How to be a good ob/gyn intern...

[pruritis_ani]

I saw a similar thread on the surgical forums, and I thought it would be nice to get one started for us soon-to-be interns.

Any advice on how to not only survive, but to do well? Common pitfalls? Things we should know how to do?

Help us out residents! Remember, we could be coming to your program, so any help you give us now could save you some headaches later...

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[jvarga]

This is a tough post to reply to since there are so many factors that go into making a good intern. However, here are some hints to help you out:
1. Always listen to your upper levels/staff
2. Never be argumentative (especially at rounds or when given direct orders)
3. KNOW EVERY DETAIL ABOUT YOUR PATIENTS (cannot be stressed enough)
4. Be a patient advocate
5. Always be courteous to your support staff (clerks, nurses, techs, etc)
6. By all means avoid the New MD syndrome ("Im the Doctor, so just do what I say"). You will be second guessed a lot as an intern, and for the most part you will be wrong.
7. Don't be afraid to say "I dont know" (you are an intern, you are not expected to know all the answers). However, do follow all "I dont knows" with "Ill find out by tomorrow".
8. Always complain UP the chain of command, not down (it never looks professional when you complain to the students)
9. Guide the students in the right direction and make sure they know how to present to the upper levels/staff
10. Answer your pages on time
11. Never demean or yell at your consultants (you are just as ignorant about their field as they are about yours)
12. Do everything in your power to help expedite labs, OR turnover, X-Ray studies, path reports, etc (especially applicable at Univeristy based hospitals)
13. Always take time to chat with your patients about something unrelated to their medical problems
14. Follow all staff commands with "Yes, sir/maam" and "get on it" immediately
15. When in doubt, ask an upper level
16. When overwhelmed, ask an upper level
17. When in need of a drink, ask an upper level
18. Sleep, eat, and read when you can
19. Don't be afraid to ask your nurses/scrub techs for advice (many of them have been doing this longer than most residents and even staff)
20. When things are slow, get to know your nurses (many of them will have great stories about your staff when they were residents)
21. Keep up with your reading (5-10 pages/weeknight will keep you more than updated)
22. Never leave clinic or the hospital until the whole team is done (one for all and all for one)
23. Smile...nobody likes a frown
24. Remember, everybody above you has gone through the same experience, if not worse (for those that worked in the pre-80 hour work week days). So dont expect any special treatment.
25. Be flexible and creative
26. Work with your classmates as a team. Do favors for each other and don't be obsessed with who worked more than who.
27. And lastly, come to the realization that you will make mistakes and make sure that you learn from them!
There are plenty more hints, but these I think are the most crucial.
Congratulations to all of you and good luck come July 1st.

 

[coolbabe76]

this is a good thred. who dont more people come forward and help the cause pf making us better interns?

 

[pruritis_ani]

yeah, awesome post! any more input? how about some practical points on what we need to know how to do, maybe some tricks of the trade on patient management?

 

[Danger Man]

This is a tough post to reply to since there are so many factors that go into making a good intern. However, here are some hints to help you out:
1. Always listen to your upper levels/staff
2. Never be argumentative (especially at rounds or when given direct orders)
3. KNOW EVERY DETAIL ABOUT YOUR PATIENTS (cannot be stressed enough)
4. Be a patient advocate
5. Always be courteous to your support staff (clerks, nurses, techs, etc)
6. By all means avoid the New MD syndrome ("Im the Doctor, so just do what I say"). You will be second guessed a lot as an intern, and for the most part you will be wrong.
7. Don't be afraid to say "I dont know" (you are an intern, you are not expected to know all the answers). However, do follow all "I dont knows" with "Ill find out by tomorrow".
8. Always complain UP the chain of command, not down (it never looks professional when you complain to the students)
9. Guide the students in the right direction and make sure they know how to present to the upper levels/staff
10. Answer your pages on time
11. Never demean or yell at your consultants (you are just as ignorant about their field as they are about yours)
12. Do everything in your power to help expedite labs, OR turnover, X-Ray studies, path reports, etc (especially applicable at Univeristy based hospitals)
13. Always take time to chat with your patients about something unrelated to their medical problems
14. Follow all staff commands with "Yes, sir/maam" and "get on it" immediately
15. When in doubt, ask an upper level
16. When overwhelmed, ask an upper level
17. When in need of a drink, ask an upper level
18. Sleep, eat, and read when you can
19. Don't be afraid to ask your nurses/scrub techs for advice (many of them have been doing this longer than most residents and even staff)
20. When things are slow, get to know your nurses (many of them will have great stories about your staff when they were residents)
21. Keep up with your reading (5-10 pages/weeknight will keep you more than updated)
22. Never leave clinic or the hospital until the whole team is done (one for all and all for one)
23. Smile...nobody likes a frown
24. Remember, everybody above you has gone through the same experience, if not worse (for those that worked in the pre-80 hour work week days). So dont expect any special treatment.
25. Be flexible and creative
26. Work with your classmates as a team. Do favors for each other and don't be obsessed with who worked more than who.
27. And lastly, come to the realization that you will make mistakes and make sure that you learn from them!
There are plenty more hints, but these I think are the most crucial.
Congratulations to all of you and good luck come July 1st.

All soldiers be forewarned!!! If the above orders are not followed and the chain of command is subsequently broken, expect the occurence of a Code Red by your platoon! Code Reds can and do come in a variety of forms such as: Iodine baths as a result of breaking scrub during the execution of a C-Section, barrack restrictions as a result of not leaving the callroom in a timely fashion when summoned by a senior officer, and having to write 'Yes,sir I will check the magnesium on my patient.' twenty times on the chalkboard of the conference room when requests from commanding officers are met with any response other than 'Sir, yes, sir.' or 'Yes, maam.'

In addition to the above Code of Conduct, ensure that no trips to the latrine or the mess hall are taken without expressed approval of your senior officer!
You will breathe, eat, sleep, drink, inhale, exhale, oxidize, reduce, metabolize, catabolize and anabolize OB for the next 48 weeks!! Do you understand, soldier?......I did not hear you! DO YOU UNDERSTAND, SOLDIER?!?!?

 

[CANES2006]

All soldiers be forewarned!!! If the above orders are not followed and the chain of command is subsequently broken, expect the occurence of a Code Red by your platoon! Code Reds can and do come in a variety of forms such as: Iodine baths as a result of breaking scrub during the execution of a C-Section, barrack restrictions as a result of not leaving the callroom in a timely fashion when summoned by a senior officer, and having to write 'Yes,sir I will check the magnesium on my patient.' twenty times on the chalkboard of the conference room when requests from commanding officers are met with any response other than 'Sir, yes, sir.' or 'Yes, maam.'

In addition to the above Code of Conduct, ensure that no trips to the latrine or the mess hall are taken without expressed approval of your senior officer!
You will breathe, eat, sleep, drink, inhale, exhale, oxidize, reduce, metabolize, catabolize and anabolize OB for the next 48 weeks!! Do you understand, soldier?......I did not hear you! DO YOU UNDERSTAND, SOLDIER?!?!?

Sir, yes, sir.

 

[ramonaquimby]

bump

 

[superspec]

The day I ask another adult if I can have a drink of water is about as likely to happen as a dog peeing the mona lisa into a snow bank. Get over yourself.

 

[MichiMO]

I think they were referring to a different type of "drink"

 

[superspec]

I think they were referring to a different type of "drink"

Hmmmm....that might even be worse!

 

[drbhooks]

I agree with most of the tips on how to be a good OB/Gyn intern, but having just finished my intern year, I would modify one of the tips. Although I think it is important to listen to authority which includes your senior residents and attendings, you can disagree with the management plan for patient care and you have no obligation to follow a command which is harm a patient's health or well-being.

One of my fellow intern colleagues saved a patient's life. She saw a patient in the ER who was a hemodynamically ectopic pregnancy who was bleeding out and had passed out in the ER waiting room. She was hypotensive, tachycardic, pale, and diaphoretic and bleeding profusely from the vagina. Instead of following the chain of command and notifying her senior resident on the L&D board, she contacted the in-house staff and they took the patient emergently to the OR. The patient had a ruptured left ectopic pregnancy and had approximately 1500-2000 cc of blood in her abdomen and pelvis. If this intern had not reacted quickly, this woman would have died. Instead of the senior resident realizing this, she reprimaded the intern for not contacting her first.

It is important to follow orders and be a team player but there are circumstances when you have to follow your instincts and clinical judgement. I am not saying be a rebel or be argumentative but to be careful. As the intern, you have the most interaction with patients and you provide the hands-on care for the patient. It is very important to know everything about your patients, be an advocate for them, and to learn from your senior residents and attendings but if you disagree with a management plan, you have a right to speak up and there is a proper way to do it up the chain of command. Senior residents and attendings are human beings as well and are falliable. They can also make errors.

When I was on gyn call one night, I evaluated a patient in the ER who I believed was an ovarian ectopic pregnancy. Pt had a positive quantative beta-hcg, complained of abdominal pain and nausea and emesis (she did not have an acute abdomen), and ultrasound showed no IUP but a mass in the left adnexa. When we went to the OR, the attending thought the L ovary looked suspicious but did not biopsy or remove the L ovary. I challenged her decision by feigning ignorance and asking several questions to understand why she was deciding to close a patient who appeared to have an ovarian ectopic pregnancy. She could not give any rational explanation and I pressed her to remove her L ovary. She refused and against my better judgement, the ovary was not removed. The attending ordered a repeat beta-hcg in the morning which was rising and we had to give the patient methotrexate. Although there are several ways to manage a patient, if you are going to take a patient to the OR and you suspect an ectopic and you see something suspicious, common sense and reasoning dictate that you remove the ovary from a beneficience and medical -legal standpoint. The patient was not an excellent candidate for methotrexate because she was bipolar and had polysubstance abuse issues (methotrexate has an anti-abuse effect if alcohol is consumed). Even other attendings who I discussed this case agreed with my rationale and although the end the patient survived and did well, I do not think it is ever inappropriate to question an attending or senior resident.

Everyone regardless of their level of training can make mistakes. I was managing a patient who was in labor and the infant's head was ballatable. I was giving the attending updates about the patient and although the staff wanted me to perform an aminotomy, I refused because I know that could potentially cause a cord prolapse and consequently lead to an emergent C-section.

I wrote an incident report of one of my fellow residents who performed a botched circumcision that remove all of the foreskin from the glans all the way to where the base of the penis meets the scrotum (way to much skin was removed!) and the infant bled profusely and developed a cellulitis and abscess under the foreskin. The infant was given Keflex, and pediatric urology was consulted and recommended debridement and a skin graft at age 8 months. I was called to see the circumcision by nursing and spoke to the resident privately to see if they were aware of the complication. Obviously this complication was unintentional and the resident felt horrible (and we have all had our share of less than perfect circumcisions). Since she was aware of the complication and the management plan but refused to alert her senior resident and staff, I took upon myself to report the incident and encouraged the nurse to do so as well.

Recently in the ER, a staff ER physician and NP (nurse practioner) failed to obtain consent and obtain a collection of evidence kit on a female patient who had been sexually assaulted. The doctor and NP attest that the consent and evidence was not obtained because the patient was not competent or coherent enough but the EMS, the ER nurse, and internal medicine physician who examined the patient during the same time period documented that the patient was alert and oriented and the patient gave a detailed account of the assault to the police, nurse, EMS, and internal medicine physician and wanted to press charges. No STD panel was done and no evidence was collected before the patient changed her clothing, took a shower, etc and the chain of evidence was broken.

Obstetrics and gynecology is a very high liability field and you must be conscientious and do what is in your patient's best interest. There are certain ethical situations where you have a duty and obligation as a health professional to question authority. Medicine does have a system of checks and balances such as peer review, quality management/assessment, etc. and these policies are in place to protect the patient and the physician.

My advice is to use your brain and your heart, be diligent and committed even when times are rough (and they will be rough), and be open minded to learning new things and having your energy and mental capacity being stretched to its limits. Most importantlly, try to leave issues at work where they belong at work and maintain a boundary between your personal and professional life. Have an outlet for stress and lean on friends and family for support. Try to have fun. You will learn so much in such a short time frame and you will be amazed at the journey you will take during your residency training.

 

[McLaren]

Thanks, for the tips.
My 1st internship rotation is in Ob/Gyn and I want to ask about covering the ER, is there any good book to help me to survive it?

 

[fuzzyerin]

Thanks, for the tips.
My 1st internship rotation is in Ob/Gyn and I want to ask about covering the ER, is there any good book to help me to survive it?

One of my attendings has a very good philosophy regarding the ER to keep in mind when seeing patients.

"You first must decide if the patient needs to go to the OR or not.
If they need to go to the OR, then go.
If not, decide if they need to be admitted or if they can go home.
If they can go home, go.
If not, admit them and reasess every 2 hours and decide - do they need to go to the OR or not.
If they need to go to the OR, then go.
If not, keep watching."

It's very simple, but it really gets the point across. There are very few surgical emergencies in Ob/Gyn - ovarian torsion, ectopic pregnancy, hemoperitoneum, hemorrhage. But sometimes a single snapshot isn't going to tell you enough. Also, treat each patient as if they are a new patient in your office, because all too often, people use the ER as a primary care clinic.

 

[boyob]

Ok so reading through this I would agree you don't have to ask the chief resident if you can go pee. Should you talk to the chief if you have an ectopic pregnancy in the ER, YES!

You are the intern. You might be a super intern.... You might be the best intern ever. And maybe you think that your management plan is so good it should go right to the attending, but if you refer to above you are the intern. Although, you might be making the right call your upper level resident deserves to be spoken to about patients that will be involved with their service. Think how you would feel if your intern called the attending every time an ectopic rolled through the door. It is simply unprofessional and it does not make poor patient care to talk with your chief. You might know alot but I bet you would be surprised if your upper level hasn't seen it a few times as well!

Remember that you can hurt people to and by talking with your chief you may have a better plan than you had before.

Yes, people make mistakes.... chiefs, attendings etc etc. But I am telling you so do interns. Don't hurt the patient...yeah that goes without saying. But to just call the attending because you feel that you know best and to not involve your upper level residents is not good advise. thumbdown
All you will do is piss people off. Don't be a know it all. Residency is long. Remember you will have to work with these people for awhile.

I do agree smile, have fun, and work hard. Talk with people/ ask questions.
You don't have to ask to pee.
enjoy

 

[JulianCrane]

Let's start this thread up again. I know a lot of us would appreciate more advice.

 

[pruritis_ani]

what a trip....I remember posting this thing, and here I am, about to be a third year...time flies!

 

[Drprttygyrl]

Most of this advice is so helpful. I visited the hospital where I will be working (UT Memphis) yesterday and it hit me, I am going to be a resident. I am very, very, VERY nervous and need all of the advice I can get. Can someone comment on their intern year and what they learned from it? Also if they could repeat their intern year (besides shoot yourself, lol) what would you do differently?

 

[jocg27]

I wrote an incident report of one of my fellow residents who performed a botched circumcision that remove all of the foreskin from the glans all the way to where the base of the penis meets the scrotum (way to much skin was removed!) and the infant bled profusely and developed a cellulitis and abscess under the foreskin. The infant was given Keflex, and pediatric urology was consulted and recommended debridement and a skin graft at age 8 months. I was called to see the circumcision by nursing and spoke to the resident privately to see if they were aware of the complication. Obviously this complication was unintentional and the resident felt horrible (and we have all had our share of less than perfect circumcisions). Since she was aware of the complication and the management plan but refused to alert her senior resident and staff, I took upon myself to report the incident and encouraged the nurse to do so as well.

wait, really?

 

[Cholinergic]

Bumping for advice for us incoming interns!

 

[CAPBonanza]

Similar yet slightly different issue:
I'm starting my third year and my first rotation is in Ob/gyn. Does anyone have in advice? any particularly good review books to read to prepare for the shelf exams? Any help would be appreciated.

 

[priinzeznisha]

ummm im apart of the hsdn (high school student doctor network0 i was wondering do you get paid to intern??? or is it jus to gain expeirience???
alsoo is it a good idea to take anatomy at a community college while in high school?? or asould i jus take like a nursing class or something..im looking for advice on getting ahead of the game just a lil bit...lol im very determined to be an obgyn...ohh and if some one would be so kindly to tell me what their favorite subject was ...and was it hard memorizin diagnoses and body parts and stuff...

 

[DrJD]

ummm im apart of the hsdn (high school student doctor network0 i was wondering do you get paid to intern??? or is it jus to gain expeirience???
alsoo is it a good idea to take anatomy at a community college while in high school?? or asould i jus take like a nursing class or something..im looking for advice on getting ahead of the game just a lil bit...lol im very determined to be an obgyn...ohh and if some one would be so kindly to tell me what their favorite subject was ...and was it hard memorizin diagnoses and body parts and stuff...

I can help with a few of the questions anyway!

You do get paid as intern, it fluctuates slightly from hospital to hospital based on cost of living, but on average I'd say it somewhere between 40 and 45 thousand a year.

I wouldn't bother taking anatomy at a local college while you are in high school. Truly all you can do "get ahead" is do really well high school, get into a solid college and then once you are there, it truly doesn't matter what you major in just do well. Work as hard as it takes for you to get above a 3.5, do well on the MCAT and hope you can get admitted to a medical school.

Finally, once you start medical school you can start doing things to help you match into OB/GYN... (Research, service, interest groups, etc.)

Hope this helps!

 

[THP]

ummm im apart of the hsdn (high school student doctor network0 i was wondering do you get paid to intern??? or is it jus to gain expeirience???
alsoo is it a good idea to take anatomy at a community college while in high school?? or asould i jus take like a nursing class or something..im looking for advice on getting ahead of the game just a lil bit...lol im very determined to be an obgyn...ohh and if some one would be so kindly to tell me what their favorite subject was ...and was it hard memorizin diagnoses and body parts and stuff...

Learn how to spell and use punctuation properly.

 

[Mopp22]

Learn how to spell and use punctuation properly.

That's some good advice.

 

[omw91]

Bumping for advice for us incoming interns! Regarding rotation schedules, is there a preference on what would be helpful to be done first?

 

[Dr. Death]

Bumping for advice for us incoming interns! Regarding rotation schedules, is there a preference on what would be helpful to be done first?

Do you get to pick? Most programs you just get what you get

 

[anonperson]

Bumping for advice for us incoming interns! Regarding rotation schedules, is there a preference on what would be helpful to be done first?

Doesn't matter.
Most places don't even let you choose.

Tips for success:
Be early
Know what is expected of you
You are the doctor now so your job is to get patients admitted/ assist in their management/ get them discharged

Read/ study every day. You should make it a goal to go through all the practice bulletins once a year.

Review and study your anatomy and surgical techniques. This can be done via textbooks and surgical videos.

A weak intern doesn't read and doesn't care about the details in general.

 

[Dr G Oogle]

Kill it in triage. Always have a plan when presenting to attending or senior. Present patients concisely and don’t ramble. If patient needs US always have US in room before getting senior, fellow or attending. Realize that scutwork isn’t a punishment and just get it done. Know everything about every patient (or do your best) on the rotation that you’re on. Don’t complain that you’re not getting to do any big cases or lots of procedures as an intern.