Obstetrics & Gynaecology: The wrap up

It’s only been 2 weeks since my O&G rotation ended but it already feels like ages ago.

Overall, I really enjoyed my time on Obstetrics & Gynaecology. I have to say thank you to the other 4, lovely students on my team: Darice, Sam, Roger and Michael (not my partner) – for your support and for being so fun to work with. There was always a joke to share or something to laugh about. And more importantly, we shared knowledge and learned heaps from each other. Thank you especially to Darice for driving me all the way home so many times in the evening! You are such wonderful company and I hope you are enjoying your time back in Singapore!

So, final exams…

O&G had 3 consecutive days of exams, how did they go?

(Note: Sorry, this might turn out to be a little long. I’m trying to put everything down to look back on in the future!)

Wednesday, May 07

A written multiple choice question (MCQ) exam. 60 questions, 30 gynae and 30 obstetric. I think there was a collective ‘what the hell happened feeling’ after finishing that exam. So much so that the cohort got together and reproduced most, if not all, questions from memory in order to further discuss them. Very dissimilar to the example of a previous exam they provided us, I think many of us felt this MCQ exam did not test fundamental knowledge required for an O&G rotation. In addition, there was unequal weighting of topics tested. For example, out of 30 obstetric questions, 3 of them (10%) asked about oxytocin – a drug used in active management of third stage labour.

Thursday, May 08

3 Obstetric OSCE stations. Each 8 minutes long and without perusal time. Talk about anxiety!

Station 1: An older lady who is obese, with hypertension on an ACE inhibitor and a previous history of 2 large babies has come in to see you (the GP) because she’s 8 weeks pregnant. The point of this station is to not only address the standard steps of care (confirm pregnancy, blood tests for type + antibodies, Hb, syphilis, Hep B/C, Rubella status, etc, dating scan, folate, diet…) but also to address her specific risk factors (age, obese, previous large babies, all risk factors for gestational diabetes and pre eclampsia, take her off her ACE inhibitor as it is a category D drug, etc).

Station 2: A lady in her late 3rd trimester has come into see you in the Antenatal Clinic with vaginal bleeding and a diffusely tender abdomen/uterus. Morphology scan at 20 weeks showed a fundal placenta – effectively ruling out placenta previa and leaving the likely diagnosis of placental abruption. Important points of this station was to identify the likely cause of bleeding, to admit her for further testing and monitoring of baby, inform theatre and anesthesia of potential need for emergency c-section, etc.

Station 3: A lady has active post partum hemorrhaging. Important points included resuscitation if necessary, discussion of possible causes (atony, retained tissue, trauma, bleeding disorder) and their management options, consenting for theatre and the need to inform the patient of the possibility she might need a hysterectomy.

I found the content of each station to be very fair and expected. However, what really disappointed me, as well as every other student I spoke with, is the lack of standardisation across examiners. For myself, the examiner at Station 1 did not let me speak freely, he only wanted me to specifically answer his questions – some of which did not even relate to a first antenatal visit. As a result, with such time constraints, I did not get a chance to say most of what is expected at such an appointment. When I proceeded to Station 2, every time I paused to think or see if the examiner had any questions, she would loudly say to me, “Don’t let me prompt you! What else do you want to say? Keep going!” She never actually prompted me with anything and I felt her constant berating very distracting and disruptive. Finally at Station 3, the examiner sat in complete silence and let me talk through anything I wanted until I stopped, only then did he ask further questions.

Overall, I think it went okay. I never know how I’ve performed at these types of exams because you are always your biggest critic. I can still think of things I should’ve said or things I could’ve left out.

Friday, May 09

3 Gynaecology OSCE stations. Each 8 minutes long and without perusal.

Station 1: Young lady is referred by GP to you in ED with few weeks history of iliac fossa pain. Ultimately supposed to rule out an ectopic pregnancy and come to the conclusion that likely ruptured ovarian cyst and/or ovarian torsion through discussion of investigations you would order and being given the results.

Station 2: Young woman presents to ED with symptoms of PID, confirmed with investigations. Incidentally, she has acute Hepatitis B. Needed to discuss her medical management including the need for hospital admission, contact tracing, contraception counselling, medical consult for the hepatitis.

Station 3: Vaginal bleeding in an older woman post hysterectomy on the ward. Management including resuscitation, discussion of consent, likely source of bleeding, etc.

Again, similar to the Obstetric cases, the cases presented to us were very fair, however, different standards of examiners across the board again. My examiners at Station 1 and 3 carried a discussion with me, letting me speak but also asking questions and pushing my knowledge, which was very good. My examiner at Station 2 was completely silent and cold, making me even more nervous. We were told multiple times that if we were struggling, not to worry, the examiners will provide prompts or attempt to put you back on track, but that certainly did not happen for me with Station 2.

I felt this was my hardest set of exams so far, mainly because of the quantity of OSCEs we had to perform and the uncertainty of whether I passed or not. I think I excelled at some stations and got a little stumped at a couple others. Marking is also very subjective, so all I can do now is cross my fingers and hope that everything went okay!

After this O&G rotation and as someone who is interested in General Practice/Family Medicine, I definitely think I will love the aspect of women’s health and antenatal care within that career pathway, yay!

And if you’re still here, a toast! To the end of second rotation! With Yoni and Christine 🙂

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