I had a great experience at OB/GYN in Queens Hospital Center. I spend time in L&D, GYN surgery/on-call, and clinic. My first week was in Labor and Delivery. Although I had to get up at 4:30 every morning (a time that I previously considered part of the night,) I was eager to come every morning to learn something new. I got to scrub in for c-sections and assist with deliveries. I also checked reflexes, urine output, heart and lungs sounds for patients on magnesium. Many of the residents and PAs were really welcoming to students and would take their time to teach us important information such as how to interpret the fetal heart tracing monitors and sonography images. It was interesting to see how they measured the amniotic fluid in four quadrants to assess for oligohydramnios. I also got to follow up with the new mothers the day after the delivery to remove bandages from c-section incisions, make sure their pain is adequately treated, and discuss birth control options. The hospital offers circumcision for those that request it, so I was able to assist with two of those procedures as well. I also participated in a simulation of postpartum hemorrhage which was really informative. I got to see how the whole team of doctors, residents, nurses and PAs work together during an emergency to stabilize the patient. The team then conducted a debriefing where they discussed what went well and how to improve the communication among the providers themselves and with the patient.
On call with GYN was probably the most challenging week of the rotation. This was my first time doing overnight shifts, so I had to get used to the change in my sleep schedule which was initially difficult for me. I assisted the residents by bringing patients from the main ED to the designated GYN room and completing a thorough OB/GYN focused patient history. Many of the patients came in for abnormal uterine bleeding and pelvic pain. One memorable encounter I had was when a pregnant patient came to the ED after being in a motor vehicle accident. The team rushed to examine her and complete an ultrasound to make sure the fetus was not injured in the crash. In GYN surgery I was able to scrub in for hysterectomies, a vaginectomy, and a d&c. I then pre-rounded on the patients the next morning and presented during rounds with the GYN team.
In the clinic I was able to participate in annual gyn visits which included breast, pelvic, and speculum exams with pap smears and cultures. I assisted with a nexplanon insertion as well as an IUD placement. For prenatal visits I used the Fetal Doppler to assess the fetal heart rate and also measured fundal height. The most challenging part of the clinic was the language barrier with many patients who did not speak English. Often the phone interpreters did not have clear audio so we would have to repeat instructions multiple times to make sure they were understood. I spent a day in the high risk pregnancy clinic, where patients have comorbidities during pregnancy and require more frequent follow up and testing. One patient that stood out to me was a patient in her second trimester who had a history of preterm delivery. She had previously received an MMR vaccine in pregnancy (in a different country) causing a preterm delivery with fetal demise. This really highlighted for me the importance of pregnancy tests before performing any procedure that may be harmful in pregnancy and the need for patient education. Carefully counseling patients regarding maternal health, STIs, contraception, and safe practices during pregnancy can make all the difference.
One aspect of this rotation that I would want my preceptor to notice was my commitment to learning. I often had to be assertive in order to find a provider to work with, and had to speak-up to ask for opportunities to assist during deliveries and other procedures. I really tried to make the most of my time here in OB/GYN. All in all, I gained a tremendous amount from this rotation and got a lot of hands-on experience that will be useful for my future rotations.
Site Evaluation Presentation:
I had two virtual site evaluations with Professor PA Carloz Melendez. During my first evaluation, I presented one H&P about a patient with abnormal uterine bleeding due to fibroids. We discussed the patient’s history and physical exam, disposition, and differential diagnoses. We specifically spoke about including malignancy in the list of differentials based on the patient’s presentation and risk factors. I also presented five pharm cards of common medications used in OB/GYN. We specifically discussed the mechanisms of action, indications, contraindications, adverse reactions, monitoring, and dosage for each. Some of the drugs I presented were misoprostol, pitocin, and terbutaline.
For my second site evaluation, I presented another H&P and 5 pharm cards. In addition, I prepared a journal article related to my H&P. Professor Melendez was a great site evaluator. He helped me to think critically regarding differential diagnoses and the diagnostic tools needed to rule them in/out. He asked appropriate questions which furthered my understanding of the topic. He also really encouraged me to be proactive about asking to assist in procedures, which helped me get the confidence to do vaginal and pelvic exams. Because Professor Melendez works as a PA in OBGYN, it was interesting to talk with him about the role of PAs in this field. I appreciated his suggestions and will certainly use his tips in my evaluation of patients in the future.