Transcript msg.med.upenn.edu

Ob/Gyn Clerkship!
Tips and Tricks!
Locations
HUP: 2 weeks of labor floor (1 week days, 1
week nights), 2 weeks of Gyn or 2 weeks of
Gyn Onc, 1 week of outpatient clinics, 1
“reading week”
Pennsy: 2 weeks on L&D, 1 week of Gyn
Onc, 1 week of UroGyn/Gyn, 1 week clinic,
1 “learning week”
Other sites: St. Lukes, etc.
On the Labor Floor
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Be proactive!
Ask to follow patients, ask to do cervical checks
Bond with the mom and the family!
If your pt is on Mg, will need q2h checks:
Physical exam including heart, lungs, brief
neuro exam, and especially reflexes!
On night float, if there is downtime: ask for
teaching, ask to help with ER consults
The midwives are GREAT! Try to work with
them at least once or twice
Labor Floor, cont
You will catch babies!!!
Get ready to suit up for vaginal births. As soon as the
resident starts getting ready, you should too. You will
need a gown, booties (you really want booties), face mask
(you really want a face mask WITH eye protection),
surgical cap, and gloves.
You will be asked to deliver the placenta. It can take
anywhere from 5-30 minutes. Apply gentle downward
traction, and gentle fundal pressure. As it comes out,
twist twist twist to keep the membranes intact.
This is a
SURGICAL
specialty!!!
Pre OR
• Look up the schedule and know what
cases you have
• Read the patient’s pre-operative
evaluation in Epic
• Have some familiarity with procedure
• Introduce yourself to the patient in the
PRA (peri-operative receiving area)
at HUP
Username:
hupor
Password:
hupor
In the OR (C/S, Gyn, Gyn Onc)
ANTICIPATE!
Try to figure out what the resident or
attending will need before they ask for it!
Suction like it’s your job. Because it is!
Retract, retract, retract! Visualization is
everything.
As soon as they ask for suture, you ask for
the suture scissors. Be ready.
It’s ok to ask some questions -- but judge for
the right calm moments….
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Great resource!
-pelvic
anatomy
- review of
basic
abdominal,
laparoscopic
and vaginal
surgeries
Pre-rounding during Gyn or Gyn
Onc
Generally, you are responsible for pre-rounding
on any patient you observed in the OR.
Learn to become efficient. See pts first, then write
up SOAP notes.
Prepare materials for rounds: Extra ABDs, gauze,
tape for dressing changes. Empty syringes for
foley catheter removal. Scissors, suture removal
kits, skin staple removal kits.
SOAP Note: Daily Progress
Note
Events from yesterday and overnight
Subjective: how pt is feeling
Objective: Vitals, I/Os (extremely important, include
urine output, drain output, comment on drainage:
serosanguinous vs purulent, etc)
PE: Appearance
Pulm
Cardiac
Abd: Dressing is clean, dry and intact (C/D/I), or
comment on wound: nonpurulent, mildly erythematous,
etc.
Extremities
Neuro
SOAP Note continued
Assessment: Ms. S. is a 65 yo G1P1001 now
POD#1 s/p total abdominal hysterectomy for
fibroids...
(POD#0 is the day of the surgery)
Plan
- Pain management, antiemetics
- Wound care
- Foley catheter removal
- Advance diet: sips, clear liquid diet, full diet, etc
- on going medical conditions: DM, HTN, etc. Restart home
medications
- Encourage incentive spirometry and getting out of bed (IS/OOB)
- DVT ppx or anticoagulation (for onc pts)
- Outpatient follow-up
Note about I/Os
In Sunrise, select your patient
Select Flowsheets Tab
Bottom left hand corner: select I/Os
Scroll down to see urine output, drain output, IVF for the
past 24 hours
Ask your resident to walk you through it first
Sunrise
A good way
to figure out
what
happened
overnight if
you don’t
hear signout.
You can see
what orders
were placed
Where you can see
patients’ labs and
studies. Cardiology
studies (ECHOs),
EEGs, and some
special radiology
may only be
available on
MedView
The Sign-Out: Don’t
touch unless you’ve
asked, but a great
way to keep track of
the patients overall
clinical picture and
To-Do list: CHECK
OFTEN
These are where
you can find vitals
and other things
like Is/Os
The MAR: where
you can check
what pills nursing
has given, when
the next
scheduled dose is
Clinic
First experience with outpatient medicine
- Observe one patient interaction first
Before going into the room, gather pt history from
EPIC
Take a brief history, note the vitals, do whatever
exam is appropriate and report back to attending
with A/P.
If motivated, ask to help with procedures (esp during
family planning with IUD placements)
G_P_ Whaaa?
This is a good time to refresh your memory of Gs & Ps!
Gravida = number of times she’s been pregnant
Para = number/types of birth
G_P_ _ _ _
Four spaces after P: full-term births, pre-term births,
abortions/miscarriages/ectopics, living children
Ex. G3P2012 = 3 pregnancies, 2 full term births (clarify
SVD or C/S), 1 miscarriage or abortion, with 2 living
children
Topic Presentations
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Start with a summary source (UpToDate)
Be focused! Brevity is the soul of wit here
more than ever.
Make a handout. But say more than is on the
handout
Incorporate actual evidence: UpToDate is a
great place to find references, then you can
quote the actual papers
End strong: Zinger, 3 take away points
Books
Review Books:
***Blueprints (questions at the end)
First Aid for the Ob/Gyn Clerkship
Question Books:
***Case Files
PreTest
Kaplan QBook
A&L
UWorld Questions
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General Tips for Success
Always ask what you can do to help
Always stay with your patient: bring them to the
PACU after surgery and stay there until the PACU
team has assumed care
Find ways to be helpful and independent
Be friends with the nurses and the scrub nurse!
Be interested, self-motivated, ask questions
Be punctual! And be prepared to work long hours.
Don’t ask to leave. Ask if if there is anything else
you can do to help.
Practice knot tying and suturing at home.
Find time to re-charge
Schedule time with your friends/family
- This is SO important!
Time management
- Keep doing what you love: exercise, cook,
watch TV, read, etc
- Know that the hours are long but…
it’s only 20 days of your life (4 days per week
x 5 weeks on service)
Try to have fun!
Supplemental stuff
Supplemental stuff
● UpToDate from Home
● Access the hospital's Extranet at
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https://extranet.uphs.upenn.edu/
Use your MedView username / password to log in
Create a bookmark on your home page for UpToDate
Click on the "+" that's on the far right side of the "Web
Bookmarks" heading
Name your bookmark and put this URL in the URL spot:
http://uphsxnet.uphs.upenn.edu/uptodate
Click on new bookmark that's now on your home page
Use UpToDate like you would from on campus
Don’t let your empathy
get fatigued!!
Taking an extra moment to listen to your
patient is a good way to improve patient
care, help your team, and make the
experience more fulfilling for you.
From your upperclassmen-and-women
It all became worth it…
“...Each time I saw the look on the face of a new mom when she heard her
baby’s heartbeat for the first time.”
“...When a beautiful family told me they will remember me always after I
delivered their gorgeous baby boy, and gave me a vote in choosing his
name!”
Support Systems
Clerkships can be stressful and emotional, but you are never alone.
Suite 100:
- JoMo, Barb, Helene
- Tutors set up through suite 100
Organized counseling:
- CAPS: http://www.vpul.upenn.edu/caps/
- Therapists in the community (Barb from Student Affairs can provide names and contact info)
- Paired mentoring: SNMA, LMSA, Elizabeth Blackwell, House mentors
Other people to turn to:
- Doctoring preceptors
- Advisory deans
- Clerkship directors (it’s really ok to talk to them!)
- Mentors you have connected with in pre-clinical years (through clinics, volunteering, etc)
- Friends and family outside of medicine