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Ob / Gyn Residency Overview

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Obstetrics and Gynaecology covers medical and surgical care specific to women, including both the delivery of children and pre/peri/post-birth care (obstetrics) and the diagnosis and management of conditions affecting the female reproductive system (gynaecology). An obstetrician or gynaecologist may act in a consultant role, but may also be involved in the provision of primary care, with lasting and meaningful relationships with patients being developed. Salaries for those in ob / gyn are in the middle of the pack, with the median clinical salary sitting around $309,000.

Residency Core Requirements

Obstetrics and gynaecology is a four year residency – training must be at minimum four years in an accredited program, of which three years must be focused on reproductive health care and ‘ambulatory primary health care for women’. Work therefore includes the prevention, diagnosis and management of disease, as well as consultant work and community work. Subspecialty training is available after residency and includes reproductive endocrinology, gynecologic oncology, maternal-fetal medicine, urogynecology and family planning.

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Application Statistics & Competition

In the most recent available data, there were 2044 applicants for 1503 spots, making a ratio of 1.36 applicants to each position. Looking at US MD Seniors, 212 failed to match out of 1315, whilst for DO Seniors there were 371 applicants, with 241 matching. This is a match rate of 65% for DO applicants, which is relatively low. The Mean USMLE Step 1 score for those who matched successfully was 232, and the mean Step 2 score was 248. A step 1 score of 200 would mean a match probability of 65%, whilst a score of more than 240 meant a match probability of 89%. This therefore makes ob /gyn one of the more competitive residencies for any applicant, not just DOs and IMGs.

Sample Interview questions

Tell me about the definitive management of ectopic pregnancy.

Management can be either expectant, medical or surgical. Expectant management involves monitoring serum bHCG and multiple ultrasound scans to monitor the pregnancy in the expectation that it will spontaneously resolve. This is suitable if the woman is pain-free, hemodynamically stable, and a tubal ectopic is visible on ultrasound. Serum hCG <1000 IU/L> or 1000-1500 if they meet the criteria above.

Medical management involves methotrexate to stop the growth of the ectopic. This is suitable if the woman has no significant pain, an unruptured ectopic with an adnexal mass of less than 35mm, and no intrauterine pregnancy on USS. Serum hCG should be less than 1500 IU/L typically.

Surgical management is offered if there is significant pain, follow-up is impossible, the adnexal mass is greater than 35mm, foetal heartbeat is visible, or serum hCG is greater than 5000 IU/L.

What are the management options for breech birth?

Management for breech (at term) includes external cephalic version, followed by vaginal delivery, or C-section. ECV involves manually rotating the foetus into a cephalic presentation, by applying pressure to the abdomen (of the mother) with ultrasound guidance. There is a 40% success rate in primiparous women, and 60% in multiparous women. If this is unsuccessful, then an elective C-section may be required, or vaginal delivery may continue. ECV will not be attempted if there is antepartum haemorrhage, multiple pregnancy, ruptured membranes, previous c-section, or abnormalities on CTG.

Vaginal delivery carries multiple risks including birth asphyxia, intracranial haemorrhage, and foetal trauma. Preference is therefore to deliver without traction, and with an anterior sacrum during delivery to decrease the risk of foetal head entrapment. There are various contraindications, including footling breech, macrosomia, previous C-section.

A C-section may be booked as an elective procedure and is the most common way of managing breech presentation. It is preferred for preterm babies, and also if ECV is unsuccessful. There are fewer associated risks.

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Important considerations

It’s vital to bear in mind just how competitive this choice of residency is. Even MD applicants with strong scores from good schools will still need to ensure that their letters of recommendation, personal statement and remainder of their application is strong across the board if they wish to guarantee a match. Additionally, do remember that there are a number of different subspecialty options and that many will therefore continue training beyond the core four year residency.

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