My fourth rotation was OBGYN at Woodhull Medical Center. In this rotation, I had several different schedules. My first week I did three days on-call, with two days GYN and one day OB. My second week I was on GYN service during the day, meaning I saw postpartum patients, postop patients and went to any GYN consults with the on-call PA. The last two weeks of my rotation were spent in the clinic. While on GYN service for a week, I would round with the PA on any of their postpartum patients and evaluate whether they were ready for discharge yet. We discussed what should be evaluated, such as fundal height, leg swelling or tenderness, if the patient has been ambulating, if their wound is healing well (if the patient had a c-section) and so on. Similar to my previous rotation, I was grateful to be working with PAs for many of my shifts, as it allowed me to obtain a better understanding of the PAs role in the hospital on-call as well as in the clinic.
When given with the opportunity to present a patient, I had to immediately recall the differences of presenting an OBGYN patient. For example, it is vital to include LMP, GP status and EGA when applicable. Additionally, there are several symptoms that are almost always asked to OBGYN patients such as chest pain, shortness of breath, dizziness, abdominal pain, vaginal bleeding, vaginal discharge etc.. However, I think I did an adequate job of remembering to present the patients this way and on including any pertinent positive/negative symptoms. Despite performing a few pelvic exams on my emergency medicine rotation, I, at first, struggled to do pelvic exams while on this rotation. However, over time, I felt more comfortable using the speculum and performing these exams. It was especially helpful to have the correct OBGYN beds that allows for the patients to be in proper lithotomy position. I found that I still struggled with providing education to patients, however I am always attentive in listening to the providers when they give information so I can learn how to approach or explain certain diagnoses.
One memorable experience that I will carry with me was this one patient who had an ectopic pregnancy while I was on my overnight GYN call. She was waiting in the emergency department for a few hours between the emergency department and GYN service both being busy. I ended up being the first person from GYN to speak with her and I was glad I could be the first student practitioner to speak with her. I reassured her that I would tell and have those above me come down as soon as possible, as I understood her frustration in waiting hours for new developments in her care. The GYN PA and attending diagnosed the patient on bedside sonogram with an ectopic pregnancy and the patient had to be taken to the OR. It was a good experience for me to be able to see the patient first and witness the entire evaluation (history, physical exam, sonogram) and then be able to observe the laparoscopic surgery in the OR. At the end, the attending even showed me the ectopic/embryo and it was incredible to see.
Other memorable experiences included being able to perform transvaginal and abdominal ultrasounds on pregnant patients. I have not had too many experiences with ultrasound on my previous rotations, so to be able to do several ultrasounds was extremely gratifying and beneficial to my learning experience.
I would hope that my preceptor was able to see that I was eager and willing to learn more about OBGYN. I was more than willing to participate in the patient’s care when afforded the opportunity and wanted to continue honing my OBGYN physical exam skills. For my following rotations, I hope to continue to work on my physical exam skills and ability to relay education to patients. I plan to accomplish that by doing as many exams as possible and also continuing to listen to the providers when they explain a certain diagnosis to the patient.
I am surprised that I liked OBGYN more than I thought I would. I found it to be a very fascinating rotation and believe there is a lot of patient education that can be provided in this field. The knowledge I gained on the importance of providing support and listening to patients on sensitive matters can be extended into any other rotation that I have left or specialty that I choose to go into. I intend to use these skills, and utilize my listening skills, as I continue with my rotations and during my next rotation in ambulatory care.