Site/ Medical Education Coordinator: Dr. Rebecca Cherniak (Rebecca.cherniak@nygh.on.ca)
Site/Medical Education Administrative Assistant: Enela Lumshi (enela.lumshi@nygh.on.ca)
Welcome to the North York General Hospital Obstetrics and Gynecology rotation. You will have a one-month rotation as an R1 and a one-month rotation as an R2.
The focus of R1 will be on in-patient OB with some gynecology. The obstetrical services include obstetrical triage, labour and delivery, and postpartum care. You will have some exposure to the gynecological service through the gynecology ward, emergency room consults, and assisting in the OR.
In year two, you will have exposure to outpatient office-based practice. These clinics are a mixture of obstetrics and gynecology. You may also have exposure to special NYGH Clinics, which include Amniocentesis and Genetics, Early Pregnancy Assessment Clinic (EPAC), and Biophysical Profile (BPP). During this time, you may also be spending some time on labour and delivery and some inpatient time.
Ensure that any vacation/conference day requests are submitted early, preferably two months prior to the start of your rotation to your OB-Gyne Chief Resident. There will be multiple residents on the service, and only 1-2 residents can be on vacation at any given time. Time off is granted on a first come first serve basis.
The Obs/Gyn Chief Resident is responsible for creating the call schedule. A few months prior to the start of your rotation, the chief resident will contact you and ask for requested time off, half day back, academic half days, and other requests. Make sure you indicate which nights and weekends you cannot be on call and give a first and second choice for vacation weeks including a commentary on what the request of vacation is for (ie wedding, etc). Approximately 1-2 weeks prior to the beginning of the rotation, you will receive a daily schedule (obstetrics, gynecology, or float), as well as a call schedule.
You will also be emailed a resident orientation document. Please read the document prior to the start of the rotation. Orientation takes place on the first Monday of the block. Meet at 7:00AM, at the designated location (usually 2nd floor Rm 2E-278, but this may change).
When you are on L&D, you will be working directly with the ObGyn Staff on call. Note that they do 12- hour shifts (0700 - 1900 and 1900 - 0700) - New changes are coming for the OBGYN call requirements - This page will be update once officially announced.
Triage
At triage, you will evaluate all obstetrical patients for any complaints. Take a focused history and perform appropriate physical exam. You should be supervised when doing any vaginal exams. Formulate a plan and review with the staff (either on call or MRP). Do not send anyone home without reviewing with staff. Do not examine patients under 34 weeks GA without discussing with staff first (they may need a fetal fibronectin test).
Labour and Delivery
Sign up for labouring patients. The first on-call OB is responsible for all deliveries. Follow the patient until delivery or until the end of your shift. You may also be called to assist at all C-sections. There is a second OB on call who is in-hospital from 8 AM to 5 PM during the week - they assist with C-sections and will be managing/delivering any of their own patients on labour and delivery. The elective C-sections are usually daily at 8AM, 10AM, 12PM and 215PM. There may also be booked external cephalic versions on Tuesday and Wednesday afternoons at 215PM.
Postpartum Care
If you are assigned to L&D, meet on 2W every morning at 7AM to round on all antepartum patients, postpartum C-section patients, and postpartum complicated vaginal delivery patients. You are responsible for writing a clinical note on all of these patients and dictating patients that are being discharged using DynDoc.
There is a "Scut List" of non-urgent issues that need to be dealt with at 8am, 2pm and 10pm.
When you are on Gyne, you will be working primarily with the Chief Resident (CR). The CR will organize morning and afternoon rounds. You will review all consults and ward patients with the CR.
OR
Occasionally, you will need to assist in the OR. This is an opportunity for you to solidify your understanding of pelvic anatomy and of common gynecologic procedures and indications.
Inpatient Coverage
If you are assigned to Gyne, round on gyne inpatients every morning at 7AM on 5North. This will be organized by the CR. You will also round on gyne inpatients every PM after ORs are completed. After PM rounds, you will help handover gyne inpatients to the resident on-call. Note that Termination of Pregnancy (TOP) patients are rounded on only by the chief resident. However, overnight emergencies will be dealt with by the resident or staff on-call.
ER/Ward Consults
Consults during the weekdays are to be reviewed with the CR or the second on call Gyne staff during the weekdays. On nights/weekends, the consult must be reviewed with the staff on-call. If the patient is unstable, inform the CR and/or Staff immediately. All ER and ward consults need a brief dictation. All inpatient gyne patients need a discharge dictation as well.
After 6pm and on weekends, you will cover L&D, post-partum, gyne, and all ED consults. Weekday call is 7AM to 6PM while weekend call is 8AM to 6PM. The schedule is set by the CR.
There are Grand Rounds on Wednesday mornings. City-wide rounds take place on Friday mornings. There is a schedule posted in the resource room on the L&D floor. Your CR will remind you of these rounds. You are expected to attend even if post-call.
In addition to rounds, there is formal resident teaching every Friday from noon-1PM in room 278. This is mandatory unless you are post-call. You must inform your clinic supervisor Friday morning that you will need to leave early to attend this teaching. The topics include: technical skills workshop (week 1), review of fetal heart rate tracings (week 2), OBGYN bread-and-butter talk by FM OB (week 3), and SOGC guideline review (week 4).
Guide to Labour & Delivery (Originally made for clerks doing their OBGYN rotation at NYGH)
At the end of your rotation you are expected to have gained experience in the areas listed below:
Initial assessment of patients coming in through the assessment / triage room.
Accurate vaginal examination and continuing care until delivery.
Be competent in performing a normal vaginal delivery.
Be competent in identifying a normal FHR tracing (fetal heart rate) and be able to identify abnormal FHR tracing.
Understand methods of induction of labour.
You should be also be comfortable with the following skills:
Perform a safe artificial rupture of membranes
Manage induction of labour
Repair of uncomplicated vaginal and perineal lacerations
Repair of episiotomy
Assist at forceps and vacuum delivery
Assist at cesarean section.
Suggested Reading Topics
Below are some suggestions regarding learning topics.
Preconception
Risk assessment
Preventative care
Antenatal care
Risk assessment
Screening tests
Fetal assessment
Common symptoms
Evaluation of bleeding
Infections
Hyperemesis
High risk pregnancy
Multiple gestation
GDM
IUGR
3rd trimester bleeding
Post-dates, Premature labour, PROM
Labour & delivery
Fetal assessment
Labour patterns
Induction
Analgesia
VBAC
Delivery positions
Post-partum care
Common concerns
Breastfeeding
Fever
Depression
Psychosocial issues
Family adjustment
Sexuality
Medications in pregnancy and lactation
Pregnancy loss
Residents are continuously being evaluated by the staff they work with (doctors and nurses). The rotation requires at least 6 completed evaluations in order to complete your rotation evaluation. Ask the staff to fill out an evaluation before the end of their shift. These encounters can be a single clinic encounter or even a full call shift. The OB staff usually hand-over at 7am and 7pm.
Residents are encouraged at any time to feel free to discuss any concerns that they might have with the educational leads.