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Confidence Building During Medical Training

My fellow medical students, interns, residents and attendings: I am not a medical student but an emeritus professor of Obstetrics and Gynecology at the University of Miami Miller School of Medicine, and also a voluntary faculty member at the Florida International University Herbert Wertheim College of Medicine. I have a great deal of contact with medical students and residents. During training (as student or resident), gaining confidence in one's own abilities is a very important part of becoming a practitioner. This aspect of training does not always receive the necessary attention and emphasis. Below I describe one of the events of confidence building that has had an important and lasting influence on my career as an academic physician. I graduated from medical school in Belgium many years ago. I came to the US to do my internship in a small hospital in up state NY. I was as green as any intern could be, as medical school in Belgium at that time had very little hands on practice, as opposed to the US medical graduates. I had a lot of "book knowledge" but very little practical confidence in myself. The US graduates were way ahead of me. My fellow interns, residents and attendings were really understanding and did their best to build my confidence and never made me feel inferior. One such confidence-building episodes I remember vividly. Sometime in the middle part of the one-year internship, I was on call in the emergency room and was called to see a woman who was obviously in active labor. She was in her thirties and had already delivered several babies before. The problem was that she had had no prenatal care at all and there was no record of her in the hospital. I began by asking her some standard questions, like when her last menstrual period had been and when she thought her due date was. I did not get far with my questioning as she had one contraction after another and she was not interested in answering. Soon the bag of waters broke and she said that she had to push. The only obvious action for me at that point was to get ready for a delivery in the emergency room. There was no time to transport the woman to the labor and delivery room. There was an emergency delivery “pack” in the ER, which the nurses opened for me while I quickly washed my hands and put on gloves. Soon after, a healthy, screaming, but rather small baby was delivered and handed to the pediatric resident who had been called. At that point it became obvious that there was one more baby inside the uterus. Realizing that I was dealing with a twin pregnancy, I panicked, as in my limited experience during my obstetrical rotation some months earlier I had never performed or even seen a twin delivery. I asked the nurses to summon the chief resident, who promptly arrived to my great relief. I immediately started peeling off my gloves to make room for the resident to take my place and deliver this twin baby. However, after verifying that this baby was also a "vertex" without any obvious problem, he calmly stood by, and over my objections, bluntly told me “you can do it”, even though I kept telling him that this was a first for me. I delivered this healthy, screaming twin baby in front of a large number of nurses and doctors crowding the room, only to realize that this was not the end of it and that indeed there was a third baby. Now I was really ready to step aside and let the chief resident take over. However he remained calm and again, stood by and assured me that I could handle this situation. I am not even sure how many triplets he had delivered himself as they are not too common. Baby number three appeared quickly and also was healthy and vigorous. What a boost to my self-confidence that was! I only delivered one other set of triplets later in my career and that was by C-Section. All three babies came head first. If one of them had been a breech the situation might have been quite different. What I will never forget is the implied lesson in confidence building the chief resident gave me. I have always remembered that. In fact I have put this approach in practice numerous times when the roles were reversed later in my career as teacher. Often in a somewhat difficult situation at the bedside or in the operating room, a student or more junior doctor would refer to me to take over and finish a procedure he or she did not feel qualified to do. Many times I would reassure and encourage that person to continue while I talked him or her through it. Many of these junior doctors have told me afterwards how they appreciated this confidence building. Of course one has to be careful to balance this approach with patient safety and I have never delegated responsibility in critical situations and have often taken over when a junior doctor was having trouble. Those interested, can read more about my experiences in the US and a number of other countries, in a free e book, entitled "Crosscultural Doctoring. On and Off the Beaten Path" can be downloaded at this link. Enjoy!  
DR William LeMaire
over 5 years ago
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1602

Obstetrics in Flow Charts: Revision Summary for Finals

This slide show should be an easy way to cover almost all of the obstetric information you will need for your final exams. It covers pregnancy, emergencies, infections, miscarriages & still births, TOP, induction, c-sections, normal labour, antenatal care and post natal care.  
speakerdeck.com
over 4 years ago
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10

WHO | Caesarean sections should only be performed when medically necessary

​​10 APRIL 2015 | GENEVA - Caesarean section is one of the most common surgeries in the world, with rates continuing to rise, particularly in high- and middle-income countries. Although it can save lives, caesarean section is often performed without medical need, putting women and their babies at-risk of short- and long-term health problems. A new statement from the World Health Organization (WHO) underscores the importance of focusing on the needs of the patient, on a case by case basis, and discourages the practice of aiming for “target rates”.  
who.int
over 4 years ago
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0
11

Is early induction or expectant management more beneficial in women with late preterm pre-eclampsia?

This is one of a series of occasional articles that highlight areas of practice where management lacks convincing supporting evidence. The series adviser is David Tovey, editor in chief, the Cochrane Library. This paper is based on a research priority identified and commissioned by the National Institute for Health Research’s Health Technology Assessment programme on an important clinical uncertainty. To suggest a topic for this series, please email us at uncertainties@bmj.com.  
feeds.bmj.com
over 4 years ago
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Lifestyle changes or metformin reduce type 2 diabetes risk in women with gestational diabetes, US study shows

Women with gestational diabetes have an increased risk of type 2 diabetes for years after giving birth, but intensive lifestyle changes or metformin therapy reduce this risk by more than a third, a US study has found.  
feeds.bmj.com
over 4 years ago
Www.bmj
0
14

Is early induction or expectant management more beneficial in women with late preterm pre-eclampsia?

This is one of a series of occasional articles that highlight areas of practice where management lacks convincing supporting evidence. The series adviser is David Tovey, editor in chief, the Cochrane Library. This paper is based on a research priority identified and commissioned by the National Institute for Health Research’s Health Technology Assessment programme on an important clinical uncertainty. To suggest a topic for this series, please email us at uncertainties@bmj.com.  
feeds.bmj.com
over 4 years ago
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16

Pre surgery preparation for diabetic pregnant woman for Elective Caesarean section

Prepare for USMLE,UK,CANADIAN,AUSTRALIAN, NURSING & OTHER MEDICAL BOARD examinations around the globe with us.Understand the basics, concepts and how to answ...  
youtube.com
over 4 years ago
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QUICK OBGYN: Contraindications to External Cephalic Version (ECV)

Prepare for USMLE,UK,CANADIAN,AUSTRALIAN, NURSING & OTHER MEDICAL BOARD examinations around the globe with us.Understand the basics, concepts and how to answ...  
youtube.com
over 4 years ago
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11

Research on medical abortion and miscarriage may change international routines

Two scientific studies led by researchers at Sweden's Karolinska Institutet are expected to form the basis of new international recommendations for the treatment of medical abortions and...  
medicalnewstoday.com
over 4 years ago
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New research shows a statistical significant association between increased LARC usage and reduction in teenage pregnancy and abortion rates in England

New findings, published in the International Journal of Women's Health, show increased long-acting reversible contraception (LARC) usage in England was significantly associated with...  
medicalnewstoday.com
over 4 years ago
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2

Strong association between pollutants from coal-burning stoves and miscarriages in Mongolia

Burning coal for domestic heating may contribute to early fetal death according to a new study by experts from The Saban Research Institute of Children's Hospital Los Angeles and Ulaanbaatar...  
medicalnewstoday.com
over 4 years ago
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4

New DNA test offers miscarriage clues

New research shows an alternative DNA test offers clinically relevant genetic information to identify why a miscarriage may have occurred years earlier.  
medicalnewstoday.com
over 4 years ago
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Risk of miscarriages not increased by NSAIDs

Women who take nonsteroidal anti-inflammatory drugs (NSAIDs) during pregnancy are not at increased risk of miscarriages, confirms a new study published in CMAJ (Canadian Medical Association...  
medicalnewstoday.com
over 4 years ago
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1

Modern Methods Of Abortion Are Not Linked With An Increased Risk Of Preterm Birth

The link between previous termination of pregnancy (abortion) and preterm delivery in a subsequent pregnancy has disappeared over the last 20-30 years, according to a study of data from Scotland...  
medicalnewstoday.com
over 4 years ago
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0
0

Medications Used To Treat Rheumatoid Arthritis May Affect Abortion Rate In Women

A new study published in the American College of Rheumatology (ACR) journal, Arthritis Care & Research, reveals that women with rheumatoid arthritis (RA) who were on methotrexate (MTX)...  
medicalnewstoday.com
over 4 years ago
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Maternal gestational diabetes linked to autism risk for offspring

A new study suggests that exposure to gestational diabetes while in utero could increase the risk of developing autism spectrum disorder for children.  
medicalnewstoday.com
over 4 years ago
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20

Study finds gestational diabetes associated with greater risk of autism in children

Children whose mothers developed gestational diabetes by the 26th week of pregnancy were at increased risk of developing autism later in life, according to a new Kaiser Permanente study...  
medicalnewstoday.com
over 4 years ago
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12

Potential cause of preeclampsia may share links with disorders such as Alzheimer's

New research has identified a potential cause of and a better diagnostic method for preeclampsia, one of the most deadly and poorly understood pregnancy-related conditions in the world.  
medicalnewstoday.com
over 4 years ago
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28

New research aims to refine increasingly popular plastic surgery procedures: Buttock augmentation and vaginal rejuvenation surgery

Two of the fastest-growing plastic surgery procedures are gluteoplasty or 'butt augmentation,' to improve the appearance of the buttocks; and labiaplasty to address cosmetic and functional...  
medicalnewstoday.com
over 4 years ago
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Birth weight and pregnancy complications associated with enamel defects

At the 93rd General Session and Exhibition of the International Association for Dental Research, researcher Bertha A.  
medicalnewstoday.com
over 4 years ago