The best person to contact regarding queries is Miss Charlotte Patient via email or in person. She is the consultant in charge of supervising us and also oversees the SHO rota. She will provide a local induction when you start the rotation.

It is also a good idea to contact the SHO in charge of the rota well in advance before starting the rotation (addiesogsho@gmail.com).

Do ensure that you have access to the blood gas machines in the Rosie too(one in Lady Mary Ward and the other one in DU) or else you will be very unpopular among the team members!

This specialty is based in the Rosie and at ED. You will receive a tour of important locations during induction. Also important to know where to go in ED to see referrals - this will usually be in 'Area A or C', always ensure you know where the gynae trolley (normally found in Area C) is before you start seeing your patient!( though it is advisable to keep a metal sponge forceps in your pocket as it is not always available in ED; very useful when seeing a patient with possible retained product of conception). Another important location to know is Gynaecology theatres in the ATC (33 or 34) where you may find the registrars or consultants as well as the emergency theatre (On Level 3 above the concourse)

There are multiple registrars / trainees who are split into teams by consultants in both obstetrics and gynecology. The FY2's or other SHO's will have a rolling rota which guides where you will be based. Majority of the department is made of midwives, specialist nurses as well as theatre staff, anesthetists and sonographers.

The rota includes time on gynaecology ward (Daphne), gynae on call (Clinic 24 / ED), delivery unit, Maternity triage (clinic 23), Postnatal ward (Lady Mary ward) and elective Caesarean sections lists. Night shifts are also included, in which you are in a team of three (SHO, junior reg for delivery unit and senior registrar). Annual leave can be taken on caesarean weeks or ward weeks only, but swaps may be available and study leave may be requested if done in advance.

A typical week depends on which week of the rota you are on. Each week is different and offers different learning opportunities and experiences.

“Special interest week and elective C section list” - This is your chance to assist in the elective C section lists everyday: mornings of Monday, Wednesday, Thursday and Friday, and afternoons Tuesday and Thursday. Outside of these times you are free to attend clinics in and outside obs and gynae.

Week covering Lady Mary and Daphne ward (8am-5.30pm) - Your time is split between Daphne and Lady Mary Ward. Covering the post natal ward (Lady Mary) mainly involves reviewing post natal patients (all emergency c section patients should be examined by you the day after their surgery), discharge letters, prescriptions, drug chart jobs. You will mainly work with the midwives on lady Mary as you are their first port of call. One of your most common jobs on this ward will be reviewing patients so that they may be discharged to midwifery-led care. This is usually all C-section patients. A review usually consists of making sure the woman is well and their scar is healing properly. The midwives write the majority of discharge letters. However, some patients will require a doctor's discharge letter, for example emergency c-section patients. However, you are required to completed the TTO part of the discharge if the patient requires drugs. The common drugs eg ferrous sulphate, lactulose and co-amoxiclav are kept as TTO packs on the ward - ask the midwives for more information.

The gynae ward (Daphne) starts with a ward round in the morning at around 8am with each consultant to see their patients. After the ward round your main jobs are standard junior doctor jobs such as discharge letters, blood taking, cannulas. It may be a bit difficult to find time to go to theatre as you are usually the only junior doctor covering the ward.

Week on call in Delivery Unit- These are both great learning opportunities. The junior Spr covering DU is always readily available and is responsible for seeing the patients on DU. On a DU shift your responsibilities include - cannulas (midwives can do but may need your help), bloods, and blood cultures, assisting in emergency C sections, clerking in patients occasionally, prescribing medications. You will also hold the bleep for obstetric emergency calls.

Week covering clinic 23 and Sara ward (8.30am-7pm)- Clinic 23 is a Maternity Assessment Unit - It is a clinic where antenatal women come with acute problems such as high blood pressure, abdominal pain etc. The midwives working with you are very good and offer very good advice. Your role is to review patients they have seen and are concerned about. You can then ask for a senior review if required. Sara ward is the antenatal ward. Most of the ward rounds take place at 8.30am and there may be jobs for you to do. The rest of your jobs are mostly bloods and prescribing for inductions.

Week on call in gynae (8.30am-8pm) - Spend most of your time in Clinic 24 (early pregnancy unit) seeing patients up to 12+6 weeks pregnant with problems mostly abdominal pain and bleeding. The most common cases are miscarriage and ?ectopic pregnancies. The nurses in clinic 24 are really experienced and helpful and will let you know what you need to do! You take referrals from A+E and see patients there. If it is a referral from another specialty, the Reg on call usually takes it. You admit new patients from A+E if needed to Daphne ward.

Gynaecology ward (Daphne) 0800 - 1730. When nurses handover in the morning, they create a hand over list. This is what you can use for your ward round with the consultants. Different consultants will review patients so even if you don't see them, try and find out from that team's registrar about the plan. When you finish, hand over to the SHO on call (gynaecology SHO) as well as informing nurses of outstanding jobs. Always check results at the end of the day and act upon them if needed.

Delivery Unit 0830 - 2000. Handover with the team happens in the reception of the unit with the midwife in charge present. The doctors are updated on the patients. Ward round will happen after this. This shift can be very variable because it can be very quiet or you can assist in assisted vaginal deliveries, cesareans, medical reviews etc. The night SHO may hand over jobs to you here too.

Gynaecology on call 0830 - 2000. You attend handover at 0830 on the delivery unit where the night SHO may hand over jobs to you here. There is no patient list. You see patients as needed in Clinic 24 and review patients in ED. You return at 8pm to handover to the night doctors. Clinic 24 stops seeing patients after 5pm - so referrals will need to be seen in ED. When referrals are made from ED, ask for observations, blood results, urine test results. If pregnancy test is negative can be seen by another speciality first before referring to gynaecology. In a typical week you could be doing thursday to sunday oncall - where on the weekend you would also do the ward round on Daphne

Clinic 23, Lady Mary Ward and Sara Ward 0830 - 1900. The night SHO may hand over specific jobs for the patients on the antenatal or postnatal ward to you but there is no specific handover for this slot. According to the rota you can do 3 days of gynaecology on call and then 2 days of CL23. On Lady mary ward there is a jobs book where nurses write jobs in. 24 hours after an emergency cesarean section review the patients for discharge.

Elective Cesarean list / Gynae special interest - 0815 - 1700. You are the assistant in theatre for the elective list. Monday morning list, tuesday afternoon list, wednesday morning list, thursday all day and Friday morning list. When not assisting you have extra time to either attend gynaecology theatre or gynaecology clinics.

Nights 2000 - 0830. Handover in the evening and morning is on the delivery unit. Handover all jobs as needed to the day team. On nights you cover all departments, including referrals from ED with help from the junior and senior registrar. Jobs are like any other types of ward cover, including going to theatre for emergency patients.

Gynaecology: early pregnancy bleeding and or abdominal pain in early pregnancy (up to 14 weeks or before first trimester scan) - history, examination including speculum (depending on quantity of bleeding) and bimanual (if abdominal pain), Bhcg may or not be indicated, ultrasound depending on results of bloods. Nurses can chase results and inform patients if stable. Differentials to think of are miscarriage, implantation pain or bleeding, bleeding in early pregnancy (extremely common), ectopic (escalate quickly), pregnancy of unknown origin.

Generally patients referred from ED should have a positive pregnancy test before they are referred unless already accepted by the gynecology registrar.

Obstetrics: Bleeding - abdominal examination, fetal heart sounds, CTG if indicated, speculum - if heavy may need admission for monitoring. Abdominal pain - abdominal examination, fetal heart sounds, CTG if indicated, urine dip and observations, trial of pain relief. PV discharge - abdominal palpation, speculum and swabs (+/- treatment) Dysuria - same work up for UTI with or without treatment depending on symptoms and urine dip results Headache, visual disturbances, peripheral oedema - always think of pre-eclampsia and follow the flow charts / guidelines Hyperemesis - if severely dehydrated admit for IV fluids (regime stated in guidelines) and anti emetics

Patients can be admitted from ED, Clinics, Clinic 23 / 24, elective admissions and referrals from other hospitals. Depending on the shift you are on will guide who you clerk in and where.

Gynaecology post op patients will have varying lengths of stay depending on recovery. Daphne ward can have quite a high turn over of patients so if possible try and do discharge summaries pre-emptively elective or emergency cesarean section patients should be reviewed after 24 hours for discharge to midwife care

Any types of follow up that is needed will normally be stated i.e (gynaecology clinics, OASIS clinic (for 3 - 4th degree tears)

Bloods, cannulas, prescriptions should all be as other wards and departments. Always have a chaperone for examinations (even in ED) Familiarize yourself with the speculums and VE in the department because speculum examinations and VE's are extremely common

If you order a scan, check with the department if not discuss it with the radiologist on call.

Patients are normally triaged by nurses in the clinics therefore will only ask you to see them if they are worried.

Midwife's in clinics and wards will normally follow-up results but check just in case, this is good practice.

A large part of the job involves the EPIC system - do not be afraid to ask for help if there is something that you have difficulty with.

You are the first port of call for whatever part of the rota you are on, unless it is an emergency in which nurses or midwives may call the registrar directly. try and answer your bleep as soon as you can, document any discussion or decisions made so all are aware and handover plans to nursing staff or evening teams appropriately

If you are worried about a patient ask the nurses or midwives for advice as they are very experienced in dealing with these patients but any patient you are worried about should always be escalated to the registrar even if just for discussion regarding management.

Gynaecology registrar 156 0787 Obstetrics Registrar 156 0980

It is a banded job with a fixed rota for all SHO's. Some shifts have long hours therefore maintaining a social life can be difficult, but in view of oncalls you get days off to cover these. The time off and annual leave is ample leave!

-The proformas in Clinic 23 are a good guide with regards to common presentations of patients and management plans as well as the guidelines on the intranet -The midwives and nurses are extremely valuable sources of information therefore always ask them for advice if you need it -Be aware of basic O&G presentations - good resource for this is the oxford handbook of O&G

The nurses and midwives are a great source of information and guidance, so if you are stuck or unsure - always ask! They are all friendly and approachable and will advise where possible.

Be confident in your speculum technique as this will not only help your examination but make a difficult situation slightly easier if you do it properly without too much discomfort. Always try and build a rapport as with any other patient but be acknowledge their fears and concerns - don't be afraid to use words like miscarriage or intercourse etc

Always take a full gynaecology/ obstetric history including information and any previous surgery

When you start, be familiar with what is expected of you in the shift that you are doing so that you are not surprised with other jobs coming up.

Read up about pre-eclampsia/HTN in pregnancy - as soon as any lady has a blood pressure of 140 systolic or 80 diastolic you WILL get bleeped and often demanded to come review the patient.