There are many reasons a medical student may struggle on their obstetrics and gynecology (OBGYN) rotation. There is an obvious lack of medical knowledge or procedural skills common to all clinical rotations. But, on OBGYN, it can be especially challenging for male medical students to gain the confidence to feel comfortable talking about sensitive topics and being present for sensitive exams. (The same goes for female students in Urology.)
In particular, those straight out of undergraduate studies or those with younger-looking appearances may be perceived by patients as too young or immature to handle the importance of assisting in the birthing process. For those who are afraid that their status of being “just a student” — or feeling like an outsider or possessing a too-young appearance — may hinder their ability to gain the experience necessary to consider a career as an OBGYN, I offer the following hypothetical scenario. (This has often crossed my mind as I’ve come to terms with my own capabilities.)
It is your first day of your OBGYN Acting Internship as a fourth-year student. You head off to see your first patient in the labor department: a routine induction of labor for mildly elevated blood pressures. You know the drill: continue to check blood pressure and write her admission orders. You know how to get her from a closed cervix to two centimeters, from two centimeters to five centimeters, how to rupture membranes and when to start pushing and deliver. You have had this experience many times in your third year and have read up on the delivery process extensively.
You enter the room and introduce yourself as a student-doctor. You say, “Hello there, ma’am! My name is Student-Doctor X, and I will be taking care of you today. It looks like you’re here to have a baby?”
“Oh my gosh, you are way too young! There’s no way you can help me. Get me the real doctor.”
You’re shocked. This was not what you expected after deciding to commit your professional life to this career. But, alas, here you are, and now it’s up to you to manage the situation. You take a seat and begin a conversation with the ultimate goal of convincing this mother to allow you to help her deliver.
“I understand your concern that I appear very young. I can assure you I am very capable of managing your delivery. Random question: how would you feel if the pilot of your next cross-country flight was performing his first flight as a new pilot?”
“That would scare me halfway to Sunday,” says the mother. “There’s no way a first-time pilot can be good enough to fly across America!”
“It’s a great point. What if I told you that the pilot was at the top of their class, consistently got great grades on all of the written and simulation examinations and was told by all of their educators that they would make a fantastic pilot?”
“That’s all nice and good, but that has nothing to do with real-life experience, right?”
“Maybe, maybe not. What if I told you that not only were they a fantastic student, but also that, required by law, they have an extremely well-trained and well-experienced pilot sitting right next to them at all times, able to answer any questions and help guide them through their first flight?”
“Hm, that seems nice. I do like that the other pilot has a lot of experience. But why not just let the experienced pilot fly instead and have the new trainee watch? How come they cannot just gain the experience by observing?”
“It certainly would be a lot easier. The new trainee, however, has already watched a good number of flights while in school. It’s very important for the new pilot to gain actual hands-on experience in order to become an experienced pilot. Learning the intricacies of all parts of an airplane is important, but without being in the pilot’s seat and actually flying, all that earlier training cannot account for tactual experience. How do you think the experienced pilot got to where they were? They must have flown with their own experienced pilot.”
“And, what if I was to tell you that for a majority of the flight, the plane will be in autopilot. The plane can practically fly itself! All the pilots have to do is continue to monitor the dials, make sure everything is going smoothly, and occasionally correct manually for turbulence, weather and any unexpected events.”
“That is nice. It should give a lot of time for the experienced and inexperienced pilots to communicate with each other and teach on the job while not immediately risking the health and safety of the passengers. I think if that situation were to arise, I would feel comfortable letting the inexperienced pilot fly the plane with the close oversight of the experienced pilot.”
“I’m glad to hear this. I would as well. It is definitely important to have a lot of safety checks in place to ensure nothing goes wrong. I bring up this topic as I believe this analogy fits perfectly into our situation here. I am a lot like that inexperienced pilot, achieving great grades in written and simulation exams earlier in medical school as well as receiving top evaluations from my preceptors. I am also required by law to have an experienced pilot, or attending physician, with me at all times. This physician is currently in the workroom waiting to hear my report about your situation. We will work together extensively to ensure you receive the best quality care. I do not do anything on my own without first consulting with my attending to ensure everything is in line with the best standard of practice. I have also seen my fair share of deliveries in my time as a medical student.
Furthermore, since we are in the Labor and Delivery Department, and you are going to have a baby, a lot of my job is on autopilot. Birth is a very natural process and your body does most of the work for us. It is my job to ensure that your blood pressure and other labs are within normal limits. I will perform routine exams and other small procedures to ensure that the birth process goes according to plan and in the proper fashion, but otherwise, it is up to you and your body to decide how fast or slow this process goes. I will likely be more involved when you are fully dilated to guide the pregnancy into completion, just as the pilot helps guide the plane onto the landing strip. I do understand your concern, but I can assure you that you will receive the best quality care and that the best way for me to help other expecting mothers is to get the most supervised hands-on experience as I can. With that all said, would it be okay to examine your cervix now to see how dilated you are?”
“Certainly, student-doctor, go right ahead.”