I completed my fifth rotation in obstetrics and gynecology at Woodhull Hospital from May 20 to June 21, 2024. This rotation provided me with a deeper understanding of the unique health needs of women at different stages of life, from adolescence to menopause, and highlighted the importance of providing tailored care. I became proficient in ordering and interpreting various prenatal tests and screenings, such as ultrasounds, glucose tolerance tests, and blood tests for conditions like anemia and infections. This skill is crucial for the early detection and management of potential complications. I also learned to identify and manage high-risk pregnancies, including conditions like gestational diabetes, preeclampsia, and multiple gestations, which involve close monitoring, additional testing, and sometimes specialized care plans to ensure the best outcomes for both mother and baby.

Postpartum care was another area of significant learning. I learned to monitor the mother’s physical recovery, checking for signs of infection, excessive bleeding, and ensuring the uterus is returning to its normal size. Surgical experience was a major component of this rotation. I gained significant experience in assisting and performing cesarean sections, learning the indications for a C-section, preoperative preparation, surgical techniques, and postoperative care to minimize complications. Additionally, I assisted in various laparoscopic procedures, such as diagnostic laparoscopy, treatment of ectopic pregnancies, and ovarian cyst removals. These experiences underscored the importance of minimally invasive techniques in reducing recovery time and complications.

This rotation also heightened my awareness of the cultural factors influencing patients’ healthcare decisions. I learned to provide culturally sensitive care that respects diverse backgrounds and beliefs, an essential skill in ensuring effective patient communication and compliance. Despite these gains, I recognize the need to improve my diagnostic skills, especially in complex cases where symptoms may be subtle or atypical. I plan to achieve this by dedicating more time to studying case histories and understanding differential diagnoses in depth. Dealing with the emotional aspects of patient care, especially in obstetrics and gynecology, was challenging at times. I need to develop better coping strategies and seek mentorship or counseling if needed to build emotional resilience.

For future rotations, I will adopt a more proactive approach to learning. I will dedicate time to self-directed learning, using resources like medical journals, online courses, and textbooks to deepen my knowledge in areas where I feel less confident. I will regularly seek feedback from my supervisors and peers to identify areas of improvement and adjust my approach accordingly. Before each rotation, I will set specific learning objectives and goals to ensure I have a clear focus on what I want to achieve. Furthermore, I will continue to educate myself on different cultural practices and beliefs to provide even better patient-centered care. By implementing these strategies, I aim to enhance my clinical skills and become a more competent and compassionate physician Assistant.

Site Visit Evaluation.

During my OBGYN rotation at Woodhull Hospital from May 20 to June 21, 2024, I underwent a comprehensive site visit evaluation conducted by PA Carlos Melendez. This evaluation included two key meetings: one midway through the rotation and a final assessment. During these sessions, I presented two complete History and Physical (H&P) reports, a pharmacological drug card, and one journal article. PA Melendez provided constructive feedback aimed at enhancing our clinical skills, particularly in patient assessment and medical documentation. He reinforced the critical elements of prenatal and postnatal care, including routine checkups, managing complications, and providing support for new mothers.

One of the cases I presented involved a patient experiencing left lower quadrant and suprapubic pain for one day. Through this case, I learned how to respond to obstetric emergencies such as ectopic pregnancy, preeclampsia, and postpartum hemorrhage. This experience enhanced my ability to act swiftly and effectively in critical situations using ultrasound imaging, Bhcg results, and blood work such as CBC and CMP. Additionally, we discussed the stages of labor and the various pharmacological agents used to induce labor, as well as the appropriate timing for their administration.

I also had the opportunity to discuss an article on the efficacy of medical management of leiomyoma-associated heavy menstrual bleeding (HMB). The article emphasized that medical management is typically the first-line approach for treating HMB associated with fibroids. Various options are available, including nonsteroidal anti-inflammatory drugs (NSAIDs), tranexamic acid (TXA), hormonal contraceptives (COCs), the levonorgestrel intrauterine system (LNG-IUS), and gonadotropin-releasing hormone (GnRH) agonists/antagonists. These treatments aim to alleviate symptoms by reducing menstrual bleeding and, in some cases, shrinking fibroid size.

In particular, I expanded on tranexamic acid (TXA), an antifibrinolytic agent. TXA is a synthetic lysine analogue that works by blocking the lysine binding sites on plasminogen molecules. Normally, plasminogen binds to fibrin clots and converts them into soluble fibrin degradation products through its activation to plasmin. By competitively inhibiting plasminogen activation, TXA prevents the breakdown of fibrin clots, thereby stabilizing clots and reducing bleeding. TXA is important in the treatment of heavy menstrual bleeding and the short-term prevention and control of bleeding in patients with hemophilia.

Overall, this rotation significantly enhanced my understanding and skills in OBGYN, particularly in managing obstetric emergencies and heavy menstrual bleeding. The constructive feedback from PA Melendez and the practical experiences at Woodhull Hospital have been invaluable in preparing me for a career in healthcare.