OB/Gyn do’s, don’ts and pearls: a guide for students on the rotation Resident of the day

Objectives General knowledge What you can expect from the residents What we expect from you How to shine on each service Transitions between services Miscellaneous pearls and helpful hints Alphabet soup

General Issues Get the most out of the rotation You may have no interest in OB/GYN, but learning as much as you can will make you a better doctor

Code of Ethics Know why we’re doing what we’re doing Meet the patient, learn her history, read about the disease process before surgery In the OR Get involved – learn how to position the patient, help move the patient, help clean up the patient, etc. Be the first in the OR to help with setup and the last to gown Take ownership of your patients Watch for lab results, vitals, new information

MD Interaction Room Reserved for those on L&D Students on other services should refrain from using this room (please use other facilities to study…library, Sorrell Center, cafeteria, Durham) It is ok to store your things in there, but keep in mind that OB rounds are from 7-8: DO NOT interrupt rounds

Labor and Delivery: UNMC What to expect: Rounds at 7am (8am on weekends) Scheduled cesarean sections or IOL’s Deliveries Postpartum tubal ligations Outpatients (>20weeks with OB complaints) Circumcisions In general, the more available and involved a student is, the more you get to do

Labor and Delivery: UNMC What we expect from you: Round on the postpartum patients Add your initials in the student column by your patient Divide the patients with your classmates Write SOAP notes Bring up any questions or concerns PRIOR to rounds Present your patients at rounds Pertinent pos and neg only, no routine vitals Speak up if you saw the patient Practice before you present Divide the laboring patients Meet her in between cervical exams, learn her history, discuss plan with resident Fill out a blue card afterwards (no abbreviations)

Labor and Delivery: UNMC What we expect from you: C-section patients Meet the patient Ask the resident if you can scrub Be ready to help Be ready to tie suture Fill out a blue card See the patient 4 hrs after surgery and write a post op note

Labor and Delivery: NMC Mag Notes All patients on mag get notes at least three times per day: 0600, 1400, 2200 Students should write the 1400 and 2200 notes (the resident will include the mag note in the morning rounding note See example on gray card

Labor and Delivery: NMC How to be helpful: Keep the board up to date (pts in labor get checked every 1- 2hrs Get the babies rounded up for circumcisions (tylenol, lidocaine, baby hasn't eaten in last hour) Keep a "to do" list on the white board (circ’s, post-op notes, etc)

Labor and Delivery: NMC If you feel like you are stuck in the interaction room: Watch the monitors You can figure out when someone is pushing, a new patient arrives, a patient is having decels Follow the intern on the floor You can always ask one of us "Can I come with you?" If you feel like you don't know what it going on with your patient, read through progress notes in the chart or ask a resident

Labor and Delivery: NMC Don’t! Stay in the interaction room all day Do an exam on a patient without the resident present

Labor and Delivery: Methodist Morning rounds at 8am. SOAP notes on antepartum patients – done by 0730 Round with MFM resident and staff After rounds, get the list of laboring patients from the charge nurse Meet the patients and nurses Meet the doctors Stay involved and visible Coordinate with the OB resident

Labor and Delivery: Methodist Befriend the nurses They will help you figure out when the deliveries are Meet the generalists and explain who you are and why you are there Ask the generalists if you can scrub for c-sections Be present for all MFM c-sections and deliveries

Labor and Delivery: Methodist During the day: Check on antepartum pts throughout the day (if labs, repeat bp’s, ctx status) Labor pts: checked q2-3hrs by nurses, keep up to date on how the pts are progressing Assist resident with any new admissions

Gyn/Onc What to expect OR cases for suspected or known cancer Uterine, cervical, ovarian, vulvar, etc Possible Da Vinci surgery Sick, hospitalized patients Clinic Many patients will be receiving chemotherapy

Gyn/Onc Friday before you start, talk with the students who were on that week We check out when we change services, so should you Have one student page the resident (usually the intern) on Friday to get the plan. Friday before your week of Gyn/Onc, get the surgery schedule for the next week Read about the patient before the case and understand why the type of surgery was scheduled.

Gyn/Onc Daily: rounds in am and pm Monday: Surgery with Remmenga Throughout the day, read the nursing notes on your patient (VS, I/O tab) Monday: Surgery with Remmenga Tuesday: Surgery with Rodabaugh Finalize your topic with chief resident Wed, Thurs, Fri: clinic See the return patients, check out with resident, then check out with attending Go with the resident to see the new patients Friday afternoon Students present a 10 min gyn/onc topic Make a one page handout (put your name on it)

Benign Gyn Surg What to expect OR cases for benign disease Hysterectomies, ablations, D&C’s, TVT’s, etc ER consults throughout the day Gyn Chief Clinic (Wed afternoons) Clinic Add ons

Gyn Surg Monday (wear scrubs) Tuesday (wear scrubs) am hospital rounds, OR cases Tuesday (wear scrubs) am rounds, OR cases Wednesday (dress up) pre-op conference at 7am, am rounds, Grand Rounds, M3 education, pm Chief clinic Thursday (wear scrubs) am rounds, 7am teaching (topic to be chosen every Mon), OR cases Friday (wear scrubs) am rounds Students present a 10-15 min gyn topic (one page handout) Please have topics picked by Tues am of GYN week

Gyn Surg Friday before you start, talk with the students who were on that week We check out when we change services, so should you Have ONE student page the resident (usually the intern) on Friday to get the plan, then pass plan to other student teammates. Friday before your week of Gyn Surg, try to get the schedule for the next week Read about the patient before the case and understand why the type of surgery was scheduled!!!! Make sure you know how to get scrubs and access the OR schedule for the next week so you can prepare appropriately. You may have to page intern on Sunday to see if there are any patients you need to round on Monday am.

OB/Gyn Clinic What to expect Variety of patients with ob or gyn concerns Go see the return ob’s Ask before seeing a new ob, but plan to see them See the gyn patients (focused history, wait on the exam until the physician gets there)

What to Expect From Your Residents Teaching We will pass on the basics of OB/GYN with a focus on likely shelf questions Maximize your educational opportunities We will get you involved with high-yield cases No busywork Things we ask you to do are important for patient care Address your concerns If you are having trouble, let us know

General Pearls Phrases for students: What can I do to help? What should I read about for tomorrow? Ask questions as they come up It is easier to learn and remember a concept when you can associate it with a patient Treat the rotation as a job interview Put out your best effort and you will be rewarded with a better experience and a greater increase in knowledge

G’s & P’s G: gravida (number of pregnancies) P: para (number of deliveries) A: abortus (number of abortions/ectopics) G_TPAL Gravida, term, preterm, abortus, living children Ex: G3 P1112 Ex: G3 P1012

Ob/Gyn = Alphabet soup CTX: contractions LOF: loss of fluid VB: vaginal bleeding TAH: total abdominal hysterectomy TVH: total vaginal hysterectomy BSO: bilateral salpingoophrectomy LAVH: laparoscopic assisted vaginal hysterectomy LVH: laparoscopic vaginal hysterectomy PTL: preterm labor SROM: spontaneous rupture of membranes PROM: premature rupture of membranes PPROM: prolonged premature rupture of membranes

Ob/Gyn = Alphabet soup GDMA1: gestational diabetes mellitus, diet controlled GDMA2: gestational diabetes mellitus, controlled with meds ROB: return ob visit NOB: new ob visit s/p: status post h/o: history of IOL: induction of labor PNV: prenatal vitamin TVT: transvaginal tape

Ob/Gyn = Alphabet soup SVD: spontaneous rupture of membranes (sometimes NSVD: normal spontaneous vaginal delivery) PLTCS: primary low transverse c-section RLTCS: repeat low transverse c-cestion PPTL: post partum tubal ligation BTL: bilateral tubal ligation LVAVD: low vacuum assisted vaginal delivery OVAVD: outlet vacuum assisted vaginal delivery LFAVD: low forceps assisted vaginal delivery OFVAD: outlet forceps assited vaginal delivery

Have fun! Key concepts: Get involved Read about the patients Find ways to be helpful  Approach the residents if you are having problems