OBGYN Shelf Exam Tips with Personal Reflection

Hesham Hassan, M.Sc.
Jul 20, 2017
6 min read

So, OBGYN was my first shelf exam and I did not know what to expect with the rotation or the exam. OBGYN is a unique aspect of medicine where women's gynecological health needs are met and welcoming the next generation through obstetrical care makes up a large part of the patient population.

THE EXAM

110 NBME questions and 2.5 hours of a wide variety of women's health related questions. The exam was proportionate in the variety of obstetrical and gynecologic questions. Only having 110 questions that cover anything related to women is not enough to show that you have mastered all the topics, but the sample of questions are diverse enough to give you a good idea of your understanding of OBGYN. The questions were very fair and the vignettes did not make me feel as though I was wading through information trying to find an answer. Generally, the exam answers were heavily based on most prevalent cases you would see in real life and not on the rare, once-in-a-lifetime cases. Knowing well the hypothalamic-pituitary-gonadal and HPA (adrenal) axis will definitely make you strong on the exam, and is a great example of how the biochemistry and physiology of basic science years plays into your understanding of diagnosing and treating patients. Pharmacology is not too heavy on this exam, except for pharmacology as it pertains to pregnancy (contraindications, managing HTN in pregnancy, drugs during delivery, etc.). Infectious disease and pregnancy is also a high-yield topic, along with indications for treatment versus delivery. A good fifth of the exam related to women's needs post-menopausal, and this is where my urogynecology portion of my clerkship helped secure my grade. Take the time to understand urinary incontinence and pelvic organ prolapse because you will see these topics multiple times on the exam and they are not generally seen if you are in a general OBGYN practice.

If I could redo anything, I would have looked at the most common conditions seen in OBGYN and concentrated on knowing those problems in complete detail. It seems to me that the majority of the questions come from these areas and for obvious reasons. If you do not know how to access this information, it is accessed via a subscription to AAMC's Careers in Medicine Choosing a Medical Specialty > Obstetrics and Gynecology > The Work > list 1-5 under Patient Profile on the left side of the screen. I highly recommend considering a year subscription starting in M3 to help you research the different components of each specialty, and use the many resources available toward residency planning...but I digress.

THE RESOURCES

Online MedEd Videos are amazing. The screening protocols and the generalities give a great overview. The focus on prevalance rates for a developed country come in handy when you are between those pesky two questions on the exam where you need to decide the most likely diagnosis. Watch all of these free videos, and watch the more complicated videos twice if need be.
UWorld Step 2CK Qbank is gold. Too many students "save" the questions until preparing for Step 2CK itself but I recommend using the questions early on in M3 because they will help you develop the clinical reasoning you need.
First Aid for Step 2 - the OBGYN section here is very general and vague. This is good as a preview before starting the rotation but otherwise will not give you the detail needed for the exam.
Case Files OBGYN - This is awesome. I went through case files during my first two weeks of the rotation and I am glad that I did because many of the questions on the exam were cases from the book. I recommend going through the book lightly first for an overview early in the rotation (save these questions) and then again more heavily during the last bit of the rotation while doing the questions.
APGO uWISE Qbank - These questions above all others are a MUST. My school pays for us to have access to this resource (and great thing too because a year subscription is like $300+). The OBGYN clerkship does not do a good job of informing students of how to access the resource, and most students probably didn't pay attention during IMF. For Ross students rotating now, go to eCollege and click on the Clinical Cores and Clerkships - Obstetrics and Gynecology course link > Helpful Tools (under Corse Home on the left pane) > and then read the information under the header "APGO Medical Student Resource Page". Follow these steps and start this from the beginning of your clerkship. Find out why you are missing the questions, and redo all of the topics that you do not pass the first time or do not feel comfortable with after passing. These questions are closest to the NBME questions, and some of them appear almost verbatim. Seriously, use this resource above all others if you can only do one because of time constraints.

THE ROTATION

Overall, I LOVED this rotation. Before starting OBGYN, I was ignorant and told myself "I don't think I could look at vaginas all day." Being in OBGYN had me reflect a lot on the experiences I had with my wife's doctor during her pregnancies, and the feelings I had as an expecting parent on the patient side of the fence. Now, seeing it from the physician's side has helped me see the complete picture of what it takes to bring a child into the world.

One preceptor asked me, "Why do you want to practice medicine?" I replied that I wanted to practice medicine because I want to celebrate life by helping people to lead a healthy and good quality of life. I continued on a side note about how I already knew that "I do not want to wait around for people to die." I continued, "I already have my own children, and after investigating child protective services I don't want to be responsible for other people's children over time". I further explained how I am not a fan of managing chronic hypertension or diabetes, because watching and waiting for these illnesses to run their course is similar to the waiting around for people to die.

"Hmm," my preceptor responded and then continued to explain how what I want from medicine aligns with what she did as well when choosing OBGYN. The practice has some of the healthiest patients, and some of the happiest experiences that counterbalance the negative experiences and losses that occur. Women are more likely to be upfront about problems, and to adhere to treatment options they choose. And what better way to celebrate life than to help welcome a person into the world on their day of birth?

The doctors I learned from on my rotation, as I had two preceptors, were phenomenal but their knowledge was intimidating at first. I had no clue what to expect because it was my first rotation, but they helped me develop the transitional thinking I needed to move from basic sciences to clinical sciences. My first attending was great at pimping me with questions to foster the thought processes needed to develop a differential (and funny how those questions seemed to appear on the NBME exam...). My second attending, who primarily delivered babies and performed well woman exams, helped me understand the business of medicine and the art of delivering quality obstetrical care. She encouraged me to see myself doing OBGYN, as she could sense I developed an interest, and she gave me a better understanding of what to expect longterm in the field should I choose OBGYN. The nursing staff in the labor and delivery ward had some of the kindest and most educational staff. Two charge nurses I had shadowed boasted that this was the field for me or that I was a "natural", and that they could see me being a great obstetrician which makes me more confident that I could succeed.

Most students have this expectation that OBGYN's are met with lawsuits leading to increased malpractice insurance and horrible hours because "babies are born at all hours of the day and night", but both of my preceptors conveyed the lifestyle is good and the work is rewarding. My wife and I have talked about the pros and cons already, and currently OBGYN is on my list of residencies to research and apply to for the 2019 match. More information regarding a career in OBGYN can be found through ACOG or by clicking this link for a PDF that answers many general questions students have.

This really was a fantastic experience, and I have already scheduled electives in Urogynecology and General Obstetrics and Gynecology for my fourth year...most students do not fall in love with a specialty at the start of third year from what I've heard, but at this point I cannot see myself doing anything else. I am excited for my next rotation, Family Medicine, as there will be OBGYN exposure again and maybe the variety of cases seen in FM will appeal to me as much as the variety in OBGYN did...we shall see! I am grateful for such an amazing clerkship that was followed by a great psychiatry rotation. I am loving third year so far, being a quarter of the way through, and I cannot believe how quickly it has been progressing. More to come for sure!

If you have any questions or suggestions, please reach out to me. I look forward to any insights or comments below, and thank you for taking time out of your day to listen to my story as I hope it brought something great to your day.