A Guide For Clinical Year USM [O&G posting]

Peace be upon all of you,

Obstetric and Gynecology is one of the major posting. You will spend 6 weeks in year 4 and another 5 weeks during fifth year.

During fourth year, you will focus more on obstetric case while in final year, you will focus more on gynecology case, but of course you have to learn both in fourth and fifth year.

Most of the student will consider it as a killer posting. Well, it’s kind of true because quarter of student in my batch fail this posting and need to come for a remedial including me. Few of us couldn’t make it and need to re-sit fourth year.

However, this posting is not really difficult if you come to wards and practice physical examination lot and lot of time. You also need to practice presenting the history and management of the patient so that you can do well during the clinical examination.

Basically, the case in wards are quite the same. Maybe there are some differences in management depending on patient. Therefore it is a patient-based approach. You may take a brief look at common case and common question asked by doctor for obstetric case that I’ve write during my free time here: http://www.slideshare.net/jacknaim/long-case-examination-for-phase-iii-medical-students-usmkk

Ok, here basically what you need for this posting

1) Guide book by O&G department

2) Physical examination tool

a) Stethescope (rarely need in this posting)

b) Tendon hammer (you need it in pre eclamptic case or pregnancy induce hypertension)

c) Measuring tape (this is your MOST needed tools)

d) Two ruler (to measure JVP since some patient have heart problem)

e) Two pen torch

f) PE set that you can buy from senior consist of (Snellen chart, cotton wool, tongue depressor, dark paper for lump examination, tooth prick to check for nerve sensation.

3) Reference book (you may use emedicine and journal as weel)

a) Ten teachers is your basic book that you need to understand

b) Illustrated text book in obstetric and gynecology may enhance your understanding

c) Book made by our lecturer which is Labour Suit Guidelines is very beneficial in managing patient in labour room.

d) You may need to read NICE guidelines, RCOG Guidelines, WHO Guidelines. However, our center did not follow strictly these guidelines.

Requirement for this posting

1) Attendance

COMPULSARY and you may fail this posting if attendance is un satisfactory

2) Tutorials

Please divide yourself accordingly for tutorials and meet respective lecturer at least one week earlier to know what topic you should cover

3) Clinics

You need to clerk the patient and present it to MO to get the signature. One patient is for one student. However, sometimes you may need to share the patient.

Year 4 students need to attend ante natal and combined clinic while fifth year student need to attend gynecology clinic.

4) Log book

i. Requirement needs to be fulfilled depend on block co-ordinator. During my time, we need to observe five normal delivery,then conduct five normal delivery, five CTG, five IV line, 5 CBD, 10 case presentation at clinic, 20 cases at obstetric ward, 20 cases at gynecology ward, and need to observe 2 caesarian section and other problematic delivery like twin, breech and instrumental delivery.

5) Case presentation

- Divide yourself for case presentation. Each of you will have at least one chance to present to the lecturer.

6) Report writing

You need to submit total of two report writing to your supervisor which is at the end of second and fourth week. Some lecturer may replace it with homework or hand written case write up.

7) Wards.

Divide yourself according to the team to cover 2 Akik (Team A and C), 2 baiduri (Team B and D and 1S (Gynecology wards). Please go to post natal clinic as well because you will learn a lot about patient management. There, you will understand why the patient delivered normally and why some of them need instrumental delivery or c-section. Some of the eclamptic patient will be managed there after the delivery.

a) Morning rounds

Compulsory and follow your team. Be at wards at least at 8 a.m in the morning

b) Cover patient

Some may suggest that you divide the patient. But I don’t believe that this is the best approach. For me, It is better for you to know all the cases in your team by going through their medical note. You should know the problem list of the patient, result of investigation (blood profile, any blood investigation, ultrasound, Bishop score, CTG)

8) On call

On call is at Labour room. For year four student, you need to be at labour room from 6 pm until 6 a.m while final year student need to be there from morning until 12 a.m.

Only one student can attend one patient except from 6 p.m to 12 a.m (1 fourth year and 1 final year)

Make sure you know the location of instrument needed like amniotic hook, forceps, stir up, VE set and others.

11) Exam

a) MCQ (final year will sit for MCQ exam only)

b) Long case

Tips

a) Labour room

i. You may get to labour room through department, lift near the clinic and entry door at first floor.

ii. Once you get there, put your bag nicely on cupboard near the ultrasound room. Do not carry your bag all over labour room or you will be scolded

iii. In labour room, mainly we have 1 receiving room, 2 ultrasound room, 1 epidural room, 1 high dependency room, 1 room for Usains, 5 room for normal delivery, I room for pre eclampsia patient, 1 room for preterm pantry, room for on call student and 1 OT.

iv. You need to take care of patient start from receiving room until she delivered. What you can do in receiving room is take short history, put a CTG, inset IV line and assist doctor to access bishop score. Then you brought her to delivery room and learn how to plot the partogram. After the delivery, make sure you clean all the set that you use and replace it with new one.

v. Do not only observe the normal delivery, take time to learn about management of patient in high dependency room, pre eclampsia room and pre term room.

vi. You may eat in pantry and store your water inside freezer there but make sure you don’t take others belonging.

vii. You may use the room for on call student to take bath and change your clothes.

b) OT room in labour room

i. Only two students are allowed to enter OT room for each cases. Please rotate so that others may benefit as well

ii. It is only operated at working hour until 8 pm. After that, all case will be conducted in general OT room.

iii. Ask help from nurse or attendance to get OT dress, cap and mask.

c) Wards

i. Like what I have said, please be there at least 8 a.m. some MO may start their rounds earlier. Therefore, you are encouraged to come earlier as well.

ii. Here, you can assist the nurse to put the CTG, insert line, observe doctor perform VE and ultrasound, clerk patient and do other wards procedure. Please be kind and be friend with the nurses and they will help you a lot.