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Maternal-Fetal Medicine Fellowship: Program Curriculum |
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Residency & Fellowship Programs > Obstetrics & Gynecology > Maternal-Fetal Medicine Fellowship: Program Curriculum |
The first year is structured as an integrative experience. There is no block time by month but specific days during the week in which the fellow is exposed to the various aspects of Maternal Fetal Medicine. During the first year, the fellow will attend rounds on high-risk patients on the in-patient service. The outpatient schedule is outlined below and the specific experience will be found in the narrative. One day per week, each week, time is reserved for education and development of a research program. This time is used to explore both basic science laboratory and clinical research opportunities. This will be accomplished with the assistance of a research advisor selected by each fellow. Monday Morning - Ultrasound Supervision of Fellows While on Rotations The fellow is supervised by the MFMS attending when in the outpatient clinic. The fellow is supervised by the L&D attending when following laboring patients or intrapartum consults. A detailed grid is available with clinical assignments for the entire year. Graduate Education Courses Available
High Risk Pregnancy Management - Hospitalized Patients The Fletcher Allen Health Care-MCHV Campus is the tertiary care center for central and northern portions of Vermont, New Hampshire and Northeastern New York State. An active transport service is in place and the majority of women in labor less then 34 weeks within the referral area are transferred for labor and delivery management. There are 10-20 transport patients/month and 5-15 transport deliveries. The inpatient service varies between 2-8 hospitalized patients. These patients include the full range of medical complications. Teaching rounds are held with the fellows, high-risk resident and student by the Maternal Fetal Medicine attending. Patient Management conferences are held Monday, Wednesday and Friday in which patient admissions and patient management discussed. Emphasis is on physiology of the maternal conditions and accepted management protocols. Discussion is led by the on service Maternal Fetal Medicine Attending. High Risk Pregnancy Management - Diabetes Clinic The majority of insulin dependent diabetic patients in the area are managed in our clinic with only class AČ occasionally managed by private OB/Gyn. Consultation for gestational diabetes is provided with nutritional assessment, nursing education on home monitoring, as well as consultation with the perinatal staff. Out patient insulin teaching is also provided. Pre-gravid women are referred from the Endocrine Metabolic Clinic for pre-pregnancy counseling. The Clinic is staffed by the MFMS physicians, the first year Maternal Fetal Medicine fellow, the high risk obstetrical resident, a nutritionist and a certified diabetes nurse educator. . Registered nurses are available to teach women home glucose monitoring and other skills necessary for the pregnant diabetic women. High Risk Pregnancy Management - Maternal Fetal Medicine Clinic This is a continuity clinic for the Maternal Fetal Medicine patients. Between 12-20 patients are seen per session. These clinics provide outpatient consultations for various obstetrical and medical problems, i.e. hypertension, history of premature labor, or cardiac disease. Pre-pregnancy counseling is also undertaken during these sessions. The clinic is staffed by the Maternal Fetal Medicine attending, the Maternal Fetal Medicine Fellow, and the high-risk obstetrical resident. In the second and third year, the fellow assumes more complete responsibility of the MFMS service. The fellow will plan/direct morning reports and direct the care of the hospitalized patients. There will be a MFM attending as back up at this time but this is designed as an integrative experience to more directly prepare for independent practice. Maternal Fetal physiology is stressed in the patient management conferences. In addition, fellow didactics are focused on physiology. This is directed by reading Clinical Physiology in Obstetrics, Eds. Hytton and Chamberlain, Blackwell Scientific Publications and other standard texts. Leah Burke M.D, a clinical pediatric geneticist, directs the Vermont Regional Genetics Center. The Vermont Regional Genetics Center and the Familial Cancer Center is a multidisciplinary organization composed of members of the Department of Medicine, Pediatrics, Anatomy, Pathology, Psychiatry and Obstetrics. Certified genetic counselors provide the majority of the advanced maternal age counseling. Preconception counseling and pregnancy genetic counseling is under the direction of the MFMS and sessions are scheduled weekly. The Quad Screening Program is under the direction of Denise Bonyun, M.S. C.G.C. The screening program covers the State of Vermont and eastern New York State. The MFMS provides genetic counseling and evaluation for both low and high alpha-fetoprotein tests. The program has been functioning for the past 15 years. The cytogenetic laboratory is under the direction of Mary E. Tang, M.D. in the Department of Pathology and is capable of handling amniotic fluid cells as well as leukocytes with on-site karyotyping. Selected biochemical assays are also available. The Genetics Center coordinates monthly meetings attended by all members during the Wednesday didactic session. The format rotates between maternal fetal medicine prenatal presentations, teratology presentations, and pediatric evaluations, medcine and cancer. Basic genetic principles are taught using Genetics in Medicine, Ed. Thompson and Thompson as a guide. The Vermont Regional Genetic Center has a Teratology Registry under the direction of Dr. Leah Burke. The registry consists of two toll free number in which a patient can call with questions of possible drug and chemical exposures. The agent in question is then researched as to the possible effects on the pregnancy. The pregnancy is monitored and follow-up may include a neonatal examination. This information is currently being computerized for easier access. Teratology questions are presented in the genetics meetings. Fellows have access to REPROTOX through the Fletcher Allen Health Care Computer System. Women are sent to the MFMS for preconception counseling related to different drug exposure. The department of anatomy and neurobiology has active research protocols on the role of many drugs in early embryogenesis. A recent MFM fellow worked in this lab and developed a new model in the chick embryo to study the effects of Valproic acid. The infectious disease program is under the direction of Elizabeth Bonney, M.D. We provide the consultation for any suspected fetal infections. There is a medicine HIV Clinic which has a federal grant to provide services throughout the state. All pregnant patients with HIV are referred to Burlington for pregnancy care and delivery. The Medicine service presents an 8-week lecture series each summer on HIV infections. Dr. Bonney is available for consultation on all infectious disease problems in the Department and regularly evaluates such patients with the fellows at their request. Fellows are invited to those sessions of the bimonthly infectious disease rounds that are pertinent to their training. The neonatal intensive care unit consists of Jerold Lucey, M.D., Jeffrey Horbar, M.D., Roger Soll, M.D., Ann Johnston M.D., Charles Mercier, M.D., and Gautham Suresh, M.D. M.B.B.S. There is a Neonatology fellowship program approved for one fellow per year. The nursery currently accepts patients from the referral area of Vermont, New Hampshire, and New York State. There are 21 intensive care beds with availability for step-down care within the pediatric wing. A weekly combined conference with pediatrics reviews all admissions to the ICN with follow-up as to their problems. Hospitalized patients or pregnant women with fetal anomalies are presented before birth and management plans discussed. One session per month is a review of stillborn and neonatal deaths. The department of Pediatrics runs the Vermont Oxford Network. This is an association of over 350 NICU units around the world, which share data and participate in management trials. This database is available to the MFMS and has been used as the basis for several publications. Obstetrical ultrasound is under the direction of David Jones M.D, of the division of Maternal Fetal Medicine. A Fetal Diagnostic Center has been established and is located within the Maternal Fetal Medicine Clinic Space. In the first year, the fellow has 2 days per week concentrated in ultrasound. During this time the fellows are exposed to 2nd trimester scanning, amniocentesis, fetal growth abnormalities, Doppler, fetal echocardiography, first trimester screening, chorionic villus sampling and follow up of previously diagnosed fetal anomalies. Time is also spent during these sessions for counseling newly identified and previously identified abnormalities. Fetal echocardiography is performed jointly with pediatric cardiology and Maternal Fetal Medicine. Dr. Scott Yeager, a pediatric cardiologist, and Dr. Ira Bernstein have special expertise in fetal echocardiography and are available for these evaluations. Opportunities are available during the 2nd and 3rd years to gain experience depending on fellow needs. The Section of Anesthesia is committed to providing quality obstetric anesthesia care. There is twenty-four hour coverage and epidermal anesthesia is available to all patients at the request of the attending obstetrician. Dr. Eva Kristensen and Dr. Chris Viscomi are the individuals primarily involved with Obstetric Anesthesia by staffing anesthesia services on the Labor and Delivery Unit. Both have additional training in Obstetric Anesthesia. Formal obstetric anesthesia teaching includes six to eight hours of formal lectures per year for anesthesia residents which fellows are welcome to attend. There are also three lectures for the OB/GYN residents on obstetric anesthesia. Informal teaching consists of readily available consults and attendance at Grand Rounds and Morbidity/Mortality Statistic conferences. The fellow has a 1 month rotation in the SICU under the direction of Fred Rogers M.D. During this time, they learn all aspects of invasive monitoring and critical care. All pregnant patients admitted to the ICU have a mandatory MFMS consultation. The majority of the patients are transferred to the MFMS and managed jointly with the in house anesthesia staff. Dr. Brenda Waters is our perinatal pathologist. A monthly session, which is part of the pediatric conference, is devoted to perinatal pathology. Patients with stillbirths or neonatal deaths are presented. All FAHC patients are presented and selected cases referred to Dr. Waters from other hospitals. The second and third year are primarily devoted to research activities. During the research time, 1/2 to one day per week is spent in the high-risk clinic. The statistics course and second course are taken during this time. Fellows are encouraged to pursue both clinical and basic science research projects during their fellowship. Fellows are encouraged to apply for internal and outside funding for research projects in order to learn how to develop a research program. Additional Educational Requirements Fellows are required to take a minimum of two graduate level courses during their fellowship one of which must be a statistics course. The second course is at the discretion of the individual and should be selected to assist in career goals. Additional arrangements can be made for other courses if necessary. Four months of the second and third years are spent in clinical work, one month SICU, and three months in MFMS. One in house night call is required per month. Additional paid moonlighting opportunities are available. We limit the total in-house calls to 5 per month due to residency work restriction requirements (80 hour work week). |
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