My very first clerkship rotation was in OBGYN outpatient clinics which I posted about here including some tips for surviving clerkship in general. This past month was a continuation of my OBGYN experience. The first 3 weeks were based in the birthing center where I had the opportunity to take part in a variety of interesting tasks:
Interview and examine pregnant patients in triage
Assist with vaginal deliveries and C-sections
Round on post-partum patients
Conduct consults in the ER
My last week was Gynecology-based where I got to assist with some gynecology surgical procedures in the OR, round on post-op patients, see patients in Gynecology/Early Pregnancy clinics and conduct consults in the ER.
What I enjoyed most:
I very much enjoyed interacting with pregnant patients and helping them through the beautiful, life-changing experience of welcoming their child into the world. I was also grateful to come out of this rotation with tangible, practical skills like delivering babies and suturing.
What I struggled with most:
The environment was fast-paced and quite stressful. It was difficult seeing patients experience pregnancy loss, particulary having gone through the experience myself. The schedule was exhausting with evening/night shifts and 2 weekends back-to-back. I definitely struggled with balancing work and family life and missed the kids a lot.
My take home message:
OBGYN is a great speciality in many ways. There is plenty of variety in terms of the work, it is rewarding bringing babies into the world and being a part of patients lives during such critical moments. For me personally, the demanding lifestyle was not a good fit for my family life, but I am grateful for all that I learned during this rotation and that it helped to clarify my interests more definitively.
I just completed my 2-week rotation in Pathology and I really enjoyed it. My days consisted of a variety of activities such as grossing specimens in the lab (that is, examining and cutting them in preparation for creating microscopy slides), looking at slides under the light microscope and electron microscope, plenty of studying as well as attending autopsies, tumor boards and rounds. I also had the opportunity to observe intraoperative consultations which is when a surgeon excises a sample during a surgery and asks the pathologist to make a quick slide (better know as a “frozen” section) in order to have a preliminary diagnosis, usually in the context of cancer.
What I enjoyed most:
First of all, I think microscopes are just so cool! Secondly, I had a fantastic team to work with! I also liked the flexibility and variability of the day with a lot of autonomy and self-directed learning. For example, my main interests for this rotation were renal and gynecology pathology so I was able to tag along with the residents and staff physicians specializing in these areas. I particularly enjoyed “sign-outs” when the staff, resident and I would sit at the teaching scopes (several microscopes connected to a main one so that you are all viewing the same slide) as this is where you get a lot of useful teaching on how to identify various structures. I also really appreciated that I got to brush up on my anatomy! The schedule was fairly light and I got to see my kids more often than in other rotations which was great!
What I struggled with most:
I missed patient contact and also sometimes felt helpless in cases where we diagnosed cancer since the clinical management is not done by the pathologist.
My take home message:
I think Pathology is a great rotation for medical students to consider regardless of your interests because it exposes you to a different side of medicine and will increase your understanding of various disease processes which is very useful to know in the clinical world. For example, I now have a much better understanding of glomerulonephritis, nephrotic syndromes and gynecology-related cancers. I also have a much better idea of how to interpret pathology reports and the amount of work that goes into creating one! I would currently rank Pathology as a “medium” as a future potential specialty for me because I still have to reconcile the fact that there is not much in the way of patient contact. However, it really resonated with me in terms of the intellectual aspects and I loved the detective work behind it.
My next rotation is an elective in Medical Genetics which sounds fascinating! Stay tuned!
It has been 3 weeks since I started clerkship and it is going very well so far. I started off with Obstetrics/Gynecology outpatient clinic where I had to give two presentations on cases I encountered during the rotation. I was also exposed to various diverse clinics:
Obstetrics: following pregnant women at various stages of their pregnancies, interpreting prenatal screening tests, measuring fundal height, finding the baby’s heart beat with doppler ultrasound (one of my favorite parts of this rotation!) and taking GBS samples
Gynecology:managing endometriosis, menorrhagia, performing pap tests and colposcopy
Gynecology-Oncology: managing patients undergoing treatment for ovarian cancer
Diabetes: managing pregnant patients with Diabetes Type 1, Type 2 or Gestational diabetes
Fertility clinic: managing patients trying to conceive via IVF or IUI.
Ultrasound: observing the routine ultrasounds for pregnant patients performed at 12 and 20 weeks of pregnancy as well as measuring nuchal translucency.
My reflections on this rotation: I found this to be a generally fast-paced,diverse environment with plenty of opportunities to do some procedures.
What I enjoyed most:I very much enjoyed the patient contact and sharing the joy of pregnant mothers awaiting the arrival of their little ones. I also enjoyed the clinics where I had the most autonomy to interact with patients on my own. My favorite clinic of the rotation was without a doubt Obstetrics!
What I struggled with most: There was a steep learning curve as I generally only spent one day in each clinic and every clinic runs differently. I had to learn to adapt quickly.
My take home message:I learned so much from this rotation and felt that I improved in my history-taking and charting skills. I will wait until my OBGYN inpatient rotation to make a final decision about choosing this specialty but on a scale of low-medium-high, I would put Obstetrics and Gynecology as a “low” because I have much less of an interest in Gynecology than Obstetrics and there are alternative routes to practising Obstetrics (more on that later!).
My coping strategies on rotation:
I have a 2.5 hour daily train-commute which can be exhausting but I am using this time to study, read my Bible, decompress after a long day and also to read other topics/books that are of interest to me.
I make use of technology to stay in touch with my family and keep connected. For example, since I have to leave very early in the morning before anyone is awake, I Face-Time my hubby and kids every morning once I arrive at the hospital so I can see their adorable faces before I start my day. This is so energizing for me!
I have some prayer time during my 10-minute drive from my home to the train station (and on the way back as I reflect on my day). This plus reading my Bible on the train daily has kept me in a very positive state of mind despite feeling physically exhausted.
I aim to complete my reading/studying on the train so that once I am home, my focus is fully on my family.
It is challenging to find time to exercise so I wake up 15 minutes earlier every 2 days to have a short workout and then have my longer 35 to 45 minute workouts on the weekend.
Stay well hydrated and fed throughout the day. I carry granola bars in my white coat pocket or scrubs and carry around a bottle of water when feasible. This does wonders for your energy levels!
I had one particularly bad day last week where I felt extremely tired and did not feel my performance on rotation that day had been good at all. We have to remember that despite the really difficult days, there are better days to look forward to and it is all part of the learning process as we hone our skills.
I am currently on rotation in the Neonatal Intensive Care Unit and it has been both challenging and fantastic! I can’t wait to share with you my experiences on this rotation over the coming weeks!