Rotation Recap: Women's Health

The overall experience of my Women’s Health rotation was definitely a top favorite! This had MANY factors playing in to it that I can’t wait to share with you all. But before I get started, don’t miss out on the 2nd part of this Women’s Health segment written by one of the coolest PA’s I know (I kid you not she’s GOALS). Stephanie Howard, a Physician Assistant here in Knoxville, TN who ALSO precepts PA students on their Women’s Health Rotation- she’s going to give you the scoop!

So let’s start with the basics:
Location: Florida
Hours: My hours were all over the place, this is because my preceptor was a physician for the hospitalist group for 3 of the Women’s Hospital locations. I would work from 4 hours shifts to 36 hour shifts depending on the day or week. This isn’t the standard expectation for rotations & I definitely didn’t mind because I was given my own on-call room I could crash in or study if we didn’t have any patients come in to our Obstetrics Emergency Department.

Preceptor: Although my preceptor wasn’t Stephanie, he was really cool and so sweet. He understood the responsibilities we had as students and would let me take days to study or rest up when we were on-call.

Attire: Hospital administered scrubs

Responsibilities of the PA student: I would arrive 30 mins early to any shift we had to go over and discuss the status of each patient admitted to each floor we were covering.
Our responsibility was to cover patients ranging from primarily the OBED triage, Labor and Delivery, Mother/Baby suites, and any other referral from different wings of the hospital. As a student I would do every pelvic exam and contribute getting an HPI from each patient. I would also type up each patient for my preceptor to quicken the process of dictation for the both of us (with his supervision of course).
Basically, if a patient did not have a pre-existing private physician or was being covered by a physician who does not have privileges at that specific hospital, we would take care of them!

My experience was unique and in most rotations you’ll likely be in a private physicians office with patients who have insurance coverage. This was not the case on my rotation and most of the women we saw not only didn’t have insurance, but didn’t have any pre-natal care either. This makes things a bit difficult when it comes to pregnancy and caring for both mom and baby. Having no prior care, we would run labs and ultrasounds to find out the gestational age of the baby/estimated date of delivery, Rh compatibility, disease status, the list can go on…
However, I really enjoyed the OB hospitalist experience and was able to participate in the teamwork that operates between OB/GYN, Maternal Fetal Medicine team, Nurses, Internists, and the rest of the hospital staff.  

Glimpse inside our typical shift: Most shifts would last about 12-13 hours, we would begin learning the status of each patient from the prior covering physician and then we would make a game plan on how to tackle the day or evening. Between rounds we would get calls from the OB-ED triage in which we would have to run down to report on with patients presenting with immediate concerns. These chief complaints could range from possible contractions, decreased fetal movement, premature rupture of membranes, missed period, unusual vaginal discharge, etc (you name it, we probably saw it)

What to expect:
          o   Get comfortable talking about menstrual cycles and vaginal symptoms (sorry, guys
               there’s no way around it
          o   Know how to talk to patients who are in current pain (some will present in labor)
          o   Be prepared to do a lot of pelvics! (refer to video below to prep)
          o   Know that each patient is going to be different. I always inform my patient where I’m    
              going to touch & what is may feel like before I touch the area to avoid any
              uncomfortable experiences. During pelvic exams the patient is quite literally looking
              toward the ceiling, they have no idea what’s happening beneath the drape- being
              informative & keeping them involved in the process can make the visit more comfortable.

Things I would do differently: Study more! This exam was my lowest EOR score because I didn’t take the time to sit down and study- but I did pass. So my advice to you, take the time to review the PAEA topic list!
Things I loved the most: Free food from the Doc lounge, an actual blessing from the PA Student heavens. I may or may not have snuck a number of meals to-go…but, who’s counting?

Anddddd now, what most of you have been waiting for if you didn’t just scroll ahead
How to prepare for your OB/GYN rotation:
Topics to be familiar with

  • Abnormal Uterine Bleeding (AUB): have a good set of differentials in mind- this is a VERY common presentation.

  • Fetal Heart Monitoring: Helpful video (scrub to min 1:32)

  • Common labs you will need to order on patients depending on their trimester. I have a great chart I used for this that I'm unsure how to upload on my site, if you want it feel free to email me!

  • Common GYN presentations: Know how to differentiate Bacterial Vaginosis from a yeast infection, from Chlamydia, Gonorrhea, PID, etc.

  • Know which questions are pertinent and which can wait; the situation may be urgent and getting the right information right away (aka know your FHT & labs to order)

  • How to do an OB exam:

  • Prep Material I recommend: I personally used Rosh Review, OnlineMedEd & Pance Prep Pearls [as always]