OB/Gyn do’s, don’t’s and pearls: a guide for students on the rotation

1. OB/Gyn do’s, don’t’s and pearls: a guide for students on the rotation Resident of the day

2. 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

3. 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

4. Code of Ethics • Know why we’re doing what we’re doing • Prior to surgery or delivery: • Meet the patient, learn her history, read about the disease process • 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 • Try to make the resident look good • Watch for lab results, vitals, new information • Get involved • look for ways to help and make your experience better

5. OR Etiquette • Ask the supervising resident if it is ok to scrub for the case • Throw your gloves before stepping out to scrub • Write your name on the white board in the OR where it says "student" • Rules of thumb: use the type of scrub that the most senior person nearby is using • Scrub as long as the most senior person scrubs • Be the last person to walk in the room to get gowned up

6. General Knowledge: Scrubbing • Traditional Scrub • Wet hands/forearms • Clean nails using enclosed nail pick. • Scrub nails, fingers, hands, wrists, arms. • Important aspect is total contact time with soap • Rinse so that dirty water doesn't drip down to your fingers • Avagard is an acceptable alternative • Be sure Avagard dries before gloving • Directions on the bottle

7. 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

8. Labor and Delivery: UNMC • What we expect from you: • Round on the postpartum patients • Divide the patients with your classmates • Write SOAP notes before the resident’s note • 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 • Divide the laboring patients • Meet her, learn her history, discuss plan with resident • Fill out a blue card afterwards (no abbreviations)

9. 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 • Write the op note • Fill out a blue card • See the patient 4 hrs after surgery

10. Labor and Delivery: NMC • Mag Notes • All patients on mag get notes three times per day: 0600, 1400, 2200 • Students should write the 1400 and 2200 notes • See example on gray card

11. 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) • Write Rx’s for your pts who are going home • Med reconciliation under the discharge tab • Everyone goes home with Colace, ibuprofen + something else for pain, PNV, Iron if anemic, script for OCPs if indicated

12. 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

13. Labor and Delivery: NMC • Don’t! • Walk into a room when a patient you haven’t met is delivering • Stay in the interaction room all day • Write your notes late or after a resident • Do an exam on a patient without the resident present

14. Labor and Delivery: Methodist • Morning rounds at 7am. • SOAP notes on antepartum patients – done by 0630 • After rounds, get the list of laboring patients from the charge nurse • Meet the patients and nurses • Meet the doctors • Stay involved and visible • Meet with resident in am or afternoon for a teaching session

15. 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

16. Labor and Delivery: Methodist • During the day: • Check on antepartum pts throughout the day (if labs, repeat bp’s, ctx status) • Labor pts: checked q1.5-2hrs by nurses, keep up to date on how the pts are progressing • Assist resident with any new admissions

17. 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

18. 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, 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.

19. Gyn/Onc • Daily: rounds in am and pm • Throughout the day, read the nursing notes on your patient (VS, I/O tab) • Monday: Surgery with Remmenga • Tuesday: Surgery with Rodabaugh • 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

20. Gyn Surg • What to expect • OR cases for benign disease • Hysterectomies, ablations, D&C’s, TVT’s, etc • ER hits throughout the day • Clinic

21. Gyn Surg • Monday • am rounds, pre-op at 7am, OR cases • Tuesday • am rounds, OR cases • Wednesday • am rounds, education, pm clinic • Thursday • am rounds, am teaching, OR cases • Friday • am rounds • Students present a 10 min gyn topic (one page handout)

22. 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. • 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. • Ask questions after preop conference

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

24. 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

25. 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

26. 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

27. 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

28. 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

29. 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

30. Have fun! • Key concepts: • Get involved  • Read about the patients  • Find ways to be helpful  • Approach the residents if you are having problems  • Show students how to add the service lists in Carecast