Emergency Clinical Guide Presents The Obstetric/Gynecologic Clerkships

The Ob/Gyn clerkship consists of one month of inpatient obstetrics, and one month of inpatient gynecology. The gynecology month is further subdivided into two weeks of "benign," and two weeks of "gyn-onc" (oncology - malignancies). Both months are augmented by weekly experiences in an outpatient practitioner's office, with an attending to whom you're assigned for the entire rotation. Recent changes have removed the student experience on the benign service, but you may still remain responsible for the information from that area that we've listed below, and there is some discussion that the rotation may return in the future.

Obstetrics concerns itself with issues of pregnancy and childbirth. Gynecology encompasses any medical issue that can broadly be termed "women's health," although it has traditionally focused on the reproductive system. During your months in Ob/Gyn, you'll be exposed to patients with an enormous variety of conditions: from healthy women coming in for yearly exams to women with advanced uterine, cervical, and breast cancers; from regularly scheduled pre-natal checks to complicated pregnancies and deliveries; from having conversations about birth control to assisting in complicated surgical procedures.

During Ob, you're expected above all else to keep an eye on your patients. Know their numbers (dilation, effacement, station, fetal heart rate and decelerations), know their medical conditions and potential complications, and know generally how they're doing. Use your free time to read.

During Gyn, you're expected to contribute to a service that is largely organized along surgical lines. Know your patients and their conditions, and make sure you've read about whatever disease you're treating - details are essential, particularly on the malignant service. Know your anatomical landmarks and potential complications - prepare as you would for any surgery.

There is a program on the computers in the Ob floor that will help you prepare for the final exam - you should plan to complete this program at least twice - it pays large dividends not only on the exam, but during the rotation, as well.

This is a hospital-based service, and call is q3. Labor is unpredictable, and it's more common to be awake most of the night than it is to sleep through the night.

There is a wide variety of new concepts and terminology introduced during this rotation. You'll need to read a lot and ask many questions early on, but as the month progresses and your familiarity increases, things get infinitely easier. You're expected to be able to interpret fetal heart tracings, to start to understand ultrasound images, to calculate due dates, to be able to discuss different screening modalities (such as amniocentesis, chorionic villus sampling, etc.), and to assist in both vaginal and surgical deliveries.

This service is filled with a variety of house officers who need to be assertive about gaining their experience - not only ob/gyn house staff, but family practice house officers, as well - but they are often very friendly and eager to spend time with students teaching. You need to be clear about your goals as the month progresses - the quality of your experience is more directly tied to your aggressiveness about being involved here than it is on any other service. The house staff will respond to your requests to participate, but only if you make those requests.

Be aware that you're likely to get little to no experience doing cervical exams, which are used to determine dilation. For many reasons (including patient comfort, minimizing risk of infection), this isn't something that you want performed more than necessary, and the family practice and ob/gyn residents need the experience more than you do. You can, however, look forward to hands-on involvement in "catching" babies, in examining newborns, and in a variety of other activites.

Finally, don't expect to be involved with the high-risk pregnancies, which are routed to the maternal-fetal medicine (MFM) service at FAHC - this type of pregnancy is something you'll be more qualified to learn about once you've become more comfortable with more typical pregnancies, such as you'll see during this rotation.

The benign service is geared towards common gynecologic problems including infertility, bleeding, pain, hormonal imbalances, endometriosis, endometritis, infections, menstrual irregularities, and anatomic abnormalities (prolapses, cystocoele/rectocoele, etc). During this two-week stretch, you'll see the more advanced forms of these conditions, since the focus is inpatient. You'll spend lots of time in the OR, and will gain lots of experience in hysterectomy. As a medical student, you'll do lots of retracting, which can get tiring. You should be sure to review the effects of different hormones on the different phases of the menstrual cycle.

The gyn-onc (oncology) service is dedicated to treating various neoplastic conditions. You will need to quickly develop facility with the various staging and grading systems for cancers in various anatomic locations, as much time is spent on the implications of different classifications. It's unrealistic to try to learn all staging criteria for all cancers, but you should understand the staging of your individual patients and how it relates to their prognosis and treatment. You should be trying to gain a broad understanding of the types of neoplasms that can arise in the pelvis. A thorough familiarity with the gross anatomy of the pelvis is an enormous advantage in the OR.

You'll be assigned to an Ob/Gyn provider for the entire two-month rotation. You typically spend one afternoon a week in that office. This is often viewed as the high point of the rotation for many students - one-on-one attention, the outpatient setting, and the more relaxed atmosphere all contribute. You'll see a wide variety of concerns, but the primary issues you need to gain familiarity with are the pelvic exam, the breast exam, menopause, and birth control medications and their side-effects. As with any outpatient experience, the quality of your time is a function of your relationship with the attending. You should try to maximize the potential benefit of this time.