Tag Archives: Medical School

*blink blink*

I have been swamped in all areas of my life lately. Between a rotation in gynecologic oncology that had me waking up at four most mornings and had OR days that easily stretched into fifteen hours long, to my seven year old’s birthday, to applications for residencies, to working on research, there are many days I don’t even touch my computer. If I do it’s to look up a medical topic to study or to do research.

I actually slept 10 hours a few nights ago. It was incredible. I still feel sleep deprived, and I am not a sleeper. I usually say “Sleep is for the weak,” which proves I am meant to do obstetrics. But, even I have my limits.

It is really exciting to be at a point in my educational path at which I can focus on obstetrics and gynecology. I still have core rotations in family practice and emergency medicine and an elective in cardiology ahead, but my boards are done. Pretty much, it’s ob/gyn, full speed ahead otherwise.

I am going to be spending two weeks at a Family Planning rotation site. This will be my first rotation at my local ob/gyn residency program. Eek.

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Applying to residency

I filled out my ERAS (Electronic Residency Application Service) and sent it to fourteen obstetrics and gynecology residency programs. I also uploaded my personal statement.

I am doing a gynecologic oncology rotation this month. It has been great, but really busy. I have been working from before sunrise every day until after sunset most days. And this is Florida, so the days are long here. I was getting a touch of seasonal affective disorder / sleep deprivation crankiness last week. I had this weekend off, so I am feeling a little rejuvenated. We have seven surgeries scheduled tomorrow, so I am going right back into the fire.

I have one interview invite so far. I don’t have my letters of recommendation in yet, so I’m not completely freaking out. Yet.

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Board scores, driving, public health and applications

Sorry I have been so scarce. I have been doing a rotation at a community health center that is 90 miles from my house. I commute most days. The kids started school last Monday, and I have started doing doing ERAS, the electronic residency application.

I got my USMLE Step II scores back. (I am a DO student. I took both the COMLEX and the USMLE because I will be doing the MD match. If you want to read more about this, I wrote about it here) Since I talked about my scores for Step I to of how well I did, I guess I’m going to this time around.

I did really well. Very well. Much better than I thought I did. It should make it a bit easier to get interviews at MD programs, I hope. Now I am going through the application process and getting ready for elective rotations.

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One more board exam

Tomorrow I am taking the Step II COMLEX. Then, I am done with board exams until I am a doctor.

I would feel some relief, but that just means I need to get my applications to residency in, and then start the interview process.

Eep.

Wish me luck, please, for all of the above.

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All board review and no play…

I have my USMLE Step II CK on Saturday, and my COMLEX Step II CK August 1st. So, sorry I haven’t had time or mental functionality to blog much. I have tons of stuff I have wanted to share. Let’s see if my medical fact clogged brain can remember a few of them.

NPR has been rockin’ lately. First, I heard Morocca say “hula doula” on Wait Wait, Don’t Tell Me” recently. They have been running a really great series on birth called “Beginnings: Pregnancy, Childbirth and Beyond”. It included a great piece on elective inductions that provoked a lot of comments when I shared it on my Facebook page.

NPR’s Facebook feed also tipped me off to a new report by the Institute of Medicine, “Clinical Preventative Medicine for Women: Closing the Gaps” which recommends mandating insurance coverage of contraception,” since it is preventative medicine. To quote Rachel from Women’s Health News, “Duh!”.

In addition to copay-free coverage of birth control, the Institute recommended:
screening for gestational diabetes:

*human papillomavirus (HPV) testing as part of cervical cancer screening for women over 30
*counseling on sexually transmitted infections
*counseling and screening for HIV
*lactation counseling and equipment to promote breast-feeding
*screening and counseling to detect and prevent interpersonal and domestic violence
*yearly well-woman preventive care visits to obtain recommended preventive services

Hear, hear.

Anyway, I should be studying. Wish me luck.

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Sorta studying

I am doing daily board review. Today I did most of it in front of a Mystery Diagnosis marathon. That counts as review, right? I got a few of the diagnoses correct. And, I will remember the signs, symptoms and work up for the others.

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Night of the fourth year medical student

Yes, I am rising from the great beyond of rural rotations. I am, as of July first, a fourth year medical student. Hello, senioritis! I am doing a board review month. I am taking the MD and the DO boards. Soon. Eek.

I have a lot of posts jumbled around in my head. They may show up in one way or another soon, since I will want to procrastinate while studying.

Oh, and good luck to all of my former classmates who are starting their residencies. Double eek!

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Hands on in the boondocks

Howdy. I have been busy, as usual. Not only working at a new rotation site, which has been wonderful, but driving more than three hours a day to get to and from this site.

Our medical school requires that we do three months of rural rotations. I am doing two at a community health center in the middle of the state. The surrounding town is a farming town, with a large migrant population.

I am absolutely loving it. I am starting off with the ob/gyn, and we do gynecology, family planning and obstetrics. It is a very hands on rotation with an attending physician who is eager to teach. I have done many pap smears, STD tests, contraception counseling, cervical checks on full term pregnant women, and I GOT TO INSERT AN IUD. That plus a journal club, a training on human trafficking and a training on contraception compliance. Not bad for the first week and a half!

Our first two days consisted of orientation, and the longest time slot was given to the lactation consultant, who I love. She is working on a “Men and Women’s Health Day.” When I gently pointed out to the Medical Coordinator of the site that it was trans exclusive, they took me seriously. I am going to be the point person for any individuals identifying as trans (or anyone else who has questions in that area) the day of the health fair. Apparently they had some there last year and were at a loss. I am going to start with the resources linked to by Rachel at Women’s Health News and go from there.

I’ll try to check in again. If I could type while I drove, I’d have a ton of posts. Instead I am listening to board review materials. And looking at the swamp wildlife. And trying to avoid a speeding ticket.

I can easily see myself working at a community health center. This is totally my bag.

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Back from ACOG

I am back from the American College of Obstetricians and Gynecologists Annual Clinical Meeting in Washington DC. It was wonderful. I mostly stuck to the medical student track again.

Some highlights – I thought the lecture on Misogyny and Women’s Health by Dr. David Grimes was brilliant, and sad and hopeful at the same time. I was impressed that ACOG chose that topic for the presidential program, which meant it was on the main stage on the main day. Although many people walked out (I am hoping it was because the program was a little bit behind schedule and the exhibit hall was opening rather than people uninterested or challenged by the material), he still had a good sized audience, and received the only standing ovation I witnessed at the convention.

Stump the Professors was fun, as usual. The medical student program was well run and helpful. My favorite part, however, was when I decided to leave the residency fair early and head to the poster sessions. I got to talk to someone who did research on publicly funded community doulas for poor women, among other topics. I also got to interact more with people from programs I wish to apply to than there were present at the residency fair.

I was also really happy to talk to more than one practitioner about episiotomy, including a maternal fetal medicine specialist who does a lot of research, and have them say it is to be avoided, even when applying forceps.

Now I am trying to get back into the swing of life, and working on elective rotations and other school stuff. Ugh.

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When routine care is not evidence based care

I am studying for my shelf exam (my end of rotation exam, for those of you not well versed in the jargon) on ob/gyn. I am using one of a popular series of board review books. Every single question in the chapter on intrapartum fetal monitoring had the use of an intrauterine pressure catheter (IUPC), and most mentioned a fetal scalp electrode.

Shudder.

I am not sure what the prevalence is of IUPC use. I have not seen it in most of the labors I have been to, but I have definitely seen them used. In one labor I went to, the IUPC and/or fetal scalp electrode had to be replaced three times because of problems.

As far as I know, there is no evidence supporting their use. I found this article, which is a rare randomized trial with a significant number of subjects. There seems to be no advantage to using them. When that is the case, I think it is only ethical to use the less invasive intervention, which would be external monitoring.

There are a few quotes I find interesting in this article. Here’s one:

“The American College of Obstetricians and Gynecologists (ACOG) and the Society of Obstetricians and Gynaecologists of Canada (SOGC) advise the use of internal tocodynamometry in selected circumstances, such as when the mother is obese, when one-on-one nursing care is not available, or when the response to oxytocin is limited. The Dutch Society of Obstetrics and Gynaecology recommends its use in all cases of induction or augmentation of labor.2″

Well, I have never seen one to one nursing in labor and delivery in a hospital. Never.

Also, here’s another one:

Induction or augmentation is necessary in approximately 20% of all deliveries, and internal monitoring is thought to quantify the frequency, duration, and magnitude of uterine activity more accurately than does external tocography.1-3″ (Emphasis mine)

Wow, really? Unfortunately, there are poor statistics on the prevalence of interventions in labor, but Listening to Mothers cites an induction rate of 48% for first time moms, and “Only 41% of the women had a labor that began on its own.” This link didn’t have the statistic for augmentation, but from what I remember, more than 70% of labors were augmented by oxytocin.

So, 20% of that is necessary, and what does that make the rest? Depends on who you ask. Some practitioners will say it is active management, aka “doing what we can to get the baby out…that’s what you’re here for.” I call it excessive interventions that lead to possible iatrogenic risk.

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