Sunday, August 30, 2009

The Learning Curve

I’m finally finished with my first OB rotation! The moment is bittersweet. I love obstetrics. It is exciting, emotional, and empowering. It is also one of the most difficult rotations of intern year. I struggle to stay under the 80 hours of work each week. Each day, I am pulled between the operating room, the labor floor, Triage, and the postpartum floors. Our Triage is unique in that we see all pregnant women regardless of gestational age as well as non-pregnant patients with GYN issues. We essentially function as a women’s emergency room. It is great for my training and experience, but it also means there is never any downtime. When I am not in a delivery or on the floor, I am in Triage seeing several patients at a time. Aside from the hours, the technical skill set we are expected to acquire is huge. In addition to fundamental knowledge about pregnancy and women’s health, we have to master the technical aspects of the trade. Learning how to read a fetal monitor. Learning how to work the ultrasound machine. Learning how to check a woman’s cervix as she progresses towards labor. Learning to deliver a baby. Learning to break her water or insert a device to measure her contractions. Learning to do a C-Section – how to get into the pelvic cavity, pulling the baby out, clearing out the uterus, suturing, knot tying… the list goes on and on.

As a medical student, I got a taste for some of these skills and learning them was always fun and stress-free because there was always someone who walked me through it. Now as an intern, I’m much more on my own. Clinical decisions are made based on my exams or assessments. Avoiding a tear or birth complications are based on me delivering her baby as smoothly as possible. Avoiding post-operative pain and bleeding after a C-section depends on me controlling the bleeding by suturing and tying knots well. There is so much more pressure riding on my skill set than ever before. It’s a scary place to be because I truly want the best for my patients. But I also can’t second-guess everything I do simply because I am new at this. Part of my learning to be a good physician is taking ownership of my clinical judgment.

So, now, I leave Obstetrics a little more skilled and a little wiser. Above all, I leave with determination to do things even better, and with more confidence, the next time around.

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