Thursday, May 11, 2017


Anuja Singh
Resident in OB/GYN at MGH/BWH


As a third year OB/GYN resident, teaching is an important part of my job. Initially, much of it was clinical knowledge and management but as time has gone on and my own skills have developed, it has also been teaching procedures and surgical techniques. In the US, however, we have the luxury of having attendings closely observing and supervising in every case, big or small. In Botswana, interns and medical officers do not always, or even often, have this benefit. Scottish Livingstone Hospital (SLH) is a 200-bed facility in Molepolole, about 60 km from the capital Gabarone. There are 4 hospital departments: Medicine, Pediatrics, OB/GYN, and Surgery. Each department has 1-2 attendings. Teaching is a primary goal for all of the attending physicians but, given clinical demands and number of trainees, always having one on one training, as I often enjoy in my clinics or surgeries, is not possible. Moreover, it could be argued that for an attending to watch over a medical officer’s each and every clinical or surgical decision would not be in that medical officer’s best interest as medical officers take call overnight by themselves, covering all of OB/GYN and doing whatever needs to be done, though with attending physicians available for by phone and for in person assistance in case of emergency. Medical officers must, therefore, quickly gain confidence in their skills and decision making, knowing that help is, though available, certainly not in the building. 

In this setting, one of the main ways I felt like I could contribute at SLH was by teaching the interns and medical officers. During my second week at the hospital, one of the medical officers approached me after hearing about a woman with a first trimester missed abortion who needed to undergo a dilation and evacuation. While she was not assigned to the unit taking care of this patient, the medical officer had done an evacuation the prior week that was unsuccessful and thus had been on the lookout for more so she could get better. I happily agreed and we together took the patient to the operating room. 

While it was a minor procedure, this was the first time I had taught it without the reassuring presence of an attending behind me, adding an extra little tip here and there and, more importantly, providing me with the comfort that help was at hand should anything go awry. Thankfully, though, it did not. I talked the medical officer through the procedure, trying to strike the balance between guiding her through it while still allowing her to do the procedure and gain confidence and making sure the patient was safe that my teachers had seemed to do so easily. She did great and so did the patient. 

The next week the medical officer found me after morning report. She had been on call that past weekend and a patient had come in bleeding with an incomplete abortion. The medical officer had taken the patient to the OR herself, completed the evacuation and the patient had gone home, her bleeding resolved.

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