Intern Ready: Ob/Gyn

Starting OB/GYN residency can feel overwhelming. In this episode, we break down the practical survival tips every incoming intern needs — from managing patients on Labor & Delivery and Gynecology, to studying efficiently, thriving in the OR, and protecting your wellbeing through a demanding first year. Topics Covered: Your Job as an Intern – Be open to feedback, manage multiple patients, ask for help early, and set expectations with your chief. On Labor & Delivery – Fetal heart rate interpretation, cervical exams, induction algorithms, magnesium management, and postpartum hemorrhage protocols. Golden rule: if you're thinking "should I call my senior?" — call. On Gynecology – AUB workup by age, pregnancy of unknown location, ectopic pregnancy, ovarian torsion, and the post-op fever differential (5 W's). How to Study Without Burning Out – Read about your patients, review bad outcomes, keep a "Learning Points" note, and use quick resources like UpToDate and ACOG Practice Bulletins. In the OR – Know the surgical indication, patient background, positioning, closing, and anticipate next steps. Communication – How to navigate emotional deliveries, fetal demises, complications, and difficult conversations with families. Emotional Reality – Expect imposter syndrome and moral distress. Debrief, find your co-interns, and protect your empathy. Physical Survival – Eat before shifts, carry snacks, compression socks, and protect sleep on golden weekends. Recommended Resources: UpToDate ACOG Practice Bulletins Infant Risk HCP – Pregnancy and breastfeeding med safety app Reprotox ASCCP – Pap/colpo algorithms CDC STI App US MEC/SPR – Contraception OB Wheel (pregnancy dating app) Open Evidence App USPSTF – Preventive Care MDCalc NCCN App FIGO App POP-Q App About the Speakers: Host: Lucy Brown, MD, MPH – Resident physician at Johns Hopkins GYN/OB. Dr. Brown is passionate about medical and resident education and will be pursuing a Fellowship in Complex Family Planning after residency. Guest Speaker: Jennifer Doorey, MD, MS – Academic Ob/Gyn at The Johns Hopkins University School of Medicine. As the founder of MedReady, Dr. Doorey seeks to advance clinical medical education by developing resources for medical students and clinical educators. Intern Ready: Ob/Gyn is a podcast aimed at interns and off-service residents beginning their post-graduate training in Obstetrics and Gynecology. The views expressed are the speakers' own and do not constitute medical advice.

Your pager goes off — the ED has a GYN consult. Now what? In this episode, we walk through exactly how to triage, evaluate, and staff a benign gynecology consult in the emergency department, from the moment you get the call to closing the loop with your team. Topics Covered: Triage Procedures Logistics: Know the ED layout — pelvic exam rooms, supply locations. Clinical Assessment: Determine hemodynamic stability, active bleeding, starting hemoglobin, and the consulting physician's level of concern. Hemodynamically Unstable Patients: Immediate bedside evaluation. Coordinate 2 IVs, Type and Screen/Cross, coags, bedside FAST exam, and NPO status for potential surgery. Hemodynamically Stable Patients: Chart check, review imaging (TVUS), read up on the differential (UpToDate, ACOG), and inform your senior team. Patient Evaluation Introduce the GYN team and provide context to the patient. Gather a full history: HPI, PMH/PSH/OB-GYN history, medications, allergies, social history, and barriers to follow-up. Prepare supplies for the physical exam (bed pans, speculums, swabs, cultures) and ensure proper lighting. Obtain necessary consents (including blood consents if relevant) before staffing. Staffing the Consult Stay organized — use your notes and outline the case. "Don't bury the lead" — start with a clear one-liner on assessment and disposition (medical management vs. surgical intervention). Developing an Assessment and Plan Own it — formulate an independent assessment and plan, not just a data report. Present reasonable management options (medical vs. surgical) to the attending. Place the patient on the team handoff list. About the Speakers: Host: Lucy Brown, MD, MPH – Resident physician at Johns Hopkins GYN/OB. Dr. Brown is passionate about medical and resident education and will be pursuing a Fellowship in Complex Family Planning after residency. Guest Speaker: Jennifer Doorey, MD, MS – Academic Ob/Gyn at The Johns Hopkins University School of Medicine. As the founder of MedReady, Dr. Doorey seeks to advance clinical medical education by developing resources for medical students and clinical educators. Intern Ready: Ob/Gyn is a podcast aimed at interns and off-service residents beginning their post-graduate training in Obstetrics and Gynecology. The views expressed are the speakers' own and do not constitute medical advice.

Your first day in benign GYN clinic is fast-paced and can feel overwhelming. In this episode, we cover what to expect, what to review ahead of time, and practical tips for running an efficient, patient-centered clinic visit — even when you only have 15 minutes. Topics Covered: What to Expect on Your First Day – A mix of new patients, annuals, return visits, and problem-based appointments. Common complaints include contraception, AUB, pelvic pain, abnormal discharge, STI testing, and post-op checks. Expect a fast pace and feeling slow at first. What to Review Ahead of Time Well woman visit guidelines AUB basics (PALM-COEIN) and the initial workup ASCCP guidelines (brief overview) Contraceptive options and the Medical Eligibility Criteria app Vaginal discharge workup — STI testing, wet prep Tips for a Smooth, Efficient Clinic Pre-chart! Check for recent ED visits, PCP discussions, last pap, imaging, STI results. Document as you go — brief notes while talking, make them complete later. Optimize your EMR — templates that make sense, favorite order sets. Make eye contact. Biggest Challenges and How to Overcome Them Efficiency: Practice-focused HPIs. Sensitive conversations: Sexual history, IPV screening, menses — be direct and compassionate. Pelvic exam confidence: Be trauma-informed, narrate what you're doing, be quick and confident. Don't tell patients to expect pain. Saying "I don't know": Explain your thinking, discuss with the attending, and come back. Advice We Wish We'd Known – Your confidence in pelvic exams improves dramatically. Give it time. About the Speakers: Host: Lucy Brown, MD, MPH – Resident physician at Johns Hopkins GYN/OB. Dr. Brown is passionate about medical and resident education and will be pursuing a Fellowship in Complex Family Planning after residency. Guest Speaker: Adrianna Gorniak, MD – Gyn/Ob resident at Johns Hopkins Hospital in Baltimore, MD. She has a passion for all things gynecology, with a special interest in complex benign gynecology. Intern Ready: Ob/Gyn is a podcast aimed at interns and off-service residents beginning their post-graduate training in Obstetrics and Gynecology. The views expressed are the speakers' own and do not constitute medical advice.

Join this episode to learn about postmenopausal bleeding (PMB) — the incidence, the etiologies, and the diagnostic approach to a patient presenting with uterine bleeding after menopause. A special focus is placed on endometrial hyperplasia and endometrial malignancy, including associated risk factors and the use of transvaginal ultrasound and endometrial sampling in the evaluation. Critical evaluation of PMB is important as the leading concern is cancer until proven otherwise in this patient population. Keywords: Postmenopausal bleeding, Transvaginal ultrasound, Endometrial hyperplasia, Endometrial malignancy/cancer, Endometrial sampling Topics Covered: Overview of PMB – Definition, incidence (5% of office GYN visits, 4–11% of menopausal patients), and why the leading concern is endometrial cancer until proven otherwise. Etiologies Polyp (~35%) – Localized overgrowths stimulated by estrogen; mostly benign but higher concern for malignancy/hyperplasia in PMB patients. Atrophy (~30%) – Low estrogen leads to endometrial/vaginal atrophy, micro-erosions, and spotting. Uterine Fibroid (~5%) – Less common postmenopausally; if a PMB patient has fibroids, still assume endometrial pathology. Endometrial Carcinoma (6–14%) – Most common gynecologic cancer in the U.S. Type I (estrogen-driven, favorable prognosis) vs. Type II (high-grade, aggressive). Endometrial Hyperplasia (with and without atypia) – May coexist with or progress to carcinoma in 30–50% of cases. Other causes – Proliferative/secretory endometrium, medications (HRT, anticoagulants, tamoxifen, SSRIs), post-radiation, infection, and non-uterine sources. Risk Factors for Malignancy – Increasing age, obesity, unopposed estrogen, tamoxifen, early menarche, late menopause, nulliparity, PCOS, Type 2 DM, Lynch syndrome, Cowden syndrome, and family history. Diagnostic Approach History and physical exam Transvaginal ultrasound (TVUS) – Endometrial thickness measurement; normal <4 mm in postmenopausal women; sensitivity 94–97%. Endometrial sampling – In-office EMB vs. OR-based hysteroscopy with D&C, including benefits, risks, and how to choose. Follow-Up and When to Refer – Management by pathology result, when to proceed to HSC D&C, and indications for Gyn Oncology referral. Resources: UpToDate: Approach to the Patient with Postmenopausal Uterine Bleeding ACOG Committee Opinion: The Role of Transvaginal Ultrasound in Evaluating the Endometrium of Women with Postmenopausal Bleeding ACOG Clinical Consensus: Management of Endometrial Intraepithelial Neoplasia or Atypical Endometrial Hyperplasia APGO Topic #54: Endometrial Hyperplasia and Carcinoma ASCCP Cervical Cancer Screening Guidelines About the Speakers: Host: Lucy Brown, MD, MPH – Resident physician at Johns Hopkins GYN/OB. Dr. Brown is passionate about medical and resident education and will be pursuing a Fellowship in Complex Family Planning after residency. Guest Speaker: Emily Stock, MD – Chief...