Jul 25 - Aug 8
1) We are entering the last few days of clinical teaching before our exams (Obstetrics & Gynaecology). It has been a hectic two weeks, as we juggled between morning bed-side teachings in the wards, filling in our clinical logbook, as well as completing our case write-ups in time. Thankfully, all of that is a thing of the past. Monday will be our final bed-side teaching before our O&G end-of-rotation examinations on Thursday / Friday. This is followed by a 9-day study break before the end of fourth year examinations, consisting of written papers and a 20-station OSCE practical session.
2) Let's see if I can explain how the clinical exams work. Each exam candidate is assigned a patient, either in the obstetrics ward or gynaecology ward. We are given around 30 minutes to obtain a coherent history (i.e. ask the patient questions) and perform any physical examinations as we see fit. Then, we have a 20 minute session with two examiners, which will include presentation of the case, demonstration of the physical examination, as well as discussion on management and long-term follow-up. That's basically it.
3) Looking back at the rotation, I have found obstetrics and gynaecology to be very interesting and challenging at the same time. Doctors frequently remind us that the job scope involves managing the long-term care of not one but two lives - that of the mother and the baby. Also, a lot of management decisions (especially during labour and delivery) is time-sensitive - there is absolutely no room for any delay whatsoever. A good example would be when my friends and I were awaiting a mother to deliver in the labour ward. Having waited for more than an hour, we decided to go outside to take a breather. A few minutes later, we returned - only to find that she had already delivered!
4) This rotation also made me aware of the sacrifices that mothers have to make - before, during, and after birth. Going into the rotation, I was aware of the pain and stress that comes with childbirth, but nothing could prepare me for actually being there as it happens. We witnessed various types of delivery, including spontaneous vaginal deliveries (natural childbirths), assisted deliveries (vacuum, forceps), and C-sections. Babies who were delivered healthy and well would be immediately placed on the mother for skin-to-skin contact and subsequent breastfeeding. Babies who were not active or not breathing well would be immediately handed to the paediatrics team for neonatal resuscitation and evaluation. This further highlights the importance of inter-departmental coordination, specifically between the O&G team and paeds team.
5) In the gynaecology department, the doctors manage patients with reproductive system issues. A common presenting complaint is abnormal uterine bleeding, which comprises heavy or prolonged periods, painful periods, irregular periods, reduced periods, or absent periods. There is a laundry list of causes to explain these symptoms, ranging from mild, benign causes all the way to cancerous causes. Therefore, women are constantly reminded of the need to undergo regular pap smears, especially with advancing age. During my posting, I had the opportunity to clerk patients with fibroids, cancers, and miscarriages. It also taught me how to approach sensitive issues (e.g. past relationships or sexual partners, past miscarriages or C-sections) with tact and diplomacy. All in all, it has been a huge learning curve for me.
6) It has been a great experience thus far, and hopefully the exams will go smoothly as well. I'll end my blog post here, as I should probably get back to work haha. Thanks very much for visiting as always, and have a great week ahead. Stay safe and stay happy, cheers!
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