I concluded my clerkship year in April. How crazy is that? Since that time —

1. I took Step 2 Clinical Skills at the end of May — I passed guys!
2. I took Step 2 Clinical Knowledge at the beginning of July (score is still pending)
3. I completed a 2 week elective in radiology
4. I completed a 2 week elective in allergy/immunology
5. I spent a month in the northeast for an away rotation

This post, admittedly long overdue, has been drafted for months. One of my friends (hi Ronke!) told me that I have to publish this post before she started her OBGYN rotation (aka on Monday) so I clearly didn’t take her too seriously.

As always, please take my advice with a grain of salt. If you’re looking for more advice, these are some pretty great places to check out as well.

• Bloggers: Ben White, Jenny W, and Bhuvani.
• Reddit: tigecycline, FawnLeibowitz, and hiaips.

Obstetrics and Gynecology at TUSOM: OBGYN is a 8 week rotation split into about a month of obstetrics and a month of gynecology. The best week is preceptor week – you go to deliveries, surgeries, and attend clinic with one attending. It’s an opportunity to be really hands-on and even more importantly you get a chance to see the daily grind of an OBGYN attending. Schedules depend on which site you end up at: Lakeside (OB – a ton of students, easy to get lost in the crowd) / UMC (GYN) or Lakeside (OB) / Alexandria (GYN – more rural hospital, hands-on experience!)  or West Jeff (OB/GYN – few students, lower volume) / UMC (GYN). I spent time at West Jeff since I was familiar with the hospital already – I spent time there on my surgery rotation. Didactics for this rotation include: weekly clerkship school (~2 hours) and weekly grand rounds (1 hour). Outside of the shelf examination and evaluations, you’re also responsible for submitting H&Ps, observation forms (physical examination and history taking), a log of procedures and cases, and patient questionnaires. There’s also a graded standardized patient experience.

On the Wards: The first thing you have to get used to are GsPs. G = gravida (number of pregnancies) P = para (the outcomes). The mnemonic I use to remember the order of possible outcomes = TPAL. Term. Pre-term. Abortions. Living Children. TPA = # in terms of pregnancies and it doesn’t matter if these pregnancies are multi-fetal.

• Presentations: Here’s how I structured mine for new patients. SOAP notes are more casual and include subjective updates + objective information (vitals and physical exam – if there are changes), assessment and plan.
  • One-liner: Jane Doe is a XX year old G#P#### female with past medical history significant for XX admitted due to XYZ.
  • History of Present Illness: The story (given chronologically). Pertinent ROS. Any recent and important illnesses. Course in the ED.
  • Review of Systems: All ROS otherwise negative aside from what was mentioned in the HPI. It’s really important to address contractions, vaginal bleeding, fetal movements, and vaginal fluid for any OB patient.s
  • Past Medical History & Past Surgical History
  • Prenatal Care
  • Home Medications
  • Allergies
  • Social History: Home environment (location / apartment or house or mobile home / who lives at home). Alcohol intake. Tobacco use. Illicit drug use.
  • Family History: Pertinent family history.
  • Vitals: Tmax, HR, RR, BP, O2 sat (on room air or otherwise specified)
  • Physical Exam: General, HEENT, Throat, Respiratory, Cardiovascular, Abdomen, Extremities / MSK, Skin, Neuro, Psych.
  • Labs/ Studies particularly prenatal laboratory findings
  • Assessment & Plan
• Resources: If you have time between when you pick up a patient and when you have to present, UptoDate is a great place to do some reading and to find some pearls to throw into your assessment & plan and to prepare for pimp questions. The “red book” as affectionately dubbed by residents should be your first resource.
  • In the Whitecoat: Maxwell Quick Medical Reference, Reflex Hammer, Penlight, and Stethoscope.

In the Library: It is common knowledge that internal medicine, surgery, and obstetrics and gynecology are the big three clerkships that are the most exhausting. It’s definitely challenging to sneak in studying while you’re running around on labor and delivery. This field is filled with really exciting and interesting pathology! I found myself really enjoying preparing for shelf. That being said, this was my last rotation so I was 1) good at shelf exams at this point and 2) a little burnt out.

• Textbook: I used the recommended course textbook and this book (Beckmann)  was easily one of my favorites. The chapters are manageable (10-15 pages) and there are corresponding videos and questions which I will address later. I took a look at Blueprints Obstetrics and Gynecology and quite frankly I wouldn’t recommend it.
• Videos: The Association of Professors of Gynecology and Obstetrics (APGO) has a video series that corresponds with the Beckmann text. The videos are 5-10 minutes long (really not a huge time suck if you watch at 2X) and are a great primer for the textbook or a great way to review if you know that you don’t have the time to read chapters again. I found these videos to be an absolute godsend and really well done.
• Flashcards: I bought the Lange OBGYN flashcards to keep in my white coat for easy studying. I found the cases to be really relevant and high-yield. It was also a super great tool to revisit when I was getting ready for Step 2. I definitely found these cards to be a huge part of my shelf success.
• Questions: I spent the first half of the clerkship working through the APGO questions that correspond with the Beckmann textbook. While these questions were fine… I found the interface to be kind of annoying to use.  You do need to have an account setup by your school! I started to work through Shelf Life: OBGYN. This book is amazing. I’ve raved about this series before but I think that this book is easily the best in the series. I wasn’t able to work through all 500 of the questions prior to shelf but I did work through the entire book prior to Step 2 and I legitimately saw so many questions on my board exam that were similar to those in shelf life! As always, I made sure to get through UWORLD and also the NBME exams.

If I could repeat the clerkship: I reflection, I would not have prioritized the APGO questions. I think that UWORLD 2x is better than working through the APGO questions + UWORLD. The APGO questions are more or less recall from the textbook and while it can highlight some things you may have forgotten, you can get a sense of the high-yield content from the video series. I probably would have worked through more of Shelf Life: OBGYN. I made sure to complete the book prior to Step 2 and that was an absolute life-savor.