Rotation: OB/GYN

Now that I am done with my rotations until the New Year, I am catching up on posts about my third year rotations. Expect more frequent posts from me now that things are –somewhat– slower for me.

Name/Location of Clinical Rotation

2 weeks of GynOnc, 2 weeks of private practice (urogyn/reconstructive) and 2 weeks of L&D

What did I like most about this specialty?

The number of immigrants and refugees that we saw on a regular basis; finding fetal heart tones, deliveries! I got to catch a lot of babies, there were even several cases of twins, I got to use the Ultrasound machine and help run triage in L&D, and I felt like a part of the team.

We used the DaVinci robotic unit in GynOnc surgery, which was cool… but the first time I scrubbed in on a robotic surgery, I’m sure the resident thought I was the dumbest med student ever because I asked if scrubbing in was the same as for non-robotic surgeries…. because you just stand in the corner while the surgeons have their backs to the patient, working with the robot, and at the end of the surgery you might get to place a few sutures on the laparoscopic sites.

When I was on Labor & Delivery I was the only unpaired student, so instead of seeing half of the triages, births, and doing half of the morning rounds and prescriptions, I did ALL of them. I was exhausted all the time but I got some of my best evaluations of the year on that service. The one bonus was that my chief let me go home a couple hours early on the Sunday of Mother’s Day because I rocked my job, so I got time to spend with my own baby instead of catching someone else’s.

What did I like least about this specialty?

It basically meant another 4 weeks of surgery…. ug.

Did this clinical rotation give me a good sense of what practice in this specialty would be like?

I think we got a very well-rounded view of what OBGYN entails, with having two-week sub-rotations in the clerkship, with time in the outpatient clinic as well.

Did my interests, values, kills and personality fit with this specialty? If yes, how did they fit? If not, why might they not be compatible?

There are a lot of ethical issues in OBGYN, which can be draining if you get lots of them back to back. There were cases that I was in on that made me question a lot of my beliefs, which I found to be a good — if not essential, really — experience for me as I develop into a physician.

What are the possible practice settings exist for this specialty? Do any of them interest me and do I know enough about them?

Inpatient and outpatient, community-based with hospital privileges; lots of options.

What info do I still need?

None–I feel like I got enough experience to understand their work and their thought process in regards to the services they offer to know that it is not a specialty for me.

Has my perception of this specialty changed? If yes, how?

So, parts of it I really liked, like L&D. Other parts, like GynOnc that were mostly surgical, I didn’t like so much. Overall though, it was a great experience.

Did my clinical rotation experience influence the likelihood of choosing this specialty?

I know that OBGYN is not the specialty for me because I am not surgically-motivated or enthused, and there is a TON of surgery involved in OBGYN.

Right now, how interested am I in this specialty?

It’s actually higher up on my list than I anticipated, but still below Pediatrics and Internal. One of my attendings even told me that she hoped that I went into OBGYN because I would be great at it (and it was my second highest shelf score).

What information do I still need to evaluate this specialty? Any other comments or reflections?

There were times that babies died. We had several pregnant ladies that came in with vaginal bleeding and absent heart tones. That part is heartbreaking. There is a scream that only expectant mothers can emit, and it is the most heart-wrenching sound I have ever heard. There is nothing like it.

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Rotation: Inpatient Neurology

Name/Location of Clinical Rotation

Inpatient stroke at our local stroke center/Inpatient General Neurology

What did I like most about this specialty?

It was pretty relaxed. I got to spend a lot of time with my patients, and there was a lot of time to think and research things for my patients.

What did I like least about this specialty?

There were some really sad stories, and what I didn’t like about Neuro was that a lot of the time, the patients never got better; at best, we might halt or slow a disease process, but we didn’t really fix anything.

Did this clinical rotation give me a good sense of what practice in this specialty would be like?

I was on inpatient stroke/neuro consult and had my ED experience, which gave me a lot of unique experiences. I enjoyed that part, and I feel like I got a view of a large scope of that sort of practice.

Did my interests, values, kills and personality fit with this specialty? If yes, how did they fit? If not, why might they not be compatible?

I liked that I got so much time with my patients, but it isn’t the right specialty for me. It did not click at all.

What are the possible practice settings exist for this specialty? Do any of them interest me and do I know enough about them?

There’s inpatient, outpatient, and subspecialties in stroke and lots of things that I didn’t know about prior to this rotation! I feel like I got a good view of them, but I don’t see myself pursuing neurology. Right now my list is: IM>Neuro>Surgery, but I’m only on my third rotation!

What info do I still need?

None–I feel like I saw enough and got a good enough feel of it to know that I am interested in looking elsewhere for my specialty selection.

Has my perception of this specialty changed? If yes, how?

I learned a lot on this service. I really sucked at localizing lesions in the beginning, and with the neuro exam encompassing so many steps, I was always nervous performing a total neuro exam in front of my attending and residents. I felt like I had a good relationship with many of my patients. I still wonder about some of them, how they are doing. I do have a much higher respect for the specialty now.

Did my clinical rotation experience influence the likelihood of choosing this specialty?

Now that I’ve gotten a chance to really see what working in neurology is like, I do not think I will be selecting it, but it has been a positive experience.

Right now, how interested am I in this specialty?

IM>Neuro>Surgery at this point.

What information do I still need to evaluate this specialty? Any other comments or reflections?

Some of these patients were so sad. I tried to give my patients plenty of time to complete the MMSE exam, but it was frustrating to them as well as me when they tried so hard on this silly set of tests and sometimes could just not do them no matter how hard they tried.

Registering for Step 1

Over summer, while I was on bedrest to prevent preeclampsia, I spent some time researching how to register for Step 1 and how to build a study scheudule (mostly because I was so bored while on bedrest and had the free time). From what I found, it looked like I didn’t need to worry about that until at least November, which seemed forever away at the time.

Right before the Block 2 exam, my class got an email about how to register for the exam. Being so close to block week, I put that on the backburner. It wasn’t until a week and a half before Block 3 that I finally went through and looked at the email we got from school about how to register for it.

I was officially registered for my test date by early November. Most people don’t register so early for the exam, and it’s really not necessary to do so, but I had my reasons for wanting it done and out of the way.

Over that previous summer, we were told the date we needed to take the exam by (June 23rd or 24th) so that we have it done before third year orientation. My daughter’s birthday is in mid-June, and we wanted to have a few weeks between my Step 1 date and orientation for a family vacation. Knowing this, and knowing how many weeks I wanted to take for dedicated study time, and factoring in days off for special events (my brother’s college graduation ceremony, running my second half marathon, etc), I knew the target date that I wanted to take the exam. I also knew which testing site I wanted (the one where I took the MCAT, a very small testing center close to home). Since the testing site was really small, and since I still had plenty of funds from my loan disbursement (this test is more than $500 to take), and knowing that I HAD to have that exam over with before my daughter’s birthday, I knew I wanted to register as soon as possible.

It was actually a really easy process. I went to the NBME website, logged in, and selected my three month window of when I wanted to take the exam. I then could print off the form I needed school to sign saying that I was eligible to take the test (gotta love security measures, right?). Luckily, I still had extra copies of my last passport photo, so I could use that for the form (again, gotta love security). Then I had our academic affairs staff sign the form and add the school seal (security…). I then had the letter sent overnight mail that required a signature so I could track it, and so that I knew without a doubt that my sensitive information was received (it was only a couple of bucks, so I didn’t really care about the extra cost). When the NBME received my paperwork, I got an email saying that it would probably take 3 weeks to get my official testing permit sent to me; I needed the testing permit before I could log back in to the website and look for a testing center and select a date (the security on this exam is nuts!).

It didn’t take three weeks. I had my testing permit in less than three days. I immediately logged into the NBME site, chose my testing center, and they still had plenty of seats open on my target test date. It was so easy, and so quick to get it done by registering so early. Everyone’s situation is different, but doing things this way made it a lot less stressful, and I didn’t have to think about the registration process anymore. If there’s any advice I could give about registering for the exam, it would be to register early to get it out of the way.