Hmmmm…what can I say about OB/Gyn? Honestly, it was the clerkshipI most dreaded, even more than Pscyh…and my concerns turned out to be legit. I am just not cut out to work in this environment. Let me preface this with the fact that I have the utmost respect for those who choose to work in this field. I met some very sharp physicians. However, it just is not my cup of tea! I spent 2 weeks in Gyn surgery & 2 weeks on the OB words.
At SCHI (Saginaw Cooperative Hospitals, Inc), they run an excellent OB/Gyn residency program. So, the teaching is excellent, lectures very informative and they truly do invest themselves in your learning…but, for a sub-set of the attendings, the same cannot be said. Now, all of the attendings are very supportive & available to the residents…just not to the medical students. The residents either do not see or understand this delimma, which places you, as a student, into some iffy situations.
Even more so, the nurses in our OB section are very very very protective and do not seem to care for med students. Not to say that I did not expect a degree of this – remember, I have spent YEARS working in pediatrics where it is much the same. However, as a general rule, even in the PedsICU, you at least gave the newbies a chance to earn their stripes. In the OB ward here…no matter what you did, even if you were intent or considering going into OB, you were not given the opportunity to earn their respect. This made for a very contentious atmosphere.
For my 2 weeks on the OB wards: add all of this up and couple it with my really not wanting to be there yielded a less than enjoyable experience.
The OB wards format was totally different from IM & surgery. You showed up at 0600 for lecture & rounds - although you did not actually round on patients. Essentially, the folks going off call gave a run down of all the ladies in holding pattern on the OB ward and any potentially interesting surgeries for the day were discussed. This was followed by a 30~45 minute lecture on an OB/Gyn topic. We then hit either the ward or the OR.
You acquired patients as they arrived in the screening rooms. If a lady thought she was in labor or having a problem, she was sent to the screening rooms on the OB floor. If she was in active labor, she was transferred to the actual OB ward…if not, she was sent home. You, the student, would do the intitial assessment, present her to the resident, who would repeat your work. You would then discuss & refine what you did. Then, one of you would present the case to the attending, usually over the phone. If the lady was admitted, she became your patient, which meant you rounded, assessed and wrote a note a max of every 2 hours – more frquently as things progressed. The resident usually went with you to assure you were correct in your assessment…very little independence!!!
During the actual birth, you got to do as much as you wanted. They more or less eased you into the process. Intially, you watched. Then , you got progressively more involved, first by birthing the placenta and gradually into actually delivering the baby. That part was very cool! However, you checked a LOT of cervixes, listened to a lot of hollering and got ignored a lot for the reward of a single delivery.
For the 2 weeks of Gyn surgery – hell, it was like being back in the OR! It was great! Matter of fact, I went into my 2 weeks of Gyn surgery immediately following my month with Dr. Reyes (see my surgery clerkship story in the surgery clerkship thread). It was great & I already knew what to do & when to do it; so I was allowed to do a good bit, although not as much as with Dr. Reyes.
One of my good friends there, same year as me but he's an MI St MD student, went into OB/Gyn with similar dread…he was destined for the ER, so he said. However, half-way through, he was thinking that maybe OB/Gyn was his calling. Last I chatted with Seamus, he was doing back-to-back OB/Gyn & Er clerkships at an outside facility to make his final decision…I am anxious to learn what he chooses.
My OB-Gyn Clerkship was 8 weeks long. We spent 4 weeks on the OB side and 4 weeks on the Gyn side. The OB side was 2 weeks in Labor and Delivery catching babies. I ended up with 8 deliveries including a set of twins. The second two weeks was spent in the High Risk section. We generally observed lots of ultrasounds and spent time in the high risk clinic. I really got involved with my patients who were on bedrest for pre-term labor. My best friend and I ended up making phone calls and delivering movies to mothers who were on strict bedrest and wanted some company.
The GYN side involved two weeks of waiting around in the OR for emergency cases. I got to observe plenty of ectopic pregnancies and hysterectomies. When there were no Gyn cases, I scrubbed in on Surgery cases. (I am never one to miss an opportunity to scrub in).
The last two weeks were spent in the offices of a private OB-Gyn group. My attendings were 4 very young and attractive female OB-Gyns who have a wonderful practice located near Howard. They have a whole floor devoted to their practice which includes total women’s care from menarche to post-menopause. They have a couple of NPs and PAs who work with them. It was a great experience. I loved their approach to patient care in that they were very comprehensive. They even had classes on relaxation and nutrition. It was a great experience.
I found OB-Gyn less appealing because I love treating every age and sex of patient. I knew that I would not be happy just treating female patients. I also like more surgical variety than OB-Gyn afforded. I did learn as much as I could involving the acute abdomen in a female patient. That was my goal coming into OB-Gyn.
OB-Gyn was the second most popular specialty in my class behind Internal Medicine. Anesthesia was third. The folks who went into OB-Gyn were evenly divided between male and female graduates. This year, it looks like OB-Gyn still has pretty solid numbers.