Obstetrics & Gynecology

     Everyone in the OB/GYN rotation is required to do a case presentation for Dr. Stubblefield (OB/GYN Chairman) and Dr. Brown, which is 20% of your grade. The rest of the grade is 20% board-type exam, 20% oral exam, 20% evaluations and 20% practical exam. The practical consisted of about 30 slides set up in the clinic that required you to read ultrasounds, identify gross pathology, interpret fetal heart strips, interpret hysterosalpingograms, etc....and then answer questions. There is also the "practical" part in which you will go through about 10 stations and will be expected to perform a number of obstetrical and gynecologic skills on professional patients (i.e. live women). There are didactic sessions everyday from 4:30-6 PM and oncology lectures on Fridays.

This rotation was phenomenal at BMC. Each block is divided into three groups, and each group rotates through labor and delivery, inpatient gynecological service, and "Dr. Brown's Clinic" (which includes other specialty clinics, i.e. High Risk, Colposcopy, STD). Call is overnight for both labor and delivery and for GYN Surgery and depends on the number of students in your assigned group. There is no call when you are in the clinics.

Dr. Brown’s clinic is the highlight of the rotation. You will become very comfortable with the pelvic exam, pap smear and cultures, sizing the uterus (make sure he brings out the different sized balls--they really help!), and many other issues. You will have a two-hour interactive/didactic session (which is VERY helpful) in the morning with Dr. Brown, after which you will have breakfast, and then start seeing patients at 9:00 AM. You may be asked to present a topic (like IP sessions) that came up in regards to one of your patients during the morning sessions. Remember—no matter how comprehensive your research is, Dr. Brown will still have enough to talk about for 1-2 hours! The one drawback to clinic is that you will not have time for lunch, so if you get cranky without food, make sure to bring something to munch on while you are working on charts. Basically, Susan Mahair (Dr. Brown's right hand) directs the entire clinic rotation so if you want this portion of the rotation to go smoothly DO AS SHE SAYS.

On Labor and Delivery, most students, depending on the census, get to assist (and in some cases, actually deliver) in deliveries both vaginal and cesarean sections. To maximize your experience, stay close to your resident and intern as well as the midwife on call. If you are interested, they will be more than willing to get you fully involved. Not only do you participate in deliveries, but also get a chance to triage patients who come in with bleeding, preterm labor, etc.

During GYN surgery you will see patients in the ER, see cases in the OR and follow patients on the floor. In your group, 1 person will be sent to ENC. At ENC, you will see more oncology cases whereas at HAC you will get to see more "bread and butter" (i.e. hysteroscopies, lap tubal ligation, hysterectomies, etc.) This is very similar to the general surgery rotation. Students must cover ALL cases. For those not in the OR, you will follow the Gyn consult person.

OB/Gyn at Framingham is busy but rewarding. The clerkship is designed such that students spend 3 weeks on Labor and Delivery, and three weeks on in-patient gynecology. Students also participate in three weekly clinics: Tues 6 PM-9 PM, Thurs 6 PM-9 PM, and Fri 9am-12noon. The call schedule is usually q4 or q5 the entire 6 weeks (including weekends), which is more call than your classmates will have at B.U.

The teaching at Framingham is definitely a strong point. Unfortuately, the current chairman of the department is leaving in June 2000, but the other faculty members are also very interested in teaching students and residents. B.U. students usually work with 2 Tufts medical students; in addition, there are usually two 3rd year residents and one 2nd year resident.

Students at Framingham come back to Boston on Wednesday mornings for lectures, but the rest of the time is spent at Framingham. I would also recommend an EZ pass for those students doing their rotation at Framingham.

In all, the rotation at Framingham provides an excellent foundation in OB/Gyn. Your experience is very much self-directed, and if you show interest, the faculty and staff are very receptive and will make the rotation very rewarding.

Swagata Mandal, ‘00

I chose to do my OB/GYN rotation last year in Framingham because the idea of working with Dr. Brown scared me to death. I later learned that his bark was worse than his bite and that students had a great experience at BMC, but I feel that my experience at Framingham was just as good, if not better. Students don’t lose out by not being at BMC.

Dr. Blanchette is the chairman of the department there (unfortunately, I heard that he leaving), and he is definitely an advocate for the students and for their learning. He spends a great deal of time teaching the students each week and has arranged a daily lecture schedule, to be given by the different attendings. The lectures cover most of the important topics in OB/GYN (i.e. those that show up on exams). Given the nature of the specialty, expect a lot of deviations from the initial schedule. Although intimidating at first, Dr. Blanchette is an excellent teacher and leaves the students well prepared for both the written and oral exams. His enthusiasm and confidence are contagious.

The hospital is shared between students from BU and students from Tufts. The call schedule is divvied up among all the students, and the time on either the OB or GYN service is split up as well. Of course, the frequency of call depends on the number of students there. The residents are from both the BI and NEMC.

The OB service is busy, with about 10 deliveries per day, and 1 or 2 C-sections each morning. The patients are mostly private, and their individual attendings have varying levels of comfort with student involvement. Once you have worked with an attending a few times, he or she is usually willing to let you do part or all of the delivery. I think that every student gets to "catch a baby" during the rotation. The clinic patients are covered only by the residents, and those deliveries are the ones in which students have the most involvement. As a tip, if you want to do some studying, save the OB part of the rotation for the second half, as there is a lot of down time on the L&D service.

The GYN service is usually pretty busy, but all the cases are usually done by 4 or 5. The surgeries are routine GYN cases. Many vaginal hysterectomies (stay away from too many of these—for medical students, the vag hyst usually means retracting for hours in a cramped space), laparoscopic surgeries, and D&Cs. "Open" cases are not as common, and are pretty interesting. Gyn Onc cases are rare. Every once in a while something freakish comes along, like molar pregnancies or teratomas with hair and teeth.

Unlike the OB/GYN rotation at BMC, there is no separate "clinic" rotation. Instead, there is clinic several mornings a week, and one evening clinic to 9 or 9:30 every week as well. There is also a high-risk clinic for which only the on-call student is responsible. Also, there is an "optional" Teen Clinic where all the providers are female. At times it seemed unfair that since I was the only female student in my rotation, I had an extra clinic. In the end, it was a lot of fun working with adolescents, and I did a lot of teaching. Sue Mahoney, the nurse who runs the clinic, makes it all worthwhile.

There are really three disadvantages of doing OB/GYN at Framingham. One is the commute—35-45 minutes via Route 9, opposite the direction of traffic. The Masspike is another option, but of course costs money and is only 10-15 minutes faster. The second disadvantage is the fact that students take call throughout the duration of the rotation, whereas students at BMC have a reprieve from call while they are on the Clinic service. The third disadvantage lies in the day-to-day running of things. Things are fine from an administrative point of view, but fall apart when it comes to running the "service," since there isn’t really one. Residents are required only to cover and follow-up on clinic patients, and rounding doesn’t happen (which may not be a disadvantage, I guess…). Also, while Dr. Blanchette is in charge of formal teaching, the residents are in charge of your floor experiences. Since objectives there are never really made clear, there is a lot of uncertainty about the students’ role(s) on the floor.

Overall, I think Framingham offers an excellent OB/GYN experience in a community setting (i.e. the "real world" for many people). You get to see how smoothly things run away from BMC, and also get to work with a different patient population. Dr. Blanchette is a great advocate and resource, and students never have another opportunity to work so closely with a department chairman. The rotation there prepares students well for both the oral exam and the written one. (Also, Dr. Blanchette has a very erudite way with words, which comes in handy when you’re looking for people to write coherent letters of recommendation for residency.)