OB/Gyn do’s, don’ts and pearls:

a guide for students on the rotation

Resident of the day

ObjectivesGeneral 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

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

Code of Ethics

Know why we’re doing what we’re 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

MD Interaction Room

Reserved for those on L&D

Students on other services should refrain from using this room (please use other facilities to study…library, Sorrell Center, cafeteria, Durham)

It is ok to store your things in there, but keep in mind that OB rounds are from 7-8: DO NOT interrupt rounds

Labor and Delivery: UNMCWhat to expect:– Rounds at 7am (8am on weekends)– Scheduled cesarean sections or IOL’s– Deliveries– Postpartum tubal ligations– Outpatients (>20weeks with OB complaints)– Circumcisions

In general, the more available and involved a student is, the more you get to do

Labor and Delivery: UNMCWhat we expect from you:– Round on the postpartum patients

• Add your initials in the student column by your patient• Divide the patients with your classmates• Write SOAP notes • Bring up any questions or concerns PRIOR to rounds

– Present your patients at rounds• Pertinent pos and neg only, no routine vitals• 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)

Labor and Delivery: UNMCWhat we expect from you:– C-section patients

• Meet the patient• Ask the resident if you can scrub• Be ready to help• Be ready to tie suture• Fill out a blue card• See the patient 4 hrs after surgery and write a post op

note

Labor and Delivery: NMCMag Notes– All patients on mag get notes at least three times

per day: 0600, 1400, 2200– Students should write the 1400 and 2200 notes

(the resident will include the mag note in the morning rounding note

– See example on gray card

Labor and Delivery: NMC

How to be helpful:– Keep the board up to date (pts in labor get

checked every 1- 2hrs– Get the babies rounded up for circumcisions

(tylenol, lidocaine, baby hasn't eaten in last hour)– Keep a "to do" list on the white board (circ’s, post-

op notes, etc)

Labor and Delivery: NMCIf 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, 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

Labor and Delivery: NMC

Don’t!– Stay in the interaction room all day – Do an exam on a patient without the

resident present

Labor and Delivery: MethodistMorning rounds at 8am.– SOAP notes on antepartum patients – done by

0730– Round with MFM resident and staff

After rounds, get the list of laboring patients from the charge nurse– Meet the patients and nurses– Meet the doctors– Stay involved and visible– Coordinate with the OB resident

Labor and Delivery: MethodistBefriend the nurses– They will help you figure out when the

deliveries are

Meet the generalists and explain who you are and why you are there– Ask the generalists if you can scrub for

c-sections– Be present for all MFM c-sections and

deliveries

Labor and Delivery: Methodist

During the day:– Check on antepartum pts throughout the

day (if labs, repeat bp’s, ctx status)– Labor pts: checked q2-3hrs by nurses,

keep up to date on how the pts are progressing

– Assist resident with any new admissions

Gyn/Onc

What to expect– OR cases for suspected or known cancer

• Uterine, cervical, ovarian, vulvar, etc• Possible Da Vinci surgery

– Sick, hospitalized patients– Clinic– Many patients will be receiving

chemotherapy

Gyn/OncFriday before you start, talk with the students who were on that week– We check out when we change services, so

should you– Have one student page the resident (usually the

intern) on Friday to get the plan.Friday before your week of Gyn/Onc, get the surgery schedule for the next week– Read about the patient before the case and

understand why the type of surgery was scheduled.

Gyn/OncDaily: rounds in am and pm– Throughout the day, read the nursing notes on your patient (VS,

I/O tab)

Monday: Surgery with RemmengaTuesday: Surgery with Rodabaugh– Finalize your topic with chief resident

Wed, Thurs, Fri: clinic– See the return patients, check out with resident, then check out

with attending– Go with the resident to see the new patients

Friday afternoon– Students present a 10 min gyn/onc topic– Make a one page handout (put your name on it)

Benign Gyn Surg

What to expect– OR cases for benign disease

• Hysterectomies, ablations, D&C’s, TVT’s, etc

– ER consults throughout the day– Gyn Chief Clinic (Wed afternoons)– Clinic Add ons

Gyn SurgMonday (wear scrubs)

– am hospital rounds, OR casesTuesday (wear scrubs)

– am rounds, OR casesWednesday (dress up)

– pre-op conference at 7am, am rounds, Grand Rounds, M3 education, pm Chief clinic

Thursday (wear scrubs)

– am rounds, 7am teaching (topic to be chosen every Mon), OR casesFriday (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

Gyn SurgFriday before you start, talk with the students who were on that week– We check out when we change services, so should you– Have ONE student page the resident (usually the intern) on Friday

to get the plan, then pass plan to other student teammates.

Friday before your week of Gyn Surg, try to get the schedule for the next week– Read about the patient before the case and understand why the

type of surgery was scheduled!!!!– Make sure you know how to get scrubs and access the OR

schedule for the next week so you can prepare appropriately.– You may have to page intern on Sunday to see if there are any

patients you need to round on Monday am.

OB/Gyn Clinic

What to expect– Variety of patients with ob or gyn concerns– Go see the return ob’s – Ask before seeing a new ob, but plan to

see them– See the gyn patients (focused history, wait

on the exam until the physician gets there)

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

General Pearls

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 patientTreat 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

G’s & P’sG: 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 P1112Ex: G3 P1012

Ob/Gyn = Alphabet soupCTX: contractionsLOF: loss of fluidVB: vaginal bleedingTAH: total abdominal hysterectomyTVH: total vaginal hysterectomyBSO: bilateral salpingoophrectomyLAVH: laparoscopic assisted vaginal hysterectomyLVH: laparoscopic vaginal hysterectomyPTL: preterm laborSROM: spontaneous rupture of membranesPROM: premature rupture of membranesPPROM: prolonged premature rupture of membranes

Ob/Gyn = 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

Ob/Gyn = 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

Have fun!

Key concepts:1) Get involved  2) Read about the patients  3) Find ways to be helpful  4) Approach the residents if you are having problems