Michigan, Ascension Providence Hospital 

OBGYN CORE

Hello everyone!

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My name is Lana Hariri and I am a current 3rd year medical student at AUC. I was so graciously asked by Tayler to talk about my different experiences at Providence Hospital in Michigan. 

 

OBGYN in Michigan is 6 weeks is broken up in the following:

  • 1 week L&D at Southfield

  • 1 week GYN surgery in Southfield

  • 1 week L&D at Novi

  • 1 week GYN surgery at Novi

  • 1 week night-shift on Labor and Delivery in Novi

  • 1 week outpatient in Southfield 

 

OB - Southfield

  • I usually arrived at 6am to be on the safe side, sign-outs/shift change is at 6:30am

    • They use a white-board system and write all the info on the patients there. So make sure to pay attention to who is close to delivering so that you can see a delivery 

  • After that, you have a 1-hour 7a-8a “Morning Report” where residents go over topics in the conference room 

  • DUTIES IN OB: 

    • When patients walk in, they are placed in 1 of the 4 Triage Rooms. The nurses will see them first, then come into the conference room and let residents/students know they are ready to be seen

    • Students usually go and see the patient and do the H&P on CPN  (see below for info on CPN) 

      • CPN is a system that we only have access to in the patient’s room 

      • It is unique to OB, won’t find it anywhere else

    • Type in the H&P and then present to your resident

      • I only did heart, lungs, and extremities 

      • In the last week of my rotation, one of the residents let me ultrasound to confirm that the baby was head-down. That was super cool and I highly recommend you ask your resident to let you do that because it will help them out a lot :) 

    • If you want to see a delivery, check the board to see who is close to delivering

      • You MUST introduce yourself to the patient before delivery and/or C-section, or else you will not be allowed to watch/scrub in. 

      • Just say, “HI my name is X, I’m with the OB team today. Just wanted to introduce myself in case you find me here in the delivery. Is there anything I can do for you right now?”

    • There can be lots of downtime in OB, so bring study material 

    • The residents don’t really tell you what they’re doing/going, so just be “alert”

 

C-Sections:

  • You will probably scrub in for most C-sections

  • Usually, the residents/interns close and do stuff, so just be prepared to watch and observe

  • C-section ORs are on the L&D floor 

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General Things to Ask in OB: 

  • When you start a note make sure it’s in this format:

    • 39 G2P1001 at 36 6/7 presents with sudden onset contractions… continue HPI....
      +FM
      +CTX
      +LOF
      -VB

  • IMPORTANT NOTE INFO!

    • For an OB patient, you must, must, must ask the big 4:

      • Are you feeling baby move? (+/- FM) fetal movement

      • Are you having contractions? (+/- CTX) Contractions

      • Are you bleeding vaginally? (+/- VB) 

      • Any loss of fluid? (+/- LOF) 

    • Ask when last Ultrasound was 

    • GTPAL

      • I messed this up a few times in the beginning so here is a quick breakdown

      • Gravida - how many pregnancies total (full-term, miscarriages) 

      • Term - how many babies born full-term (37 weeks plus)

      • Preterm - how many babies born PREterm (Less than 37 weeks) 

      • Aborta - how many babies aborted/miscarried 

      • Living - how many living children

      • We had one lady who has been pregnant 7x, 2 kids, 4 abortions, and pregnant sooo

        • G7P2042

          • If 1 was full term and the other not full term - G7P1142

    • GYN History: 

      • Ask about STDs, abnormal pap smears

      • Hx of fibroids, cysts, polyps 

    • Pregnancy

      • Ask the patient very detailed questions about past pregnancies

      • Year baby was born (or miscarriage), how many weeks, vaginal, C-section, any complications?

        • For every pregnancy!!

      • Hx of PreE 

    • Fetal Heart Tracing (FHR)

      • This will be on your OB shelf! 

        • Know the acronym VEAL CHOP! Will help for Shelf

      • All the residents have the FHR on the computers. I was super lazy and did not really pay attention to it at all 

 

Quick Facts to know 

  • VBAC = Vaginal birth after C-section

  • TOLAC = Trial of Labor after C-Section

  • Normal FHR: 110 - 160 bpm

  • “D-Cell”: Deceleration in the baby’s heart rate

  • “A-Cell” Acceleration in the baby’s heart rate 

  • **I feel like OBGYN was a whole new language, so if there isn’t anything you understand/know/acronym, look it up :) ** 

OB - Novi:

  • I arrived at 6:45am because signouts/shift change is at 7am

  • Duties are the same but in Novi, patients don’t have specific triage rooms, they are just assigned a room. 

 

OB Night Shift at Novi:

  • I arrived at 6:45pm because signouts/shift change is at 7pm 

  • Nights aren’t bad as long as you schedule your sleep kind of well haa so this is my recommendation

    • Taking a nap Sunday before your shift will help WONDERS

    • After Sunday night (aka Monday morning), I would sleep from like 730-12 (unfortunately not too long because of the sun entering the window) so if you have an eye mask or shades that would be really good :) 

    • I wouldn’t get out of bed until I absolutely had to start getting ready to give my body some rest. 

 

GYN Novi + SF: 

  • Duties are pretty much the same at each hospital. I would look at the cases in the AM but the residents would pick and choose which ones

  • Sometimes I would be asked to round on patients post-op in the AM and write a note, but only a few times. By the time I got to the room to round, the intern was already there so it was kinda pointless.  

  • Laparoscopic procedures are really cool. I really liked seeing the GYN procedures because when doing OBGYN questions, it helped knowing what they were talking about. 

  • Beware

    • Vaginal Hysterectomies - they’re not really fun for students bc we just stand there and can’t see anything. There would be 3 people by the vagina operating and you can’t see anything :/ 

  • Duties in OR:

    • Help residents break down the bed for D&Cs are stuff. (just take out the last 2 parts of the bed)

      • Put legs up on the sling thingy 

    • Take the bed out of the OR

    • Pull gloves, gown for you + resident

    • Write name on the board

 

Wednesday Didactics:

  • 7a-1pm:

    • Each didactic day is different. Sometimes the residents present a topic, the attendings do, reps from tech companies come, etc. 

 

Outpatient:

  • See patients in the clinic: wellness checks, pap smears, ultrasounds, etc. 

  • Paired up with a resident 

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Hope you guys found this helpful! Feel free to reach out to me/Tayler for any questions regarding the rotation or anything else!

 

- Lana Hariri

Tropics MD