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Anyone have any insights on Stanford? How's the program? How's the clinical training?
Anyone know anything about Stanford?
- Thread starter JulianCrane
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My wife went there for her REI fellowship. I do anesthesia and am familiar with OB. I thought (and she did too) that their residency program was not that great. East Palo Alto used to supply them with their complicated patients, but EPA is getting gentrified and it is not that bad anymore. Stanford is not really that busy in general.
When my wife was pregnant with our first kid, she started contracting around 20 weeks, turned out she had a huge fibroid that got intermittently ischemic. We had been getting all of her OB care at Alta Bates over in Oakland. One Monday morning at 0830, she started contracting (27 weeks), the bridges over to the East Bay that time of day were parking lots. We just wanted some terb or a nifedipine to get them to chill out. She was in a lot of pain. She tried to get me to check her cervix, but I declined, I only deal with one orifice, the larynx. So, we decided to take a chance and go to Stanford. We got there and they checked us in and the senior resident said she was 1-2 cm dilated. About an hour went by, no IV, no terb, no nothing. Finally after about 2 hours, an attending showed up, my wife was really in pain and still nothing happened.
I said, let's leave AMA and go to Alta Bates. We had been there before at 24 weeks, they got her comfortable, no problems. She said we couldn't leave AMA from where she was doing her fellowship (their REI program is pretty good, though there are better programs.) So, she moved the contract-o-meter off her abdomen, to her chest for 15 minutes, sucked up the pain, and said, "Look, I am not contracting anymore." They didn't even examine her and they let us go.
We went right over to Alta Bates, they gave her a bag of LR, some tocolytic therapy, and a fetal fibronectin. Also, turns out her cervix was closed, neither the senior resident nor junior resident did a correct cervix exam. Fetal fibronectin was negative, her contractions stopped, and we went home. Delivered at 39 weeks.
I think there are better programs.
When my wife was pregnant with our first kid, she started contracting around 20 weeks, turned out she had a huge fibroid that got intermittently ischemic. We had been getting all of her OB care at Alta Bates over in Oakland. One Monday morning at 0830, she started contracting (27 weeks), the bridges over to the East Bay that time of day were parking lots. We just wanted some terb or a nifedipine to get them to chill out. She was in a lot of pain. She tried to get me to check her cervix, but I declined, I only deal with one orifice, the larynx. So, we decided to take a chance and go to Stanford. We got there and they checked us in and the senior resident said she was 1-2 cm dilated. About an hour went by, no IV, no terb, no nothing. Finally after about 2 hours, an attending showed up, my wife was really in pain and still nothing happened.
I said, let's leave AMA and go to Alta Bates. We had been there before at 24 weeks, they got her comfortable, no problems. She said we couldn't leave AMA from where she was doing her fellowship (their REI program is pretty good, though there are better programs.) So, she moved the contract-o-meter off her abdomen, to her chest for 15 minutes, sucked up the pain, and said, "Look, I am not contracting anymore." They didn't even examine her and they let us go.
We went right over to Alta Bates, they gave her a bag of LR, some tocolytic therapy, and a fetal fibronectin. Also, turns out her cervix was closed, neither the senior resident nor junior resident did a correct cervix exam. Fetal fibronectin was negative, her contractions stopped, and we went home. Delivered at 39 weeks.
I think there are better programs.
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such as? particularly in southern california, in your opinion?
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Umm...I'm a little confused...first, if your wife's cervix wasn't dilated or effaced, technically, she does not fit the criteria for preterm labor. Labor is contractions sufficient to produce cervical change, also effacement of 80% or greater or dilation greater than 2cm. Also, a negative fetal fibronectin alone was enough to show that she would not be delivering in the next 7 days, if not 14 days due to a strong negative predictive value. Tocolytics should not be administered unless you have a patient in preterm labor with the likelihood of delivering soon. Then, you use them long enough to get a steroid window. Otherwise, tocolytics should be not be used, as their efficacy has not been proven to get someone to term. I am glad that everything turned out ok, but I don't think Stanford's clinical decision making was poor...
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woah woah woah---talk about getting off track. the discussion is about stanford, not ucsf... secondly, mdjob, I am so sorry that you had such a poor experience with stanford. However, your story, while interesting and pretty darn personal, doesn't exactly help us get an idea of what the residency training program is like.
anyone with some more relevant input?
anyone with some more relevant input?
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First of all, be careful as a medical student lecturing anybody about medical issues. My wife had a complicated picture, especially a pedunculated fibroid that grew rapidly, becoming intermittently ischemic, therefore producing contractions.
You clearly have never had a child, as contractions are painful and make it difficult to do your job. You are correct that tocolytics (including magnesium according to some new studies) have not been shown to change the ultimate outcome of preterm labor. The goal was pain control.
Regarding the residency, I thought it was sad that neither the junior nor senior resident could even do an accurate cervix check. They both claimed she was 1-2 cm dilated. The experiened attending at Alta Bates said she was closed. My wife said that neither resident even touched her cervix. It was a rather awkward situation to be at your training (fellowship) program and realize that you are receiving poor care and the residents are not getting the experience/training to properly evaluate an OB patient. Evaluation of preterm labor is something an OB resident should learn as an intern and be able to do in their sleep.
One experience does not sum up a program, but I have never been so unimpressed in my life. There has to be better programs out there.
You clearly have never had a child, as contractions are painful and make it difficult to do your job. You are correct that tocolytics (including magnesium according to some new studies) have not been shown to change the ultimate outcome of preterm labor. The goal was pain control.
Regarding the residency, I thought it was sad that neither the junior nor senior resident could even do an accurate cervix check. They both claimed she was 1-2 cm dilated. The experiened attending at Alta Bates said she was closed. My wife said that neither resident even touched her cervix. It was a rather awkward situation to be at your training (fellowship) program and realize that you are receiving poor care and the residents are not getting the experience/training to properly evaluate an OB patient. Evaluation of preterm labor is something an OB resident should learn as an intern and be able to do in their sleep.
One experience does not sum up a program, but I have never been so unimpressed in my life. There has to be better programs out there.
