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aggie08

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Ask me anything.

I'm an Ob/Gyn and will be finishing my residency at the end of the month.

Female, married, early 30s, 3 young kids (one born in residency). Was a med school reapplicant.

Also a *long* time SDN member and appreciative of all the great advice I found here.
 
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libertyyne

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Did your spouse work in medical school?
Any tips for surviving medical school with kids?
How much time did you have to spend with your family in residency ?
 

aggie08

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Did your spouse work in medical school?
Any tips for surviving medical school with kids?
How much time did you have to spend with your family in residency ?

SPOUSE WORKING
My spouse worked through med school, he does computer programming.

MED SCHOOL WITH KIDS
My twins were not born until the middle of MS4 (and #3 during PGY-3), so no great advice on med school with kids since I was basically done by then. Although, I think it would be similar to now - you have to make a very specific effort to find time to study and religiously set it aside. In that same vein you absolutely must put your studying/work aside and focus on your kids and spouse sometimes too. Keeping those from overlapping all the time made sure I could focus 100% on work when I was working/studying and on family when it was time to do that.

TIME WITH FAMILY AS A RESIDENT
How much time is hard to quantify. This is going to vary rotation-to-rotation, year-to-year, and definitely program-to-program. The key is to look for balance over time and not hyperfocus on your balance between life and work at one specific point. The tendency if you do that will be to look at a very busy day or week and go "I have completely lost my balance." I think no matter what you do with your life you will feel like you don't spend enough time with your kids...unless you're always with them and then maybe you don't feel that way? Who knows. However, I feel like I have been absolutely involved in my kids lives. I make an effort to come to school/daycare events, I take off on their birthdays every year, I use my vacation time wisely, and we have a great life. Residency is hard and time-consuming, but my kids are not deprived of their momma (that being said, there were rotations that were much, much busier that they saw me a lot less. Our program has rotations that are very intense and others that are more laid back - this afforded me more balance. Choosing your program wisely is absolutely, positively important).
 
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Thank you!!!

I'm a non-trad, will be in early 30's when I finish med school. Currently thinking about having a 4th year baby and my husband works full time while I'm in school. I have lately become interested in Ob/Gyn, but I'm worried about the on-call lifestyle post-residency as far as balancing my home life with my professional aspirations.

How did you handle your pregnancy during interview season and arranging 4th year? What was your childcare situation like, and was it difficult to have childcare that adapted to the hours of a resident? What kind of practice will you be going into when you finish up?
 
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futuremdforme

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How do you and your husband balance household responsibilities?

Did you apply broadly for residency programs? How did you make yourself an attractive applicant?

Any advice for 3rd/4th year students on rotations?
 
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cjcarter

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Did you catch any flak from your co-residents and/or attendings when you were pregnant during PGY-3? Did you purposely wait until the latter end of your residency to have another child? I will be 29-30 by the time I start residency so I'm interested to hear about your situation (if you don't mind sharing) as I will likely be in a similar one down the road.
 

aggie08

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Thank you!!!

I'm a non-trad, will be in early 30's when I finish med school. Currently thinking about having a 4th year baby and my husband works full time while I'm in school. I have lately become interested in Ob/Gyn, but I'm worried about the on-call lifestyle post-residency as far as balancing my home life with my professional aspirations.

How did you handle your pregnancy during interview season and arranging 4th year? What was your childcare situation like, and was it difficult to have childcare that adapted to the hours of a resident? What kind of practice will you be going into when you finish up?


MS4 BABY
4th year baby (err...babies for me lol) was really good timing, with exception of that meaning I had two 6mo olds when I started my intern year. There is no great time, but 4th year worked well. I will not lie, intern year was very difficult, but at my program the calls are very heavily front loaded and each year becomes much, much easier.

PREGNANT WHILE INTERVIEWING
Interview season was a challenge, but it was workable. I delivered in early December about 5w preterm, so was QUITE pregnant all through interview season. I tried to anything I REALLY wanted early and limit alone-travel and flying after 30w. Again, it was a challenge but we worked it out. After they were born I took 4w off and then hauled them across the state with me for another couple interviews. Not super enjoyable and certainly not ideal, but workable.

CHILDCARE IN RESIDENCY
Childcare situation has varied by year.

MS-4: I got a lot of time off with them bc I front-stacked all my rotations. After that I flew in family from various places to help for a week at a time (only ended up being about 8w I think).
PGY-1: We had an Au Pair. This works well for flexibility, but they do have very controlled hour limits, so it cannot be your only option if your spouse does not have a flexible schedule. Because my spouse has a very predictable job it worked fine for us.
PGY-2-4: Regular old daycare. No issues, but again if my spouse wasn't off on normal holidays would have been harder.

We have lots of residents who are parents and have spouses with less flexible jobs (some double-resident families as well). Most of them do some combination of daycare for normal hours with a back-up babysitter for illness/holidays/etc. They make it work, but it requires a little more configuring (and money) that way.

ATTENDING PLANS
I'll be in a 0.7FTE practice (meaning I work 3.5 clinic days per week) plus 1 in 5 call (meaning <1 call night per week and <1 call weekend per month). Although it is home-call, the volume of the practice makes call-ins relatively frequent (this is the tradeoff for having a large call pool).
 
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aggie08

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How do you and your husband balance household responsibilities?

Did you apply broadly for residency programs? How did you make yourself an attractive applicant?

Any advice for 3rd/4th year students on rotations?

HOUSEHOLD RESPONSIBILITIES
We just kind of work together to get everything done. My best advice is if you're working 80 hours/week as a resident and you have children, outsource ANYTHING you can afford (cleaning, lawn care, etc.) - it's not lazy, you're trading the time you'd spend on those things for time with your family. It's worth it to us.

APPLYING
I applied relatively broadly, although I had an area of the country I was a bit more focused in.

ATTRACTIVE AS AN APPLICANT
I had competitive Step 1 scores and chose not to do any away rotations after we found out there were two babies in there. I would have been rotating after viability and was very concerned about preterm delivery necessitating me to choose between leaving my sick babies alone somewhere in a NICU (no.) and delaying graduation. I figured if they were super early, but in my hospital, I could work out my rotations more easily and hopefully still finish. Despite not doing away rotations, I ended up at my top choice program. Making yourself attractive depends on what point you're at in your training. As a MS1/2 make good scores, Step 1 is SUPER important because it gets your foot in the door - you can get a great program with a mediocre step score, but having a great step score will be really useful in getting a lot of interviews and putting the ball in your court for choosing a program that meets your needs.

MS3/4 ADVICE
For MS3/4 WORK HARD. That is the best advice I have. After having rotated and then worked with students the past 4 years it is very obvious who is lazy and who wants to learn. Take every moment to ask relevant questions, look up patient pathologies, and soak up every minute of learning you can. It's very hard to teach students who have an entitled attitude ("I'm paying to be here...blahblahblah.") and you will learn so much more if you are just busting your butt and looking for ways to learn. Be sensitive to the residents' job as well - remember they are also trying to learn and may not be totally comfortable with everything yet, may be in a time crunch, may be rounding with an extra-obsessive staff that day and thus be hyper-focused on their own notes/care. Getting great reviews on your Ob rotation looks really good on your application and is easily achieved by being a normal human, working hard, and truly wanting to learn. (I was also on the interview committee for our program my PGY-3 year).
 
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Lawpy

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What would you recommend male medical students do to succeed in OB/GYN rotations in 3rd year? What about for male students who may be interested in pursuing OB/GYN for residency given that they are currently underrepresented?
 
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aggie08

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Did you catch any flak from your co-residents and/or attendings when you were pregnant during PGY-3? Did you purposely wait until the latter end of your residency to have another child? I will be 29-30 by the time I start residency so I'm interested to hear about your situation (if you don't mind sharing) as I will likely be in a similar one down the road.

RESIDENT MATERNITY LEAVE
No flak. I'm at a program where almost everyone has a baby at some point before they finish tho. That being said, with ObGyn being 80% female most programs are well-equipped to manage maternity leave coverage.

Contrary to some advice, I strongly believe you should ask about maternity leave coverage on the interview trail (not in formal interviews, but talk to the residents about it). This is a NORMAL topic and if you are met with side eyes or snubbed noses that is NOT your program. My program's response to this question is universally that we have coverage down to a T for maternity leave and we do not berrate new moms for taking time off with their littles. This will HIGHLY vary by program.

PREGNANCY TIMING IN RESIDENCY
I purposefully waited until the latter end, but less bc of the schedule and more because of just already having two at a time and not being ready for another baby quite yet. I would highly advise against having a baby intern year, at least in my program, but it depends how your program is structured. Our program has a very, very small call pool and proportionally more call for the interns, where as PGY-2/3 share a call pool with fewer overall call-days and thus the coverage is significantly less heavy for co-residents when you're out as an upper level. Aside from coverage, intern year is long and tough without also having to figure out how to keep another human alive. We have had residents deliver during intern year, but I found myself very happy I was not in that situation. You need to base this on the structure and typical practice of your program though. And again, there will never be a great/easy/convenient time - only less difficult times. You will make it work whenever it's good for (and also knowing that it is completely laughable we think we can really plan any of this very well at all).
 
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aggie08

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What would you recommend male medical students do to succeed in OB/GYN rotations in 3rd year? What about for male students who may be interested in pursuing OB/GYN for residency given that they are currently underrepresented?

MALE STUDENTS/RESIDENTS
Nothing different than I recommend to females! Be kind, work hard, and be truly eager to learn. Be sensitive to your patients needs and don't be offended with the occasional request for a female provider (our male residents love this, bc it happens infrequently enough that they get a kick out of coming out of the room and telling their upper level to do their work for them). For better or worse male applicants automatically get a little bump in their ranking since they are underrepresented. We absolutely love having students interested in our field rotate with us - male or female! But honestly, it's viewed very positively when we have a male student interested or applying. The underrepresentation is not due to not getting in, it's due to way less applicants choosing this field if they are male.
 
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aggie08

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This was from PGY2 maternity shoot, her twin was getting me a Keystone from the fridge.

Don't mind the trailer, gawd that's so embarrassing. Now that I'm almost gonna be an attending we're upgrading to a DOUBLE. WIDE.


A/S/L?

(.... I may be the only one old enough for that joke )
 

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libertyyne

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This was from PGY2 maternity shoot, her twin was getting me a Keystone from the fridge.

A/S/L?

(.... I may be the only one old enough for that joke )
16/f/cali
 
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raiderette

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Thank you so much for this! Did you have opportunities to learn abortion procedures in your program? I am very interested in reproductive rights and know that few opportunities exist to learn this surgical procedure.
 
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Entadus

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were you a UC Davis Aggie?
 
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aggie08

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Thank you so much for this! Did you have opportunities to learn abortion procedures in your program? I am very interested in reproductive rights and know that few opportunities exist to learn this surgical procedure.

I am not trained in D&E.
 

libertyyne

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since I'm sure the OP would prefer to remain polite, I will intercede.

*facepalm*
Since you you misunderstand the seriousness of my inquiry I will quote from uptodate.

"The rationale for intrapartum FHR monitoring is that identification of FHR changes potentially associated with inadequate fetal oxygenation may enable timely intervention to reduce the likelihood of hypoxic injury or death. Although virtually all obstetric societies advise monitoring the FHR during labor, the benefit of this intervention has not been clearly demonstrated and this position is largely based upon expert opinion and medicolegal precedent.


No significant differences between techniques were noted for the following newborn/childhood outcomes:

•Acidemia (measured in cord blood) (relative risk [RR] 0.92, 95% CI 0.27-3.11)
•Apgar score <4 at five minutes (RR 1.80, 95% CI 0.71-4.59)
•Neonatal intensive care unit admission (RR 1.01, 95% CI 0.86-1.18)
•Hypoxic ischemic encephalopathy (RR 0.46, 95% CI 0.04-5.03)
•Perinatal mortality (RR 0.86, 95% CI 0.59-1.24)
•Neurodevelopmental impairment at ≥12 months of age (RR 3.88, 95% CI 0.83-18.2)
•Cerebral palsy (RR 1.75, 95% CI 0.84-3.63)
●Although use of continuous electronic FHR monitoring resulted in fewer neonatal seizures (RR 0.50, 95% CI 0.31-0.80), the seizures prevented by electronic FHR monitoring did not appear to be associated with long-term consequences [4,5].
●Continuous electronic FHR monitoring resulted in more operative vaginal deliveries for abnormal FHR patterns or acidosis (RR 2.54 [95% CI 1.95-3.31]), fewer spontaneous vaginal births (RR 0.91, 95% CI 0.86-0.96), and more cesarean deliveries for abnormal FHR patterns or acidosis (RR 2.38, 95% CI 1.89-3.01). Overall risks of instrumental vaginal and cesarean delivery were also statistically increased (RR 1.15 and 1.63, respectively). Data for low-risk and high-risk subgroups, preterm pregnancies, and high-quality trials were consistent with these overall results.

"
So an appreciable increase in C-sections with no reduction in long term adverse outcomes. thus my question, FHT monitoring, voodoo or nah?
My question was just a serious question regarding the efficacy of the practice of monitoring in a joking manner. I have seen experts look at the same strip and come up with completely different interpretations, the literature even tested the same people with the same strips at time intervals and received different answers from the same people reviewing the same strips some time apart!
 
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Pusheen

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I am not trained in D&E.
To branch off of that, do some of your ob/gyn colleagues not perform elective abortions? Wondering how common it is for docs to decline to do them due to personal beliefs.
 
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libertyyne

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Do you enjoy the OR time more or managing deliveries more or the GYN part?
 
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EIShopeful

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Thank you so much for this! Did you have opportunities to learn abortion procedures in your program? I am very interested in reproductive rights and know that few opportunities exist to learn this surgical procedure.

If you are interested in learning abortion procedures- join or start your med school's chapter of Medical Students for Choice (Medical Students for Choice ) and then apply for OB/GYN residencies that are part of the Ryan Program (Home page | Ryan Program ) or a family medicine residency that is a part of the RHEDI program (Vision, Mission & Values – RHEDI )
 
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Entadus

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Since you you misunderstand the seriousness of my inquiry I will quote from uptodate.

"The rationale for intrapartum FHR monitoring is that identification of FHR changes potentially associated with inadequate fetal oxygenation may enable timely intervention to reduce the likelihood of hypoxic injury or death. Although virtually all obstetric societies advise monitoring the FHR during labor, the benefit of this intervention has not been clearly demonstrated and this position is largely based upon expert opinion and medicolegal precedent.


No significant differences between techniques were noted for the following newborn/childhood outcomes:

•Acidemia (measured in cord blood) (relative risk [RR] 0.92, 95% CI 0.27-3.11)
•Apgar score <4 at five minutes (RR 1.80, 95% CI 0.71-4.59)
•Neonatal intensive care unit admission (RR 1.01, 95% CI 0.86-1.18)
•Hypoxic ischemic encephalopathy (RR 0.46, 95% CI 0.04-5.03)
•Perinatal mortality (RR 0.86, 95% CI 0.59-1.24)
•Neurodevelopmental impairment at ≥12 months of age (RR 3.88, 95% CI 0.83-18.2)
•Cerebral palsy (RR 1.75, 95% CI 0.84-3.63)
●Although use of continuous electronic FHR monitoring resulted in fewer neonatal seizures (RR 0.50, 95% CI 0.31-0.80), the seizures prevented by electronic FHR monitoring did not appear to be associated with long-term consequences [4,5].
●Continuous electronic FHR monitoring resulted in more operative vaginal deliveries for abnormal FHR patterns or acidosis (RR 2.54 [95% CI 1.95-3.31]), fewer spontaneous vaginal births (RR 0.91, 95% CI 0.86-0.96), and more cesarean deliveries for abnormal FHR patterns or acidosis (RR 2.38, 95% CI 1.89-3.01). Overall risks of instrumental vaginal and cesarean delivery were also statistically increased (RR 1.15 and 1.63, respectively). Data for low-risk and high-risk subgroups, preterm pregnancies, and high-quality trials were consistent with these overall results.

"
So an appreciable increase in C-sections with no reduction in long term adverse outcomes. thus my question, FHT monitoring, voodoo or nah?
My question was just a serious question regarding the efficacy of the practice of monitoring in a joking manner. I have seen experts look at the same strip and come up with completely different interpretations, the literature even tested the same people with the same strips at time intervals and received different answers from the same people reviewing the same strips some time apart!
The question: 'Do we have evidence that FHT monitoring benefits our clinical outcomes?' is a different question than 'Can FHT monitoring tell us anything about the stress/oxygenation/acid-base status of the fetus?', to which the answer is Yes, sometimes.

That is, it's not always helpful but in certain situations it can save 2 lives. It's an extra tool in the belt to help the clinician feel a little more confident they can avoid a catastrophic outcome. Yes we have more c-sections and complications from that, but you're weighing that against the smaller proportion that need a c-section but don't get one. It's apples and oranges

Disclaimer: I am not an OB-GYN
 
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libertyyne

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The question: 'Do we have evidence that FHT monitoring benefits our clinical outcomes?' is a different question than 'Can FHT monitoring tell us anything about the stress/oxygenation/acid-base status of the fetus?', to which the answer is Yes, sometimes.

That is, it's not always helpful but in certain situations it can save 2 lives. It's an extra tool in the belt to help the clinician feel a little more confident they can avoid a catastrophic outcome. Yes we have more c-sections and complications from that, but you're weighing that against the smaller proportion that need a c-section but don't get one. It's apples and oranges

Disclaimer: I am not an OB-GYN
There is no evidence that continuous electronic fht monitoring decreases neonatal or maternal mortality or morbidity compared to auscultation, yet there is evidence it increases the likelihood of c-section and associated complications, seems like a lose lose situation to me.

Disclaimer: not even a medical student.

EDIT: I have manged to derail OP's wonderful thread. We can discuss this via PM. I was just hoping to get OP's input as a expert and her perspective.
 
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Entadus

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There is no evidence that continuous electronic fht monitoring decreases neonatal or maternal mortality or morbidity compared to auscultation, yet there is evidence it increases the likelihood of c-section and associated complications, seems like a lose lose situation to me.

Disclaimer: not even a medical student.
That's true, but think about it. You're talking about listening to baby's heart tones with a stethoscope and graphing it religiously for hours. No thanks
Let it come up on a monitor instead
 

TheFutureFatMan

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Any advice for men entering the field? I hear a lot about how it's not a friendly specialty to male medical students and that it's getting harder for men to match. To me this seems like skewed perspective (you tell ten people about a bad experience, but only one person about a great one).

Any thoughts?
 
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raiderette

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Since I have always wanted to be in OB/GYN what do you think of the stereotypethat everyone is mean? So many horror stories on SDN, yet my experience is completely different, with most attendings being happy, fulfilled and proud of making a difference.
 
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Dr G Oogle

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maybe I can provide a little insight as a dude in obgyn. As the op already mentioned (and I can verify from being at interviews and rank meetings) that there is actually a slight edge given male applicants all other things being equal. only a handful of times have i encountered a patient asking for a woman physician and as the OP says it is a blessing in disguise , in reality you will encounter this only in school and (rarely)in residency because women who prefer women docs will just not show up at your office. Male obgyns are just as busy as women, just like women urologists are just as busy as men. There are a fair number of women uros who treat males exclusively (especially male infertility docs). This issue especially stops being apparent if you pursue a fellowship as subspecialists are relatively few.

As far as the specialty not being friendly to male students I think it is a self fulfilling prophecy rooted in a bit of misogyny and ignorance. If from day 1 you expect to be treated poorly and act super defensive and rude you will not have a great experience. If you go in with an open mind and are prepared to work hard you will have a great one. I never even considered obgyn until i did my rotation.
Patients aren't necessarily asking you to leave a room because you're a male but because you're a student, dont take it personally. Urology patients frequently ask students to step out, it's just that all students have to do obgyn and only a few end up doing urology rotations so you hear about it more in ob.

Both the best and worst students I've had with me have been guys (neither wanted to do obgyn and both wanted to to match into the same surgical subspecialty) but one came in with a great work ethic, treated patients kindly and I once caught him going around all of the L&D to meet the patients in case they delivered, all were happy to have him. You can guess how the "bad" student behaved and how each perceived their rotation experience.
 
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TheFutureFatMan

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maybe I can provide a little insight as a dude in obgyn. As the op already mentioned (and I can verify from being at interviews and rank meetings) that there is actually a slight edge given male applicants all other things being equal. only a handful of times have i encountered a patient asking for a woman physician and as the OP says it is a blessing in disguise , in reality you will encounter this only in school and (rarely)in residency because women who prefer women docs will just not show up at your office. Male obgyns are just as busy as women, just like women urologists are just as busy as men. There are a fair number of women uros who treat males exclusively (especially male infertility docs). This issue especially stops being apparent if you pursue a fellowship as subspecialists are relatively few.

As far as the specialty not being friendly to male students I think it is a self fulfilling prophecy rooted in a bit of misogyny and ignorance. If from day 1 you expect to be treated poorly and act super defensive and rude you will not have a great experience. If you go in with an open mind and are prepared to work hard you will have a great one. I never even considered obgyn until i did my rotation.
Patients aren't necessarily asking you to leave a room because you're a male but because you're a student, dont take it personally. Urology patients frequently ask students to step out, it's just that all students have to do obgyn and only a few end up doing urology rotations so you hear about it more in ob.

Both the best and worst students I've had with me have been guys (neither wanted to do obgyn and both wanted to to match into the same surgical subspecialty) but one came in with a great work ethic, treated patients kindly and I once caught him going around all of the L&D to meet the patients in case they delivered, all were happy to have him. You can guess how the "bad" student behaved and how each perceived their rotation experience.
Thank you for your feedback!
 

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Thanks for doing this. Did boards studying affect your marriage at all? And how did you go about discussing geography and residency options when it came time to rank, babies and all?
 

aggie08

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FHT strips , voodo or nah?

The question: 'Do we have evidence that FHT monitoring benefits our clinical outcomes?' is a different question than 'Can FHT monitoring tell us anything about the stress/oxygenation/acid-base status of the fetus?', to which the answer is Yes, sometimes.

That is, it's not always helpful but in certain situations it can save 2 lives. It's an extra tool in the belt to help the clinician feel a little more confident they can avoid a catastrophic outcome. Yes we have more c-sections and complications from that, but you're weighing that against the smaller proportion that need a c-section but don't get one. It's apples and oranges

Disclaimer: I am not an OB-GYN

There is no evidence that continuous electronic fht monitoring decreases neonatal or maternal mortality or morbidity compared to auscultation, yet there is evidence it increases the likelihood of c-section and associated complications, seems like a lose lose situation to me.

Disclaimer: not even a medical student.

EDIT: I have manged to derail OP's wonderful thread. We can discuss this via PM. I was just hoping to get OP's input as a expert and her perspective.

Woo, you guys have really gone down the rabbit hole. Sounds like you've been around a few L&D checkouts with the MFMs present. :)

Okay, here's my input - then I'll move back to the thread topic as well.

IMPORTANT POINTS

First, we have to consider that there are multiple types of fetal strips - it appears we're discussing intrapartum monitoring here. (As opposed to discussing outpatient non-stress tests, BPP, etc.)

Regarding Intermittent vs Continuous
  • Above is accurate - continuous EFM does not decrease fetal mortality, cerebral palsy, HIE, or NICU admission. It does decrease seizures (however, these appear to be more benign seizures, if you will, considering there is no change in neurologic outcome differences).
  • HOWEVER, these studies compare continuous EFM vs intermittent auscultation, NOT vs no monitoring.
  • So, intermittent auscultation and continuous monitoring are both permissible forms of monitoring.
  • Logistically, intermittent auscultation is near impossible in a busy L&D (akin to asking an ICU nurse to intermittently check a patient's O2 sat in order to make sure they are oxygenating okay - continuous pulse ox is far more reasonable).
  • In a low-risk patient requesting no continuous monitoring, I make every effort to work with them and their labor nurse in order to achieve a happy medium.
  • Monitoring of some sort - intermittent or continuous - likely does decrease mortality. There are no (and will likely never be any) well-powered studies randomizing NO monitoring to continuous to intermittent.
  • Of note, we are looking at outcomes which are extremely rare (intrapartum death) and potentially/likely associated with events occurring prior to labor in a large majority of cases (cerebral palsy), so finding statistical significance is very hard at baseline.
Regarding Cesarean Risk
  • We have lots of studies that say continuous EFM increases interventions like c-section and operative delivery (when compared, again, to intermittent monitoring). True.
  • Caveat: Studies showing above outcome are quite old. More recent, highly powered studies have failed to show this difference.
Regarding Interpretation
  • As mentioned, realizing that inter-observer reliability is extremely variable (as is intra-observer - meaning if I read the same strip 6mo from now I may call it something completely different) is SO important. The monitoring is another vital sign which should be used in conjunction with the entire clinical picture. A baby with a terminal decel or sudden bradycardia to the 60s combined with a mother who is having some bleeding will most certainly have an improved outcomes thanks to the ability to see and intervene on a complete abruption earlier.
So....
  • I personally feel like, when used in conjunction with a clinical picture and not acted on as a sole entity, that continuous EFM is a beneficial intervention. I also have no problem using intermittent auscultation if the patient request this (although, we don't have good recommendations on how often is truly helpful). From a personal standpoint I feel strongly that EFM saved the life of my third child, nobody will ever convince me otherwise. I do think it has the potential to increase section rates, particularly in litigation-heavy areas. I personally try to adopt a very pragmatic, patient, tolerant view of tracings - especially in patients who are near delivery.
  • Additionally, it doesn't matter what I think - until a more reliable form of monitoring comes along there will be no getting rid of continuous EFM. It's something we have to use the best we can until we have something better.
There ya go.

Voo doo or nah? Somewhere in between. ;)
 
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aggie08

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To branch off of that, do some of your ob/gyn colleagues not perform elective abortions? Wondering how common it is for docs to decline to do them due to personal beliefs.

TERMINATIONS & PROVIDER CHOICE
I live in the South. It is extremely common for ObGyns here not to participate in elective terminations (and actually quite common to run into people who will not participate in ANY terminations - even medically indicated - if the fetus is still alive). Additionally, there are still many hospitals which do not even allow elective terminations to be performed in the facility. We even have difficulty staffing our ORs (and occasionally our L&Ds) for medical terminations. The culture of where I am located drives this and elective terminations are performed almost exclusively at dedicated facilities.

STERILIZATION/CONTRACEPTION
Additionally, there are still hospitals in this part of the country which operate under a Catholic religious base and do not even allow surgical sterilization (tubals, Essure, etc.) to be performed in their facility. On the extreme of that there are Catholic-based clinics which limit contraceptive options which can be prescribed (no IUDs, no emergency contraception, etc.).

I interviewed at a program (not the program I chose, but it's not far from here) where the residents could not learn tubal ligation at their primary facility and were actually having to pre-op their patients and schedule their tubals at a hospital across town then go over there for their sterilization training. Welcome to The Bible Belt.

Do you enjoy the OR time more or managing deliveries more or the GYN part?

OPERATING VS OFFICE VS LABOR/DELIVERY
Interestingly I chose this field thinking I'd love the Ob and tolerate the operating and office-Gyn through residency then make my way to an REI (reproductive endocrinology & infertility) fellowship and never do any of that nonsense again.

I really, truly did not enjoy surgery as a student. I hated standing there for hours watching people do things I didn't understand or enjoy. I was uncomfortable. People seemed on edge. It never felt smooth. I was afraid to move or touch anything.

During residency I absolutely fell in love with the OR. I love surgery and got very, very close to applying to an Onc fellowship because I enjoyed it so much. I have received such excellent generalist and operative training that it convinced me I couldn't do a fellowship, because I was really sad at the thought of giving up any one area of the field.

So, I really love all of it. Managing labor is fun, but we do it so much that I will not miss having dedicated L&D board days when I get into the real world. I look forward to being able to do clinic and OR then head to L&D for deliveries/checks/management when needed! Among my colleagues I expect that I will have a far more OR-heavy practice than some of the others.

Any advice for men entering the field? I hear a lot about how it's not a friendly specialty to male medical students and that it's getting harder for men to match. To me this seems like skewed perspective (you tell ten people about a bad experience, but only one person about a great one).

Any thoughts?

MALE OB/GYNS
Great input above (similar question I answered and also an answer from @Dr G Oogle . Our male residents are well-loved by the program, their patients, the nurses (omg the nurses...there is SO much Estrogen from patients to nurses to residents to staff...they will advocate EMPHATICALLY for a male applicant they've never met just to get some testosterone into L&D). If you love the field you will not feel out of place due to being male. No probs.

Since I have always wanted to be in OB/GYN what do you think of the stereotypethat everyone is mean? So many horror stories on SDN, yet my experience is completely different, with most attendings being happy, fulfilled and proud of making a difference.

THOSE BITCHES
The age old question. I find myself commiserating this with my colleagues often.

I have a couple of theories. Who really knows...it's definitely a pervasive belief among incoming MS3s.

Where I went to med school there was one somewhat grumpy resident, she made a quiet/reserved med student cry mid-L&D hallway on my rotation. This got perpetuated into "the mean Ob/Gyn residents" even though every other resident was amazing (and, in fact, an ObGyn resident won the all-department yearly teaching award my 3rd year of med school and two of the years I've been in residency at a different program - so we can't all be that terrible).

One issue I see is that there is a subset of students who expect to be guided through things and when you work in an environment that is high-stress and non-stop people will feel ignored. Being short/direct/goal-oriented can get interpreted as being harsh/mean when it's meant only as efficiency.

Another issue is that we are nearly all strong-personalities. For whatever reason this field attracts sarcastic, take-no-****, obsessive people. It can be overwhelming to be in that environment if you tend towards more reserved/shy. People with strong personalities do extremely well on their Ob rotation, as long as they know how to harness their actions/words and not come off as holier-than-thou.

Surgery residents (particularly female surgery residents) also seem to get this reputation and I think it's for a really similar reason.

It's very interesting on this side, because I have a tendency to get glowing reviews from about 50% of the students, then average good-not-amazing-not-terrible reviews from about 25%, and "she ignored me/she's mean/she told me I was wrong" from the others. I can always predict when I have a group of students who will give me mediocre or bad reviews - there are factors from my end that play into it (what rotation I'm on, how busy we are, the number of ****ty outcomes we've had, how tired I am, if my baby refused to sleep, if my night call turned into a 36hr shift bc L&D was insanity, etc) and there are student factors that play into it (how prepared each student was - I do not beat around the bush when I'm frustrated that a student doesn't know their patient or anatomy in the OR, how interested they were - not that you need to LOVE Ob, but some people just have an obvious desire to learn and others do not, what point in the year it is for their rotations, how the group communicates with each other and with us, etc.).

Anyway, we aren't dinguses, but most of us do set the bar high and have no problem letting people know when we're disappointed. Some people do this with more tact than others and some students appreciate it while others are very offended. I think if you come in prepared, eager to learn, and work hard you will have no problem seeing the happy side of Ob.

That being said, I'm also at a very non-malignant program and went to a non-malignant med school. :)

Thanks for doing this. Did boards studying affect your marriage at all? And how did you go about discussing geography and residency options when it came time to rank, babies and all?

STUDYING/MARRIAGE
I'm assuming by boards you mean USMLE Step (currently studying for my written Ob/Gyn boards). I don't think board-studying was much different than med school in general. My husband is extremely self-sufficient and low-maintenance and has taken training in stride with very little complaints. As mentioned earlier, strong relationships will be fine and rocky relationships will have every little crack magnified. My marriage has not been affected negatively by training, but we've been together since we were 20yo and have made very directed efforts to keep our goals in line and our family/marriage a priority.

GEOGRAPHY/RESIDENCY
We knew we didn't want to go anywhere super cold, since that was important to us we drew a line across the US and decided to apply only South of too-effing-cold. It seems arbitrary, but something has to help you narrow down a starting point. We found programs where I'd get good training in vaginal surgery and forceps and made sure to apply to those. After interviews I ranked based on a number of things - how much we liked the people (super important), location/proximity to family (we're still not super close to most of our family), cost-of-living (resident salaries do not vary much by COL, so this was super important to us coming in with 2 kids), etc.
 
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aggie08

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Do you ever regret pursuing MD for reasons that it took away from family / life balance? I care about having a family and want to be a mother one day, but I am nervous that medical school/residency will be a lot of stress that takes away chances to meet a spouse, start a family, or enjoy life outside of work. I very much appreciate your thoughts on this.

REGRET
So, it sounds like you're still trying to decide whether to go to med school. I cannot comment on meeting a spouse, considering my husband and I met in college prior to me getting into med school. However, I did share all those concerns and overall feel like I've done what I wanted to do with my life and have no regrets. A lot of my classmates came into med school single and left married, though. ;)

If I said I have never had a day where I feel like I chose the wrong career (usually on the crazy rotation where I left before the kids were awake and got home after they were asleep) I would be lying. However, I would argue that everyone probably feels like that at some point - even stay-at-home-parents have days they feel like they did the "wrong" thing by deciding to not work outside the home.

I chose medicine and I would do it again. Med school, honestly, was not as horrible as I had it chalked up to be in my brain (after the initial 6mo adjustment period). I really enjoyed med school (again, after the first 6mo in which I frequently panicked that I was not only going to fail out, but that I was not cut out for it and that someone had accidentally accepted me). Finding a true, deep desire to just LEARN anything is of incredible importance to both surviving and enjoying med school and residency.

Choosing a specialty is a whole different discussion than choosing medicine, though. If anyone is interested in that we can discuss it as well, but it's probably going to be a much longer answer.

I am happy with both my decision to be a doctor and my specialty choice. While I would not want to do my intern year again, because it super sucked (due in part to outside factors and in part to it being an overwhelming/scary/intense/busy adjustment to medicine), I wouldn't go back and change anything. You can have a family and be a doctor, you just have to make sure you keep your priorities lined out and have a supportive spouse who also values what you do at work.
 
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GoodWillShunting

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maybe I can provide a little insight as a dude in obgyn. As the op already mentioned (and I can verify from being at interviews and rank meetings) that there is actually a slight edge given male applicants all other things being equal. only a handful of times have i encountered a patient asking for a woman physician and as the OP says it is a blessing in disguise , in reality you will encounter this only in school and (rarely)in residency because women who prefer women docs will just not show up at your office. Male obgyns are just as busy as women, just like women urologists are just as busy as men. There are a fair number of women uros who treat males exclusively (especially male infertility docs). This issue especially stops being apparent if you pursue a fellowship as subspecialists are relatively few.

As far as the specialty not being friendly to male students I think it is a self fulfilling prophecy rooted in a bit of misogyny and ignorance. If from day 1 you expect to be treated poorly and act super defensive and rude you will not have a great experience. If you go in with an open mind and are prepared to work hard you will have a great one. I never even considered obgyn until i did my rotation.
Patients aren't necessarily asking you to leave a room because you're a male but because you're a student, dont take it personally. Urology patients frequently ask students to step out, it's just that all students have to do obgyn and only a few end up doing urology rotations so you hear about it more in ob.

Both the best and worst students I've had with me have been guys (neither wanted to do obgyn and both wanted to to match into the same surgical subspecialty) but one came in with a great work ethic, treated patients kindly and I once caught him going around all of the L&D to meet the patients in case they delivered, all were happy to have him. You can guess how the "bad" student behaved and how each perceived their rotation experience.

As a male, did you ever question your decision to go into Ob/Gyn while in medical school? I know you briefly touched on what's it's like in practice from the view of some patients, but did you ever feel, "not-as-comfortable" telling friends/family/classmates?

This is a very stupid and shallow question- I totally get that, let me clarify, haha:

When I started M1, I already had some interest in Ob, yet when I looked into joining the specialty interest group I was met with blank stares, so I pretty much put Ob out of sight. I pretty much felt like I had to explain myself.

Thanks!




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Dr G Oogle

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Yes I did and i found several male mentors to speak to about it and they helped me make a decision. As it happens my fellowship is through urology and the Uro residents feel like they have to explain their career choice to non medical people also.

Who in the specialty interest group looked at you with blank stares? I can't imagine it was faculty or residents since men are heavily recruited to the specialty just like most male specialties are trying hard to recruit women.

The truth is if you find the material interesting and see yourself taking care of trhis patient population or are interested in a specific subspecialty that is all the explanation you need to provide to people.

I don't want to hijack this post from Aggie so if people have more questions we can start a thread in the obgyn forum or you can PM me.
 
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Domepiece

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Choosing a specialty is a whole different discussion than choosing medicine, though. If anyone is interested in that we can discuss it as well, but it's probably going to be a much longer answer.

Enjoying reading all about the world of OBGYN from those who are so thorough with their answers!

I'd love to hear your thoughts on the specialty selection process. I'm very much a neophyte at this point, but through some of the interviews on The Undifferentiated Medical Student, a podcast of interviews with various medical specialties, it seems that the specialty selection process goes down in a variety of ways and is very individual dependent.

If you could describe your experience with making a decision, as well as any advice you have (in general, or, if you're feeling generous, by year of med school), I'd most certainly appreciate it! Also, what was your experience with those students who came into med school sure of what they wanted to specialize in with regard to their ultimate specialty choice?
 
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turayza

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You mentioned considering REI and onc - are you planning to do a fellowship? If I am interested in doing an OB sub specialty, how can I explore that / be competitive for fellowship?

Thank you, and congratulations on finishing residency!
 

aggie08

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Enjoying reading all about the world of OBGYN from those who are so thorough with their answers!

I'd love to hear your thoughts on the specialty selection process. I'm very much a neophyte at this point, but through some of the interviews on The Undifferentiated Medical Student, a podcast of interviews with various medical specialties, it seems that the specialty selection process goes down in a variety of ways and is very individual dependent.

If you could describe your experience with making a decision, as well as any advice you have (in general, or, if you're feeling generous, by year of med school), I'd most certainly appreciate it! Also, what was your experience with those students who came into med school sure of what they wanted to specialize in with regard to their ultimate specialty choice?

CHOOSING OB/GYN
A lot of my class came in with plans to be one thing and chose something different, but there were also a good amount with very specific plans which they proceeded with. For me, I came in with the basic belief I would not enjoy a surgical specialty and that pursuing one would thwart my plans to have a family. I was planning to do ER or Pediatrics well into my third year. I started 3rd year saying "I'll keep an open mind and I'm willing to do anything, except Gynecology...I will never be a Gynecologist."

In hindsight I can see that I was interested in the field from the beginning. In first and second year I very much enjoyed my repro and endo blocks.

During third year I really enjoyed the thought that went into my Internal Medicine rotation and enjoyed the time, but it left me wanting more to "do." There was so much thinking, but I wanted more action. Then I did Psyc and just really didn't enjoy talking and talking and listening and listening. Again, I needed more "to do." I liked moving around and being physically busy. I started my Ob rotation on Gyn Onc and was equal parts amazed and horrified. The OR was incredibly intimidating, but I was fascinated by the abilities of the surgeons. I was intrigued by the fact that they had such strong relationships with their patients. I did not enjoy watching people operate and was very intimidated by the OR. I was also extremely caught up in what other people thought of the field (points alluded to in this post - that we're all a bunch of mean girls, that you can't have a family, that ObGyns are unhappy litigation magnets with no life...). I did Ob and it was obviously awesome - I don't think anyone goes through L&D and doesn't think it's kinda neat to be in a delivery. I started realizing that the Ob floor was one of the only areas of the hospital where people *wanted* to be there. It was a really different environment - from the overall feel of the unit to the nurses and their interactions with their residents/staff, to the patients. Then I did REI and I fell in love with the field. I still love this field. I also kinda had a role model-crush on the REI I worked with, because she was a really sweet, happy, skilled momma doc who took amazing care of patients.

So, I just really loved my rotation. I was leaving for a really awesome trip the day after I finished and despite looking forward to it, was sad to not be going back to the hospital. It was just different than my other rotations. I spent the next half of third year trying really hard to talk myself into something else and out of ObGyn. I was still really caught up on what others thought and the preconceived notions I had about how surgical specialties mean you have no life.

After some heart-to-heart convos with a male MS4 going into Ob (who had also reluctantly changed his mind after loving the field and who also had a family), a couple of mentors in and out of the field, a classmate who very astutely told me "you were SO happy on that rotation, you loved it.", and my husband I decided that choosing what I loved was important and that not choosing it because of stereotypes or ideas I could not even prove based on observation was not a good plan.

It basically came down to - if you choose something you don't love because of your family you're going to be unhappy at work and that will translate to being unhappy at home. You could regret your choice and resent the fact that it was due to them. However, I also knew if I was happy at work it would be so much easier to leave my (then theoretic, hopefully-someday) kids at home with someone else while I went to work.

This has all played out precisely like that - I love this field. It is interesting. It is fun. There is adrenaline. A lot of times it's so happy (however when it's not happy, though, it is really really hard - but I actually really love the sad part of the work too, can discuss that later if anyone is interested). Patients are generally young and healthy. There is some OR, some clinic, lots of procedures, the potential to work shift work (as a laborist) if you're so inclined.

It was a process, as you can see. I make it sound relatively easy in that synopsis, but this really was a very long course of months trying to convince myself I didn't want to do Ob. At the end of the day you should choose what you're good at, what you're interested in (you gotta learn this stuff forever), and what you believe you truly love.
 
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aggie08

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You mentioned considering REI and onc - are you planning to do a fellowship? If I am interested in doing an OB sub specialty, how can I explore that / be competitive for fellowship?

Thank you, and congratulations on finishing residency!

FELLOWSHIP
I did not apply to fellowship.

I not only considered repro-endo, I basically came into residency 100% sure I was doing it. I truly thought it was my calling. I proceeded with the plan, set up my CV to apply, researched, published, got the CREOG scores I needed, presented, spoke, went to conferences...got all set to apply. Then I did Oncology and it totally threw me for a loop.

I went into my Onc rotation thinking it'd be fun, but that it was everything I was less-enthused about in ObGyn - a LOT of OR, a LOT of sick patients, older patients, unhealthier patients, sad cases. I walked off my first month of Onc totally in love. I not only liked the OR, I absolutely loved it. I deeply enjoyed caring for the patient population. Everything about Onc was just awesome to me.

So I came off my Onc rotation deciding I'd totally mis-gauged myself and started researching Onc fellowships. In the meantime fellowship app time drew closer and I found myself delivering a continuity Clomid baby and thinking "that could be the last infertility treatment I ever do." Then I would go to a c-section or do a forceps delivery and think "man if I do a fellowship - Onc OR Repro-Endo then sometime very soon there will be a last baby I ever deliver." Then on Onc I'd think "If I do REI then next year will be my last hysterectomy." It was this revolving cycle of basically grieving giving up the skills I worked very hard to learn and had enjoyed a lot. I continued to consider Onc through my final month (late third year) and at that time basically had to break up with the idea. I just wasn't so committed to it that I was ready to say goodbye to the rest of the field. In considering REI I felt a little sad at the ASRM meeting when I realized how very little real surgery most repro-endos were doing. So, I decided that I could have an infertility-heavy generalist practice and still do a good amount of REI stuff, with exception of IVF, but then get to follow my patients through their pregnancy and delivery AND do major Gyn surgeries. It just made sense to me in seeing how much I was struggling to let go of various parts of the field that maintaining a broader scope was what I needed to do.

That being said, I purposefully chose a practice where if I hate being a generalist I am not in a small private practice where it'd be impossible to try and apply to fellowship down the line. I think the chances of that are really low, as I'm loving my chief year and the broad skill base I have.
 
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libertyyne

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Do you have any tricks for studying with children in the house ? I am assuming you had to study for board certification etc after medical school.
 
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aggie08

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Do you have any tricks for studying with children in the house ? I am assuming you had to study for board certification etc after medical school.

Studying with kids in the house is quite literally impossible for me. I have to physically remove myself to get anything done. I am also very much a "chunk" study-er - in that I do better with 1-2 hours dedicated to studying than I do with 5-10min here and there. I have had to adapt to using any down time at work to read/study (except for this downtime I've been using to play on the internet the past few days lol...I should be studying for boards!). Again, this small volume time to study is not ideal with my study style, but it helps me get a little done.

The biggest thing is trying to work out with my husband weekend and/or evening hours to dedicate to studying (this is mostly for when I am prepping for big things like Step 3, "CREOG" our resident inservice exam each year, and especially now for written ObGyn boards).

So, for day-to-day studying that I just need to do to be a good doctor I'll try to make use of downtime at work. I tend to read/study over lunch several days each week when I'm in clinic instead of having a social lunch hour. I also try to make specific goals for each week with whatever team I'm on with - ex "read this practice bulletin and discuss with team on Wednesday afternoon." Learning about patients and reading when I'm seeing someone with a specific problem is very, very useful to me.

For big-test studying I will work out with my husband days that are good for me to either stay at the hospital late and hide away to study or days I can leave on the weekend for a few hours and study at a coffee shop or something.

It really just comes down to planning and sticking to a plan. It is far more difficult than studying without kids was, but it's not impossible.
 
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Entadus

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FELLOWSHIP
I did not apply to fellowship.

I not only considered repro-endo, I basically came into residency 100% sure I was doing it. I truly thought it was my calling. I proceeded with the plan, set up my CV to apply, researched, published, got the CREOG scores I needed, presented, spoke, went to conferences...got all set to apply. Then I did Oncology and it totally threw me for a loop.

I went into my Onc rotation thinking it'd be fun, but that it was everything I was less-enthused about in ObGyn - a LOT of OR, a LOT of sick patients, older patients, unhealthier patients, sad cases. I walked off my first month of Onc totally in love. I not only liked the OR, I absolutely loved it. I deeply enjoyed caring for the patient population. Everything about Onc was just awesome to me.

So I came off my Onc rotation deciding I'd totally mis-gauged myself and started researching Onc fellowships. In the meantime fellowship app time drew closer and I found myself delivering a continuity Clomid baby and thinking "that could be the last infertility treatment I ever do." Then I would go to a c-section or do a forceps delivery and think "man if I do a fellowship - Onc OR Repro-Endo then sometime very soon there will be a last baby I ever deliver." Then on Onc I'd think "If I do REI then next year will be my last hysterectomy." It was this revolving cycle of basically grieving giving up the skills I worked very hard to learn and had enjoyed a lot. I continued to consider Onc through my final month (late third year) and at that time basically had to break up with the idea. I just wasn't so committed to it that I was ready to say goodbye to the rest of the field. In considering REI I felt a little sad at the ASRM meeting when I realized how very little real surgery most repro-endos were doing. So, I decided that I could have an infertility-heavy generalist practice and still do a good amount of REI stuff, with exception of IVF, but then get to follow my patients through their pregnancy and delivery AND do major Gyn surgeries. It just made sense to me in seeing how much I was struggling to let go of various parts of the field that maintaining a broader scope was what I needed to do.

That being said, I purposefully chose a practice where if I hate being a generalist I am not in a small private practice where it'd be impossible to try and apply to fellowship down the line. I think the chances of that are really low, as I'm loving my chief year and the broad skill base I have.
I'm loving this thread so thanks to the OP! It's my last week of ms3 (male) and I'm about 95% sure about applying ob-gyn (up from 90% yesterday) :nod:
 
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aggie08

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Did you have any male co-residents? How was their experience?

Our program usually hangs out around 18-25% male, so I do have male co-residents. I have never asked them directly, but I've never heard anyone say anything about feeling like being a guy negatively impacted them. Honestly, I think this is probably 100x more discussed and worrisome to med students trying to choose Ob than to male residents and staff. @Dr G Oogle may be able to weigh in on that more than me, but I have never heard them say anything even remotely related to being male as a negative aspect of their job (other than the rare patient who wants a female provider, but again this is rarely an issue).
 
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Dr.Jekyll75

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I was wonder if you could speak about the difficulty of obtaining a fellowship such as fertility and its competitiveness.
 

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I've found absolutely nothing specifically negative about being a man in ob/gyn as a resident or fellow. I even recall one specific memory of me driving to see my parents as a third year resident and realizing how very content I was. The majority of patients do not care one way or another in acute settings: labor/surgery and those that prefer women doctors aren't going to come see you in the office.

I think the concern some people have is the (erroneous) belief that you must be a woman to help a woman in labor or to understand the pain of dysmenorrhea, or the emotional impact of a hysterectomy. But the truth is most doctors don't experience what their patients do: just like most oncologists don't have cancer and most neurologists have never had a stroke, Most obgyns have not and will not need a hysterectomy, may never be pregnant or give birth and those docs are not less capable of providing excellent , compassionate care to their patients. This issue of "men in obgyn" exists , and is much more prominent than the equivalent "women In urology" is that unfortunately there have been and to a lesser degree still exist male obgyns can be extremely dismissive and sometimes downright misogynistic to their patients.

A recent example includes a patient who had disabling pelvic pain without a specific etiology, her previous doctor, an older man (but not that much older than me) basically told her it was in her head. She subsequently sought care from woman, but I ended up seeing her do to a scheduling issue. All she was looking for was someone to acknowledge that she had a problem not that she was making one up, she didn't have a problem with men per se, but had a very bad experience with one, but her n=1 is all she knows, so of course this patient would make such a generalization. This sort of behavior is not limited to pain disorders (where dismisiveness spans specialties) but also can be seen in labor management and counseling for surgery. I can sympathetize because I've had that sort of experience with male doctors as a patient myself and have tried to avoid Physicians like that, and in the few interactions I've had as a patient I've actually found myself preferring a woman doctor to a man. Sure there are women doctors that behave In the way I described but In my personal experience there are fewer of them. If you are kind, compassionate, skilled and thorough being a man obgyn is a nonissue.

I'm not really sure how else to answer that question, unless there are specific concerns you have.

I think obgyn is an incredibly rewarding field with one of the broadest scopes of practice and as @aggie08 alluded too innumerable ways to shape your practice...things like gender, desire to have kids, opinions of other people on your specialty choice etc. should not play a huge role in your decision (especially as deterrents) if you are really interested in the field.
 
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DoctorCrush

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Thank you so much for doing this!

If your program D.O. friendly? In your opinion, how difficult is it to break into Gyn Onc fellow? I've heard that it's definitely one of the competitive ones but what kind of credentials and wholehearted app will one need? Thank you!
 
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