OB/Gyn dos, donts

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 were doing what were doing
Prior to surgery or delivery:
Meet the patient, learn her history, read about the disease
process
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
Try to make the resident look good
Watch for lab results, vitals, new information
Get involved
look for ways to help and make your experience better

OR Etiquette
Ask the supervising resident if it is ok to scrub for the
case
Throw your gloves before stepping out to scrub
Write your name on the white board in the OR where
it says "student"
Rules of thumb: use the type of scrub that the most
senior person nearby is using
Scrub as long as the most senior person scrubs
Be the last person to walk in the room to get gowned
up

General Knowledge:
Scrubbing
Traditional Scrub
Wet hands/forearms
Clean nails using enclosed nail pick.
Scrub nails, fingers, hands, wrists, arms.
Important aspect is total contact time with soap
Rinse so that dirty water doesn't drip down to your
fingers
Avagard is an acceptable alternative
Be sure Avagard dries before gloving
Directions on the bottle

Labor and Delivery: UNMC

What to expect:

Rounds at 7am (8am on weekends)

Scheduled cesarean sections or IOLs
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
Divide the patients with your classmates
Write SOAP notes before the residents note
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

Divide the laboring patients

Meet her, 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

Meet the patient

Ask the resident if you can scrub
Be ready to help
Be ready to tie suture
Write the op note
Fill out a blue card
See the patient 4 hrs after surgery

Labor and Delivery: NMC

Mag Notes
All patients on mag get notes three times per day:
0600, 1400, 2200
Students should write the 1400 and 2200 notes
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 (circs, post-op
notes, etc)
Write Rxs for your pts who are going home
Med reconciliation under the discharge tab
Everyone goes home with Colace, ibuprofen + something
else for pain, PNV, Iron if anemic, script for OCPs if indicated

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

Dont!
Walk into a room when a patient you
havent met is delivering
Stay in the interaction room all day
Write your notes late or after a resident
Do an exam on a patient without the
resident present

Labor and Delivery: Methodist

Morning rounds at 7am.
SOAP notes on antepartum patients done by
0630

After rounds, get the list of laboring patients

from the charge nurse
Meet the patients and nurses
Meet the doctors
Stay involved and visible

Meet with resident in am or afternoon for a

teaching session

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 bps, ctx status)
Labor pts: checked q1.5-2hrs 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, 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.

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
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

Gyn Surg
What to expect
OR cases for benign disease
Hysterectomies, ablations, D&Cs, TVTs, etc

ER hits throughout the day

Clinic

Gyn Surg
Monday
am rounds, pre-op at 7am, OR cases

Tuesday
am rounds, OR cases

Wednesday
am rounds, education, pm clinic

Thursday
am rounds, am teaching, OR cases

Friday
am rounds
Students present a 10 min gyn topic (one page handout)

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.

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.

Ask questions after preop conference

OB/Gyn Clinic
What to expect
Variety of patients with ob or gyn concerns
Go see the robs and write a note
Ask before seeing a nob, 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

Gs & Ps
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

Show students how to add the service lists in Carecast