Department of Obstetrics & Gynecology

Survival Skills

L & D/Call Survival Skills

Be on time. Board sign out (check out and check in) in the morning is at 0700, 1730 on weeknights and 1900 on weekends.
Introduce yourself to the third year resident at the board, and to the interns that will be on call that day or night.
On the bottom of the board, the C-sections, versions, cerclage, inductions etc. for the day are written. Decide between the medical students on the team who will do the C-sections etc. for the day. There is usually at least one C/S in the morning so everyone will have a chance.
Be assertive. Let the residents know that you want to participate or watch procedures. If you know that they are going to do an ultrasound, IV etc. and would like to see it or do it, TELL THEM. If they say no, do NOT give up. DO NOT take it personally if they tell you no. Sometimes it is not appropriate for the student to be present, or a patient has specified wishes for students not to be present. Keep a good attitude, and ask if you would like to try something. Also, ask lots of questions. The residents seem very busy, but remember, this is your education, and most residents will take the time to teach if you ask questions.
Choose one or two patients on the board to follow. Ask the third year resident who they suggest (i.e. who will probably deliver during the time you are there or patients with interesting medical problems, like diabetes or pre-eclampsia).
Put your name in the box with the patient's name that you are following. Look through the patient's chart and familiarize yourself with her history and her management plan. Tell the resident managing the patient that you would like to be involved in the care of that patient.
Introduce yourself to the patient, and write a note on a regular basis, every 4 hours and whenever anything in the management changes (like rupturing membranes, starting pitocin, etc.) (see sample attached) Note: the patient does not need a cervical exam every time you write a note. Usually, when the patient feels changes like increased contractions or the need to push, a cervical exam is done. You must ask the resident that is following the patient to check the cervix with you. Do not check the cervix by yourself.
Go to Testing and Triage. On a small white board the OB patient's initials and chief complaint are written in blue (Midwife patients in purple and FP in brown).
Introduce yourself to the secretary and the nurse for T & T.
Write your name and pager number on the white board that is on the left when you are facing the computer.
You can see OB patients written in blue and write a note (see sample attached). The only exceptions are private patients (PVT by the name) or residents and/or their spouses.
Find the intern, and present your patient. The intern will see the patient with you before you present to the third year resident at the board at L & D.
Present the patient to the third year resident, and follow up on your T&T patient.
If it is time, check on your patient on L&D and write a note.
Check back in at T&T

C-section Survival Skills

(especially for those who have not had Surgery)

Do NOT enter the operating room without a hat and mask, and of course scrubs (top and bottom).
Shoe covers, which are highly recommended, are outside the OR doors.
Let the attending or at least the second year resident know that you will be joining them for the C/S.
With your hat and mask on, enter the OR and find the OR tech (usually the person who is already scrubbed in and setting up the instruments).
Introduce yourself to the OR tech, and ask if you should pull your own gloves and gown. If yes, the gloves are on the wall that you face when you walk into the room and the gowns are on that same wall on the bottom shelf.
Walk carefully around the OR table, and select your gloves. Do NOT touch anything that is blue including the OR tech. She may ask you to drop your gloves onto the table. Do so carefully. Open the package and drop the gloves onto the table without touching anything, the same with the gown.
Wait until the attending and the resident start scrubbing. Choose a scrub brush, either iodine or soap. Wet the brush/sponge and your arms up to your elbows and hands. Lather the soap on your arms up to your elbow before you start cleaning your nails. Clean under each nail. Think of your fingers as a box with four sides. Scrub each side ten times, then palms, back of hand and side, then arm (like a box) all four sides. Rinse, letting the water run from your fingertips to your elbow. Do NOT touch anything. The nurse or OR Tech has the right to make you scrub all over again if they think you have contaminated yourself.
ALWAYS scrub longer than the attending and resident. Wait to enter until both the attending and resident have entered the OR.
If the OR door is closed, enter backwards, pushing the door with your backside.
Stand near the table where the OR tech is, and put out one hand. He or she will hand you a towel.
Lean forward so that you do NOT touch the towel to your clothes, and using the top half of the towel, dry one hand.
With the wet hand, still leaning over, take the bottom half of the towel (the unused dry half) and dry your other hand.
Without lifting your hand above your shoulders or below your waist, turn and toss the towel into the linen bag (usually against the wall by the door where you enter).
he OR tech will open your gown. Put your arms in. You can pull your sleeves up with your hands inside the gown, but be careful not to touch the gown with your bare fingers. Someone else, usually a nurse, will tie the back of your gown either before or after you put the gloves on.
Place the fingers of your dominant hand out of the sleeve with the white part on the entire palm of your hand.
The OR tech will get your glove ready for you to put your hand in. Do NOT touch her gloved hands with your bare hand. Spread your fingers slightly with your thumb facing your palm. With some pressure put your hand in the glove.
With that gloved hand, pull up the sleeve of the other hand, exposing your fingers with the white part over the entire palm of your hand.
With your index finger and tall man, pull the folded part of the glove that the OR tech is holding, and help put your hand in the glove.
In front of you hangs a red and white card with two ties for the gown. Hold the card in your right hand, and pull the tie on the left side of the card with you left hand. Do not let go of the card, or the tie.
Hand the card with the tie on it (in your right hand) to the person who is tying the back of your gown.
Turn around counterclockwise, and grab the tie that is attached to the card that the person is holding.
Hold the tie tightly, and the person will pull the card releasing the tie. You can now tie the two ties together on your left side.
Fold your hand across your abdomen, and do NOT raise them above your head or put them behind you because those areas are considered unsterile.
Be prepared to stand next to either the attending or the second year resident during the surgery.
Your usual job during the surgery is to hold the bladder blade. The attending or resident will direct you the first time, but be ready when they ask you.
After the sewing is done (some attendings or resident might let you sew), your next job is to staple the wound closed.
Take the stapler in your dominant hand. The attending or resident will bring the tissue together, and you should press firmly, and flat on the skin, and squeeze the trigger.
In order to make the job easier for the person bringing the skin together; don't release the staple until the person brings the next section of tissue together for you to close.
When the stapling is done, the area will be cleaned (sometimes they want you to help), and the blue sterile area will be cleared.
The fundus will be massaged, and vaginal vault squirted with saline to clear clots.
The patient will be transferred to a hospital bed (your help is appreciated in this, usually the feet and urine bag), and this usually concludes the procedure.
The main thing is just to be ready to help out, and try to pay attention to what is going on. If you're not sure about what to do, ask. It is also helpful to watch what the attending and resident does to know when to take your sterile gloves off and put on another non-sterile pair etc.

GOOD LUCK!

Advice from other med students:
"Don't be afraid to ask to see a midwife delivery. Just introduce yourself to the midwife and ask if you can help."
"Don't ask to go to sleep when you are on 24 hour call. Wait until told."