Welcome to Introductory Obstetrics and Gynecology.

This online virtual clinical rotation is designed for the third year medical student learning OB-GYN, the healthcare of women. This model 6-week training course uses a standard curriculum that I believe can be useful to anyone at this level of training.

My intention was to create an on-line virtual rotation, or simulation, that can run parallel to a student’s own rotation, filling in missing material, broadening their exposure, and deepening their understanding of the clinical issues. This material won’t substitute for hands-on clinical experience, but can enhance that experience by providing greater understanding of the mechanics and processes.

This class takes you with me on Morning Rounds each day, Mondays through Fridays, for six weeks. Each day I’ll discuss some of the patients we are seeing or some patients I’ve recently seen in the outpatient clinic. Every afternoon, we’ll have a few short but focused lectures on important OBGYN topics. At your own pace, visit the OBGYN Skills lab where you can watch more than 40 five-minute videos, demonstrating how to perform some useful medical skill. Finally, whenever you feel you’re ready, go to the Patient Simulation Lab, start seeing patients, and start making clinical decisions. I hope you’ll learn both from your successes and your mistakes.

In real life, not everyone will want to follow this model literally. Many students will find they can move more quickly through the material, or skip

ahead to some areas of particular interest to them. I’m not troubled by that. One of the very nice things about this on-screen format is that students can move through the material as quickly as they want, at a time of their own choosing. They can repeat certain experiences as often as they like, and skip over material that proves not to be so useful to them. I won’t waste your time.

Advice

As an old, gray-haired OBGYN, I have some advice for you. Some of this could be applied to just about any human endeavor. The three essential requirements for success in any human activity are these:

1. Show up. You must be physically present, either in person or logged on.

2. Engage. If you sit in the back and ponder your evening activities, you’ll never meet with success. You must actively engage in the experience, and

3. Be pleasant. A bad attitude will doom your efforts to failure.

When I taught my children the same three principles, they asked me, “Dad, isn’t there anything more to success than that?”

And my answer was, “Yes, there are a few more things, but not many more, and they all hinge on the first three.” So in this rotation, as in all other important life processes, make sure to show up, engage, and be pleasant.

Demeanor

You are working in a professional environment and you need to act professionally. Ask questions respectfully, and use a soft tone of voice. Be kind to those around you.

Be confident, as it is contagious. Honesty is the best policy. But putting a positive spin on medical issues and beaming confidence to your patients will calm them, ease their mental pain, and usually leads to a better outcome. Be confident.

Professional Attire

Generally, you will be more effective in providing health care to women if you dress professionally. In an emergency, it makes very little difference what you wear, but in non-emergency settings, you should dress professionally.

1. It communicates to your patients that you are a professional.

2. It encourages your patient to relate to you on a professional basis, and it

3. Provides the patient confidence that you can effectively treat their medical problem.

Professional clothing generally includes:

 Uniforms (clean and pressed)

 Laboratory coats

 Suits

 Sport coats

 Dress slacks

 Casual dress slacks

 Skirts

 Casual dresses

 Dress shirts, blouses, collared sports shirts, jewel-neck blouses

 Sweaters, vests

 Dress and casual shoes

 Scrub suits where appropriate

 Socks or hosiery

Professional clothing generally does not include:

 Open-toed shoes, sandals, tennis shoes, high heels greater than 3 inches, or any footwear that may interfere with performing your job.

 Denim (jeans, of any color or style)

 T-shirts

 Clothing with potentially offensive phrases, political statements, religious statements, or advertising.

 Sleeveless tops without a jacket

 Clothing that exposes the skin of the shoulders, back or stomach

 Shorts or miniskirts

 Low-cut tops

 Athletic clothes (sweatshirts, jogging suites)

 Faded, unclean or wrinkled clothing

A few words about grooming and hygiene

Your patients will typically respond better if they have confidence in your professional skills. Good grooming and personal hygiene are an important part of that professional image. This includes:

 Regular bathing and use of deodorants to eliminate body odor

 Cologne or perfume, if used at all, should be very subtle

 Body piercing, other than ear rings, should be unnoticeable

 Hair, beards and mustaches should be neatly trimmed, clean, and in a natural color

 Fingernails should be trimmed, clean, and free of colored nail polish than can interfere with your visual check of cleanliness under the nails. Artificial nails should not be worn in surgical suites or critical care areas (ER, ICU, CCU, L&D, OR, RR, etc.)

 If your hands, face or clothing becomes soiled, go wash and change clothes. Don’t talk to family members of a woman you have just delivered with blood and meconium on your scrub suit. Change to a clean scrub suit first.

 You will inspire confidence in your patient if they see you wash your hands before touching them.

In your relationships with your patients:

 Use a soft and gentle tone of voice

 Be sympathetic to the patient’s problems

 Be respectful that they are allowing you to participate in their care, at some risk (at least perceived risk) to themselves.

 At this stage in your career, you should always have a mentor, chaperone, or other person present whenever you examine the breasts or genitals of a patient.

 Personal relationships that go beyond the normal doctor-patient relationship are usually a bad idea. Sexual relationships with patients are unethical, unprofessional, and in some circumstances illegal.

Maintain a good relationship with your teachers.

Be respectful of them and the time and effort they devote to your education.

Remember that by supervising you, they are assuming some risks. If there is a problem, you usually will not get into trouble, but they may get into a great deal of trouble.

Notify your teachers any time something goes wrong, has an unexpected outcome, or you think you may have made a mistake. All of these things can usually be easily fixed if dealt with early. If a mistake is learned about further down the clinical road, it may not be so easy to fix. Try not to make mistakes, but if you make one (and we all do…more of them when we are younger, fewer of them when we are older), let your teacher know about it immediately.

Every teacher will be wrong about some things, but right about most things. With wisdom and clinical maturity, you will discover which is which.

Value vast current knowledge as much as you value years of experience.

Personal relationships that go beyond the normal student-teacher relationship are usually a bad idea. They may also be unethical and unprofessional. If you feel that any teacher is coercing you (threats, grades, passing the course, etc.) into an inappropriate relationship, go immediately to someone within the school you can trust and report it. This might be a Department Chairman, Dean, Provost, or other official.

Relationship with other Students

We often learn much from our colleagues. Things that seem simple to you may not be so simple to your classmate. Help each other.

Medicine is an emotionally and physically demanding profession. Stresses can be high, and the stresses of daily life don’t wait until you are finished with your education before they can overwhelm you.

Mood disorders (depression, anxiety) affect health care professionals just as much (maybe more) than others. Watch your classmates for evidence of this (dysfunctional behavior, crying for no good reason, sleeplessness, overreactions of emotion) and help them out. We all need each other, and all need help from each other at one time or another.

Friends are a blessing. Look out for them and protect them.