ALSO
Posted on November 6th, 2008 No Comments »
When I was nearing the end of my third year as a medical student I spent a month in Kingman, Arizona for a rural family medicine rotation.This was “full spectrum” family medicine with more OB than most formal rotations. I liked the responsibility, had a call pager, would come in to the hospital at all hours of the night for deliveries. Usually beating my preceptors there. Disconcerting, sitting gowned and gloved in front of a crowning baby inching its way to the first cry. Once I made the mistake to ask the nurse if the attending had showed up yet. I was so nervous it would just be us in the delivery room. She went to check–then it was just me, mom, and and an imminent birthday party.
One of the scariest moments, however, was over before I could fully appreciate the seriousness of the situation. I was delivering yet another baby in the wee hours of the morning when awkwardly, the baby stopped in mid-delivery. The preceptor, usually sleepily coaching, sparked to life. In a flash he was angling and maneuvering the baby and the mother’s legs. The baby came out normally after that, it seemed to me. “That was shoulder dystocia!” he exclaimed in unfamiliar exasperation. The baby was positioned with the shoulder pinned behind the mother’s pubic bone and would not budge. Life threatening to mother and baby, knowing what to do in this situation is essential.
This and other nightmare scenarios were drilled into us for two days at The ALSO course for high risk obstetrics. As FM interns we have two months of OB and our continuity patients to care for as well so the training was much appreciated.
The lectures were presented at a fast pace at the beautiful Valle Vista country club, with its spacious lecture halls and home to an impressive golf course. While this was unexpected, the atmosphere was reminiscent of the floor (where the hospital transforms into a cozy, floral environment). Another pleasant surprise was that most of the FM residencies in Indianapolis and one from Terra Haute (with my AZCOM classmate as a new intern) all attended the training together. Everyone got along very well, especially over the lunch break. I haven’t laughed so hard in a very long time – thanks to Chris, Anna, Katie, Laura, Rachel, Kelly, Adrian, and Amy. Not only did we get the firsthand experience of the Community attendings, but the attendings from the other programs as well. It was an impressive bunch.
Along with the lectures, we had numerous workshops including forceps training, vacuum extraction, post partum bleeding, shoulder dystocia (remember suprapubic pressure), and laceration repair training on real cow tongues!All of this increased my comfort level with OB, and I will definitely still keep the “phone book” handy. The culmination of the course is the “Mega delivery” where we apply everything we learned during one unfortunate scenario on a plastic mom and baby model. Everything that can go wrong does. Before the exam, the halls were filled with studious residents reviewing their notes.
I’m grateful for running through it all on models – it was stressful and tense situation where seconds count. The entire experience was so practical and helpful, if and when the real situations arise.
For all of you prospective Community FM interns, once certified, you will be eligible to train as a course instructor. The ALSO course is taught worldwide and provides much needed skills and information, especially for providers in developing countries.
