Questions from Current Medical Students

Q Who can I contact at Western if I just want to talk about a career in OB/GYN?

There are some faculty members who would be happy to talk to you. 

Dr. Debbie Penava 519 646-6326
Dr. Akira Sugimoto 519 685-8357
Dr. Mike Maruncic 519 685-8193
Q I'm a med student but not yet in my clerkship. How can I find out if I really like Ob/Gyn?

You are always welcome to attend Grand Rounds to get a sense of what is new and current in the specialty.  See the Rounds Roundup page for topics and location.  Friday morning rounds at 8 am are also open for you to attend.  Don't forget that you can get hints from the staff listed above about how to set up an elective in first and second year to take a peek at what clinical Ob/Gyn is really like.

Q I was wondering how one might complete an Ob/Gyn residency at an accredited American university and then practise as a licensed Ob/Gyn in Canada.

It you elect to take your Ob/Gyn residency in the States, you must be sure that the training there is seen as equivalent at the site you choose to the training here. This is something you need to check out with the Royal College of Physicians and Surgeons of Canada before you ever sign on with the American program. The issue is that the key to practising in Canada is to have successfully written the Canadian specialty exams. So even though you may have passed all the American exams for the specialty, the Royal College may not see the American Program as having a standard close enough to that which they maintain in Canada. This does not mean that all American programs are inferior but there is a quite a mixture of good and not so good so you need to be vigilant before signing up. Some residency programs in the U.S. are not associated with medical schools and universities, but rather are attached to hospitals.

Q I am a third-year medical student and thinking about which residency programs to apply to at the end of this year (in Obs/Gyn of course). Everyone talks about "good programs" and "bad programs" with respect to residency, but I still haven't figured out what makes a program "good" or "bad." More importantly, how do I find out which are the "good" programs before actually getting there? Is there a ranking of programs (even unofficial) somewhere out there?

This is a dilemma that haunts all medical students heading into the application and CaRMS matching process. There is no ranking system. Even MacLeans has not felt the urge to get into this business.

What you have to do is seek out answers to some of the key questions that will tell you whether a program is good, bad or indifferent. Find out what the success rate of its residents has been on the Royal College Exams over the past 10 years or so. Get a syllabus of the formal resident teaching sessions and find out from residents in the program if they are as good as they appear on paper. Find out how much hands-on experience you can expect to get in the early years of the program and then how much you get to learn clinical judgement and administrative skills later in the program. Look for the amount of elective and research time offered in the program. No two residents have similar interests and you want to be able to tailor-make at least part of the residency to fit your particular needs. Talk to residents in the program to find out if policies regarding evaluation are followed fairly and consistently, and check to see that there is some kind of one-on-one mentoring program in place. The latter is important when you want to talk "off the record" about issues that inevitably pop up in post graduate programs.

When all is said and done, remember that all Canadian residency programs are accredited regularly by the Royal College and that they all must meet the national standard. Given the way the CaRMS match works you just have to be a bit pragmatic and relaxed about this process or it will eat you up. (By the way, of course James thinks the Western program is the best in Canada, possibly in the world, but he is slighlty biased!)

Q I am a medical student interested in Obstetrics and Gynaecology. In order to be competitive when applying to residency programs in this specialty, is it best to have done electives mainly in Obstetrics and Gynaecology to demonstrate "clear" interest in this area? If so, are electives in rural and community practices just as good as ones in the academic centres or are community rotations just lost opportunities to meet as many program directors as possible?

It is important to do some electives in Ob/Gyn to demonstrate interest. Unlike some specialties that seem to look for you to spend your elective time exclusively in their specialty, this does not seem to the case in Ob/Gyn. It would be prudent to also spend some elective time in related specialties, however, such as Surgery, Pediatrics (especially Pediatric Intensive Care) or possibly Anesthesia, or Radiology.

While it is always helpful to do an Ob/Gyn elective at the Med School where you would most like to be matched, beyond that it is is a "mugs game" to simply book your electives to meet as many program directors as possible. If you perform well in your home school and at least one other centre and then get good references from both for your CaRMS application, you can pave your way to acceptability across Canada. Remember that Canada is really a small country and program directors from coast to coast meet frequently and correspond even more frequently. They know personally the people who are writing your letters and take their comments very seriously.

Rural or even overseas electives can send a strong message about your commitment to health care outside of academic centres and have a definite place in your "elective mix." They tell program directors that you are seeking a broad perspective and want to grow and learn....good messages, which say a lot about you as a person.

Good luck!

Q I'm an MD/PhD student currently doing the PhD part of the program. I am interested in Ob/Gyn as a residency program after medical school and was wondering what opportunities are there for me during my research years? Am I able to attend rounds?

In regard to research opportunities within the Dept., James suggests that you contact Trevor Shepherd who is chair of our Research Committee.

In regard to your rounds question, you are welcome to attend Grand Rounds on Wednesdays from 8 - 9 a.m. Check the web-site to find out the schedule. You can also attend Friday morning l rounds held from 8 - 9 a.m.

Q I'm a medical student with no intention whatsoever of becoming an Ob/Gyn. My teaching in Ob/Gyn (the subject matter, not the teachers necessarily) was my least favourite area that we learned. I know I will not become an Ob/Gyn but I still want to get as much out of my mandatory clerkship rotation as I can. What can I do as a clerk to maximize my clerkship experience given that I don't like the subject matter?

James admires your candor. Ob/Gyn is not for everyone and you show your maturity in recognizing this situation in yourself and yet wanting to make something valuable out of your experience.

I suggest that in all your formal teaching and in all your clinical experiences, you look especially for ways that Ob/Gyn relates to and relies on other disciplines. For instance, there is a lot of interaction between us and the disciplines of Imaging, Surgery, Medicine, Psychiatry and Pediatrics. You might want to consider hypothetical situations where you were from another discipline, such as Medicine, and called to interact with a pregnant patient. Dealing with the physiology of a gravid woman in the third trimester puts forth great challenges to the respirologist, the endocrinologist, and the cardiologist and can make for some very interesting variations on the the themes that these specialists routinely deal with.

In other words, knowing the rudiments of Ob/Gyn such as you get in clerkship, will be helpful when you eventually encounter pregnant patients from whatever other discipline you eventually choose for yourself.

Q I am in my second year of medical school and after some time in electives over the summer, I am very interested in learning more about Ob/Gyn and eventually pursuing a career in this area. Because of my religious and ethical convictions, I am uncertain of how I would deal with the responsibility of performing pregnancy terminations. I am under the impression that when I am fully certified, I will be able to choose not to perform these procedures, as many physicians do. However, I am uncertain about whether I would need to perform them during residency. Could you please let me know if I will be required to perform terminations? Also, how should I approach this issue when in my Ob/Gyn clerkship electives and residency interviews? Should I avoid discussing the issue? I understand the responsibility I will have to my patients to refer them to other Ob/Gyn professionals for this service, and help them make the decision that is best for them. I accept that willingly as I look forward to helping women in those fragile matters as well as many others. Please help me to better understand how I can deal with this issue.

James's answer relates to policy in the post-grad program in Ob/Gyn at Western. He cannot speak for all programs in Canada. He suspects that the policies are much the same, however.

As a resident you are expected to be knowledgeable regarding methodologies of inducing abortion and be technically capable of performing surgical terminations. That said, the procedures necessary for terminations are very similar to other procedures that are necessary to treat other pregancy pathologies. Therefore, you do not need to do terminations in order to meet the certification requirements.

Residents in our programs have the choice of whether they wish to become directly involved in the pregnancy termination program offered through the LHSC women's clinic. There is no coercion. As you point out, from an ethical point of view, you will be expected, however, to inform patients of all their options regarding the handling of an unwanted pregnancy and make appropriate referrals.

Finally, in interviews for residency programs, you need not feel obliged to raise your ethical position on the issue. Furthermore, program directors and interview teams, should not be asking you direct questions on your position on elective terminations.

As a medical student, in electives, a simple request not to be involved in termination procedures should be all that is necessary if you are asked to assist at such a procedure.

James thinks you will find Ob/Gyns to be understanding of both sides of the argument in this debate. They have had to make up their own minds on the issue and know how difficult it is to reach a comfortable position in this regard.

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Q I am a first-year medical student and I am very interested in OB/GYN and would like to get some more first-hand experience in the field. Is it possible to arrange for summer "electives" with an OB in London during the first and second years of med school to get more of a feel for the discipline? If so, how am I best to arrange this? Thanks!
A Your best bet is to contact Dr. Rob Gratton who is in charge of all undergrad education for our department.
Q If I am interested in Ob/Gyn and would like to get some research experience, who should I contact? I would like to assist on some projects to become familiar with the field before residency.

James's answer applies to Western only. He suggests you contact Dr. Rob Gratton who is in charge of the undergrad program. He can tell you who you should speak to re current research. Alternatively, you could contact the chair of our Research Committee, Dr. Trevor Shepherd

At other med schools contact the director of the Ob/Gyn post-grad program or the Ob/Gyn office and ask advice.


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