Category Archive: OB/GYN Rotation

Spotlight Interview: Why did you choose OB/GYN?

OB.GYN  Spotlight Interview: Why did you choose OB/GYN?

 

An OB/GYN Resident’s Perspective: From an interview with an obstetrics and gynecology resident at Banner Good Samaritan, in Phoenix, Arizona.

Part of an interview series entitled, “Specialty Spotlights“, which asks medical students’ most burning questions to physicians of every specialty.  See what doctors from every specialty had to say about why they chose their specialty and how to match in their residency.

 

  • What attracted you to OB/GYN?

I enjoyed the opportunity of working with women over the course of their lifetime health care needs.  From adolescent to geriatric patients you can develop life-long relationships with your patients and families.  Labor and Delivery is exciting and fun to be a part of.  Delivering patients was rewarding and the patients generally are very appreciative of your service. I also enjoyed working with the type of people who typically choose Ob/gyn as a career. I tried to talk myself out of it because of what others had to say, but throughout 3rd year medical school, every subsequent rotation came back to how much I enjoyed Ob/Gyn and I realized that I wouldn’t have been happier in any other specialty.

 

  • Describe an OB/GYN typical work day?

Usually it starts early (to the hospital before 6 most days, this will get better after residency), postoperative and postpartum rounding on patients in the hospital then usually clinic 3-4 days per week.  Most Ob/Gyn’s will have one full day of surgery per week.  Depending on the group you practice with, you’ll be on call about every 4th night for deliveries and one weekend a month.  Clinic may be interrupted by deliveries but they are usually quick.

 

  • What type of lifestyle can an OB/GYN expect?  

It is highly variable, if you choose to be on call for all of your patient deliveries, you can expect to be interrupted frequently as babies are born at all hours.  However most practices will share call amongst the group and with other groups.  Usually Ob/Gyn’s will be on call every 3rd-4th night and maybe one weekend a month.  That is typically home call and you come in for deliveries only. Many Ob/gyn’s are working parents and often female with a relatively normal home and family life.

 

  • What is the average salary of an OB/GYN?

Salary is highly variable based on call schedule and region but most will typically start in the low 200’s initially for most urban areas.  Rural regions tend to start much higher but the call schedule can be more demanding as well.  It is not unusual to increase significantly, again based on call schedule and delivery volume.

 

  • What is the job market like for OB/GYN?

Great! As long as people keep having babies!  There is a projected shortage in all aspects of medicine and Ob/Gyn is no different.  You can typically find a job close to any area where you may want to live.

 

  • What can you tell us about OB/GYN Sub-specialties?

All subspecialties are three year fellowships: Gynecologic oncology, Maternal Fetal medicine, Reproductive endocrinology and infertility and urogynecology.  Salaries and lifestyles are generally improved with all of those specialties to varying degrees and there is always a market for them.

 

  • What are the potential downsides of OB/GYN that students should be aware of?

Like I mentioned before, babies are born at all hours, especially at 3 o-clock in the morning.  However you can make the schedule what you want, if you join a large group you’d have to take less call but you’d likely be busier during those call nights.  Malpractice insurance and lawsuits are a well known downside to the field. As long as you understand this going into it and it is not a surprise, it will not be a problem.

 

  • What else would you tell medical students who are considering OB/GYN?

In the end you choose a specialty that you really enjoy. Don’t choose solely based on lifestyle or salary.  Don’t try to fool yourself either though, those things are important but if you hate your job, it makes for a miserable lifestyle.

 

Editor’s Note: For more help choosing a specialty in medicine, I highly recommend The Ultimate Guide to Choosing a Medical Specialty Spotlight Interview: Why did you choose OB/GYN?.


Spotlight Interview: Matching in OB/GYN

OB.GYN  Spotlight Interview: Matching in OB/GYN

 

An OB/GYN Resident’s Perspective:  From an interview with an obstetrics and gynecology resident at Banner Good Samaritan Hospital in Phoenix, Arizona.

Part of an interview series entitled, “Specialty Spotlights“, which asks medical students’ most burning questions to physicians of every specialty.  See what doctors from every specialty had to say about why they chose their specialty and how to match in their residency.

 

  • How competitive is the OB/GYN match?

The overall competitiveness of OB/GYN is about average. The average board score for Step 1 is usually in the low to mid 220s. There are many more female applicants than male applicants right now.

 

  •  What must a student do to match well in OB/GYN?

Audition rotations in programs you are interested in can be very helpful but you have to impress people during the rotation. It is very easy to do a rotation and just coast through it.  They are called audition rotations for a reason.  Do well on Step 1, show improvement on Step 2 if needed and get letters of recommendation from people who really know you, not just big names

 

  • What are residencies looking for in an OB/GYN applicant?
Programs are looking for someone who is motivated, works hard and helps those around them.  Intelligence is obviously important but strong work ethic goes much farther.

 

  • What should students look for in an OB/GYN residency?

Look for a program where the residents are happy.  Well trained and well taken-care-of residents are happy residents and it is obvious on interview day which residents are happy.  It is important to note not just what the residents tell you but how they say it.  Every one of them will say they are happy and pleased with the program but it is easy to see those that are truly happy.

Editor’s Note: I remember a number of resident’s giving me similar advice throughout medical school. I must admit, I was skeptical. Anyone can fake it during an interview day, right? How can I learn in residents are happy during an 8 hour interview? The reason everyone will keep telling you to pay attention to this is because it is ABSOLUTELY tangible if the residents are happy or not. If you are paying attention, there is no way they can fool you. Happy residents are excited to see each other, they speak to their attendings when they see them and have ongoing friendships with them, they have lives outside of work, they don’t have to think long about why they love their program, they are quick to explain what features of their program set it apart. You may not think this is a big deal now, but I assure you that the temperament of a residency program will make or break the next 3-7 years of your life.

 

  • Do you have any advice on the application, letters of recommendation, personal statements, or how to rank programs?

Get letters from doctors who know you well, not just big names. As a fact, personal statements are cheesy but try to minimize cliché terms. Rank programs on gut feel taking all things into consideration.

 

  • What do you wish you knew before application/interview season?  

I prepared well. Just read as much as you can about the match and be prepared to ask questions during your interviews.

 

  • What other advice do you have for students applying to OB/GYN residency?

Do what you enjoy, you’ll be training in this specialty and working in it for the next 35 years so make sure you like what you do and the type of people you’ll be working with.

 

Editor’s Note: Applying for residency or preparing for your interviews? I highly recommend First Aid for the Match Spotlight Interview: Matching in OB/GYN and The Successful Match: 200 Rules to Succeed in the Residency Match Spotlight Interview: Matching in OB/GYN.







Top Ten Books for Third Year Medical Students

This list is part of a series of articles about the best books for medical students. Click on the Med School Books Main Page to see other lists including the best books for each year in medical school, the best books for each clinical rotation, and the best books for USMLE Steps 1, 2, and 3. 

1. First Aid for the Wards:

Beginning the third year of medical school is a daunting task. I shook like a little kid the first time I had to present on rounds. In retrospect, I wish I had read this book before I ever started third year. It provides great advice about prerounding, rounding, presenting patients, and working with your clinical team. It also gives rotation specific advice for each of the main third year clinical clerkships.

2. Pocket Medicine:

I consider pocket medicine a must-have for all students and residents. I used it during medical school and am still using it in residency. It highlights all the most common clinical illnesses and presentations. For each illness it describes the clinical presentation, signs and symptoms, diagnostic tools, and treatment plan.

3. Maxwell Quick Medical Reference:

A small book with a big role. Nearly every medical student I know carries this book in their white coat. It contains clinical pearls and references that are very high yield. Additionally, it contains sample notes (progress, transfer, procedure, admission, etc).  It is about the best $10 you can spend.

4. Case Files:

The Case Files Series Top Ten Books for Third Year Medical Students (Amazon link) is my favorite clerkship study series. Similar to the Pretest Series (#5) and the Blueprint Series (#6), Case Files publishes one book for each medical student clerkship. The book teaches principles through a series of 50-60 cases.  After each case is presented, the relevant clinical teaching points are discussed and followed with a series of questions. For my style of learning, this was the ultimate study tool during third year. I particularly recommend Case Files Neurology Top Ten Books for Third Year Medical Studentsand Case Files Family Medicine Top Ten Books for Third Year Medical Students.
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5. PreTest:

Another series of books for each medical student rotation, the PreTest Series Top Ten Books for Third Year Medical Students (Amazon Link) are simply question banks in print form. Their questions are very good and hit on relevant material. Although I prefer USMLEworld as a straight question bank tool, the Pretest books allow you to always have questions at your side for bus rides, downtime at the hospital, etc. Along with many medical students, I particularly recommend PreTest Pediatrics Top Ten Books for Third Year Medical Students, which was eerily similar to the shelf exam.

6. BluePrints:

The Blueprints Series (Amazon link) Top Ten Books for Third Year Medical Students is a third series with one book for each medical school clerkship. Unlike the case-based presentation of Case Files and the q-bank format of PreTest, the Blueprints series are more like textbooks. They aim to teach the most pertinent clinical facts without becoming too dense. Each book is about 300 pages and contains a wealth of information…if you can get through it. Blueprints Obstetrics and Gynecology Top Ten Books for Third Year Medical Students
is widely considered the most useful; I used it and did very well on the shelf.

7. Surgical Recall:

If you are interested in surgery or even interested in obtaining a good grade in your surgery rotation, you need to know what is going on in the OR. Surgical Recall provides step-by-step details of surgical procedures including surgical indications, pre-operative management, intra-operative management including a walk-through of the surgery, and post-op management. It will really help you shine in the OR.

8. First Aid for the USMLE Step 2 CK:

Yes, you will probably find a ‘First Aid’ book in each of my Top Ten book lists. This is because I have found them to be the best tool at solidifying the most important points of each phase of medical school. During third year the First Aid for Step 2 CK (Clinical Knowledge) was a great way to make sure I knew the most important facts. It is certainly not sufficient to study alone.

9. MKSAP for Students:

MKSAP is a resource produced by the American College of Physicians and used by nearly every internal medicine resident in the country. The book series is huge (15 volumes?) and not for student use. However, their question book for students is incredible. Next to USMLEworld there is no better question bank to prepare for shelf exams like internal medicine and family medicine.

10. Step-Up to Medicine:

You will also find this book at the top of my list for the the internal medicine rotation. However, it is so good that I thought I should mention it here too. The book comes highly recommended by nearly every student that has ever used it. It will give you a great base to study from and find out what you need to study more.

Honorable Mention:
  1. I can not create a list of study tools for third year medical students without mentioning USMLEworld.  After using many Q-banks, many question books, and other resources, I have concluded that USMLEworld provides questions most consistently similar to the real shelf exams and boards as well as provided the clearest explanations.
  2. The Pestana Notes are an absolutely necessary resource for students on the Surgery rotation.
  3. Success on the Wards: 250 Rules for Clerkship Success Top Ten Books for Third Year Medical Studentsis a highly rated book for third year students
  4. 250 Biggest Mistakes 3rd Year Medical Students Make and How to Avoid Them Top Ten Books for Third Year Medical Students is written as the same authors as “Success on the Wards” and also comes highly recommended.
  5. The Ultimate Guide to Choosing a Medical Specialty: Top Ten Books for Third Year Medical Students Really, this books should be in the Top Ten.  I left it off because it is not specifically for third year medical students. However, it is one of the best resources available for deciding what is important to you in a specialty, and comparing variables across all medical specialties. I highly recommend it.
  • Updated April 27, 2012

How to instrument tie: A video tutorial

instrument tie 150x150 How to instrument tie: A video tutorial

jpatrick.net

In recent posts I highlighted some great training videos on suturing and on one and two handed knot tying. In this post I will recommend a video tutorial for instrument tying.  As with the other suturing and knot tying skills, it is very important that medical students learn early in their careers how to instrument tie.  This is the bread and butter of knot tying.  If you are proficient with the instrument tie you will impress residents and attendings and they will be much more willing to give you responsibilities in the OR.  The video below is a straight forward review and tutorial of the instrument tie.  As with all other knots, remember that a square knot is not complete until you have made two opposing throws; otherwise you are tying granny knots.

One and two handed surgical knot tying: A video tutorial

two handed surgical knot tying 150x150 One and two handed surgical knot tying: A video tutorial

In two recent posts I recommended some great video tutorials for suturing and for instrument tying.  This post will focus on learning how to tie one and two handed knots in the operating room.  As with previous skills, it is very important that medical students learn to tie surgical knots early in their training.  Let me offer one experience from medical school to illustrate this fact.  This is a true story.

After finishing rounds with the residents on my OB rotation I was assigned to work in the OR with the chief of benign gynecology surgery at a community hospital.  He also happened to be the rotation coordinator and was responsible for my grade and evaluation.  The first case was an open tubal ligation. As the case was ending the attending turned to me and said, “hey, we have to close the fascia, can you tie knots?”  Luckily, I knew quite well how to tie.  I picked up the suture and threw a few two handed knots down.  My attending was seriously impressed and told everyone on the team.  He gave me a raving evaluation and spoke specifically about how I was “well prepared for the OR.” So, take it from me, learn these knots! Always remember Rule #1: tie square knots, not granny knots! Two throws are required to complete the knot. 

1. The two handed knot.  This is the knot that you will actually use in the OR. Most surgeons never tie one-handed knots and some even forbid them.  So, this should be your bread and butter. After watching a few tutorial videos I am convinced that this is the best.  It comes from the University of Texas at Houston and walks you through the basics. The audio is very good, so find some earphones. Always remember that a square not requires two throws to be completed.

2. The one handed knot: This is a more confusing knot and far less high yield because very few surgeons ever use it or expect it.  It is notoriously difficult to teach and to learn.  The best video I have found is shown below.  Unlike the previous video, there is not audio to walk you through the knot.  Rather, the knot is completed slowly and each difficult section is repeated.  Remember, you must tie two throws to make a complete square knot. This is important when tying a one handed knot because the two throws are completed using two different techniques.

Finally, there is more than one way to tie a square knot.  Here is one more video that demonstrates the two handed and one handed method clearly. Similar to the second video, there is no audio.  Go get some gloves and some suture and practice along with this video.

How to suture a wound: A video tutorial

how to suture a wound 150x150 How to suture a wound: A video tutorial

Before you start your third year of medical school you absolutely need to know how to suture.  In this post I will provide some of the best video tutorials for suturing. (See my other posts to review one and two hand surgical knots and instrument tying.) During my general surgery rotation and OB/GYN countless attendings and residents would look at me as the case was ending and say, “hey med student, can you suture?  Will you close while I dictate?”  I was also asked to suture quite a few lacerations during my ED rotation.  Learn early and learn often.  Your school will likely have a suturing training course, but you need to keep fresh.  I recommend the two videos listed below as tutorials.  The first (not youtube, so you have to click on it) is the most professional and has some images to help understand the mechanics.

Video 1: From medicanalife.com

Video 2:

 

It is also very important to know a few common pimping questions (below).  The Medscape website offers a very good and very free review of all of these questions.

  1. The indications for suturing vs. glue vs. healing by secondary intention
  2. Time to removal of stitches
  3. Types of suture, and when to use each
  4. How and when to use lidocaine and/or epinephrine prior to suturing
  5. Lethal dose of lidocaine (I have been pimped on this at least 10 times)
Let me emphasis one last time.  Learn to suture, and learn well.  During my surgery rotations I was asked on the spot to sew up a panniculectomy, countless skin grafts, and some other major wounds. The residents and attendings would have never asked for my help if I did not first impress them with my suturing ability.

Proper gowning and gloving, a training video

As I mentioned in a previous post about how important it is to know proper scrub technique, it is equally important to know how to gown and glove. Most students will receive formal training in these techniques.  However, if you are planning on being in the OR either for shadowing or elective rotations before you receive training, be sure to watch this video and the video on proper scrub technique