My Obstetrics and Gynecology rotation at QHC was an excellent experience. Prior to beginning the rotation, I was unsure if I would enjoy this specialty. This clinical experience has helped me recognize that this is a specialty I could possibly see myself working in. It seems like the joy of helping deliver a baby (either spontaneous vaginal delivery or C-Section) never dissipates. Additionally, the surgical aspect of the specialty is something that greatly interests me. I think it is rewarding when pregnant patients continue to follow up with you throughout their pregnancy and you can see them progress. During this time, critical patient-provider relationships are built. Additionally, when patients present with GYN complaints, they are often scared and sometimes embarrassed. It is important to provide your patients with reassurance, validating their emotions, and remaining nonjudgmental when they are seeking care. Additionally, “normalizing” the topics discussed during the visit helps the patient be more honest with the clinician and allows for better perceived (on the patient’s part) and actual care.

During this rotation, I was exposed to several new techniques that are specific to OB/GYN. For example, the use of cardiotocography permeates and informs clinical practice in this specialty. The residents and PAs at QHC helped me to interpret the findings and how the findings might inform what interventions we utilize. For example, when patients are experiencing variable decelerations, we first might try repositioning the patient (if they are lying on their back, we will move them to the left lateral position). Additionally, I had great experience learning to perform ultrasound in obstetric patients. The residents and PAs helped me learn how to perform a Biophysical Profile (BPP), how to measure crown-rump length, and how to measure amniotic fluid index (AFI). This rotation involved learning a lot of technical skills. I had the opportunity to perform many PAP smears and G/C cultures. One challenge that I had involved the use of Leopold’s maneuvers to determine fetal lie. The PAs with whom I worked seemed to be able to accurately predict fetal position – which was confirmed with ultrasound! However, when I would perform Leopold’s maneuvers, I would have great difficulty in differentiating the structures. They mentioned that this comes with a great amount of practice – which helped me feel much better.

There were several challenging situations that had presented themselves during this rotation. One such occurrence I can think of was the case of a patient that had presented for placement of an IUD. Prior to IUD insertion, the PA ordered a Urine hCG, which incidentally was found to be positive. After calling the patient into the room and breaking the news, the patient was shocked and started crying (tears of sadness) within seconds. This was a really interesting situation because when the PA and I had found out about the positive pregnancy result, we had absolutely no inclination as to how the patient’s emotional response would be. In this situation, the PA and I helped to comfort the patient and a sonogram was performed dating the pregnancy at a little over 5 weeks. The PA discussed with the patient that she had time to think about what she wished to do with the pregnancy. This situation reinforced how important it is to respond to your patient’s emotions and be there to support them. Another “type of patient” that I found challenging during this rotation were patients that do not follow up. As previously mentioned, there are a multitude of reasons for why patients don’t follow up. I think it is important for the clinician to try and ascertain why the patient is not making their appointments. The patient and the provider both, usually, have the same goal in mind – which is ensuring that the patient remains healthy. If we can understand what barriers there may be to follow up care, we can help to eliminate them and help our patients live healthier lives.

Memorable patients and experiences I’ll carry with me from this rotation are the “Thank Yous” from new mothers and fathers after assisting in either vaginal or C-section for their newborns. It is such a beautiful thing to me to see the emotional experience that ensues during and after healthy delivery of newborns. On the opposite end of the spectrum, two memorable experiences I will carry with me includes observing a D&E for a patient at 22 weeks’ gestation and an inevitable abortion with delivery of a 17-week fetus.

The knowledge I’ve gained here that I think is applicable to other rotations and disciplines is largely emotional knowledge. I think that this rotation reinforced how important a strong patient-provider relationship is, how important it is sometimes to just be there for your patient to speak to, and for you to be a strong support system for them.

One thing I would want my preceptor or other colleagues to notice about my work was that I was constantly trying to learn – academically and technically. While on labor and delivery, if there was nothing “happening,” I would ask nurses if I could perform venipuncture, IV insertion, nasal swabs for viral PCR, PPD insertion, etc. Furthermore, in clinic, I would ask the clinicians with whom I worked if I could perform the breast exam, pelvic exam, PAP smear, G/C testing, etc. Overall, I hope that it was obvious that I was interested in gaining as much experience as possible in order to practice learning the proper techniques for such skills. Additionally, I hope it was evident that rather than studying while things were “slow,” I would look for ways in which I could help the team.

For the following rotations, I wish to improve upon my assessments and plans. My action plan to accomplish that is to continue working on my differential diagnoses and learning how to narrow that down into a diagnosis and its management. I will continue asking my preceptors and the staff with which I work for feedback regarding my presentations and particularly ask how I can improve.

As I mentioned to the residents and the PAs with whom I was working, this rotation taught me that I am lucky that I will never have to experience labor pains. However, I assured them that in the future, whenever it may be, I will certainly be right beside and supporting the woman bearing our children.

Overall, my experience at QHC was unforgettable. I am thankful for the knowledge and expertise that was shared with me during these past 5 weeks. The team with which I worked helped facilitate my learning, and I was particularly grateful for my preceptor Mrs. Gloria Sacco.