GYN ONC SURVIVAL GUIDE

Guess who just finished her GYN oncology rotation last week and is quite relieved? I learned so much and operated a ton but make no mistake, it was a grueling eight weeks. And during those weeks {and previous years}, I've definitely noticed certain things that the medical students seem to struggle with consistently on this rotation. This post will hopefully serve as a helpful guide to navigating this rotation as a medical student.

First and foremost, let me start by saying that oncology (in any field) is an emotionally taxing yet very rewarding experience. You are dealing with very sick, often dying patients so it's going to be tough at times. And your job is to stay strong for your patients when they need it and to empathize with them too. Some patients make that harder than others but at the end of the day, I just had to remind myself that every patient is dealing with a devastating diagnosis in their own way.

That being said, this rotation is a fantastic opportunity to operate a LOT {as a resident} and to see/help with all sorts of surgeries {as a student} and an excellent chance to learn. Let's start with some basic facts about GYN oncology as a specialty:

GYN Oncology is a field of OBGYN that focuses on the diagnosis and treatment of cancers of the female pelvic organs {vulva, vagina, cervix, uterus and ovaries}. They are also one of the few {if not the only} surgical oncologists who not only operate on their patients but also manage their entire chemo regimens too. Every GYN oncologist completes a 4 year OBGYN residency followed by a 3 year fellowship.

Now getting into the tips. The list below is full of suggestions based on what worked for me when I was a student as well as from a resident's perspective, what is going to be the most helpful to us. By knowing these ahead of time, you should have no trouble acing your rotation if you want to stand out!

If you're not interested in OBGYN or GYN oncology, that's cool too! You can look out for my upcoming post that will have similar tips to ace all your clerkships, whether surgical {which I'll tell you now will have some overlap with this post} and non-surgical. I'll try to go into as much detail as I can remember {it's been a few years now lol} and include a residents' perspective.

**************************** TIPS FOR GYN ONC ******************************

• Know your patients. You're gonna get pimped and these patients are complicated, let me tell you. Make sure you know how to find what you need on the EMR. I like asking the nurses how a patient's night went because patients sometimes omit certain events of the night that would be good to know {like whether they threw up overnight, etc.}.

• Know the surgeries you are involved with prior to going into them. Nothing is more frustrating to us as residents and to the attendings as when we ask a simple question about the surgery that we're about to do/doing and having the student not even be able to pretend they know the answer. Don't be that kid. We don't expect you to be able to list every single step {at least, not until you're an intern lol} but just have an idea of what the case involves and why we're there {i.e., what is the patient's diagnosis and why is this surgery appropriate for it}.

• Know the pelvic anatomy. Your'e gonna get pimped. The attending {or resident} is 100% gonna point to something and ask you what it is during surgery. Be prepared. But also know that unless you're a whiz who knows the answer to every single question or you're the opposite and don't know anything, we're not really gonna remember lol.

• Familiarize yourself with the staging for endometrial, cervical and ovarian cancers. You don't need to know this in detail at all but it is a favorite rounds question to ask how we stage a certain gyn cancer -- cervical cancer is the most common one in my experience {both as a student and resident}. If you wanna be way ahead of the game know it for vulvar and vaginal cancers too.

• For endometrial cancer, know the difference between and the characteristics that define Type I vs Type II

• For ovarian cancer, know the 3 groups of cell types {stromal, germ cell, epithelial} and which cancers fall under each category.

• Know the classic presentations of endometrial, cervical and ovarian cancer.

• Know the GENERAL treatments for the different cancers. By this, I just mean which cancers get chemo vs radiation vs surgery vs some combination of these.

• For bonus points:

- Know the common side effects of the main chemo drugs used {there's only a

handful}

- Know the classic pathology findings associated with things like granulosa cell and

yolk sac tumors {this is a favorite pimp question amongst our attendings specifically}.

• Become an expert at driving the uterus! That’s basically your job during robotic/laparoscopic cases and it’s actually super important with helping us visualize and dissect appropriately during surgery.

The main thing to realize is that onc is generally considered a pretty difficult rotation at most programs so anything you can do to make your residents' lives easier will make you stand out. That doesn't mean getting them coffee or bringing homemade baked goods {though that's awesome too! lol}, but figure out what you can do to make the service run more smoothly. Things like prepping the vitals and labs on the list in the morning, hunting down a radiology read and helping to obtain records from outside facilities {that one's super important} all may seem like scut work {because it kind of is}, but realistically those are the easiest ways for a student to help us as residents. Like I said earlier, onc is a busy service with very sick patients and a lot of daily stressors and annoyances. If you're able to take away even fraction of those stressors and annoyances, you are helping the team a great deal and you'll be remembered as that awesome 3rd year or that incredible sub-I*, and who doesn't want that?

SUGGESTED RESOURCES

• Quick and dirty guide {that fits in your white coat}

• Quick and dirty guide {that doesn't fit in your white coat}

• Comprehensive textbook

• Pre-surgery cram {aka when you're trying to read about your surgery on your phone 5 mins before scrubbing in -- for real though, this is an excellent site to see the steps of almost all gyn/gyn oncology surgeries}

• Pelvic anatomy atlas {things to know in surgery}

*sub-I = sub-intern, cka extern, aka 4th year student {whether visiting or not}. i've heard it be called many things so it might be something different where you are.