Your OBGYN rotation is a 6 week block broken up into three 2-week sections including: 2 weeks OR, 2 weeks labour and delivery (LDR) and 2 weeks of ambulatory/office.This rotation can have longer hours, but is be very rewarding work.

During this rotation, you will see the full scope of practice of OBGYN and have the opportunity to work closely with a variety of health care providers including LDR nurses, midwives, family physicians, family residents and OBGYNs.

In Prince George, all of the uncomplicated pregnancies and vaginal deliveries are followed by family doctors. You will end up working very closely with many of them in LDR. They are used to having learners around and are often very keen to have you involved in patient care. Family doctors also scrub in as first assist if their patient goes for a C-section.

The OBGYNs handle more complicated deliveries and all C-sections. You will work with them more closely during your OR and ambulatory portions of the rotation, but you will see them around LDR managing the more complicated labours.

OR: During your time in the OR, you will spend each day with a different OBGYN. You will be able to find the procedures and operating surgeon on the OR slate. It is a good idea to look at the slate a day ahead so you can review the anatomy and indications of the planned procedures. Each morning, you can arrive around 7:15 to review the patient's chart and introduce yourself to the patient. After introducing yourself, you can start writing the OR note and post-op orders. If you are unsure what to fill out for a certain section, you can consult with the OBGYN after the case. For cases that are admitted to the hospital following the procedure and C-sections you are a part of, you will round on them each morning before the OR starts.

Ambulatory: During the ambulatory blocks, you will be working in the office with different OBGYNs. You will be given your schedule ahead of time. It is a good idea to phone the OBGYNs office and double check your start time a couple days ahead, as their schedules are often changing. In office, you will have the opportunity to take histories and do physical exams/ pelvic exams. Common presentations in the office include abnormal bleeding, pelvic pain, infertility and complicated pregnancies. During this rotation, when you are on call, it is only until 11pm as you are expected to be in office the following morning. If you have patients who delivered while you were on-call, you need to round on them before you go to the office.

LDR: During your LDR block, this will be your main opportunity to engage with the obstetrical portion of the rotation. You will be involved in assessment of pregnant women, management of labour and delivery and postpartum care. For this part of the rotation, it is important to make yourself present and engaged on the ward. During the day, if you aren’t there, the nurses aren’t likely to call you. However, if you invest your time and show you are interested in being part of a patient's care, they are more willing to have you involved. The daily flow starts at 7am where you can listen to handover at the nursing station. If you have any patients whose deliveries you were involved in, make sure to round on them in the morning. Women will come in throughout the day for assessments, which you can be involved in. If a woman starts labour and you are involved, make sure to be checking in on her every couple hours and writing a progress note to track her progress. If there are multiple women labouring, it can feel overwhelming and as though you should be involved in all of their care, however it is often better to just focus on one patient. Once a patient starts pushing, you can potentially be in the room for hours. If a patient is to go for an emergent C-section and you have been involved in their labour, you will assist with that C-section.

On-call for this rotation is overnight, in-house call. Generally, if you are on OR or ambulatory, call will start at 5pm, but when you are on LDR, your call shift will start at 7am when you start your shift that day.

When you are on-call, it is mainly for LDR, so basically the duties are the same as if you were on the LDR portion of your rotation. It is important to write your name and phone number on the white board in the LDR nursing station. If there are any pink-slipped (emergency) OBGYN procedures happening in the OR, you can also be involved in those. Finally, if there are any consults that come into the ER (usually gyne consults), you may be asked to see them by the OBGYN. When you are on-call, like on your LDR block, you will mainly be involved in assessments of pregnant women and managing labour and delivery.

When you are on-call, you do not need to stay up all night! If there is nothing happening, then go to bed! However, if you have a patient who is labouring overnight, you should wake up every couple hours and go down to check on them and write a progress note. If their labour starts to progress more quickly, the nurses will likely call you. For ambulatory block, you are only on call until 11pm so you can go to the clinic the following day.

On the LDR block, you are post-call at 7am, but make sure to round on your patients (if you have any) before you leave. For OR rotation, you are expected to stay for the first MAJOR case (C-section, hysterectomy…) of the day. Following that, let your operating surgeon know you are post-call and go home. They are quite good about letting you go home if you are post-call.

When it comes to LDR, the nurses are one of your best resources. Make sure to introduce yourself to all the LDR nurses and take time to build relationships with them. They are often the gatekeeper into patient care in the LDR, so if they trust you, they are more likely to involve you.