OB/GYN Rotation in Miami

Mt. Sinai Hospital in Miami Beach, where I do rotations.

In pediatrics, I had gotten the chance to see newborn babies soon after birth, and follow up on them for their first few days into life. Then, I got to see kids of all ages, all the way up until 18. Then in Internal Medicine, I got to see people from 18 and onward, through their middle years to old age. Sadly, I’ve even seen individuals at the end of their lives as I tried reviving them with CPR during my ER shifts. Now in my rotation for obstetrics and gynecology (Ob/Gyn), I feel like I’ve completed the circle, seeing the process leading up to birth, and being there at that special moment to welcome a new child into the world. Ob/Gyn is a completely different world on its own, and it’s a very interesting rotation.

My friend Dave and I were assigned to a group of five physicians at Mt. Sinai Hospital. They have their own outpatient clinic at the hospital and they also work inpatient as well, and so Dave and I are fortunate to be able to get an equal amount of both. We are also rotating with two other students from the Physician Assistant program at Barry University (where Irene is currently in her third year), and so together, we take turns rotating between the clinic and the hospital floor.

All of our attendings have been really outstanding, and willing to teach. They will often sit down with us to give us a lecture on topics like normal labor and delivery, pre-eclampsia, post-partum bleeding, gestational diabetes, contraceptives, etc. They also give us a lot of hands-on experience and have us see patients on our own, which is great practice for our future. At the same time, we also help them out by filling out progress notes, H&P’s, helping them save some work.

Every morning, we go to the hospital at 7 or 8am to pre-round on the patients on the post-partum floor before the doctor gets to the hospital. The post-partum floor is where the new mothers go right after they deliver their babies. For c-section patients, the mothers may stay for 3 days if all is well, and for natural deliveries, they may stay for 2 days. Every morning we get a list of the patients from the nurses, and the four of us students divide up the patients that we are going to see. For each patient, we ask questions to see how she is doing, check on her labs, and do short physical exams by ourselves. We write progress notes and put them in the patient charts. When the doctor arrives, we then report to him/her our findings, and then we go see the patients together. The doctor then reads over what we have written in the progress notes then signs or edits them.

After we’re finished seeing all the patients on the Post-Partum wing, we then head over to the other floors to see patients who had Ob/Gyn consults ordered for them. These patients usually are those who were admitted to the hospital for non-Ob/Gyn reasons, after which their doctors found reason to consult Ob/Gyn specialists.

Finally, we then go to the Labor and Delivery wing to see if there are any new patients. If so, we go check on the patients then fill out the History and Physical (H&P) forms on them for the doctor. The doctor monitors the cervical dilation and contractions of the patients, and makes sure that the fetal heart rate is OK, and once the dilation gets close to 10 centimeters, the patient is ready to deliver. So far in the last 4 weeks of my rotation, I’ve gotten to observe and help out in 8 c-sections and 6 natural deliveries. During c-sections, I’ve gotten to scrub into the OR, work alongside the doctor and surgical tech, and help in suctioning blood and amniotic fluid, holding the bladder clamps down, helping the doctor cut stitches, and stapling the incisions together. Some other surgical procedures I have seen so far include myomectomy, LEEP procedure, and tubal ligation.

For natural deliveries, we also get to scrub in as students and work alongside the doctor in assisting the delivery. For each delivery, we learn more and more about how to do it, and eventually, I got to catch a baby with my own hands for the first time. It was one of the most amazing experiences I’ve had in my life. It truly was an honor to be a part of someone’s life at the beginning, and a blessing to see the parent’s reaction when they meet their child for the first time.

While all four of us students pre-round together in the mornings, in the afternoons, we split up and half of us stay on the floor while the other two go to the outpatient clinic for the rest of the afternoon. Here, we see patients who come in for gynecological check-ups, prenatal care, and simple office procedures. I’m not sure if it’s because we’re male students or not, but the experience in the clinic so far hasn’t been as hands-on as on the floor. At most in the clinic, we students use the fetal doppler to measure the fetal heart rate, measure fundal height, as well as help take out staples from patients who had recent c-sections. While I have not done other things like taking pap smear, female genital exam (though we’ve done them on the island before), or putting in a IUD, I have certainly seen quite a few of them already. Being male also means that sometimes patients do not feel comfortable about me being in the room altogether and there have been quite a few times where the doctor had to excuse me from the room because of patient preferences. I can understand that, and I’m not too surprised. Nevertheless, I try to make the best out of the experience that I have, paying careful attention to how the doctor works, speaks, and treat the patient.

Here, I’ve put together a Q&A for AUC students planning on completing their Ob/Gyn rotations in Miami:

How is the rotation scheduled?
Ob/Gyn rotations at AUC are 6 weeks long, and the amount of inpatient and outpatient will depend on the doctor you are assigned to. Students working with Dr. Ferra, Dr. Silanee, Dr. Spence, Dr. Michael/Ferro, and Dr. Kohn will rotate with their attending all 6 weeks. For students working with all other doctors, they’ll work 4 weeks of outpatient with one doctor, and 2 weeks of inpatient with another doctor.  Each doctor may ask you to come in for different amounts of time.

What are lectures like?
Every week, there is also a lecture, which usually lasts 2 hours. As of 10/2012, Ob/Gyn lectures are held on Wednesdays at 5pm, at MBCHC’s Beverley Press Center. It’s usually taught by Dr. Silanee and lasts anywhere from 1 to 2 hours. Attendance is required and taken. Dr. Silanee is an awesome lecturer, explains things so beautifully clear, and tells you everything you need to know on the boards as well as things to look out for as a future physician. His lectures are absolutely helpful. We are allowed to get one study day.

Are there any assignments to do?
Yes. Each week, students are required to do two SOAP notes on cases we see or round on. Each attending may have a different way they want you to do SOAP notes. By the end of the rotation, you’ll have 12 SOAP notes total, which we then turn in to the Ob/Gyn rotation coordinator. And of course, there is the NBME shelf exam that we must pass at the end of the rotation.

How are you graded?
You give an evaluation form to each attending that you rotate with. Each attending will fill out the evaluation and fax it to MBCHC themselves. By the end of the rotation, you will also have 12 SOAP notes written and graded. Looking at all of these, the director of the Ob/Gyn rotation will issue a final grade, either as pass, fail, or honor. In addition, you must pass the NBME shelf exam for pediatrics to pass the rotation. Minimum score to pass is 55. To honor, you need at least 79 (although honoring the exam is not a requirement to honor the rotation). If you don’t pass the shelf exam, you’re given another chance to pass it again. If you don’t pass it again, then you’ll have to retake the entire rotation. NBME shelf exam scores do not show up on your MSPE letter (Dean’s Letter) and therefore are not seen by residency directors. However, the evaluations and comments from your attendings do show up on the MSPE letter and are seen by residency directors. Therefore, do your best on your rotations to make a good impression on your attendings so they can write nice things about you on the comments section of the evaluation (vs. them leaving it blank).

Do we rotate with any other student?
Yes. We rotate with up to 3 other students. We rotate with other AUC students, Ross Students, Barry University PA students, as well as Nova Southeastern DO students sometimes.

Do you get to do much?
It depends on the attending, and patient comfort. For some attendings, you’ll mainly be shadowing. For others, you’ll get to see patients by yourself, like taking history, physical exam, assessment/plan, and present to the attending, as well as scrub in to deliveries. There are some attendings that teach a lot, while others may not as much, and you’ll have to be more proactive. Some attendings have 10am-4pm schedules, while others have 8am-5pm. It all depends on who you’re assigned to. In my experience, whether or not they let you do much, most attendings are pretty nice and laid-back. If you hear from another student about a good attending that he/she liked and you want to request a particular attending to rotate with, I’d recommend doing so before the start of the rotation.

Where do you rotate?
You may be placed with doctors who work at several different hospitals around Miami, such as Mt. Sinai Hospital (which is where I’m rotating), MBCHC’s Beverley Press Center, Jackson Memorial Hospital, Hialeah Hospital, or Kendall Regional Medical Center. Lectures are held weekley at MBCHC’s Beverley Press Center.

What is the dress code?
You will be required to wear scrubs at all times on the floor and in the office. You may also wear your short white coat over your scrubs, but they must be taken off during delivery. You will also be required to wear the ID of the hospital you are rotating that day, and then return your ID when you are finished with the rotation.

What should I bring with me on my rotation?
Bring a stethoscope and a pen. For some offices, it may be convenient to bring a measuring tape to measure fundal height of women. If you want, you can also bring a notebook and pen to record your patient notes in. Also bring a textbook (or iPad) to reference or to study with in case you have some downtime. If you have an iPhone, iTouch, or some other smart phone, great! You can download some awesome apps that are very useful for your rotations. Check out my post here: iPhone Apps for Clinical Rotations.

Are there any textbooks that are helpful?
While there are no required textbooks for Ob/Gyn, the most recommended book is Blueprints Obstetrics and Gynecology. This really is a great book to read. It gives really nice diagrams and drawings that explains procedures and concepts well. You could also do questions on USMLE World.

When would I know which hospital and attending physician I will be rotating with?
You will usually receive an email a few weeks before your rotation starts, telling you the time and place of the orientation for your Ob/Gyn rotation. This orientation takes place on the first official day of your rotation, and it is here where you will take a picture for your ID, review and sign some paperwork, and receive your schedule for your rotation, including the hospital and physician you will be rotating with and their contact information. They will also give you directions on when and where to meet your attending for the first time. However, I would highly suggest calling your attending just to confirm with them personally, not to mention to be friendly and to simply say hi.   The orientation usually takes place at MBCHC’s office in North Miami (Biscayne Boulevard).

Will I need to know Spanish?
While knowing Spanish is not required, I personally would highly recommend that you learn some before you come. Miami is unique in being one of the few major cities in the United States in which English is actually the minority. Spanish rules here. Practically everyone here uses it on the street as well as in the workplace, and this is true in the hospitals as well. The majority of patients you will see will be Spanish speakers, and most doctors, even those where Spanish is not their native language, will actually also know how to speak the language. If you don’t understand, they may be nice enough to conduct the interviews in English or at least translate for you. However, that may not happen every time, and it will help you if you at least know the basics to know roughly what’s going on. For Spanish learners like me, this rotation in Miami has actually been an amazing opportunity for me to get immersed in the language and improve my skills. I’d say about 80% of the patients I’ve seen so far are Spanish speakers (though most also know some English as well). It will definitely put me at an advantage in the future when Spanish will become increasingly important in this country, and our society will need more doctors who know Spanish.

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