Obstetrics Sub I


I did 3 Sub-I's in obstetrics (different from doing a Sub-I in gynecology). I spent most of my time on the labor floor. I suggest that you start off by buying/downloading a pocket book to take around on the ward. I used Williams. If you dont want to buy a book, make yourself a little notebook with things that you learned during your rotation. You should brush up on the basics which were probably well covered in your OB/GYN rotation. The general idea is that the more you are invested in your experience, the more you will get out of it, and the better an impression you will leave.


In some places you will be required to do "night float" where you come in the evening and leave in the morning. The schedule is pretty much the same for both night and day floats. You will get to the hospital with the interns for "preround." Here you can talk to the interns and ask how you can help make their morning more efficient. Usually that will consist of checking on the post partum patients and writing a note. You can look in the Maxwell for a sample post-partum note. The post partum patients are the responsibility of the interns so make sure that you keep an eye on them throughout the day. After that you will attend morning sign-out. This is when the current team signs out the patients to the next team. Do not speak unless spoken to! Never interrupt an intern/resident who is signing out a patient even if they gave wrong information. You can however ask to sign out patients. Tell your intern that you would like to sign out Ms. Smith and when your turn comes do it. It's scary at first but post-partum patients are repetitive mostly and you will get used to it. I suggest starting to do this a couple of days after your rotation started so you have time to get a hang of how you should present a patient. During signout take a piece of paper and mark down the "plan" for each patient. This will allow you to help your intern throughout the day. Example: let me go see if Ms Smith has her CBC results back and i'll write them in your signout sheet.


On top of post-partum patients, the interns are responsible for Triage. This goes on throughout the day, relentlessly. The chief resident is almost never in the triage area but can keep an eye on the pregnant women by looking at their monitor in the nurse's station. You will spend most of your time in the triage area. Make sure that as soon as a woman comes in you get a "one liner" on her (ex:23 yo G2P1 at 24 weeks with bleeding). If you are asked about a patient in the hallway, you have a one liner and then just say "she is being set up on a monitor by the nurse. Once she is in a room, you can go in there and take a full history. Then present the patient to the intern and confirm your plan with them. Some times you will be instructed to take it a step further and present the patient to the chief...this is a good thing.

You will also spend time on the labor floor. When you have a few minutes to yourself, go introduce yourself to all the women in the delivery rooms (do not do this if they are screaming in pain or actually delivering). Spend a couple of minutes with each of them and once you feel it appropriate ask if you can be there for the delivery if they deliver during your shift. Most women will agree to this. Then tell your chief that you have gotten to know so and so and would like to participate in the delivery. You can even ask to do the delivery. Some hospitals are great about letting you do that.


As an intern, you are also responsible for all primary C-sections. Dont be afraid to ask to scrub in. If someone asks you if you want to scrub for a C-section or delivery never say "i've seen enough already." If you participate in either a section or delivery, ask if you can help by filling out the birth certificate or delivery note. This way it shows that you are "following through" with your patients.


Some days you will be asked to work in the clinic. The idea here is the same. At first you will see patients with another resident but as soon as you get comfortable with the system ask to see patients on your own. They will give you a room and you will see the patient on your own. Afterwards present the patient to a resident. Some places will have you present the patient directly to an attending. This is great exposure. So make sure to choose "easier" patients at first until you get the hang of it.


After a long day, regroup with the interns to prepare for signout. You will have to check on post-partum patients again. There is a great opportunity to shine here. 5 minutes before sign out go into the triage area. Get one liners on anyone in the hallway and get a short history on anyone connected to a monitor. Interns are so busy with signout that they stop checking at triage at the end of their shift. By the time sign out comes, some "new" patients will be connected to the monitor. The attending will ask "who is in room 7" and you will be the only one with an answer. So look out for such opportunities.

Other than your usual schedule, there are weekly scheduled didactics and lectures. Make sure you read the chapter assigned for the week (ask an intern what it is). They will single you out and test your knowledge. There are weekly grand rounds and M&M sessions. Just enjoy those, you will not be singled out during those times.



Maternal Fetal Medicine (aka: High Risk Obstetrics)


This is one of the subspecialties in obstetrics. It involves all pregnant women who have additional health problems (ex: diabetes, pre-eclampsia, lupus, etc). You will usually be working with a second year resident and a fellow. You will come in the morning to pre-round on "antepartum" patients (patients who are high risk that have been hospitalized). You will mostly have patients with high blood pressures, shortened cervix, premature labor, etc. Most likely you will be assigned one patient to follow. Make sure you know everything that is going on with this patient and write a note in the file during "prerounds."


Then you will go to the labor floor for morning signout. Usually antepartum patients are the last to be signed out but you must remain for the entire session regardless. After that, you will go on "rounds" with the MFM attendings and fellows. You will likely have to present your patient during rounds...if you are not asked to do so and want to make an impression feel free to volunteer.


If you are in MFM, you are expected to attend all obstetric didactics. Make sure that you read the weekly chapter (ask a resident) and get your hands on articles that will be presented during journal club. You will rarely be singled out but if you do this is your chance to shine.


The rest of your day mostly involves clinic duty. You will start off by shadowing a resident or fellow and when you feel comfortable you are encouraged to ask to see patients on your own. Take your time (you are not expected to see patients at the same pace as second year residents). You will have to present patients to residents, fellows or even attendings. You will have to write the note in the patients file. So be thourough and meticulous. Each hospital is different but depending on what is offered you will also have to participate in "specialty clinics" (ex: diabetes clinic). The idea is the same.


At the end of the day, you will return to the labor floor for sign out again.


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