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OB/Gyn do

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OB/Gyn do s, don ts and pearls: a guide for students on the rotation Resident of the day Objectives General knowledge What you can expect from the residents What ... – PowerPoint PPT presentation

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Title: OB/Gyn do


1
OB/Gyn dos, donts and pearls a guide for
students on the rotation
  • Resident of the day

2
Objectives
  • General 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

3
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

4
Code of Ethics
  • Know why were doing what were 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

5
MD Interaction Room
  • Reserved for those on LD
  • Students on other services should refrain from
    using this room (please use other facilities to
    studylibrary, 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

6
Labor and Delivery UNMC
  • What to expect
  • Rounds at 7am (8am on weekends)
  • Scheduled cesarean sections or IOLs
  • Deliveries
  • Postpartum tubal ligations
  • Outpatients (gt20weeks with OB complaints)
  • Circumcisions
  • In general, the more available and involved a
    student is, the more you get to do

7
Labor and Delivery UNMC
  • What 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)

8
Labor and Delivery UNMC
  • What 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

9
Labor and Delivery NMC
  • Mag 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

10
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 (circs,
    post-op notes, etc)

11
Labor and Delivery NMC
  • If 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

12
Labor and Delivery NMC
  • Dont!
  • Stay in the interaction room all day
  • Do an exam on a patient without the resident
    present

13
Labor and Delivery Methodist
  • Morning 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

14
Labor and Delivery Methodist
  • Befriend 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

15
Labor and Delivery Methodist
  • During the day
  • Check on antepartum pts throughout the day (if
    labs, repeat bps, 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

16
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

17
Gyn/Onc
  • Friday 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.

18
Gyn/Onc
  • Daily rounds in am and pm
  • Throughout the day, read the nursing notes on
    your patient (VS, I/O tab)
  • Monday Surgery with Remmenga
  • Tuesday 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)

19
Benign Gyn Surg
  • What to expect
  • OR cases for benign disease
  • Hysterectomies, ablations, DCs, TVTs, etc
  • ER consults throughout the day
  • Gyn Chief Clinic (Wed afternoons)
  • Clinic Add ons

20
Gyn Surg
  • Monday (wear scrubs)
  • am hospital rounds, OR cases
  • Tuesday (wear scrubs)
  • am rounds, OR cases
  • Wednesday (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 cases
  • Friday (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

21
Gyn Surg
  • Friday 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.

22
OB/Gyn Clinic
  • What to expect
  • Variety of patients with ob or gyn concerns
  • Go see the return obs
  • 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)

23
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

24
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 patient
  • Treat 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

25
Gs Ps
  • G 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 P1112
  • Ex G3 P1012

26
Ob/Gyn Alphabet soup
  • CTX contractions
  • LOF loss of fluid
  • VB vaginal bleeding
  • TAH total abdominal hysterectomy
  • TVH total vaginal hysterectomy
  • BSO bilateral salpingoophrectomy
  • LAVH laparoscopic assisted vaginal hysterectomy
  • LVH laparoscopic vaginal hysterectomy
  • PTL preterm labor
  • SROM spontaneous rupture of membranes
  • PROM premature rupture of membranes
  • PPROM prolonged premature rupture of membranes

27
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

28
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

29
Have fun!
  • Key concepts
  • Get involved 
  • Read about the patients 
  • Find ways to be helpful 
  • Approach the residents if you are having
    problems 
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