicine problems too and I need to be proficient in everything. One thing that I would like to improve as I move into my next rotation is remembering my patient’s names. It may sound silly, maybe it is because access the EMR as a student can be cumbersome and writing down all of my patient’s names worries me because I don’t want anyone’s health information to incidentally shared, but I need a better system. I haven’t quite figured out what that system is yet, but at my next site I have a couple things I am going to try and see what works to better remember names. It is something I have struggled with my entire life, but if I am going to be responsible (albeit in a small way) for someone’s medical care I can certainly know their name while they are in my care.

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