Obstetrics/Gynecology Surgery Clerkship Guide

PA students
Written By Anne
 
 
 

Welcome to your clerkship rotation in Obstetrics and Gynecology (OB/GYN)!

Obstetrics and Gynecology is a specialty that focuses women’s general health and the female reproductive system. This is both a medical and surgical specialty.

 

As a clinical clerk, you'll have the opportunity to work with OB/GYN specialists, nurses, and other healthcare professionals in a clinical setting. During this clerkship, you'll gain experience in both obstetrics and gynecology, and learn to diagnose and manage a variety of conditions.

In this blog post, we'll provide a guide to help you navigate your OB/GYN clerkship.

 

I. What is Obstetrics & Gynecology?

a) Definition of OB/GYN

Obstetrics is concerned with pregnancy, childbirth, and Gynecology that deals with function and disease of women’s general health and reproductive systems.

Subspecialties within OB/GYN as per the Canadian Medical Association OB/GYN Specialty Profile:

  • Gynecologic Oncology: Focuses on the diagnosis and treatment of cancers of the female reproductive system, including cancers of the ovaries, uterus, cervix, vulva, and vagina.

  • Reproductive Endocrinology and Infertility: management of hormonal disorders related to reproduction, as well as the diagnosis and treatment of infertility and assisted reproductive technologies (ART) to help individuals and couples achieve pregnancy.

  • Maternal Fetal Medicine (High Risk Obstetrics): focuses on the comprehensive care of pregnant individuals and their unborn babies who are at increased risk for complications due to maternal or fetal conditions.

  • Adolescent Gynecology and Endoscopy: The diagnosis and treatment of gynecological conditions and disorders in adult women, utilizing minimally invasive surgical techniques such as laparoscopy and hysteroscopy for diagnostic and therapeutic purposes.

b) Topics in OB/GYN:

When reviewing for an OB/GYN clerkship, it is important to cover a broad range of topics.

Here are some key areas worth reviewing:

  • Obstetrics:

    • Normal pregnancy and prenatal care

    • Common complications of pregnancy (gestational diabetes, iron deficiency anemia, antiphospholipid syndrome, venous thromboembolism, group B streptococcus, cytomegalovirus, rubella, placenta previa, placental abruption, obstetric cholestasis, preeclampsia, etc.)

    • Antepartum, intrapartum, and postpartum management

    • Labor and delivery: the process of childbirth; get familiar with the stages oflaborr, different methods of delivery (C-section, vaginal birth, pain relief, vaginal birth after C-section), risks of pre-term labour.

    • Complications that can occur during L&D: prolonged labour, fetal distress, shoulder dystoia, postpartum hemorrhage, umbilical cord prolapse, perineal tears or lacerations, preterm labour, infectio

    • Fetal monitoring and assessment: e.g. kick counts, fetal heart rate, biophysical profile (BPP), etc.

  • Gynecology:

    • Evaluate undifferentiated complaints:

      • Amenorrhea (secondary or primary)

      • Abnormal Uterine Bleeding

      • Vaginal Discharge

      • Vulvular Itching

      • Breast abnormalities (lumps, nipple discharge, changes in appearance/textures)

      • Sexual Dysfunction

      • Genital Ulcers or Lesions

      • Infertility

      • Pelvic pain

      • Vaginal Bleeding

      • Vaginal Discharge

    • Common gynecologic conditions: such as PCOS, Endometriosis, fibroids, Pelvic Inflammatory Disease, Ovarian Cysts, Cervical Dysplasia, Menstrual Disorders such as amenorrhea and menorrhagia, urinary incontinence, vulvodynia, Pelvic organ prolapse, etc.

    • Contraception and family planning methods

    • Evaluation and management of abnormal Pap smears

    • Benign breast diseases and breast health: Fibrocystic Breast Changes, Fibroadenoma, Breast Infections (Mastitis), Breast Calcifications, Mammary Duct Ectasia, Fat Necrosis, Benign Breast Tumors)

    • Gynecologic endocrinology and reproductive disorders

  • Gynecologic Oncology:

    • Gynecologic cancers: uterine, cervical and endometrial cancer, uterine sarcoma, vaginal cancer, vulvar cancer and gestational trophoblastic disease

    • Screening, diagnosis, and staging of gynecologic malignancies

    • Surgical and medical management of gynecologic cancers

    • Palliative care and survivorship issues

  • Reproductive Endocrinology and Infertility:

    • Evaluation and management of infertility

    • Assisted reproductive technologies (IVF, IUI, etc.)

    • Menstrual disorders and hormonal imbalances

    • Polycystic ovary syndrome (PCOS) and its management

  • Urogynecology:

    • Pelvic floor disorders (urinary incontinence, pelvic organ prolapse)

    • Evaluation and management of urinary incontinence

    • Surgical and non-surgical treatment options for pelvic floor disorders

    • Pelvic floor physical therapy

  • Family Planning and Sexual Health:

    • Comprehensive contraceptive counseling

    • Management of unintended pregnancies

    • Preconception counseling and care

    • Sexually transmitted infections (STIs) and their prevention

c) Common OB/GYN Surgical Procedures

  • Cesarean section (C-section) for delivery of a baby through an abdominal incision

  • Hysterectomy for removal of the uterus

  • Tubal ligation for permanent contraception

  • Myomectomy for the removal of uterine fibroids

  • Dilation and curettage (D&C) for the removal of uterine tissue

  • Minimally invasive procedures such as laparoscopy and hysteroscopy for diagnostic and therapeutic purposes

  • Surgical management of gynecological cancers

  • Pelvic organ prolapse repair

  • Endometrial ablation for the treatment of heavy menstrual bleeding

d) Procedures performed in OB/GYN

  • Colposcopy: A procedure to examine the cervix, vagina, and vulva for signs of abnormal cells or lesions.

  • Hysteroscopy: A procedure to examine the inside of the uterus using a thin, lighted instrument called a hysteroscope.

  • Endometrial biopsy: A procedure to collect a small sample of the lining of the uterus for further examination.

  • Pelvic ultrasound: A non-invasive imaging procedure that uses sound waves to create images of the pelvic organs, such as the uterus and ovaries.

  • IUD insertion and removal: Placement and removal of intrauterine devices (IUDs) for long-acting contraception.

  • Implant insertion and removal: Placement and removal of contraceptive implants, such as Nexplanon, in the upper arm.

  • Vulvar biopsy: A procedure to collect a small tissue sample from the vulva for further analysis.

  • Sonohysterography: A procedure that involves injecting sterile fluid into the uterus during an ultrasound to better visualize the uterine cavity.

  • LEEP (Loop Electrosurgical Excision Procedure): A procedure to remove abnormal cervical tissue using a thin wire loop heated by an electrical current.

 

II. Typical Schedule in Obstetrics/Gynecology

As a clinical clerk in OB/GYN, your schedule may vary depending on the hospital or clinic where you are assigned. However, you can expect to spend most of your time working alongside OB/GYN specialists and other members of the healthcare team.

a) Schedule in OB/GYN

  • Morning Report: The day often begins with a morning report where residents discuss overnight events, new admissions, and any urgent issues regarding patients in their care.

  • Rounds: Residents may participate in rounds with the attending physician, fellow residents, and other healthcare professionals. This involves reviewing patient status, discussing treatment plans, and addressing any concerns or questions.

  • Surgeries and Procedures: Attend scheduled surgeries or procedures throughout the week, which can include cesarean sections, hysterectomies, laparoscopic procedures, colposcopies, or hysteroscopies.

  • Labour and Delivery: Attend to pregnant patients in labor. This can involve monitoring progress, conducting deliveries, managing any complications that arise, and providing postpartum care.

  • Outpatient Clinic: You will see patients for routine check-ups, prenatal care, gynecological examinations, and follow-up visits. This provides opportunities to develop clinical skills, interact with patients, and practice continuity of care.

  • On-Call Shifts: You may be involved in on-call responsibilities, which may include night shifts and weekends. During these periods, they are responsible for managing emergencies, triaging patients, and providing necessary interventions.

b) Other Clinical Activities

  • Occasional Teaching: In the afternoon, you may have time to attend lectures, grand rounds, or case presentations, depending on the schedule of your institution.

  • Completion of Documentation: After finishing your clinical duties, you will need to complete your documentation, which may include writing SOAP notes, operative notes, post-op notes, and inpatient round notes.

  • Responding to calls from the ward: Clinical clerks may also be expected to respond to pages from the ward during the day (outside of overnight call). Responding to issues on the ward refers to the daily care and management of patients who are admitted to the surgery ward. If there are missing medication orders, requirement for consults, changes in patient’s status (on exam, on labs, etc.). This allows for prompt prevention and response to complications from surgery or medical conditions that surgery patients may develop during their hospital stay

 

III. How to Study during your OB/GYN rotation

Studying for your OB/GYN clerkship requires a balance between theoretical knowledge and hands-on clinical experience. Be proactive, organized, and engaged in your learning, and don't hesitate to seek guidance from your preceptors.

  • Understand the Objectives: Familiarize yourself with the learning objectives and goals of your OB/GYN clerkship. If none are available create your own by determining what you hope to get out of the rotation. This will provide you with a clear understanding of what knowledge and skills you need to acquire during the rotation.

  • Utilize Recommended Resources: Identify reliable and comprehensive resources specific to OB/GYN. These can include textbooks, online references, practice question banks, and reputable websites. See the next section on recommended resources.

  • Focus on Core Topics: Prioritize studying core topics such as obstetrics, gynecology, reproductive endocrinology, gynecologic oncology, and women's health. Understand the pathophysiology, diagnosis, management, and treatment options for common conditions encountered in each area.

  • Use Case-Based Learning: Link your studying to clinical scenarios and patient cases that you see during the day. This approach helps you apply theoretical knowledge to real-life situations and reinforces clinical reasoning skills. Practice working through patient cases and discuss them with peers or attendings.

  • Attend Educational Activities: Actively participate in educational activities offered during your rotation. These may include lectures, grand rounds, case discussions, and simulation sessions. Engage in discussions, ask questions, and seek clarification to deepen your understanding.

  • Hands-On Experience: Take advantage of hands-on experiences during your clerkship, such as assisting in procedures, performing pelvic examinations, and participating in deliveries. This practical exposure enhances your learning and helps you understand the clinical application of concepts.

  • Seek Feedback: Actively seek feedback from your preceptors, attendings, and residents. They can provide valuable insights into your strengths, areas for improvement, and guide your learning trajectory. Use the feedback to refine your knowledge and skills.

  • Stay Organized: Create a study schedule and set aside dedicated time each day for studying. Break down the topics into manageable sections, and review them consistently. Use study aids like flashcards or mnemonic devices to reinforce key concepts.

  • Practice Questions: Incorporate practice questions into your study routine. They help assess your knowledge, identify areas of weakness, and familiarize you with the question format you may encounter on exams. Review the explanations for both correct and incorrect answers.

  • Stay Engaged and Curious: Maintain an active interest in the field and cultivate curiosity. Stay updated with current guidelines, research, and emerging trends in OB/GYN. Attend conferences, read journal articles, and follow reputable medical sources to stay informed.

 

IV. Favourite Resources in OB/GYN.

a) Mobile Apps

  • ACOG (American College of Obstetricians and Gynecologists) App: Offers resources, guidelines, and updates from ACOG, including access to their publications and practice bulletins.

  • Teach Me Surgery Mobile App: encyclopedia covering over 400 surgical topics in a visual and easy to read format.

  • UptoDate: If your school or institution has access, see if you can get this set up on your phone!

  • MDCalc (free): Over 275 calculators for health care providers to calculate algorithms, scores and risk.

  • Firstline (Institution specific antimicrobial approach/Antibiotic Steward): An app which provides guidelines on which antibiotic to use against certain pathogens based on profile of your area. You can look up data and guidelines including biogram data by antibiotic, dosing (adults and peds), and by pathogen. (e.g. Firstline is used by a few hospitals in Alberta Health Sciences, Manitoba, CHEO - Ottawa, SickKids - Toronto, Joseph Brant Hospital - Burlington and more).

b) Recommended OB/GYN Pocket Books

  • "Obstetrics and Gynecology Recall" by F. John Bourgeois: A concise pocket guide that covers key OB/GYN topics, useful for quick review and recall.

  • "Obstetrics and Gynecology: PreTest Self-Assessment and Review" by Shireen Madani Sims: Contains case-based questions and explanations for self-assessment and review.

  • On Call Surgery by Adams: An easy to follow approach to common on-call ward issues you may need to respond to as a clinical clerk on-call for General Surgery. It includes items specific to General Surgery including Pre-Op preparation, and antibiotic prophylaxis for common surgical procedures.

c) Recommended OB/GYN Textbooks

In general, you do not have to obtain large surgery textbooks to get through your rotation.

However if you do have access to these books through your university or hospital library (electronic or physical copies), try to find these texts:

  • "Williams Obstetrics" by Cunningham et al.: Considered a comprehensive and authoritative textbook covering all aspects of obstetrics.

  • "Berek & Novak's Gynecology" by Berek and Hacker: A well-regarded textbook providing in-depth coverage of gynecologic conditions, diagnosis, and management.

d) Recommended Free Online Resources

e) Recommended Journals

 

V. Patient-Specific Resources

a) Prenatal Resources

b) Delivering Multiples Resources

c) Postpartum Depression Support

d) Breast feeding Support

e) Infant and Child Health & Safety Resources

f) Parenting Resources

 

Final notes

The field of Obstetrics and Gynecology offers a wide range of subspecialties and opportunities for both medical professionals and patients. From the comprehensive care provided by maternal-fetal medicine specialists to the surgical expertise of gynecologic oncologists, the realm of OB/GYN encompasses diverse areas of healthcare.

In this clinical rotation, you have the opportunity to delve into the fascinating world of women's health. By immersing yourself in the field, utilizing recommended resources, and actively engaging in patient care, you can gain valuable knowledge and skills that will shape your future medical practice.

Anne

I am a Canadian trained and certified Physician Assistant working in Orthopaedic Surgery. I founded the Canadian PA blog as a way to raise awareness about the role and impact on the health care system.

http://canadianpa.ca
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