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OBGYN at Mount Sinai Chicago

SCHEDULE:

You will spend 2-3 weeks on Labor & Delivery (12 hour shifts day or night)

2-5 total days at different outside clinics (combined OB and GYN; up to 4 hours per clinic, possibly 2 different clinics on the same day)

2 weeks GYN OR

 

LOCATIONS:

GYN OR - 2nd floor of the main hospital

L&D - 4th floor 

Mother/Baby Unit and Nursery - 5th floor (** if you use the main guest entrance you MUST have the nurses buzz you in and out otherwise you’ll set off the alarm and make everyone hate you)

Clinics - many (addresses in the orientation packet)

 

GENERAL: OBGYN is a fascinating field. The content stretches across multiple disciplines and there are a lot of opportunities to further subspecialize. It’s also a very sensitive field that requires our continuing understanding. Many patients have social or religious objections to being evaluated by male providers, so male physicians and students alike need to be constantly aware and understanding of this.

 

The OBGYN residency program itself is quite intense and has a wide variety of personalities among the residents. Some can be harsh while others may be incredibly kind to students. This is not special to the Sinai program or OBGYN in general, but they certainly don’t have the same “happiest residents in the hospital” reputation that the Family Medicine residents have. 

 

Understand that in OB, any mistake that occurs during pregnancy and delivery can theoretically hold the physician legally liable until the child turns 18, so it’s a lot of stress that some residents appear to be navigating. 

 

The attendings are all wonderful and love to teach. Engage with them and demonstrate your interest at every turn. The program director is also very pro-student and constantly checks in that you’re happy and doing well.

 

ORIENTATION: The department spends the day acquainting students with the full expectations. They also provide you with your full rotation schedule with all paperwork. Keep this packet for the full duration of the program.

 

During some of the rotation downtime, they may offer a scrubbing session. I don’t care if you “did a scrub session in an interest group meeting on the island.” If you haven’t completed your surgery rotation by this point then get up and go learn how to scrub all over again. The people who failed to relearn were 10/10 the people who got repeatedly burned by an attending or resident for breaking sterile field. Also take this opportunity to figure out your glove sizes. The scrub techs and nurses are very hit and miss when it comes to students (as they are everywhere) and aren’t usually the nicest people in the OR when you don’t know something as simple as glove size. 

 

THE DAYS

Post-Op Rounding: You may be assigned a morning to conduct post-op rounding. You’ll need to arrive by 5:30am (earlier if you’re slow with the EMR) on the 5th floor (Mother/Baby Unit). There will be a list of C-sections (C/S) and vaginal deliveries. There are usually 4-5 students for the post-op rounding. You will split up the patients and review their charts at the back nurse’s station by the nursery before going to check on the patients yourself. There are two residents rounding (1 for vaginals and 1 for C/S). Students will not carry both types of patients because the residents may round at different times or at the same time. Important questions include current vitals, pain, discharge/bleeding, return of flatus/BMs/urine output, appetite, fatigue, weakness, difficulty breathing, breast milk status, etc. Everyone should be on L&D by 7am regardless of the status of rounding in order to present at sign-out. After sign-out you’ll go to your assignment for the day (L&D, clinic, or home).

 

L&D: Shifts run 7-7 whether that be day or night. There’s always a sign-out that begins promptly at 7a/p.  Behind the nurses station there’s a supply room with a water/ice maker and microwave. You can leave your belongings in there rather than downstairs in your locker. You don’t need to be on the floor early as you will with your clinic and OR shifts, but you absolutely need to be standing behind your residents dressed in scrubs and ready to go by 7 sharp. Morning sign-out involves all the OBGYN attendings who are in the hospital that day and these last a bit longer as they tend to pimp the residents. Try not to interrupt sign-out as it can become quite tense on its own. Just try to answer questions in your head unless the question is directed to the students.

Get in the habit of getting and giving sign-out among students at shift change since you’ll be sharing patients with the departing/arriving shifts. Don’t be the asshole that just says “bye” and leaves your colleagues to figure out what’s been going on with a patient, or, conversely, the asshole that shows up and ignores the students who have been working with the patients for the last 12 hours. It’s rude, disrespectful, and a waste of time. The residents don’t rely too heavily on students’ help but every once in a while we catch something and student sign-out plays a big part in that. 

During your shift on L&D you’ll be expected to split up and follow patients. Figure out which intern is attending to your specific patient and keep and eye on him/her. They occasionally dip into the room without you. Not because they hate students but simply because they’ve got way more to worry about to keep their own heads above water. Express to them your interest in participating at the beginning of each shift. None of them are going to assume that you want to try a pelvic exam but very few of them will refuse to teach you (and a lot of the time if they do, it has more to do with patient comfort or some other medically valid reason). You’ll likely be in the room during the delivery. Depending on the time of year and how seasoned your interns are you may get to participate up to delivering a baby. If your mother goes for C/S, you’ll be in the OR which is located directly behind the nurses station.

Be genuine about getting to know your mothers. You can’t just show up at the delivery and say “I’m student doctor X” and expect to be allowed to stay in the room for a very intimate and important day for them. Go in as often as the nurse does to check on their comfort and ask them about their lives. Know if they’re looking forward to having a baby (very important for your counseling and potential safety and support concerns). Get them ice chips or linens. Whatever you have to do to make them comfortable and they’ll welcome you into their delivery. You’ll realize that some deliveries are conducted by a midwife. At Sinai, they don’t allow attendings or residents in the room for the delivery unless there ends up being a complication. If you have a good relationship with the mother and express interest in learning about their approach to deliveries, they’ll let you attend and even participate. 

In addition to the laboring mothers, L&D also covers its own triage. Pregnant women arriving in the ED are usually shipped upstairs for evaluation. Throughout your shift you’ll be monitoring “the board” and be responsible for rotating turns for new patients with your fellow students. When a new patient comes in you’ll be responsible for getting a good OB HPI and assisting the resident with the physical exam. You’ll be asked to retrieve (and sometimes operate) the ultrasound and attach a tocometer. Some of these moms are in true labor and some just need an evaluation or observation. 

 

Clinic: Each clinic operates differently. For all students but especially male students, please don’t be offended by patients not wanting you in the room for their pap or physical exam. Regardless of the clinic, you’ll likely be doing the initial intake interview for their chief complaint and HPI. What worked for me since it can be a sensitive environment was that on the front end of my interview I explained that I was a student doctor doing training in OBGYN and that I was just there to interview her before her doctor came in to speak to her further and perform the physical exam. You might be nervous navigating the sensitivities of the job, but try to mask this a bit to preserve your patient’s level of comfort. At the end of the interview, explain to her that the doctor will be coming in alone first and if she (the patient) has any objections to you being in the room during the exam she should not feel bad about expressing that to the doctor. Never ask the patient yourself if you can be in the room. Simply tell her that her comfort is the most important. The times when this is obviously not of much concern is with your male attendings. Generally, if a female patient seeks out a female gynecologist, it was for some reason or another and those who go to male gynecologists (again, generally speaking) don’t have concerns about the provider’s sex.

 

GYN OR: During your 2 weeks in the OR you’ll split up all procedures. Note that while they stay relatively busy, you’ll likely only see up to 4 procedures during the 2 weeks. There is one resident point of contact and each day someone from the group will need to get the next day’s schedule from the resident. For laparoscopic procedures there can be 2 students (only 1 scrubs in). For all other open procedures there can only be 1 student. Try to share procedures so that everyone gets a chance at seeing 1 of each of the common types (hysterectomy lap vs open, oophrectomy/salpingectomy, LEEP, etc).

 

HOW TO SUCCEED: Study! Especially while you’re on L&D. You might find that a couple of your shifts are very slow and it’s really the only time you can sit and study for extended periods while at the hospital. Working 12 hours a day during your L&D weeks leaves very little time at home to study on workdays. Bring your computer/tablet or download Uworld to a floor computer for the day and study. Ask questions but balance being overly inquisitive with coming across as a brown-noser or lazy/incompetent student. Just as in any other rotation, keep asking yourself “why” and “how” and if you can’t come up with an answer, look it up. If the explanation doesn’t make sense to you, then ask. At least then your question will appear thought-out.

 

Spend the money on the pocket guide: Comprehensive Handbook to Obstetrics and Gynecology. It’s very concisely written and has the most accurate and pertinent information. 

 

UWISE - you are required by the program to complete this system of questions by the end of the program. It’s time-consuming so start early. You’re required to have half of the questions done by mid-term.

 

ACOG: always use them for any guidelines. You can check USPSTF or AAFP for some things, but you’ll notice some discrepancies. In OBGYN (in life and in shelf), we default to ACOG’s rulings.

 

Stay away from OBGYN Blueprints and don’t rely as heavily on Case Files for this rotation. Some have said Pediatrics Blueprints was more helpful for some of the developmental content, but our residents told us when they were students the content was outdated and is not reviewed often enough to stay current.

Good luck on your rotations!

Brandon Byers 

Tropics MD