Visit Type 1: New Patient Visits

BEFORE CLINIC — PRECHARTING

• Ask: Why are they here?
  • Confirmed cancer diagnosis (pathology in hand)?
  • Concern for cancer only — no pathology yet?
  • Seeking second opinion after treatment elsewhere?
  • Hereditary cancer syndrome (Lynch, BRCA)?
• HPI — how did the patient present? What symptoms?
• Workup by primary cancer type:
  • Uterine: endometrial sampling, TVUS, CT abdomen/pelvis
  • Ovarian: CA-125, imaging
  • Cervical/vulvar: Pap history, colposcopy, biopsies, LEEP, CKC
• Medical & surgical history — comorbidities, medications, prior abdominal surgeries
• Family history — relatives affected, cancer type, age at diagnosis
• Preventive screening — Pap, mammogram, colonoscopy up to date?

DURING THE VISIT

• Ask the patient: what is their understanding of why they're here and of next steps?
• Confirm and fill in gaps from chart review
• Assess functional status → ECOG performance status (impacts candidacy for surgery/treatment)
• Exam: heart, lungs, abdomen — defer pelvic exam until attending is present
• "The tissue is the issue" — cancer cannot be confirmed without pathology (endometrial sampling, biopsy, or surgical pathology)

Visit Type 2: Chemo Clearance Visits

KEY TERMINOLOGY

• Cytotoxic agents (e.g., carboplatin, paclitaxel) — target rapidly dividing cells
• Immunotherapy / checkpoint inhibitors (e.g., pembrolizumab) — immune system targets cancer
• PARP inhibitors (e.g., olaparib) — prevent DNA repair; used in ovarian cancer
• Hormonal therapy (e.g., letrozole, an aromatase inhibitor) — for ER/PR+ tumors
• Adjuvant — chemo after surgery (most common)
• Neoadjuvant — chemo before surgery (to downsize disease; often used in advanced ovarian cancer)
• Maintenance therapy — additional treatment after initial surgery + chemo to delay recurrence (PARP inhibitors, bevacizumab)

BEFORE THE VISIT — FOCUSED CHART REVIEW

• Pull up last clinic note → one-liner + oncologic summary
• Cancer type, stage, date of diagnosis
• Prior surgeries and procedures
• Current regimen — cycle #, date of last treatment
• First regimen or has there been a prior line?
• Review prior side effects and tolerance
• Labs: ANC, Hgb, Plts, Cr, electrolytes, tumor markers
• Imaging: no evidence of disease? Partial response? Progression?

DURING THE VISIT

• How did they tolerate the last cycle?
• Ask about previously reported side effects — better or worse? Any new ones?
• Look up key side effects for their specific regimen ahead of time
• Brief ROS: fatigue, appetite, nausea/vomiting
• Exam: heart, lungs, abdomen
• Goal: confirm labs are acceptable, patient is tolerating treatment, and disease is not progressing. You are not expected to manage the regimen as a resident.

Visit Type 3: Surveillance Visits

PURPOSE

• Patients who have completed treatment and currently have no evidence of disease (NED)
• Monitor for signs of recurrence — frequency and duration vary by cancer type and stage
• Example: early-stage endometrial cancer → H&P every 3–6 months for first 2–3 years, then every 6–12 months up to 5 years

BEFORE & DURING THE VISIT

• Use last clinic note: cancer type, surgeries/treatments, duration of NED
• Any chronic side effects from treatment?
• Any tumor markers or imaging being followed?
• During visit: ask about any new symptoms
• ROS: weight changes, appetite, abdominal pain, bladder/bowel function, vaginal bleeding

Resources:

• UpToDate — great starting point for any topic overview
• NCCN (free account at nccn.org) — guidelines for staging, treatment, and surveillance

Topics to Review Over Time:

• Endometrial cancer: risk factors, surgical staging, fertility-sparing management
• Ovarian cancer: approach to the complex adnexal mass, tumor markers, surgical staging
• Cervical cancer: risk factors, Pap smear guidelines, colposcopy, LEEP, cold knife cone
• Vulvar cancer: risk factors and treatment options
• Hereditary syndromes: Lynch and BRCA — surveillance guidelines and risk-reducing surgery

About the Speakers:

Host: Lucy Brown, MD, MPH – Resident physician at Johns Hopkins GYN/OB. Dr. Brown is passionate about medical and resident education and will be pursuing a Fellowship in Complex Family Planning after residency.

Guest Speaker: Angela Liang, MD – OB/GYN resident at The Johns Hopkins Hospital. She will be starting gynecologic oncology fellowship at the University of Pennsylvania.

Intern Ready: Ob/Gyn is a podcast aimed at interns and off-service residents beginning their post-graduate training in Obstetrics and Gynecology. The views expressed are the speakers' own and do not constitute medical advice.

Definition

What is infertility?

• Failure to achieve pregnancy after 12 months of regular unprotected intercourse — for patients under 35
• Shorten to 6 months for patients 35 and older
• Anyone 40+ should be seen as soon as they start trying — don't wait
• Immediate evaluation warranted for:
  • Oligomenorrhea or amenorrhea
  • Known uterine or tubal disease
  • Stage III/IV endometriosis
• Resource: ACOG Committee Opinion No. 781 and ASRM guidelines

History & Exam

HISTORY — PATIENT

• Comprehensive medical and surgical history
• Menstrual history — are cycles regular? (regular cycles suggest ovulation, but ~1/3 of regular cyclers can still be anovulatory)
• Full GYN history — pelvic infections, STIs, known fibroids, endometriosis
• Prior pregnancies with previous partners? (establishes primary vs. secondary infertility)
• Ask about: thyroid disease, galactorrhea, hirsutism, pelvic/abdominal pain, dyspareunia
• Family history: developmental delay, early menopause, reproductive problems
• Social history: tobacco, alcohol, recreational drugs

HISTORY — PARTNER

• Obtain medical and reproductive history — pregnancy takes two
• Prior pregnancies with previous partners?
• Intercourse frequency — ideally unprotected sex ~2x/week

PHYSICAL EXAM

• Vitals, weight and BMI — extremes affect fertility
• Thyroid exam; breast exam (look for galactorrhea if indicated)
• Signs of androgen excess — acne, hirsutism, male-pattern hair
• Pelvic exam — uterine size, shape, mobility; adnexal masses or tenderness

Ovarian & Ovulatory Evaluation

COMMON CAUSES

• PCOS — most common cause of ovulatory-related infertility
• Primary ovarian insufficiency (POI)
• Thyroid disease, hyperprolactinemia

WORK-UP

• Mid-luteal progesterone — obtain ~day 21 of a 28-day cycle; value >3 ng/mL suggests ovulation
• For PCOS evaluation: LH, FSH, testosterone
• Thyroid function studies and prolactin as indicated
• Ovarian reserve:
  • Antral follicle count on early-cycle ultrasound
  • AMH — value <1 ng/mL suggests diminished ovarian reserve
  • A low AMH does not mean infertility — it only takes one egg. AMH estimates ovarian reserve and responsiveness to gonadotropins for IVF/oocyte preservation.

TREATMENT FOR ANOVULATION

• Ovulation induction with clomiphene (estrogen receptor antagonist) or letrozole (aromatase inhibitor)

Tubal Evaluation

• HSG (hysterosalpingogram) — gold standard for tubal patency
• Radio-opaque dye injected through cervix; X-ray visualizes "fill and spill" through tubes
• Low positive predictive value — non-patency needs follow-up
• Hydrosalpinx: salpingectomy often recommended before IVF — fluid impairs implantation
• Known tubal factor → IVF required for conception

Uterine Evaluation

• Look for: polyps, fibroids, septum, adhesions (synechiae) — >16% of patients with infertility have a uterine abnormality on sono
• Saline infusion sonogram (SIS) — preferred over standard TVUS; saline distends the cavity to reveal lesions
• 3D ultrasound can also be helpful
• Follow-up hysteroscopy — both diagnostic and therapeutic

Sperm / Male-Factor Evaluation

• Male factor contributes to infertility in 40–50% of couples — do not overlook
• Semen analysis — gold standard; order early in the evaluation
• At-home semen tests available as a screening step if insurance or access is a barrier

Quick Recap & Intern Pearls

BUCKETS OF INFERTILITY

• Female factor (~ovarian, tubal, or uterine)
• Male factor (40–50% of couples)
• Unexplained (~30% of couples)
• Note: "Female factor" and "male factor" are simplifications — anatomy and gender identity vary. Tailor evaluation to each patient and partnership.

DO NOT ROUTINELY ORDER (PER ASRM)

• Prolactin (unless indicated), karyotype, thrombophilia panel, endometrial biopsy

INTERN CLINIC PEARLS

• Get a thorough history and physical — that is the most important part
• Walk patients through the "journey of the egg" framework: ovary → fallopian tube → uterus
• Use diagrams to explain ovulatory, tubal, and uterine factor concepts
• If the patient meets infertility criteria based on duration of attempts → refer to REI

Since the recording of this episode, Polycystic Ovary Syndrome (PCOS) underwent a name change to now be referred to as Polyendocrine Metabolic Ovarian Syndrome (PMOS). The new naming of the disease better encompasses the endocrine and metabolic effects of the disease beyond the ovary.

Resources:

• ACOG Committee Opinion No. 781: Infertility Workup for the Women's Health Specialist
• ASRM Practice Committee Documents
• UpToDate: Overview of Infertility

About the Speakers:

Host: Lucy Brown, MD, MPH – Resident physician at Johns Hopkins GYN/OB. Dr. Brown is passionate about medical and resident education and will be pursuing a Fellowship in Complex Family Planning after residency.

Guest Speaker: Arielle Valdez-Sinon, MD, PhD – Gyn/Ob chief resident at Johns Hopkins Hospital. She will be starting fellowship in Reproductive Endocrinology at Johns Hopkins in Fall 2026. She has an interest in reproductive surgery with the use of minimally invasive techniques to improve fertility outcomes.

Intern Ready: Ob/Gyn is a podcast aimed at interns and off-service residents beginning their post-graduate training in Obstetrics and Gynecology. The views expressed are the speakers' own and do not constitute medical advice.

I. Introduction & Learning Goals

Purpose: Guidance for an intern's first hysteroscopy in the OR.

Objectives: Review indications, pre-op preparation, OR setup/equipment, fluid media, and complications.

II. Indications for Hysteroscopy

Diagnostic Hysteroscopy:

• Abnormal uterine bleeding (AUB) or postmenopausal bleeding
• Infertility workup
• Evaluation of abnormal imaging findings

Operative Hysteroscopy:

• Polypectomy (removal of polyps)
• Myomectomy (removal of submucosal fibroids)
• Septum resection
• Lysis of adhesions (Asherman syndrome)
• Foreign body removal (e.g., "lost" IUD)

III. Pre-Operative Preparation

Chart Review Checklist:

• Indication: Understand the clinical reason for the procedure
• Imaging (US/MRI): Confirm uterine size (to avoid over-dilating) and location of pathology
• Comorbidities: Check cardiac, renal, and pulmonary history to set fluid management thresholds
• Cervical History: Assess risk for stenosis (prior procedures or menopause)
• Menstrual Cycle: Check current phase (bleeding can obscure visualization)

Patient Counseling (Benefits & Risks):

• Benefits: Superior diagnostic sampling and therapeutic symptom relief
• Standard Risks: Pain, bleeding, infection (low risk)
• Specific Risks: Uterine perforation (may require laparoscopy if energy was used or if there is concern for bowel injury)

IV. Equipment & OR Setup

The Hysteroscope Components:

• Telescope: The lens (0-degree for forward viewing vs. 30-degree for lateral angles)
• Sheaths: Inner and outer sheaths to house the telescope and allow fluid flow
• Inflow/Outflow Ports: For fluid delivery and drainage (use under-the-butt drapes to catch fluid for deficit calculation)
• Light Source: Warning — becomes extremely hot; keep away from drapes/patient
• Camera System & Monitor
• Working Channel: For operative instruments (graspers, scissors)

V. Distension Media (Fluids)

Isotonic Solutions (Preferred):

• Normal Saline: Compatible with bipolar electrosurgery; same osmolality as blood

Hypotonic Solutions:

• Glycine (1.5%), Sorbitol (3%), Mannitol (5%)
• Used only for monopolar surgery; higher risk of hyponatremia

Fluid Deficit Management:

• Definition: The difference between fluid into the uterus vs. fluid recovered
• ACOG Threshold: Max 2,500 mL for isotonic; however, many surgeons stop at 1,500 mL (or 750–1,000 mL for high-risk patients)

VI. Procedural Steps & Tips

• Cervical Dilation: Can use mechanical dilators or "hydrodilation" using fluid pressure through the scope
• Tenaculum Tip: Take a "sturdy bite" of the cervix to prevent tearing/lacerations
• Pressure Management: Keep intrauterine pressure lower than the patient's Mean Arterial Pressure (MAP) to limit fluid extravasation into the body

VII. Complications

• Uterine Perforation: Often occurs during dilation; recognized by a "loss of resistance"
• Fluid Overload: Can lead to hyponatremia, distributive shock, or flash pulmonary edema
• Hemorrhage: More common in operative cases (3% for myomectomy); manage with massage, uterotonics, or intrauterine balloons
• Vasovagal Reaction: Can occur during cervical manipulation or distension
• Gas Embolism: Rare; more common with older CO₂ distension methods

Resources:

• ACOG Technology Assessment: Hysteroscopy
• UpToDate: Hysteroscopy – Managing Fluid and Gas Distending Media
• AAGL – Advancing Minimally Invasive Gynecology Worldwide

About the Speakers:

Host: Lucy Brown, MD, MPH – Resident physician at Johns Hopkins GYN/OB. Dr. Brown is passionate about medical and resident education and will be pursuing a Fellowship in Complex Family Planning after residency.

Guest Speaker: Mahima Krishnamoorthi, MD – Gyn/Ob resident at Johns Hopkins Hospital. She attended Stanford University for undergrad and graduated from the Johns Hopkins School of Medicine.

Intern Ready: Ob/Gyn is a podcast aimed at interns and off-service residents beginning their post-graduate training in Obstetrics and Gynecology. The views expressed are the speakers' own and do not constitute medical advice.

Topics Covered:

• What Is Fetal Therapy? – Subspecialty of MFM treating fetal conditions before birth. Contact the fetal therapy team at 844-543-3825.
• Fetal Anemia and Intrauterine Transfusion
  • Busiest fetal transfusion center in the Mid-Atlantic (600+ transfusions to date).
  • Most common indications: alloimmunization, parvovirus infection, hydrops/hereditary spherocytosis.
  • Performed on L&D once fetus reaches viability, with betamethasone course completed.
  • Risks: preterm labor, PROM, fetal bradycardia, emergent delivery (<1%).
  • General care path: arrive → H&P → OB anesthesiology → NPO, IVF, continuous fetal monitoring → transfusion (usually in triage room) with OR, anesthesiology, and NICU on standby.
  • Post-transfusion: Continuous monitoring (fetus is paralyzed — change mother's position for decels). Advance to clears at 1 hour if no contractions and reassuring tracing. Earliest discharge at 2 hours if Category I tracing and fetal movements have returned.
• Twin-to-Twin Transfusion Syndrome (TTTS)
  • Occurs in monochorionic pregnancies — unequal sharing of volume between donor and recipient twins.
  • Fetoscopic laser ablation of placental vascular anastomoses offered for Stage 2+ (or progressing Stage 1), performed 16–26+6 weeks.
  • Risks: preterm labor, PROM, membrane separation, demise of one or both fetuses, bleeding, maternal transfusion (<2%).
  • Pre-op: consents in the Center, H&P, OB anesthesiology, NPO, IVF, Foley catheter prior to OR.
  • Post-op: magnesium 2 g/hr (titrate up by 0.5 g/hr for >6 contractions/hr). POD 1: stop mag, remove Foley, AM CBC, regular diet, ultrasound in Center, may discharge home.
• Myelomeningocele (MMC) Closure
  • Performed 24–26 weeks for isolated anomaly with normal genetics (open or fetoscopic approach).
  • MOMs trial showed: less hindbrain herniation, decreased/delayed shunt placement, improved ambulation at 30 months.
  • Maternal risks: preterm delivery, PROM, uterine incision complications.
  • Admit night prior. Morning of: A-line placed, indomethacin at 6 AM, magnesium started, Foley placed.
  • Post-op: highest risk for pulmonary edema — strict I&O, incentive spirometry is a must, continuous fetal monitoring, epidural for pain, SCDs in place. If concerns: see the patient, listen to lungs, check I&O, and CALL.
  • POD 1: AM labs (CBC, CMP), continue indomethacin/heparin/SCDs/IS. Remove A-line if all agree. Mag and Foley discontinued. Transition to PO pain control (Tylenol, Dilaudid, gabapentin, Flexeril, abdominal binder).
• Fetal Arrhythmias and Transplacental Therapy
  • Most common admission: fetal SVT (FHR >180 bpm for more than 10% of observation time).
  • Indications for transplacental therapy: tachycardia ≥180 bpm with biphasic DV, tachycardia ≥280 bpm regardless of duration, or SVT with fetal hydrops.
  • May need 24 hours of continuous monitoring to determine if transplacental therapy is needed. Risk for hydrops and fetal death.
  • Most commonly treated with flecainide; additional agents include digoxin and amiodarone.
  • Maternal baseline: EKG and CMP with ionized Ca, then continuous cardiac monitoring while initiating. Must have normal EKG indices (PR ≤0.2 sec, QRS ≤0.12 sec, QTc ≤0.47 sec).

About the Speakers:

Host: Lucy Brown, MD, MPH – Resident physician at Johns Hopkins GYN/OB. Dr. Brown is passionate about medical and resident education and will be pursuing a Fellowship in Complex Family Planning after residency.

Guest Speaker: Michelle L. Kush, MD – Assistant Professor, Maternal-Fetal Medicine, Center for Fetal Therapy in the Department of Gynecology and Obstetrics at Johns Hopkins.

Intern Ready: Ob/Gyn is a podcast aimed at interns and off-service residents beginning their post-graduate training in Obstetrics and Gynecology. The views expressed are the speakers' own and do not constitute medical advice.

Topics Covered:

• Where to Start
  • Chart check the patient — age, parity, gestational age, medical and OB problems.
  • Confirm dating with your own eyes. Trust but verify.
  • Skim prior encounters for chronic conditions and what's worked before.
  • Check if they're up to date on routine OB care (e.g., GBS swab at 36 weeks).
  • Start a note using premade templates to save time.
  • Bring your ultrasound, stethoscope, mask, and something to keep notes.
  • If the patient is on the NST, don't wait for it to complete before performing your sono.
  • Gather a focused but detailed history, then do a focused physical exam. Perform a pelvic exam as indicated (with patient consent), with or without your chief.
• Most Common Chief Complaints
  • Rule out labor / preterm labor, general abdominal pain
  • Rule out PPROM / SROM
  • Decreased fetal movement (DFM)
  • Rule out PIH / preeclampsia
  • Vaginal bleeding/spotting or abnormal discharge
  • Urinary symptoms, nausea/vomiting, constipation, headaches, URI symptoms
• How to Staff
  • Gather all data before staffing — evaluate the NST, review your slides, listen to lungs if needed.
  • Follow the standard SOAP format: Age, parity, GA, chief complaint → HPI → vitals, PE (including SSE/SVE) → your plan.
  • Think through: labs needed, ECG, formal sono, how long to monitor pressures, admission vs. discharge, and whether other services need to be consulted.
  • Your plan doesn't need to be 100% right — that's what intern year is for. Track patterns so you can apply them next time.
• Closing the Loop with the Patient – Update them as things progress. If you don't know the answer, say so, then find out (UpToDate, Open Evidence, institutional resources, your chief/senior).
• Writing Your Triage Note – Thorough but concise. Think through the differential. Update the note as labs return and the plan is finalized. Use dictation or EMR AI tools. Have your chief review notes the first few weeks.
• After the Visit – Update the patient's problem list with any new diagnoses (e.g., pyelonephritis, gestational hypertension).

About the Speakers:

Host: Lucy Brown, MD, MPH – Resident physician at Johns Hopkins GYN/OB. Dr. Brown is passionate about medical and resident education and will be pursuing a Fellowship in Complex Family Planning after residency.

Guest Speaker: Ore Afon, MD – Gyn/Ob resident at Johns Hopkins Hospital. She attended Cornell University for undergrad and graduated from the University of Toledo College of Medicine & Life Sciences.

Intern Ready: Ob/Gyn is a podcast aimed at interns and off-service residents beginning their post-graduate training in Obstetrics and Gynecology. The views expressed are the speakers' own and do not constitute medical advice.

Keywords: Postmenopausal bleeding, Transvaginal ultrasound, Endometrial hyperplasia, Endometrial malignancy/cancer, Endometrial sampling

Topics Covered:

• Overview of PMB – Definition, incidence (5% of office GYN visits, 4–11% of menopausal patients), and why the leading concern is endometrial cancer until proven otherwise.
• Etiologies
  • Polyp (~35%) – Localized overgrowths stimulated by estrogen; mostly benign but higher concern for malignancy/hyperplasia in PMB patients.
  • Atrophy (~30%) – Low estrogen leads to endometrial/vaginal atrophy, micro-erosions, and spotting.
  • Uterine Fibroid (~5%) – Less common postmenopausally; if a PMB patient has fibroids, still assume endometrial pathology.
  • Endometrial Carcinoma (6–14%) – Most common gynecologic cancer in the U.S. Type I (estrogen-driven, favorable prognosis) vs. Type II (high-grade, aggressive).
  • Endometrial Hyperplasia (with and without atypia) – May coexist with or progress to carcinoma in 30–50% of cases.
  • Other causes – Proliferative/secretory endometrium, medications (HRT, anticoagulants, tamoxifen, SSRIs), post-radiation, infection, and non-uterine sources.
• Risk Factors for Malignancy – Increasing age, obesity, unopposed estrogen, tamoxifen, early menarche, late menopause, nulliparity, PCOS, Type 2 DM, Lynch syndrome, Cowden syndrome, and family history.
• Diagnostic Approach
  • History and physical exam
  • Transvaginal ultrasound (TVUS) – Endometrial thickness measurement; normal <4 mm in postmenopausal women; sensitivity 94–97%.
  • Endometrial sampling – In-office EMB vs. OR-based hysteroscopy with D&C, including benefits, risks, and how to choose.
• Follow-Up and When to Refer – Management by pathology result, when to proceed to HSC D&C, and indications for Gyn Oncology referral.

Resources:

• UpToDate: Approach to the Patient with Postmenopausal Uterine Bleeding
• ACOG Committee Opinion: The Role of Transvaginal Ultrasound in Evaluating the Endometrium of Women with Postmenopausal Bleeding
• ACOG Clinical Consensus: Management of Endometrial Intraepithelial Neoplasia or Atypical Endometrial Hyperplasia
• APGO Topic #54: Endometrial Hyperplasia and Carcinoma
• ASCCP Cervical Cancer Screening Guidelines

About the Speakers:

Host: Lucy Brown, MD, MPH – Resident physician at Johns Hopkins GYN/OB. Dr. Brown is passionate about medical and resident education and will be pursuing a Fellowship in Complex Family Planning after residency.

Guest Speaker: Emily Stock, MD – Chief resident in the Department of Gynecology & Obstetrics at Johns Hopkins Medicine. She is currently applying for GYN Oncology Fellowship.

Intern Ready: Ob/Gyn is a podcast aimed at interns and off-service residents beginning their post-graduate training in Obstetrics and Gynecology. The views expressed are the speakers' own and do not constitute medical advice.

Topics Covered:

• What to Expect on Your First Day – A mix of new patients, annuals, return visits, and problem-based appointments. Common complaints include contraception, AUB, pelvic pain, abnormal discharge, STI testing, and post-op checks. Expect a fast pace and feeling slow at first.
• What to Review Ahead of Time
  • Well woman visit guidelines
  • AUB basics (PALM-COEIN) and the initial workup
  • ASCCP guidelines (brief overview)
  • Contraceptive options and the Medical Eligibility Criteria app
  • Vaginal discharge workup — STI testing, wet prep
• Tips for a Smooth, Efficient Clinic
  • Pre-chart! Check for recent ED visits, PCP discussions, last pap, imaging, STI results.
  • Document as you go — brief notes while talking, make them complete later.
  • Optimize your EMR — templates that make sense, favorite order sets.
  • Make eye contact.
• Biggest Challenges and How to Overcome Them
  • Efficiency: Practice-focused HPIs.
  • Sensitive conversations: Sexual history, IPV screening, menses — be direct and compassionate.
  • Pelvic exam confidence: Be trauma-informed, narrate what you're doing, be quick and confident. Don't tell patients to expect pain.
  • Saying "I don't know": Explain your thinking, discuss with the attending, and come back.
• Advice We Wish We'd Known – Your confidence in pelvic exams improves dramatically. Give it time.

About the Speakers:

Host: Lucy Brown, MD, MPH – Resident physician at Johns Hopkins GYN/OB. Dr. Brown is passionate about medical and resident education and will be pursuing a Fellowship in Complex Family Planning after residency.

Guest Speaker: Adrianna Gorniak, MD – Gyn/Ob resident at Johns Hopkins Hospital in Baltimore, MD. She has a passion for all things gynecology, with a special interest in complex benign gynecology.

Intern Ready: Ob/Gyn is a podcast aimed at interns and off-service residents beginning their post-graduate training in Obstetrics and Gynecology. The views expressed are the speakers' own and do not constitute medical advice.

Topics Covered:

• Triage Procedures
  • Logistics: Know the ED layout — pelvic exam rooms, supply locations.
  • Clinical Assessment: Determine hemodynamic stability, active bleeding, starting hemoglobin, and the consulting physician's level of concern.
  • Hemodynamically Unstable Patients: Immediate bedside evaluation. Coordinate 2 IVs, Type and Screen/Cross, coags, bedside FAST exam, and NPO status for potential surgery.
  • Hemodynamically Stable Patients: Chart check, review imaging (TVUS), read up on the differential (UpToDate, ACOG), and inform your senior team.
• Patient Evaluation
  • Introduce the GYN team and provide context to the patient.
  • Gather a full history: HPI, PMH/PSH/OB-GYN history, medications, allergies, social history, and barriers to follow-up.
  • Prepare supplies for the physical exam (bed pans, speculums, swabs, cultures) and ensure proper lighting.
  • Obtain necessary consents (including blood consents if relevant) before staffing.
• Staffing the Consult
  • Stay organized — use your notes and outline the case.
  • "Don't bury the lead" — start with a clear one-liner on assessment and disposition (medical management vs. surgical intervention).
• Developing an Assessment and Plan
  • Own it — formulate an independent assessment and plan, not just a data report.
  • Present reasonable management options (medical vs. surgical) to the attending.
  • Place the patient on the team handoff list.

About the Speakers:

Host: Lucy Brown, MD, MPH – Resident physician at Johns Hopkins GYN/OB. Dr. Brown is passionate about medical and resident education and will be pursuing a Fellowship in Complex Family Planning after residency.

Guest Speaker: Jennifer Doorey, MD, MS – Academic Ob/Gyn at The Johns Hopkins University School of Medicine. As the founder of MedReady, Dr. Doorey seeks to advance clinical medical education by developing resources for medical students and clinical educators.

Intern Ready: Ob/Gyn is a podcast aimed at interns and off-service residents beginning their post-graduate training in Obstetrics and Gynecology. The views expressed are the speakers' own and do not constitute medical advice.

Topics Covered:

• Your Job as an Intern – Be open to feedback, manage multiple patients, ask for help early, and set expectations with your chief.
• On Labor & Delivery – Fetal heart rate interpretation, cervical exams, induction algorithms, magnesium management, and postpartum hemorrhage protocols. Golden rule: if you're thinking "should I call my senior?" — call.
• On Gynecology – AUB workup by age, pregnancy of unknown location, ectopic pregnancy, ovarian torsion, and the post-op fever differential (5 W's).
• How to Study Without Burning Out – Read about your patients, review bad outcomes, keep a "Learning Points" note, and use quick resources like UpToDate and ACOG Practice Bulletins.
• In the OR – Know the surgical indication, patient background, positioning, closing, and anticipate next steps.
• Communication – How to navigate emotional deliveries, fetal demises, complications, and difficult conversations with families.
• Emotional Reality – Expect imposter syndrome and moral distress. Debrief, find your co-interns, and protect your empathy.
• Physical Survival – Eat before shifts, carry snacks, compression socks, and protect sleep on golden weekends.

Recommended Resources:

• UpToDate
• ACOG Practice Bulletins
• Infant Risk HCP – Pregnancy and breastfeeding med safety app
• Reprotox
• ASCCP – Pap/colpo algorithms
• CDC STI App
• US MEC/SPR – Contraception
• OB Wheel (pregnancy dating app)
• Open Evidence App
• USPSTF – Preventive Care
• MDCalc
• NCCN App
• FIGO App
• POP-Q App

About the Speakers:

Host: Lucy Brown, MD, MPH – Resident physician at Johns Hopkins GYN/OB. Dr. Brown is passionate about medical and resident education and will be pursuing a Fellowship in Complex Family Planning after residency.

Guest Speaker: Jennifer Doorey, MD, MS – Academic Ob/Gyn at The Johns Hopkins University School of Medicine. As the founder of MedReady, Dr. Doorey seeks to advance clinical medical education by developing resources for medical students and clinical educators.

Intern Ready: Ob/Gyn is a podcast aimed at interns and off-service residents beginning their post-graduate training in Obstetrics and Gynecology. The views expressed are the speakers' own and do not constitute medical advice.