Types of patients you found challenging in this rotation and what you learned about dealing with them

After finishing my whole rotation, I found OB patients to be challenging for me. Their management can be completely different based on their gestational age, such as prenatal care, routine checkup during pregnancy, and also delivery. There are also different tests that needed to be order based on trimester. I found that there are no short cuts to learn this. I have learned that the more OB patients I get to see in clinic, in labor and delivery, and during postpartum rounds, the more I will learn to manage based on different stages of the pregnancy. There are also a lot of routine test or exam to remember for OBGYN, such as the gestational week for ordering a certain test, the gestational week for different trimester, the blood pressure cut off for confirming different severity of pre-eclampsia, etc. Seeing more OB patients in this rotation is helpful in learning the management based on different gestational age.

How could the knowledge I’ve gained here be applicable in other rotations/disciplines?

I gain a lot of different knowledge at Woodhull’s OBGYN department. Because I have varied working shift, such as the women’s health clinic, overnight call, or day shift for GYN. In the women’s health clinic, I was able to observe many different provider’s style when it comes to interviewing and taking a history. I learned how to use EPIC, ranging from write notes to placing orders and more, how to perform the pelvic and speculum exam, which was a challenge of mine prior to starting this rotation. I find that the most challenging part of this exam is finding the cervix due to natural anatomical variations. However, it has become easier as I gain more experience after this rotation. I also worked with providers who specialized in high-risk pregnancies or infertility, which was valuable in solidifying my baseline knowledge and further understanding the pathophysiology behind these concerns. After doing my OB-call, I learned that being proactive and establishing previous rapport were important in finding a provider to work with.

How your perspective may have changed as a result of this rotation (e.g. elderly patients, kids, IV drug users, etc).

Before this rotation, I believe dealing with pregnant patients are not easy. Pregnancy brings a mix of feelings, and not all of them are good. Patients often come in labor and delivery floor with huge amount of anxiety. The patients, especially for the first pregnancy, anxiety is a feeling of unease, worry or fear of what are experiencing and what will happen to the baby. Some pregnant patients will raise all sorts of concerns and ask providers millions of questions, like why baby kicking is so much, how they bear the labor pain, which method is better to deliver the baby, vaginal or c-section. After practice how to deal with those type of situation, I understand that these emotions are normal and common to pregnant women. Trying to calm the mother down to their specific concerns. For example, some pregnant women are worried about they are not able to handle the pain. They just terrified. As a healthcare provider, I learned to calm them down by telling them the body was made to do this pain and all. Explain to them that once labor is in full swing, the endorphins will kick into high gear and for the most part, the body will take over like you have probably never seen before. I will also let them know that there are alternative pain management techniques to help make delivery more bearable like meditation.

Skills or situations that are difficult for you (e.g. presentations, focused H&Ps, performing specific types of procedures or specialized interview/pt. education situations) and how you can get better at them

For HPI, it is different from what I learned from the previous rotation. In the other rotations, such as ED, or urgent care, I learned that HPI should be very concise, and only include pertinent negatives and positives. For obstetrics and gynecology H&P, I learned that they have special things need to addressed. For example, during the initial visit of pregnancy, a full medical history should be obtained, which includes previous and current disorders, drug use, risks factors for complications of pregnancy, and obstetric history, with the outcome of all previous pregnancies, including maternal and fetal complications, like gestational diabetes, preeclampsia, congenital malformations and stillbirth. And during the subsequent visits, questions will focus on interim developments, particularly vaginal bleedings or fluid discharge, headache, change in vision, edema of face or fingers, and changes in frequency or intensity of fetal movement.