Gynecology/Gynecologic Oncology

Tips from a Faculty Perspective

Preparedness & Professionalism

  • Review anatomy before the surgery.
  • Be prepared to answer questions about blood supply to the pelvis, lymph node drainage of gyn organs, etc.
  • Meet your surgical patient in the pre-op holding area, if possible. This is especially important in patients who will be admitted.

Attitude

  • Help transport patients, if necessary (we all do this at times).

Initiative

  • Take ownership of your admitted patients-see them throughout the day. Write notes on them (check with your physician). Gather vital signs, check labs and urine output and review nursing notes in the morning before rounds for your patient.

Reading

  • Read about surgical patients the day before.

Tips from a Resident

You will be working with a fantastic group of residents (if we do say so ourselves!). If something doesn't seem to be working for you, speak up. Let us know what you want to learn, see, and do, and we will try to make it happen. What we expect in return is that you approach this rotation with enthusiasm, are willing to work as part of our team, and take responsibility for your educational experience.

There are 3 steps to this rotation:

  1. OR:
    Whether or not you plan to be a surgeon, this is a good chance to get a look at all the pathology you will be seeing in clinic, and to remind yourself about the anatomy of the pelvis.
    • Review Netter, pages 341 and 373 in particular. Things will make much more sense if you have a map of where you are.
    • Ask your chief what surgery you will be scrubbing on and review the steps; it will help you be a better assistant.
    • When you get to the OR, pull your gloves and give them to the scrub nurse. Ask if s/he needs another gown for you.
    • Help move the patient, put on the bear-hugger, put in the Foley (ask the nurse if she will let you and show you how), shave the patient, put on the TEDs and SCDs--be as helpful as possible.
    • Ask for the suture scissors when someone starts sewing. This will help demonstrate that you are paying attention.
    • Always, always, be polite to the nurses.
    • Ask questions.
  2. Rounding:
    Our rounding is different from what you will do on a medicine or surgery service. We do not "pre-round" (i.e. have the intern or student go collect vitals and see the patient before the chief gets there). We round as a team, with one person examining the patient, one writing the note, and one writing orders. This makes it hard to find a job as a medical student, but there are a few things you can do:
    • On the onc or benign service, ask to write the orders. This will help you figure out what exactly we do for patients on the post-op day one or two.
    • On the benign or HMC gyn service, volunteer to pre-round. If you see the patient first, collect the vitals and make a plan-it is much more interesting and educational. Usually we have a small enough service that getting there early only means 7am instead of 7:14. We won't make you get up at 5am! 
    • During the day, check your patients' vitals on the computer and follow up on labs. If anything is abnormal think about what could be going on before you talk to your chief.
    • Again, ask questions!
  3. Clinic:
    Usually you will be seeing patients with the chief resident. You will go in first and get a basic history, do the preliminary parts of the physical (HEENT, heart, lungs, abdomen, neuro) and then present to the chief and go with them to do the pelvic exam. 
    • Try to make your history-taking concise and thorough--nearly impossible to do as an intern, let alone on your first rotation! Your chief may interrupt you or listen in to save time.
    • Always create a differential. Some things may seem simple, but this exercise will help you catch the one or two times when it isn' straightforward (and it's good practice for your medicine rotation). 
    • Don't feel like you have to see every patient. After seeing one, take a little time to read about their problem, the treatment options, and the differential. 
    • Read. Read more. You will be able to ask better questions and take a better history when you know more about the potential problems.
    • Ask questions!