OB/Gyn do’s, don’t’s and pearls:

a guide for students on the rotation

Resident of the day

ObjectivesGeneral 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

– 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

OR EtiquetteAsk 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

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

fingersAvagard is an acceptable alternative– Be sure Avagard dries before gloving– Directions on the bottle

Labor and Delivery: UNMCWhat 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: UNMCWhat 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)

Labor and Delivery: UNMCWhat 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

Labor and Delivery: NMCMag 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

Labor and Delivery: NMCHow 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

Labor and Delivery: NMCIf 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!– 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

Labor and Delivery: MethodistMorning 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

Labor and Delivery: MethodistBefriend 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 q1.5-2hrs 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/OncFriday 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.

Gyn/OncDaily: rounds in am and pm– Throughout the day, read the nursing notes on your patient

(VS, I/O tab)

Monday: Surgery with RemmengaTuesday: Surgery with RodabaughWed, 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

Gyn Surg

What to expect– OR cases for benign disease

• Hysterectomies, ablations, D&C’s, TVT’s, etc

– ER hits throughout the day– Clinic

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)

Gyn SurgFriday 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

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)

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 patientTreat 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’sG: 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 P1112Ex: G3 P1012

Ob/Gyn = Alphabet soupCTX: contractionsLOF: loss of fluidVB: vaginal bleedingTAH: total abdominal hysterectomyTVH: total vaginal hysterectomyBSO: bilateral salpingoophrectomyLAVH: laparoscopic assisted vaginal hysterectomyLVH: laparoscopic vaginal hysterectomyPTL: preterm laborSROM: spontaneous rupture of membranesPROM: premature rupture of membranesPPROM: 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!

•Show students how to add the service lists in Carecast

Key concepts:1) Get involved  2) Read about the patients  3) Find ways to be helpful  4) Approach the residents if you are having problems