OBGYN Evaluation Reflection: For my OBGYN rotation, I presented a 25-year-old patient, who presented as a 28-week pregnant patient complaining of an allergic reaction after eating shrimp. Per the protocol at Woodhull Hospital, any ED patient who is more than 28 weeks pregnant must be sent up to labor & delivery once stabilized by the ER staff. This was the first interaction I’ve had with a pregnant patient in an emergent situation. The midwife allowed me to do a first initial encounter with the patient and to present her to the on-call L&D attending. I felt that my skills in presenting a patient have significantly improved from my first few rotations earlier this year. I was able to give a concise picture to the OBGYN attending as well as helping to formulate a plan going forward. The patient was monitored in L&D for twenty minutes on a monitor as per the attending’s plan. Luckily, the patient recovered well and had absolutely no contraction, rupture of membranes, or other indications of premature labor. This was a valuable experience for me as it was a new type of patient I was able to present and assist in treatment planning. I felt this patient was important to present as it was a fairly uncommon presentation, and I was able to discuss my approach with my evaluator as well as receive helpful criticism towards my H&P writing skills.
OBGYN Article Summary: I chose to present an article that discussed the efficacy of education and testing for STIs in teens and young adults, specifically chlamydia and gonorrhea. A total of 27 articles were included in a meta-analysis of chlamydia testing and education in several countries, including the US/Canada, Europe, Australia/New Zealand, and Asia. Programs involved classroom-based screening, opportunistic screening at school-based health centers, opportunistic screening during routine health/sports physical examinations, voluntary screening at health centers, screening at other on-campus locations, event-based screening, and other strategies. Unfortunately, only 5 of the 27 programs reported outcomes for their screening/education programs for teens/young adults. This systematic review calls into question the idea that most guidelines, while recommending testing in the teen/young adult age group, only test for chlamydia opportunistically during visits for other reasons, and retesting rates are fairly low for the number of positive cases. This is an issue as a test-of-cure is a necessary part of the eradication of STI infections and preventing transmission as well as antibiotic resistance in the future. I appreciate that this systematic review calls for the need for studying the effectiveness of current educational programs. Ultimately this study proves that screening for chlamydia and gonorrhea in educational settings is a feasible approach to screen large numbers of young people and to identify and treat new infections. Also, Mathematical modeling in Australia has predicted that screening 40% of men and women younger than 25 years annually would decrease chlamydia prevalence rapidly for 10 years in all age groups.
OBGYN Self Reflection: During my OBGYN rotation I was exposed to a new branch of medicine I’ve had almost no experience with. Having had a background in radiography prior to PA school, pregnant patients were usually one type of patient I never performed a study on. I found obstetrics specifically to be very fascinating. The realization that two patients, not one, are being seen during an OB visit was an interesting concept for me to wrap my head around. Also, the types of H&Ps I wrote were very focused and new for me. I had written a focused psych H&P with accompanying mental status exam as well as other psychiatry patient reporting tools. However, OBGYN required specifics tailored to female patients only. I had to learn so many new medical abbreviations as well, such as ROM (rupture of membranes) and how to properly report a patient’s prior obstetric history. Luckily, I had an opportunity to practice writing several SOAP notes for OBGYN patients while working in the clinic during this rotation. I learned how to properly report subjective aspects to an OBGYN history as well as reporting of women’s health-specific objective information in my physical exam. Also, I learned to be even more physically gentle and empathetic towards the patients I saw. Often times the situation surrounding these patients was very emotional and required a kind and patient approach. Both miscarriages and patients with unwanted pregnancies were going through emotional turmoil while being seen by myself and my preceptor. This rotation definitely helped me to be more sensitive to my patients. Women’s health is truly its own large specialty and requires highly trained and specialized healthcare professionals to keep both mother and baby safe.
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