OB/Gyn do’s, don’ts
and pearls:
a guide for students on the
rotation
Resident of the day
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
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
– Meet the patient, learn her history, read about the disease
process before surgery
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
Take ownership of your patients
– Watch for lab results, vitals, new information
MD Interaction Room
Reserved for those on L&D
Students on other services should
refrain from using this room (please use
other facilities to study…library, Sorrell
Center, cafeteria, Durham)
It is ok to store your things in there, but
keep in mind that OB rounds are from
7-8: DO NOT interrupt rounds
Labor and Delivery: UNMC
What to expect:
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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: UNMC
What we expect from you:
– Round on the postpartum patients
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Add your initials in the student column by your patient
Divide the patients with your classmates
Write SOAP notes
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
• Practice before you present
– Divide the laboring patients
• Meet her in between cervical exams, learn her history,
discuss plan with resident
• Fill out a blue card afterwards (no abbreviations)
Labor and Delivery: UNMC
What we expect from you:
– C-section patients
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Meet the patient
Ask the resident if you can scrub
Be ready to help
Be ready to tie suture
Fill out a blue card
See the patient 4 hrs after surgery and write a post op
note
Labor and Delivery: NMC
Mag Notes
– All patients on mag get notes at least three times
per day: 0600, 1400, 2200
– Students should write the 1400 and 2200 notes
(the resident will include the mag note in the
morning rounding note
– See example on gray card
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, postop notes, etc)
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
Labor and Delivery: NMC
Don’t!
– Stay in the interaction room all day
– Do an exam on a patient without the
resident present
Labor and Delivery: Methodist
Morning rounds at 8am.
– SOAP notes on antepartum patients – done by
0730
– Round with MFM resident and staff
After rounds, get the list of laboring patients
from the charge nurse
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Meet the patients and nurses
Meet the doctors
Stay involved and visible
Coordinate with the OB resident
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
Labor and Delivery: Methodist
During the day:
– Check on antepartum pts throughout the
day (if labs, repeat bp’s, ctx status)
– Labor pts: checked q2-3hrs 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/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, get the
surgery schedule for the next week
– Read about the patient before the case and
understand why the type of surgery was
scheduled.
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
– Finalize your topic with chief resident
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 (put your name on it)
Benign Gyn Surg
What to expect
– OR cases for benign disease
• Hysterectomies, ablations, D&C’s, TVT’s, etc
– ER consults throughout the day
– Gyn Chief Clinic (Wed afternoons)
– Clinic Add ons
Gyn Surg
Monday (wear scrubs)
– am hospital rounds, OR cases
Tuesday
(wear scrubs)
– am rounds, OR cases
Wednesday (dress up)
– pre-op conference at 7am, am rounds, Grand Rounds, M3
education, pm Chief clinic
Thursday
(wear scrubs)
– am rounds, 7am teaching (topic to be chosen every Mon), OR cases
Friday
(wear scrubs)
– am rounds
– Students present a 10-15 min gyn topic (one page handout)
Please have topics picked by Tues am of GYN week
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, then pass plan to other student teammates.
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!!!!
– Make sure you know how to get scrubs and access the OR
schedule for the next week so you can prepare appropriately.
– You may have to page intern on Sunday to see if there are any
patients you need to round on Monday am.
OB/Gyn Clinic
What to expect
– Variety of patients with ob or gyn concerns
– Go see the return ob’s
– Ask before seeing a new ob, 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 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
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
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
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!
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