I finished up my Ob/Gyn rotation at the end of December, right before we headed out for our awesome New Zealand adventure, and never got around to telling y’all about it…so here we go!
Obstetrics & Gynecology
This is a specialty that deals solely with all the amazing (and occasionally scary and not-so-amazing) things the female reproductive tract can do.
Obstetrics is derived from the latin word “obstare” which means “to stand by.” Obstetricians take care of women who are pregnant, trying to become pregnant, in the process of becoming un-pregnant or who have recently given birth. It’s a unique field in that it requires the physician take care of two patients who are literally joined together for a time.
Gynecology is the counterpart of the field of obstetrics and deals with normal physiology, as well as disease, of the female reproductive tract. It involves everything from surgery to clinical preventative care and encompasses a large array of normal and abnormal medicine.
8 Weeks: Rotations on Labor & Delivery, Night Float, Outpatient Obstetrics, Reproductive Endocrinology, Inpatient Gynecology, Outpatient Gynecology and Gynecological Oncology
Occasional lectures, practice clinical exams on Fridays
Night Float: A week on the L&D floor at night, 5:30pm – 7:30am. Includes attending births and delivering multiparous patients, as well as triaging patients who come in with obstetrical issues
Labor & Delivery: Basically identical to night float, but in the day-time hours
Outpatient: Straightforward obstetrics and gynecology clinics, including some time in ultrasound, high-risk Ob & general clinics
Reproductive Endocrinology: A field I enjoy immensely, helping women with fertility issues achieve & sustain pregnancy
Gynecological Oncology: Diagnosis & treatment of cancers of the female reproductive tract
Inpatient Gynecology: Benign surgical gynecology
Varies greatly depending on what week of the rotation we were on. Outpatient clinic is generally 8am – 5pm, while surgical specialties tended to have longer hours and Labor & Delivery/Night Float is a pretty set 12-ish hour day.
The Patients: By & large the population in this field is young, healthy patients getting routine care…there are exceptions, but the “bread and butter” of Ob/Gyn is the young, healthy woman.
The Field: I don’t know why it didn’t strike me until I was in the midst of this rotation, but this area of medicine has always been my favorite intellectually. Studying for this rotation wasn’t studying for me, it was interesting. In anatomy pelvis & perineum was my best (and favorite) section, reproductive physiology was by far my favorite…and reproductive endocrinology could hold my attention for hours. I just find it interesting & exciting.
Variety: A little bit of clinic, a little bit of surgery, a little bit of boredom and a little bit of adrenaline…all around fun!
Happiness: Sure, when things are bad in Obstetrics they are really bad and usually involve a lot of sadness. However, this is one of the only fields of medicine that deals extensively with happiness. People are never excited to be in the hospital, but if they get to leave with a baby it definitely offers some consolation…much happier than being admitted for a ruptured aortic aneurysm or acute kidney failure or alcoholic liver cirrhosis.
Surgery: I thought I would hate everything about surgery…when I didn’t it threw me for a loop. Until this rotation I would say I was about 90% sure I was going into Pediatrics, because I seriously thought I would hate being in the OR. Now, I’m not sure.
Active: This field is a lot about doing – even in clinic. You’re always doing something, which helps keep me focused and maintain my attention…pap smears, biopsies, surgeries, deliveries, ultrasounds, etc. Lots of activity in Ob/Gyn.
What I Dislike
Family Friendliness: It’s no secret that surgical fields are less family friendly than non-surgical fields. However, this is rapidly changing with each graduating class of new physicians. I experienced no negativity towards women in Ob/Gyn who have a family, but it wasn’t as overtly supportive as some of the other rotations have been.
Hours: Unpredictable hours can be frustrating for planning the rest of your life.
Going into this rotation I knew I would love the Obstetrics part, I have a real interest in all things reproductive (hardy har, keep the jokes to yourself…this blog is family friendly…usually) and thus knew I would seriously enjoy the part of the rotation that dealt with Ob. So, why did I never really consider this a career option for myself? I figured I would hate the Gynecology & surgery part of it.
And…when I didn’t it threw a loop in my life plans. Now I’m not sure what I want to do with my life…
It’s like I can hear the time ticking away…things I need to get done that aren’t getting done…letters of recommendation, away rotations, personal statements. AH!
But, like my mom told me the other day – I guess it’s better to like two areas & not be able to choose one than to go through all of this and hate everything.
I finished my Psychiatry Rotation a couple of weeks ago and figured now would be a good time to recap the Freudian experience.
Psychiatry is a specialty that deals with diagnosing and treating mental disorders. The difference between a Psychiatrist and Psychologist is in both training and job description – Psychiatrists have medical degrees (either MD or DO) and the prescribing abilities consistent with such. Psychologists typically have a PhD and do not prescribe medications. Their job descriptions are similar, but not identical and also not a subject I’m prepared to tackle. If I have any Psychiatrist/Psychologist readers who’d like to guest post on this, I’d love to have you!
8 Weeks: Four on the Inpatient Unit and four in the Outpatient Clinic
Night Float: Basically overnight call lasting from 4:30pm to 7:00am for a total of 3 days
Weekend Call: One weekend of being on-call to see consult patients
Consult Week: Five days during the outpatient portion dedicated to seeing patients who are in the hospital for a general medical condition and need care for a comorbid psychiatric issue
Child Psychiatry: Five days during outpatient dedicated to seeing pediatric psychiatry patients
Outpatient Clinic: Typically an 8am – 5pm layout consisting of seeing scheduled patients in a clinic-setting. We were responsible for bringing the patients back, getting their vital signs and talking to them about what was going on. After speaking with them we would observe the Resident and Attending assessing them and coming up with a treatment and follow-up plan. We were responsible for writing out notes for several new patients to be graded by one of our attending physicians.
Inpatient Clinic: Inpatient days start at 7am with checking in on our 2-3 patients from the previous day. We find out about things like medication side effects, appetite, mood and sleep. At 9am we have group staffing with all the doctors (residents and attendings), nurses, counselors/therapists, etc. who work in the unit. After staffing we see the patients assigned to our resident individually with both the resident and attending present and come up with a treatment plan and course of action.
USMLE World Step 2 CK Question Bank: Only has about 150 Psychiatry questions. They’re a good start, but seemed easier than the shelf and definitely not sufficient alone for shelf preparation.
What I Like
Time With Patients: Psychiatry is all about talking to your patients. There was never a time on the rotation that I felt rushed through a patient interview and it was awesome. I wish all specialties had the luxury of unrushed patient interviews.
The Lifestyle: I’d be lying if I said I didn’t enjoy the hours of Psychiatry. While there were days I was on call at night or throughout the day, it was noticeably different than Internal Medicine. The hours are really nice and the attitude is typically laid back.
The People: Almost every person I worked with in Psychiatry was extremely amicable and enjoyable to be around – this includes the patients, doctors, nurses and other staff.
Interesting Cases: The types of things you see in Psychiatry are unlike anything else. It’s equal parts amazing and interesting to see the types of things the mind can do, both good and bad, and to encounter the types of illnesses I’ve read about since my first year of college (my undergrad degree is in Psychology).
What I Dislike
Small Scope: While it’s goes without saying, the scope of Psychiatry is quite limited. I used very little of what I’ve learned over the past 2 years and, while the specialty was definitely challenging, I found it less intellectually stimulating than other areas of medicine.
It’s Slow: Psychiatry is less hands on than other areas of medicine and I found it a bit slow. While I absolutely love talking to my patients, I also enjoy active and hands-on medical care. I didn’t do a single physical exam the entire 8 weeks.
It Broke My Heart: Not just the illnesses, but the stories I heard. In those long patient interviews I learned about the resilience of the human race, but I also learned about some of the horrible things the people around us go through – physical abuse, sexual abuse, abandonment, mistreatment – it simply hurt my heart to hear these stories every day. I wanted to hug my patients and cry with them and there were many days I went home extremely disappointed in the way we humans sometimes treat each other.
Emotionally Taxing: Along the same lines, the daily life of a Psychiatrist can be extremely emotionally exhausting. The hours may be fabulous, but you often go home incredibly exhausted from the emotional requirements of the job.
Something’s Missing: Like Internal Medicine, I just felt like something was missing in this rotation. I wasn’t using the skills and knowledge I want to use and while I have great respect for everyone in Psychiatry, because Lord knows we need people who love this specialty, I don’t know that it’s for me. I want to use my physical skills and general medical knowledge a bit more than I was able to on this rotation. Again, I didn’t dread my days in any way, shape or form, but I also didn’t get excited for the day to start on any occasion during this 8 weeks.
A few weeks back I tweeted something to the effect of “I’m SO excited for my Ob/Gyn rotation, but terrified I’m going to fall in love with it. I don’t want to love Ob/Gyn!” My tweet referenced the underlying fear I harbor of loving a specialty that is demanding or lacks family friendliness. One of the first responses I received was along the lines of “Being miserable every single day at work is not worth choosing a specialty based only on lifestyle.”
The fact of the matter is – Ob/Gyn is tough. The residency is surgical, the hours are long and the lifestyle is suboptimal for people wanting to spend time with their families on a regular basis…babies don’t just decide they will grace us with their presence between the hours of 9am and 4pm and in the absence of your kid’s T-ball game or theater performance.
I started my Internal Medicine clerkship in July and my shelf exam will be on August 25th. Since I’m just over half-way done I figured it would be a good time to do a recap of the past few weeks.
Internal Medicine is a specialty that primarily deals with diseases in adults. As our clerkship director put it, I-Med is basically everything minus pregnancy, kids and surgery. It’s a very broad specialty and not unlike family medicine in some ways, but quite different in that it specifically excludes obstetrics and pediatrics.
8 weeks – 6 on inpatient, 1 in clinic, 1 with an IM subspecialty (mine was Heme/Onc)
Daily lectures, weekly “Grand Rounds” lunch meetings and various additional conferences
“Q4” Call, which means we’re on call every fourth day. Call for this rotation is 7am – 9pm and you’re required to be at the hospital that entire time, unless your resident tells you to go home. It’s a lot of call days, but we don’t have overnight call for this clerkship, so it’s not bad at all.
What time you get to the hospital and what time you leave highly depends on how your team operates, what your patient load is, how complicated your cases are and when your scheduled conferences/lectures fall in. This week we had one hour lectures at 7am and my team was rounding (this means discussing & seeing all the patients on our service as a full team) at 9am, so I didn’t have to be at the hospital until 6:40am or so to print out patient info, go to lecture at 7:00am and then see my patients. Some days we leave at 2pm or 3pm and some days we leave at 6pm or 7pm. On call days we leave at 9pm. It’s very random and different each day.
“How little sleep do you actually get?” I probably sleep about 6 hours per night, but I could honestly sleep more than that if I would be more disciplined about bed times.
“How much do you study now?” Not enough. This shelf exam is notoriously hard, so I should be studying more than I am, but it’s hard to come home and concentrate when you’ve been running around all day.
“What do you actually do?” Talk to patients, practice writing notes, pretend I can come up with diagnoses and treatment plans (they’re basically always wrong), practice history-taking and physical exam skills, help out the residents with paper work and other random stuff that makes their day a little easier, incorrectly answer questions my attending asks, fumble with BP cuffs despite knowing exactly how to take a blood pressure and doing it 10 times a day for the year I worked as an allergy tech, basically walk around looking and sounding goofy and out of place.
“What’s the scariest thing you’ve had to do on your own?” I really haven’t had to do anything scary on my own! My school did a great job preparing us to be third years by giving us ample opportunity for clinical experience during the first two. In this rotation we don’t do a lot of procedures, so it’s been pretty much without fear so far. I’ve gotten to assist with central line placements and bone marrow biopsies, though – that was lots of fun even though my job was pretty much limited to opening packages and tying sterile gowns.
“What books are you using?” Ah, good question.
Medicine Clerkship Books
Step-Up to Medicine: This is by far the most recommended book for this rotation. It’s a great overview, written in bullet-format (similar to First Aid). It’s a good review.
First Exposure Hospital Medicine: Our clerkship director issued copies of this book and the one below. They are pretty good – short chapters, quick overview and easy to read, but not enough a solo-resource for the shelf exam.
First Exposure Ambulatory Medicine: We had a quiz over this at the end of our clinic week. It’s a good, easy-to-read book, but like the other it’s probably not efficient enough for the shelf.
MKSAP For Students: I don’t actually own this one, but it comes highly recommended from a few 4th years. There’s a copy in our I-Med office, so maybe I’ll give it a looksy next week.
USMLE World Step 2 CK Q-Bank: There are over 1400 questions in Q-Bank that cover Internal Medicine. We just got access to Q-Bank on August 1st, so I havent used it much, but I think it will be helpful. The questions seem pretty tough.
What I Like
Instant Gratification: Inpatient allows for longitudinal care of hospitalized patients, so you get to see first-hand how treatments are helping (or not) over the course of a few days.
It’s Busy: There is always something to be done. I’d much rather be running around, busy and exhausted, than sitting around bored with nothing to do.
Skill: There’s a lot of diagnostic skill and brain power necessary for Internal Medicine. They are kind of like the physician investigators of the hospital…if someone isn’t sure what’s going on, they call the Medicine team. So far I’ve felt like every resident & attending I’ve been with has been a great diagnostician.
Complexity: Along those same lines there is a lot of variety and complexity in this field. It’s interesting to see people use little pieces from literally every part of their education – from Biochemistry to Fellowship training.
Opportunity: There are tons of fellowship opportunities in Internal Medicine – Cardio, Endocrine, Hematology, Oncology, GI, Infectious Disease, Pulmonology, Rheumatology, Nephrology and more. I absolutely loved my specialty week with the Heme/Onc team.
The People: I’ve really enjoyed the patients, house staff and physicians on this rotation.
What I Dislike
Something’s Missing: Kiddos. I really enjoy working with kids and Internal Medicine specifically excludes them.
Something Else Is Missing: While I’m getting to where I truly am enjoying this rotation (the first few weeks were rough), I don’t have that “feeling” people talk about getting when you’re doing what you should choose as your specialty. Internal Medicine doesn’t make me incredibly excited and I don’t feel like it’s something I’d be amazing at, but I also don’t hate it (anymore, like I said – first few weeks were rough…I think that was more the process of getting my role as a 3rd year nailed down). Who knows, though? I absolutely do not dread my days at all and I definitely enjoy what I’m doing most of the time. I just don’t know if this is “it,” so to say. Although, I seriously fell in love with Hematology/Oncology, so maybe it is.