All entries for May 2017
May 30, 2017
Obstetrics and Gynaecology continued…
We’re about halfway through our fourth specialist rotation of the year and the pace is still, shall we say, energetic. Things are going well but it takes a lot of effort to keep our noses to the grindstone at times! We look on with envy at the students in the year below us who had the last week off, bringing back fond memories of 2016! (We haven’t had a break yet.) Anyway, we are still on our Obstetrics and Gynaecology rotation right now and it’s been really interesting to see all of the issues that clinicians in this speciality confront on a regular basis.
So far, the block has been going well. Although the focus is heavily on female anatomy for obvious reasons, I’m also liking the fact that the Genito-Urinary Medicine clinics are for both sexes and cover lots of different presentations. Aside from a week with midwives and on a labour ward in our second year, we aren’t provided much exposure to the O&G side of medicine from a practical and real-life perspective until this clinical rotation. We have loads of lectures, but it’s all been very conceptual and didactic – and not very hands-on. But this all changes once we are in Phase III. At our hospital, the education coordinators have been doing a great job of giving us extremely varied exposure to different clinics and theatre opportunities, and it’s been a good form of revision.
Most of the procedures we have seen have been relatively routine, including hysteroscopies (inspection of the uterus with a little camera at the end of a tube – very similar in concept to a colonoscopy), excisions of suspicious cervical tissue and even caesarean sections. It’s been like Block 5 (Reproduction and Child Health from year 1) come to life!
Theoretically, a woman can progress through an entire pregnancy in the UK and never need to see a doctor, provided that the pregnancy is low risk and that everything progresses normally and without issue. As I’ve learnt, normally patients are referred to specialists only if there are concerns about the mother’s or the baby’s health during the pregnancy, the delivery or the post-partum period. These are the cases that we tend to see these days – and this has taken a lot of getting used to for me, since midwives don’t really exist in my country of origin, in which almost all babies are delivered by doctors. Anyway, when women are referred to neonatal clinics staffed by registrars or consultants, they usually have a condition that requires additional monitoring and support (although sometimes it’s the baby who requires attention). I’ve seen lots of endocrine issues, some obstetric cholestasis, some social-care issues and even saw a baby with a very high chance of being born with Down Syndrome who required some extra monitoring. All in all, it’s been a fascinating glimpse into the variety of humanity and I’ve loved what I’ve seen so far.
John
Luke Pemberton
30 May 2017 15:37
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May 16, 2017
Obstetrics, Gynaecology and So Much More…
In our fourth clinical rotation, my clinical partner and I are focusing on obstetrics and gynaecology for the next six weeks. It’s a very interesting lead-in from the paediatrics block, although in some ways it might make more sense for us to have done this block first – paediatrics focuses on (among many other things) babies once they’re in the open air, whereas O&G looks at them from conception through birth. But of course we have already learned a lot about both topics anyway in previous years and this is just getting stuck in more deeply. Block 5 in our first year specifically focused on reproduction and child health, and Warwick’s spiral curriculum means that we are (as always) building on knowledge that we have already gained. Needless to say, I’ve spent a lot of time revising hormone axes and reproductive anatomy from year one!
So far, a lot of our time has been spent in clinics and in teaching, and we are seeing a lot. It’s good to spend some time seeing a variety of gynaecological presentations, especially because the sensitivity of the presentation means that our opportunities to learn from observation in real life have been limited in the past. We’ve seen a lot of textbooks and Power Point presentations. Gynaecological details can be very personal, but of course they are an important part of medicine and so it’s really helpful that we’re getting such exposure throughout this block.
We don’t just pay attention to gynaecological health, of course. Our block also focuses on obstetrics (the health of pregnancy and childbirth) and sexual health as well. Obstetrics is a fascinating part of medicine to me for many reasons. Foetal embryological development plays such an important role in our health throughout our lives. We saw some childbirth and midwifery in our second years, but that was five days in total – this is six weeks, complete with very well-defined learning outcomes and lots of focused teaching. And at the risk of sounding obvious, being born is literally the most common human condition – everyone goes through it. The maternal-health aspect fascinates me as well – when I hear about some of the conditions that some women present with, it makes me grateful that we live in an age of modern medicine. Even one hundred years ago, lots of these conditions could have been a death sentence.
As mentioned above, we also look at sexual health and have spent some time in genito-urinary medicine (GUM) clinics. This is an area that I’ve been interested in for years – and maybe after qualification I will try to pursue it as a career. Dealing with presentations in this area is a fine art. Since it’s so personal, it’s necessary to be extremely sensitive and ensure that you have a patient’s trust at all times. But of course clinicians can’t be embarrassed or ashamed of discussing intimate details with patients. It’s all part of the (very interesting!) job. All of the people I’ve worked with so far have been models of professionalism, and I hope to be the same when in their position. I’m really looking forward to seeing more in this block!
John
Luke Pemberton
16 May 2017 09:06
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