DHAL: May 30, 2014

Highlights:

  • I passed my Obstetric & Gynaecology rotation! Woo hoo! Results came back last week, and if you didn’t know how I felt about the 3 consecutive days of exams, you can read about it HERE. I was genuinely worried about the possibility of failing and ended up doing much better than expected. Happy with my results and can now breathe and move on!
  • I was rostered to sit in on a 4hr teaching session for the junior doctors today. Couldn’t help myself from participating even though I think I was only supposed to be an observer but a great learning experience. Case based learning today on the topic of neurologic presentations to ED (syncope, delirium, altered mental state, overdose, etc) interspersed with clinical skills. I’m glad there will be teaching like this for me next year to help keep¬†up with relevant knowledge and skills.

Lowlights:

  • Ending the day with a headache ūüė¶

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) Рfor 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 ūüôā

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Obstetrics & Gynaecology: The biggest privilege

Yesterday, I took part in, what I believe, is one the biggest privileges as a medical student: Delivering a baby.

One of the most intimate moments for a woman and her family, where inhibitions are lost and emotions quickly bubble to the surface – pain, excitement, fear and joy.

Thank you to all families who allow us medical students not only observe but even deliver your child as part of our training experience, especially to the two women whose babies I delivered yesterday. New life is such a miracle and the experience of being the person who catches a baby as he/she is born and hand him/her to mum is one that cannot be easily written into words.

I also cannot forget to mention the lovely midwives who I have been working alongside with. Without their expertise, patience, and teaching, I would not have been able to comfortably embrace such a special experience, thank you!

Obstetrics & Gynaecology: End of Week 4

Hello friends!

What an exciting, long and busy 4 weeks!¬†Can’t believe so much time has past since my last joyful post! Thank you again to family and friends who have shared their congratulations with us! We certainly appreciate the love, friendship, and support very much.

I am completing this rotation at a different and smaller hospital outside the city, and it has taken a toll on me! Waking up at 5am in order to¬†be at¬†the hospital for 8am and not usually making it home until 6:30pm. As you can guess, there’s quite a bit of transportation time involved. With that being said, at least I have 3 hours of dedicated study time during my trips on the train? ūüėõ

There are only 4 other O&G students at this small hospital, 3 of whom I already know, which is great. We have¬†lots of¬†opportunity for hands on learning and the teaching has been quite good as well. Our schedule revolves around clinics every day, as well as time in the operating theatre which isn’t so bad. However, all of us would really appreciate having dedicated studying time as well!

I will be rostered on Birth Suite for the entirety of this coming week. As a requirement of our O&G rotation, we must ‘catch’ 4 babies. This means following and caring for mothers while they’re in labour¬†until¬†delivering their child with your own hands. Unfortunately, the other 4 students have not been able to get all 4 of their catches during their Birth Suite week, hopefully I have some more luck!

So what do I have the privilege of seeing on my O&G rotation?

A lot of antenatal care (regular follow up and high risk pregancies), post-menopausal bleeding, heavy, irregular or painful periods, abnormal pap smears, contraception, urinary incontinence and more. In theatre, we often have the chance to see minor procedures like hysteroscopy with dilation and curettage, endometrial ablation and tubal ligation to more extensive surgeries like hysterectomies (removal of a uterus) and Caesarean sections.

Only 4 more weeks to go until the end of this rotation! How time flies!