How to crush the OBGYN rotation
Updated: Sep 27, 2018
The OBGYN rotation requires special preparation. Here are a few pointers to help ensure success.
How to prepare for your OBGYN clerkship
Subject: MS3 starting on labor and delivery next week. Body: Hello, I'm an MS3 starting on L&D next Tuesday. I was wondering when and where I should meet you next Tuesday! Thanks!
Know about the different areas of OBGYN.
Obstetrics (OB) is the subset of OBGYN focused on pregnancy and childbirth. Clinically, the OB is divided into outpatient OB clinics and inpatient Labor and Delivery (L&D) services.
Gynecology is the subset of OBGYN that deals with all other areas of female health. Gyn-Onc is devoted to the medical and operative management of gynecologic malignancies. Uro-Gyn is largely devoted to the management of incontinence through medicine, pessaries, and pelvic reconstructive surgery. General outpatient gynecology is focused on issues such as contraception, pap-smears, and the proper initial management and referral of undifferentiated OBGYN issues such as pelvic pain, vaginal bleeding or discharge, vaginal itching, etc.
What to read up on before your first day.
Know the basic terminology used to identify an OBGYN patient.
"Mrs. Smith is a 43 year old G3P1112", read out loud as "Gee three pee one one one two", or "Gravida one, para one one one two", means, she has had 3 pregnancies, 1 term delivery, 1 preterm delivery, 1 abortion, and has 2 living kids.
G - Gavida. Number of pregnancies.
P - Parity. Number of deliveries.
Parity is subdivided into TPA:
T - Number of term deliveries (>37 weeks gestation)
P - Number of preterm deliveries (20-36 weeks gestation).
A - Number of abortions or deliveries at less than 20 weeks gestation.
L - Number of living children.
Quiz: What does it mean for a patient to be G3P2103? (Answer at the end of the article!).
If you're in an outpatient OB office, read about the screening tests used in pregnancy. Make sure you understand the psychopathology, diagnosis, and management of all of the diseases on the eclampsia spectrum, from pre-eclampsia, eclampsia, and HELLP.
If you're on L&D, make sure you know what the defining feature of labor is (contractions resulting in cervical change). Know the stages of labor. Stage 1 is cervical dilation and effacement. Dilation refers to the progressive widening of the diameter of the cervical os from 1 cm to 10 cm ("fully dilated"). Effacement refers to the progressive thinning/shortening "ripening" of the cervix, from 0% effaced, to 100% effaced. Dilation and effacement are periodically assessed by a "cervix check", i.e., direct manual palpation of the cervix in a patient in labor.
If you're on Gyn-Onc, or Uro-Gyn, and are heading to the OR, study the pelvic anatomy in First Aid.
If you're starting in an outpatient Gyn clinic, read up on cervical cancer screening (pap spears and the HPV test), and contraception methods.
If you're starting on a surgical service (e.g., inpatient Gyn-Onc, Labor and Delivery) or are scheduled to see an ambulatory gynecologic surgery such as those of Uro-Gyn, and have never been in an operating room, please read the first part of the surgery clerkship blog post to avoid making a fool of yourself in the OR.
What to study early on during your clerkship.
Doing the all of the UWorld Step 2 CK OBGYN questions during the first week of the rotation will be key. It's also worth completing the UWorld medicine endocrine section before the end of your rotation.
For video resources, check out the OnlineMedEd OBGYN videos (https://onlinemeded.org/obstetrics and https://onlinemeded.org/gynecology). Try to get through the videos which pertain to the service you're on during the first 5 days or so of the service. If you have extra time, watch the rest early.
Start working through an OBGYN Anki deck. We recommend the MedSchoolGurus OBGYN Clerkship Anki Deck.
What to study during the middle of your clerkship.
After you have done a first pass of UWorld OBGYN and watched all the OnlineMedEd videos, start working through UWise. UWise is a set of about 500 OBGYN questions produced by the Association of Professors of Gynecology and Obstetrics (APGO). These are high yield for the OBGYN shelf exam. Aim to finish all of UWise before the shelf exam.
General tips for a successful OBGYN clerkship.
Adjust your clinical technique to match that of OBGYN doctors.
Understand that OBGYNs are surgeons.
Be a good student. Meaning, be on time, clean and well groomed, professional with everyone you encounter, and willing to work hard and help out. Be straightforward and communicate clearly and deliberately with teammates. Introduce yourself to everyone on the first day. Don’t lie or make stuff up – if you didn’t ask the patient something something and are asked about it, just say you didn’t ask about it. Ask questions or for advice during downtime or when walking somewhere with your resident as opposed to when things are hectic.
Introduce yourself to each patient you meet. Introduce yourself to each mother on the L&D service, even if they are not "your patient". You don't want to show up for a delivery if you have never introduced yourself to the mother. Ask if you can perform the next cervix check in a patient in labor. You will be asked to deliver the placenta.
Ask if you can deliver the baby in a patient with an uncomplicated pregnancy who is having a spontaneous vaginal delivery with vertex presentation (basically, a patient who you expect will have a "normal" and uncomplicated delivery) after you've delivered several placentas. Ask this if you can deliver the baby after you and your team are called to the room of a patient about to give birth, as you are walking to the room with the resident or attending. If you ask earlier, they will say no, because it may be too early to tell if the labor is expected to be straightforward. If you ask later, i.e., in the room with a patient about to give birth, that is poor form.
Carefully observe how OBGYNs perform the pelvic exam, as it is one of the most important skills you will take home from the OBGYN clerkship. Notice the language used in order to position the patient in stirrups. Notice the proper use of gowning and draping. Ask if you can perform the next pelvic exam if you feel comfortable with how it is done.
L&D is a great time to learn about epidural anesthesia. Ask your resident if you can check out how this is performed. Try to observe several cases.
Ask for help when you need it. If you are asked to do something you have never done before and feel uncomfortable doing, ask someone on your team to walk you through it.
If someone on your team suggests that you go home for any reason, say “Sounds good! I’ll see you tomorrow!”.
How to study for the OBGYN shelf.
Finish a second pass through your UWorld OBGYN questions. Re-watch the OnlineMedEd videos. Do all of the NBME Clinical Science Mastery Series practice exams for OBGYN.
G3P2103 means that she has been pregnant three times, had two full term deliveries, one preterm delivery, no abortions, and has three living child.
Take home points.
Make sure you read about surgical etiquette before starting the clerkship. Be engaged clinically. Glove up and learn with the guidance of your residents and attendings. Ask for help. Do practice questions every day. Do UWorld, UWise, and all of the practice exams before your shelf.
Enjoy OBGYN; it will be very memorable and special clerkship!