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A “sub-internship” or “acting-internship” is typically a 4-week rotation in your fourth year of medical school where you act at the level of an intern- aka a first-year resident. This is the time in your medical school career that you’ve been waiting for! You finally get to focus and fully be involved in the specialty you have chosen. Yay! So proud of you for getting to this point. Let me tell you a little about my experience and then give you some tips to “not only survive, but to thrive” as an OB/GYN sub-I!

Before I get into the tips, let me tell you guys a little bit about my headspace going into my rotation. At this point, I had been out of school for a full academic year after working at The Dr. Oz Show. I was so ANXIOUS AND NERVOUS about going back to school. Typically the sub-internship is 4 weeks like I mentioned above, but I started out with an additional 2-week rotation in Maternal-Fetal Medicine-so basically my rotation was 6 weeks. There were a bunch of other hurdles, like not having EMR access that just had my mind all messed up. I let imposter syndrome get to me and put so much pressure on myself during my first two weeks that it messed me up and stopped me from learning and adapting the way I would have liked. I was lucky enough to have residents that were understanding and also willing to teach, but I also had to put in work and not make excuses for myself once I had a better grasp of what was required of me. If I could go back, I would tell myself to RELAX. Just do your best, be teachable, and willing to learn. Listen, the residents and attendings do not expect you to know everything. They do want to see you improve over time and take initiative with the things that you can do! You are not a third-year anymore, put a little pep in your step and stand up just a little taller.

Okay so here are my tips for the sub-specialties I worked in (this may vary based on your institution or if you are doing an away rotation in a particular subspecialty):

General

  • If you haven’t already, get your ACOG student membership (IT’S FREE.99) and download the app. You will use this to stay up to date on news in the field, for practice bulletins, and the app has a gestational age calculator that you will use on every patient you triage! Don’t forget to add “ACOG student membership” to your CV for when it’s time to applying for residency.

  • Straight up ask your intern what you can do to help them out. How do they want you to present patients? What are little things they often need to do, but it takes too much time? One of your main goals is to make sure your intern’s life is slightly easier with you around. Once you learn those skills, you become a valuable part of the team rather than dead weight and you also start to feel more like you’re going to be a doctor in that specialty!

  • Figure out your glove size and remind yourself how to scrub if it has been a while!

  • Learn how to insert a Foley catheter- you will do this a lot!

  • Practice knot-tying (both one-hand and two-hand knots) and suturing. Ask for the unused suture to practice at home or when you have downtime between cases.

  • A great way to impress your residents is to spend some time teaching the M3s you are with. You can ask them what topics they have issues with you guys can discuss it together. You don’t have to necessarily lecture them, but you can lead the discussion and give them any tips that you used to remember things.

  • You may be asked to make a presentation during your rotation, ask residents if they have any ideas on particularly interesting topics, and try to start working on it early so you aren’t cramming for this towards the end.

  • I’m convinced that OB/GYN residents do not sleep, eat, or use the restroom. Have granola bars, protein bars, or any other quick snacks on hand because time goes so fast and so much is going on that you might forget to eat!

  • Ask for feedback from your resident within the first few days. It will help you gauge what you need to improve on and also shows them that you care about doing better!

Maternal-Fetal Medicine

  • Get the clinic patient list for the next day and chart review either the night before or early in the morning. Ask the resident if you can see specific patients that you extensively reviewed. Present to the resident, then present to the attending.

  • If your patient needs labs, vaccinations, etc discuss with your resident what needs to be ordered (they already know, but it shows that you are thinking about your patient’s needs) and make sure you say that in your assessment and plan to the attending. You will look like you are operating at the level of a sub-i who now thinks critically about the next steps for your patient.

  • Read the practice bulletins on:

    • Gestational Hypertension

    • Gestational Diabetes Mellitus

    • Preeclampsia

    • Chronic Hypertension

    • Thyroid disease

    • They are many more, but I started with these and then read bulletins based on what patients presented with in the clinic

  • Preround on your patients on the floors- know the events that occurred overnight, get their vitals, go examine them, write your progress notes

  • Be ready to take the ultrasound to go round on patients with your resident

Labor and Delivery

  • Introduce yourself to multiple patients on the labor floor. You never know when you may just have to run in there and you want to make sure that the patient knows who you are.

  • Have a piece of paper with the parity of each patient, the gestational age, time of their last exam, and extra credit info like if they got an epidural or Pitocin, do they have any antenatal issues? Keep this is in your pocket to glance at it before entering each room

  • Know the 3 stages of labor

  • You better know the basics about fetal heart tracings (FHT)!

  • Management of shoulder dystocia

  • Signs that the placenta is delivering

  • Read the practice bulletin on Management of Preterm Labor

  • Layers of the abdominal wall

  • Postpartum hemorrhage signs and management

  • Pay attention to the board – when is it time for your patient’s next exam? What is the FHT looking like?

  • When it was time for a patient to start pushing, I would get my gloves and gown and put them in the room- often the delivery carts at my institution were only equipped for the resident and attending. You want to be ready, if they let you deliver the baby!

  • I eventually memorized the pertinent questions that were needed for triaging patients and that helped me improve my speed with asking H&P questions- this comes after a few days!

  • Do the H&P for the scheduled C-sections- do not wait to be asked to do this. Just say to your resident “I’m going to do the H&P for the 3 pm C-section.” or even better just go do it.

Gynecology

  • This is a surgical specialty- you will start early and end late!

  • Come in early to get vitals for all the patients on the list

  • Check with your resident if they would like you to preround on any particular patients. Or take initiative and go see the patients whose case(s) you were in the day before.

  • Update the list throughout the day- who got their labs, any social work issues that you can call to get an update on?

  • Does the team need you to update the OR schedule? Ask them if this is something they need you to do

  • Learn about how the team needs H&Ps to be done for surgical cases of the day- often you will just need to confirm the patient’s history

  • Help your resident out by texting them when the patient is being rolled back to the OR- often they have to go see ED consults or are seeing other patients

  • Be prepared to go see GYN consults in the ED

  • Introduce yourself to the circulating nurse and scrub tech BEFORE the patient is in the room. Let them know that you will be scrubbing in and ask if you can retrieve your gloves and gown. THIS IS VERY IMPORTANT. You’d be surprised how often students don’t introduce themselves.

The things I’ve listed here are obviously not an all-encompassing list, BUT if you have this list on your radar you’ll be in a much better position than I was when I started. I know this may seem overwhelming, but I promise you that you adapt quickly because you have no choice. We chose a fast-paced field and you either get with it or get left behind! lol

As always, if you have any questions or need a word of encouragement, leave a comment here or DM me on IG @afrosandanatomy. YOU GOT THIS!

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