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OB/Gyn Pearls: A student guide


General Pearls. 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 – PowerPoint PPT presentation

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Title: OB/Gyn Pearls: A student guide

OB/Gyn Pearls A student guide
  • 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

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
  • You will treat women

General Pearls
  • 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,
  • 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

General Pearls
  • Emails are sent out over the weekend prior and
    give updates for what cases are going on and for
    staff coverage
  • Use them to help look up patients and prepare for
    the week ahead
  • Check your system list on the day prior to the
    rotation to see if there are patients who need
    rounded on in the morning
  • Check out with the students from the previous
    week on Friday for GYN and GYN ONC

General Pearls
  • Please round on patients and have notes done at
    least 15 minutes prior to rounds
  • Send them to most senior level resident
  • This way we have time to look at them and give
    you suggestions for presenting
  • We want you to look good!

MD Interaction Room
  • Reserved for those on LD
  • Students on other services should refrain from
    using this room (please use other library,
    Sorrell Center, cafeteria,etc.)
  • It is ok to store your things in there, but keep
    in mind that OB rounds are from 7-8 AM DO NOT
    interrupt rounds

Labor and Delivery UNMC
  • What to expect
  • Rounds at 7am (8am on weekends)
  • Scheduled cesarean sections or IOLs, labors
  • 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

Labor and Delivery UNMC
  • What we expect from you
  • Round on the postpartum patients
  • Divide the patients with your classmates
  • Bring up any questions or concerns PRIOR to
  • Present your patients at rounds
  • 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

Labor and Delivery UNMC
  • What we expect from you
  • C-section patients
  • Meet the patient
  • Be ready to help
  • Be ready to tie suture, staple, and sew
  • Fill out a blue card
  • See the patient 4 hrs after surgery and write a
    post-op note
  • Short progress note, share

Labor and Delivery UNMC
  • 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
  • Short progress note, share
  • See example on gray card

Labor and Delivery UNMC
  • If you feel like you are stuck in the interaction
  • Watch the monitors
  • You can figure out when someone is pushing, a new
    patient arrives, or a patient is having decels
  • Follow the intern on the floor
  • You can always ask one of us "Can I come with
  • 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 UNMC
  • Dont!
  • Walk into a room when a patient you havent met
    is delivering
  • Stay in the interaction room all day
  • Write your notes late or after a resident
  • Do an invasive exam on a patient without the
    resident present

Labor and Delivery Methodist
  • Morning rounds at 8 am.
  • SOAP notes on antepartum patients done before
    rounds and sent to perinate resident
  • Round with MFM resident and staff
  • After rounds, get the list of laboring patients
    from the charge nurse
  • Coordinate with the OB resident (usually one
    student OR resident per delivery, unless MFM pt)
  • Meet the patients and nurses
  • Stay involved and visible (aka nurses station)
  • If the nurses cant find you, they wont come
    looking for you

Labor and Delivery Methodist
  • During the day
  • Check on antepartum pts throughout the day (F/U
    labs, US, etc.)
  • Labor pts checked q2-3hrs by nurses, keep up to
    date on how the pts are progressing
  • Be on the lookout for sections scheduled in the
    afternoon or that get added on
  • Assist resident with any new admissions

Gyn Onc
  • What to expect
  • OR cases for suspected or known cancer
  • Uterine, cervical, ovarian, vulvar, etc
  • Many patients will be receiving chemotherapy
    and/or radiation
  • Clinic

Gyn Onc
  • Daily rounds in am and pm
  • Time TBD
  • Throughout the day, read the nursing notes and
    notes from consulting services on your patient
    (VS, I/O tab)
  • Monday Surgery with Remmenga (wear scrubs)
  • Tuesday Surgery with Rodabaugh (wear scrubs)
  • Wed, Thurs, Fri clinic (dress clothes)
  • See the return patients, check out with resident,
    then check out with attending
  • Go with the resident to see the new patients

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

Benign Gyn Surg
  • Monday, Tuesday, Thursday (wear scrubs)
  • am hospital rounds, OR cases
  • Wednesday (dress clothes)
  • pre-op conference at 7am, am rounds, Education,
    pm Chief clinic
  • 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
  • Ask your residents for help with an idea

OR Etiquette
  • Discuss amongst your fellow students who will
    scrub for each case
  • Throw your gloves and gown
  • Write your name on the white board in the OR
  • Scrub as long as the most senior person scrubs,
    and use whatever they are using
  • Dont grab anything from the mayo stand
  • Be prepared to retract, cut suture, and sew

General Knowledge Scrubbing
  • Traditional Scrub
  • Wet hands/forearms
  • Clean nails using enclosed nail pick.
  • Scrub nails, fingers, hands, wrists, arms.
  • Important aspect is total contact time with soap
  • Rinse so that dirty water doesn't drip down to
    your fingers
  • Avagard is an acceptable alternative
  • Be sure Avagard dries before gloving
  • Directions on the bottle

Staff Clinics
  • What to expect
  • Variety of patients with OB or GYN concerns
  • Ask attending about how/when they want notes
  • Get focused history and check fundal height and
    get heart tones on ROBs
  • Take focused history with NOB and GYN patients,
    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
  • Address your concerns
  • If you are having trouble, let us know

How to be a successful student
  • 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
  • Remember there is a proper time and place for
    questions if your resident is busy
  • 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

How to be a successful student
  • Communicate with your residents
  • Text, email for any non-immediate concerns
  • Page only if necessary
  • Dont ask to go to sleep or be sent home
  • We realize the days are long
  • Theres always something you can learn

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

Sample presentations
  • OB
  • 23 yo G1P0 PPD 1 from SVD at 39w1d. Pregnancy
    complicated by history of IUGR. She is doing
    well. Minimal lochia, breastfeeding, pain well
  • Only pertinent vitals, if normal, say WNL
  • Exam findings Fundal height
  • A/P repeat the above opening sentences. Comment
    on Rh and rubella status, method of feeding for
    infant, and method of birth control

Sample presentation
  • OB (Methodist)
  • 23 yo G2P0010 at 31w6d, admitted on 5/1 for PTL.
    Pregnancy complicated by history of cervical
    insufficiency with delivery at 18 weeks. Denies
    CTX/LOF/VB. Reports FM.
  • PPROM Denies abdominal pain, fevers/chills.
  • Preeclampsia Denies HA/vision changes/SOB/CP/RUQ

Sample presentation
  • GYN ONC and GYN
  • 23 yo female, POD 1 TAH/BSO for Grade 1
    endometrial cancer. Pain well controlled on PCA,
    tolerating po intake, foley in place, has not
    ambulated yet.
  • Vital signs WNL (do not say stable)
  • Full exam, look at incision(s)
  • Comment on Is and Os
  • Labs (pertinents only)

Sample presentations
  • GYN ONC and GYN
  • Repeat your initial statement for assessment of
    the patient
  • Plan Postoperative goals, then list accordingly
    to other health issues they may have
  • If ONC patient, is their pathology back yet? Are
    there plans for chemo/radiation?

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

Alphabet Soup
  • GDMA1 gestational diabetes mellitus, diet
  • 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

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
  • Get involved 
  • Read about the patients 
  • Find ways to be helpful 
  • Approach the residents if you are having
  • Show students how to add the service lists in
  • Clinic, Gyn and Onc

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