Intro to Ob-Gyn: first rotation!!

[nope80]

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Ob/gyn is my first rotation and I'm already so nervous about it. I feel completely unaware about what is going to go on, how my days are supposed to be, what my responsibilities are/role as a member of the team, how to be proactive, ETC!! Anyone care to share some advice or give a brief intro on how it will be, what to do, what not to do. Also, do people wear scrubs when in clinic? Or do you change based on whether you are going to the OR or not? How does one know what to do or be proactive when you aren't really sure how the structure of the rotation is in terms of patient management, prerounding, and all of the other structures that happen throughout the day that I still don't exactly understand.

Basically I'm feeling really overwhelmed and any info to appease my anxiety would be appreciated👍

 

[rlwebb]

well i just spent a week in labor and delivery, my first week of 3rd year, and man i still don't know what the h is going on, it's just craziness, just try to get in there and observe everything and try to get them to let u do little things so u can learn something, and read blueprints or first aid for wards or something in the downtime, that's all i got for u.

 

[ZagDoc]

I feel completely unaware about what is going to go on, how my days are supposed to be, what my responsibilities are/role as a member of the team, how to be proactive, ETC!! Anyone care to share some advice or give a brief intro on how it will be, what to do, what not to do. Also, do people wear scrubs when in clinic? Or do you change based on whether you are going to the OR or not? How does one know what to do or be proactive when you aren't really sure how the structure of the rotation is in terms of patient management, prerounding, and all of the other structures that happen throughout the day that I still don't exactly understand

A lot of your questions are specific to your program/attending/etc, so you won't know until you are actually in the thick of it.

I started MS3 three weeks ago, and was having the same worries. I'd ask 4th years how I could do well... and they'd say something like "do anything you can do make your intern's life easier... follow up on labs, fax for records, look up immunizations, put in orders" and my response was "(1) I don't know what any of that means. (2) I don't know how to do any of those things." It's unfortunately something you just need to learn on the fly.

Think of it like skydiving. You can read every book ever written about skydiving. You can talk to a bunch of skydivers about skydiving. But until you actually get up in that plane and jump, you have no real idea what its actually like to skydive. Same goes for clinical rotations. You're going to fumble around and make mistakes and wonder WTF you're supposed to be doing that first week, but the best thing you can do to prepare for it is to accept that it's going to happen. And to realize that it happens to everyone.

A couple of specific responses to questions:
-You will know what your days are supposed to be like when you finish that first full day. There's so much variability between hospitals, teams, specialties that no one can tell you exactly what your days are going to be like. The only thing people can really tell you is that: a. early morning is pre-rounding b. morning is rounds and morning report c. lunchtime is lecture d. afternoons are putting in orders and new admits.

-You will figure out the scrubs/no scrubs questions within the first half of your first day. Never make assumptions about a rotation and show up in scrubs on the first day - because if you're wrong, its a horrible first impression and in clinicals where grades are based on how people perceive you that can be a killer. Always dress up on the first day. It's better to be overdressed than be the shmuck.

-Being proactive is all about having your radar up. The senior mention he/she just heard about a new interesting admit coming? Volunteer to be part of the admit team and write an H&P. A resident mentions that the endocrine fellow is going to talk about the management of DKA because a new-diagnosis type I diabetic was just admitted to the PICU? Get you ass over there and listen. Mr. Johnson needs his chest tube out? Say to the intern/resident "I've never taken out a chest tube before. Could you help me do it this time and then in the future I can do them for all my future patients?" Read up on your patients. Ask questions... why are they using 40mEq/L KCl instead of 20? Why is quarter normal saline being used for maintenance fluids instead of half? Is it a slow afternoon and your patient is being sent down to be cath'd and you've never seen on in person before? Ask to go along, and maybe the radiologist will also turn it into a teaching opportunity. Being proactive isn't necessary being aggressive or being a suckass - it's just finding ways to stay busy and stay engaged. The more you invest yourself in the treatment of the patients you're following, the more responsibility the team will let you assume in the process. Yeah, scut sucks, but it also opens up doors to good learning opportunities and hands on experience.

 

[nope80]

Thanks for the responses!! A few questions - what exactly is "scut" work? I hear this all the time but never really understood what this meant.

Also, in the example of the chest tube patient given above, I don't know, my first response (and maybe this is wrong) but do they really want "me" to be taking out chest tubes? A third year med student? I would never think to volunteer for something like that out of fe?ar of overstepping my boundaries (if that makes sense)...Also when you say you want to do whatever it takes to make your interns life easier - what does this mean exactly? What are things that we can do that can make their job easier specifically?

 

[Ashers]

Scut work basically is work that has absolutely no educational value whatsoever. Generally, scut is frowned upon, but many times, students call regular work "scut" because they don't want to do it.

An example from my experience -- a resident would make me put all her notes away in patients' charts all over the hospital. That is scut.

Doing a blood draw -- while it may be annoying (for a former phlebotomist), is not.

At a place where I did a rotation, the residents thought post-op notes were scut, so they wouldn't let me write them. Filling out discharge forms, writing prescriptions, etc... are not scut.

 

[smq123]

Thanks for the responses!! A few questions - what exactly is "scut" work? I hear this all the time but never really understood what this meant.

Also, in the example of the chest tube patient given above, I don't know, my first response (and maybe this is wrong) but do they really want "me" to be taking out chest tubes? A third year med student? I would never think to volunteer for something like that out of fe?ar of overstepping my boundaries (if that makes sense)...Also when you say you want to do whatever it takes to make your interns life easier - what does this mean exactly? What are things that we can do that can make their job easier specifically?

Taking out chest tubes is actually not that difficult, so yeah, you might be pulling them as a med student.

If you're afraid to volunteer for something (because you're afraid of overstepping your boundaries), it never hurts to ask, "Can I tag along?" Then, if they feel that it's ok, the residents may ask if you want to pull the chest tube, since you're there.

 

[plausible]

During a delivery (c-section or vaginal), ALWAYS wear the disposable booties that come up to your leg, and eye protection. It can get pretty messy 😱

 

[nope80]

What type of shoes do people where with their scrubs in these situations? Dankos covered with the disposable booties? I'm just wondering because I have a pair of danskos but find them to be surprisingly uncomfortable, like my foot is about to slip out the back if I'm not careful. Not to get off topic🙂

 

[Ashers]

What type of shoes do people where with their scrubs in these situations? Dankos covered with the disposable booties? I'm just wondering because I have a pair of danskos but find them to be surprisingly uncomfortable, like my foot is about to slip out the back if I'm not careful. Not to get off topic🙂

I felt that with my Danksos, too, and my feet never actually slipped out. I also felt like I was going to trip downstairs if I was running down the stairs in my Danksos. After trying many pairs of shoes, I found that Danskos were more comfortable than tennis shoes or Crocs for long cases -- for me. Yes, do wear the big boot covers over any shoes you choose to wear (go to the knees). Those boot covers give better protection than the small ones -- so your socks stay cleaner, and so do your pant legs -- which is especially important in OB/gyn messiness and some ortho cases.

 

[Re3iRtH]

hey Zagdoc, you mentioned med students are allowed to put in orders?
So far, not the case on my first rotation.

 

[45408]

hey Zagdoc, you mentioned med students are allowed to put in orders?
So far, not the case on my first rotation.

Depends. Sometimes you can write them and they can co-sign them, but that really doesn't save anyone time since they have to follow you, signing charts, unless you're writing admission orders. If you're at the VA though, CPRS will let you enter them all in the computer for many patients, and the resident/attending can just co-sign them all at one sitting.

 

[cpants]

During a delivery (c-section or vaginal), ALWAYS wear the disposable booties that come up to your leg, and eye protection. It can get pretty messy 😱

Best advice so far. And under those booties wear comfortable shoes you don't care about throwing away. Danskos are cool, but for OB i recommend a cheap or old pair of sneakers. There is a high likelihood that your shoes will get messed up, even with regular bootie wearing.

If your residents aren't actively educating you, you need to ask them to. No, that doesn't mean ask them to explain preeclampsia to you. That is your job to look up. It means that when they are going in to measure how dilated a mom is, ask them to show you how. When they are doing an ultrasound, tag along and ask questions. You are paying for an education. Make sure you get it. Don't be scared, the residents will actually appreciate your interest. They are used to students running at the first mention of a pelvic exam.

 

[ZagDoc]

hey Zagdoc, you mentioned med students are allowed to put in orders?
So far, not the case on my first rotation.

Like Prowler said, I can put in new orders but I have to send to the intern/resident to co-sign. If you earn a track record of accuracy and the trust of your resident to dose drugs and put in orders accurately, they don't have to double check you as much, and it saves them a ton of time. Time they often spend teaching. Yeah it sucks being an order monkey, but the intern feels the same way. Plus it means I can almost go a complete discharge by myself.

Unfortunatey I can't modify or d/c orders. Right now I'm in the PICU where orders are typically already in the computer and are more constantly changing, cancelling, etc. So I'm pretty much worthless. But on the floor where things move slower and orders typically come in a daily instead of hourly batch, you can really do your intern a service.