Maternal-Fetal Medicine Fellowship

Overview

The fellowship program at the University of Washington is designed to give participants a well-rounded experience in Maternal-Fetal Medicine. Fellows finishing the three-year fellowship are able to fulfill requirements for productive careers in academic medicine or in private perinatal practice. Clinical and research time are equally divided during the 36-month period.

The delivery volume at the University of Washington is ~2,000 per year, with over 20% being low birth weight secondary to a variety of high-risk perinatal disorders. There is an active program in prenatal diagnosis serving over 1,000 patients per year. Fellows participate in and are directly supervised by Maternal-Fetal Medicine faculty in subspecialty clinics: infectious disease, hypertension, prematurity prevention, diabetes, and fetal medicine/ultrasound. In addition, fellows have their own high-risk continuity clinic that spans the entire three-year period.

Five Maternal-Fetal Medicine faculty have NIH-funded research projects. Basic and clinical research projects under the supervision of Maternal-Fetal Medicine faculty have repeatedly resulted in SMFM oral and poster presentations by current and past fellows. In early 2002 a new 2 million dollar renovation of the obstetrical unit provided state of the art facilities for patient care and comfort.

In 1999, the UW's Department of Obstetrics and Gynecology was one of 20 Ob/Gyn sites chosen nationwide and funded by the National Institutes of Health to be a Women's Reproductive Health Research (WRHR) Career Development Program. Our funding has been renewed through 2014. We have one current scholar, and eight who have already completed their WRHR training. The department can support a maximum of three scholars, so opportunities exist for continued research development after completion of a three-year fellowship for selected applicants.

2015 Application Information

Application Deadline: May 31, 2014

It is essential that candidates appear for an interview if they wish consideration for our fellowship. Interviews are one full day in length and dates are to be determined. We will be participating in the fellowship Match, so you will need to contact the National Matching Program at http://www.nrmp.org/fellow to receive the Specialties Matching Service information.

One position is available in our Maternal Fetal Medicine Fellowship on a competitive basis. Candidates may apply through the ERAS Fellowship site at http://www.aamc.org/students/eras.The application deadline is May 31, 2014 for the fellowship training that will begin July 1, 2015.

All applications must include:

  • ERAS Common Application Form:
    • Visit ERAS Fellowships for further instructions as our program accepts ERAS-submitted application only.
  • Personal Statement:
    • Include a narrative up to one page in length, that addresses
      • Your most meaningful experience(s) and how they have influenced your life, and
      • Why you have chosen to pursue a career in MFM.
  • Three letters of recommendation:
    • Letters of recommendation from at least three current medical mentors are required, one of which must be your Residency Program Director.

Contact Information:
This email address is being protected from spambots. You need JavaScript enabled to view it., MFM Fellowship Coordinator
University of Washington
Department of Obstetrics & Gynecology
1959 NE Pacific Street, Box 356460
Seattle, WA 98195-6460
Phone: 206-221-0328
Fax: 206-616-9479

Maternal-Fetal Medicine Faculty

Cheng Edith dept web Edith Cheng, MD, MS
Professor and Director,
Maternal-Fetal Medicine
Medical Director,
Marternal Infant Care Center
Thomas Benedetti, MD, MHA
Professor and Vice Chair
Director, Education Division
Zane Brown, MD
Professor
Associate Director, Residency Program
Justine Chang, MD
Assistant Professor
Delaney Shani Dept web

Shani Delaney, MD
Assistant Professor

Easterling Tom Dept web Thomas Easterling, MD
Professor

Gammill Hilary Dept web Hilary Gammill, MD
Research Assistant Professor
WRHR Scholar
Gravett Michael Dept web Michael Gravett, MD
Professor and Vice Chair

Jane Hitti, MD, MPH
Professor
Director, Maternal-Fetal Medicine Fellowship
Adjunct Professor, Epidemiology
Jennifer Jolley, MD
Assistant Professor
Sophia Lannon, MD, MPH
Assistant Professor
Ma Kimberly Dept web Kimberly Ma, MD
Acting Assistant Professor

stephenson-famy Alyssa Stephenson-Famy, MD
Assistant Professor
Assistant Director, Residency Program
holing Emily Holing, PhD, ARNP
Teaching Associate
Diabetes & Pregnancy Nurse Practitioner
kenny Kathleen Kenny, ARNP, CNM, MA
Teaching Associate
Women's Health Nurse Practitioner

Fellows

Hoppe Kara Dept Dept Web Kara Hoppe, DO
Fellow, Acting Instructor
2012-2015
Tronnes Ashlie Dept web Ashlie Tronnes, MD
Fellow, Acting Instructor
2012-2015
Lai Jasmine Dept web Jasmine Lai, MD
Fellow, Acting Instructor
2013-2016
Weed Samantha Dept web Samantha Weed, MD
Fellow, Acting Instructor
2013-2016
Mitchell Timothy Dept web

Timothy Mitchell, MD
Fellow, Acting Instructor
2014-2017

 Shree Swati Dept web Raj Swati Shree, MD
Fellow, Acting Instructor
2014-2017

 

Midwives

Bonnie Bernstein, CNM, MSN, ARNP
Teaching Associate
Certified Nurse Midwife
Mary Bolles, CNM, MN, ARNP
Teaching Associate
Certified Nurse Midwife
Michelle Grandy, CNM, MN, ARNP
Teaching Associate
Certified Nurse Midwife
Midwifery Practice Manager
Robyn Holloman, CNM, ARNP
Teaching Associate
Certified Nurse Midwife
Cynthia Rogers, CNM, MSN
Teaching Associate
Certified Nurse Midwife

Quick Facts

Number of first year positions available: Two
ACOG Board Approved Program? Yes
ACOG Certified/Eligible? Yes
Faculty appointment for Fellow: Fellow, Acting Instructor
Courses Offered (Board Requirement) Biostatistics/Epidemiology
Physiology
Embryology/Teratology
Program Emphasis:
Laboratory/Animal Research: 25%
Clinical Research: 25%
Patient Care: 40%
Teaching/Conferences:  10%
# Fellows graduated, past five years: Six
Current # of Fellows: Two 1st yr, two 2nd yr, 2 3rd yr
ACOG-approved # of Fellows: Six

At all times, Fellows will adhere to an 80-hour work week.

High-Risk Pregnancy Management

The medically complicated pregnancy is an emphasis during the first year of the fellowship. The first year fellow has one half day/week in clinic for high-risk continuity patients. An attending perinatologist manages the content of the clinic and serves as a mentor. Each continuity patient serves as a focus of fellow education. The fellow and the attending pull the important papers relevant to each patient. A notebook of cases and literature is maintained for each patient. The fellow's case load is reviewed monthly.

The 2nd year fellow continues to carry a case load of medically complicated patients, but the emphasis shifts to medical genetics and prenatal diagnosis. In each of the first two year clinics, the attending monitors the composition of the clinic and the experience of the fellow. Patients are directed into the clinic to maximize the fellow's breadth of experience.

During the 1st and 2nd years, fellows rotate through the following high-risk OB clinics and manage specific patients under the supervision of faculty. Each specialty area addresses the physiological basis of their medical specialty with readings, case conferences and one on one didactics.

Clinic Attending Perinatologist
Prematurity Prevention & Multiple Gestation Thomas Benedetti, MD, MHA
Michael Gravett, MD
Jane Hitti, MD, MPH
Obstetrical Hypertension Thomas Easterling, MD
Diabetes in Pregnancy Zane Brown, MD
HIV Jane Hitti, MD, MPH
Prenatal Genetics and Fetal Therapy Edith Cheng, MD, MS
Jane Hitti, MD, MPH
Michael Gravett, MD

High-Risk Obstetrical Experience

Maternal-Fetal Physiology

The fellows' clinical case load serves as the focus for education in maternal-fetal physiology. Each case is the subject for review of appropriate physiology (normal and pathological), and review of management based on an understanding of the physiology. Case load content is reviewed to offer direction in the assignment of appropriate patients to meet the breadth of the fellows' educational needs.

Genetics and Teratology

Fellows receive training in the area of genetics and teratology through management of patients with Dr. Edith Cheng and/or the genetics counselors. The clinical experience includes genetic counseling of couples at risk for conception with autosomal conditions requiring complex DNA mutational analyses.

The cases are chosen to introduce the fellow to the concepts of traditional Mendelian inheritance as well as nontraditional mechanisms, such as those involved in mitochondrial inheritance and anticipation, as seen in disease involving expansion of trinucleotide repeats. Fellows experience the complexity of such cases by completing the actual step-by-step preparations required for prenatal diagnosis:

  • reviewing medical records and completed molecular studies for diagnosis confirmation,
  • arranging transport of tissue/DNA from appropriate individuals,
  • counseling the couple, and
  • follow-up of the results

In the past year, we have completed prenatal diagnosis in pregnancies at risk for congenital adrenal hyperplasia, agammagloblinemia, X-linked myotubular myopathy, cystic fibrosis, hemophilia, and ?- and ?-thalassemias.

Fellows also receive experience in the management of patients with genetic disorders by following such patients with Dr. Edith Cheng. Past and present patients include women with cystic fibrosis, Gaucher's disease, sickle cell anemia, and Ehlers-Danlos syndrome Type IV.

Infectious Diseases

For fellows pursing the infectious disease focus, there is a three-week course in July of the first year, which is an intensive lecture and seminar series in infectious diseases. Clinical rotations on the pediatric and adult infectious disease consult services and a month in the clinical microbiology laboratories provide in depth exposure to infectious disease diagnosis and treatment.

Fellows spend three months in the Maternal/Child HIV Clinic and have the option to work up to one-half day/week in the Harborview Medical Center or UW Medical Center HIV Clinic and the Harborview Sexually Transmitted Diseases Clinic. During clinical obstetrical rotations, fellows learn to manage pregnant women with antepartum, intrapartum, and postpartum infections, and fellows are preferentially assigned prenatal diagnosis patients with possible fetal infection.

The Ob/Gyn departmental conference schedules include many Grand Rounds and other lectures on infectious disease topics, and fellows are encouraged to attend the weekly clinical infectious disease and biweekly HIV-clinical conferences and sexually transmitted diseases research conferences. In addition, several fellows in the past have chosen to take courses offered in HIV (interdisciplinary 520 Acquired Immunodeficiency Syndrome) and virology (Microbiology 540 Virology).

Neonatology

For fellows entering the program without clinical rotations as residents through the Neonatal Intensive Care Unit, a one-month elective rotation as house staff in the NICU is encouraged to better understand the care and complications of preterm infants. All Ob/Gyn faculty and fellows who take day or night call in Labor and Delivery must have current certification in the American Heart Association Neonatal Resuscitation course.

Additional exposure to neonatology occurs through the Ob/Peds/Anesthesia conference, through participating in NICU rounds to follow-up on infants born to mothers under their care, and through regular consultation with faculty neonatologists about complicated obstetrical and neonatal management situations.

Dr. Christine Gleason, Director of Neonatology, has extensive experience in laboratory research studying the effects of cocaine and alcohol in the developing fetal sheep brain and hopes to collaborate with perinatal faculty and fellows in the laboratory. A fellowship in Neonatology at the University of Washington was established in July of 1999.

Ultrasonography

During an average experience, the fellows should have the following experience in a setting of direct supervision. This total does not include experience on Labor and Delivery, the Antepartum service, and fetal testing using biophysical profiles.

Suspected anomalous fetuses 168 (Prenatal Diagnosis Ultrasound Clinic)
Routine ultrasound scans 198 (1/2 day per week)
1st trimester-routine/NT 100 
 Cervical lengths 150 
 Total (average) 616 

Prenatal Diagnosis Ultrasound

During their clinical rotations, perinatal fellows spend one half day per week in the prenatal diagnosis clinic for one year. Each week they see three to four patients that are referred secondary to being at risk for or suspected to have an anomalous fetus based on an outside ultrasound. The fellow is responsible for performing the ultrasound examination, counseling the patient about the significance of any findings, developing a management plan for the remainder of the pregnancy, and performing any diagnostic tests (amniocentesis and fetal umbilical blood sampling) that are necessary. The fellows are supervised by one of the perinatal faculty (Drs. Michael Gravett and Jane Hitti) with the assistance of a certified genetic counselor and a registered diagnostic medical sonographer. Many of the patients seen in this clinic are referred for the remainder of their pregnancy care which is provided by the fellow.

Routine Ultrasound

For one half day per week until proficient, fellows are assigned to scan 3–4 patients having routine (16–20 week) ultrasound. This activity is supervised by one of the perinatal faculty plus a registered diagnostic medical sonographer and is designed primarily to enhance the fellows' ultrasound experience in a mostly normal population and to allow them to increase their experience with patients with multiple gestations.

Early Ultrasound and Transvaginal Ultrasound

During their rotation through the Prematurity Prevention Program, fellows get the opportunity to scan early pregnancies, (~20/rotation) and gain experience with cervical length ultrasound exams (~70/rotation). These exams are supervised by the perinatal faculty and a registered diagnostic medical sonographer.

Obstetrical Anesthesia

The Obstetrical Anesthesia service at the University of Washington Medical Center consists of five faculty physicians with fellowship training in obstetrical anesthesia, headed by Heathcliff Chadwick, MD, and an obstetrical anesthesia fellow. Maternal-Fetal Medicine fellows work closely with the obstetrical anesthesia staff and fellow in developing delivery plans early in pregnancy for complicated patients and in caring for critically ill patients on Labor and Delivery.

Obstetrical anesthesia teaching rounds are held four days per week from 7:00 to 9:00 AM. The first hour is spent reviewing management of cases from the previous 24 hours and planning management of current patients. The second hour is a didactic lecture on topics in anesthesia and obstetrics.

MFM fellows are encouraged to participate in these teaching rounds. In addition, anesthesia management of complicated patients is discussed in the weekly Obstetrics/Pediatrics/Anesthesia conference on Thursdays. If MFM fellows desire further anesthesia experience, elective time in the operating room or intensive care unit is available.

Facilities

Inpatient Facilities

The inpatient obstetrical facility at the University of Washington Medical Center is adjacent to the departmental academic offices. A new state of the art perinatal unit was completed in January 2002, increasing space for Labor & Delivery, Antepartum, and Postpartum areas by over 10,000 square feet.

Labor and Delivery (8,481 sq ft)

In-Room Monitoring Capabilities
No. Type of Room Electronic Fetal   Maternal Automated BP   O2 Saturation   Central Hemodynamic
9 Labor/Delivery/Recovery X X X Possible
2 Centralized Triage X X X Possible
2 Operating X X X Possible

-Two ultrasound machines
-Maternal and fetal blood gas analysis is performed in the central medical center STAT lab
-Amniotic fluid testing for lung maturity is performed in the medical center lab using fluorescent polarization

  • Postpartum (8,800 sq ft)
    -18 rooms with rooming in for most mothers
  • Antepartum (8,400 sq ft)
    -14 rooms with electronic fetal monitoring connected to centralized monitors
  • NICU (6,508 sq ft)

Outpatient Facilities

The outpatient clinic (Maternal and Infant Care Clinic) is at the University of Washington Medical Center (UWMC):

  • 7,645 sq ft
  • 15 exam rooms
  • Procedure room for U/S exam, amniocentesis, fetal umbilical blood sampling, and laminaria placement for pregnancy termination
  • Ultrasound room
  • Hemodynamic evaluation room
  • Fetal surveillance room

Available Equipment:

  • 2 ultrasound machines for abdominal and vaginal ultrasound
  • Electronic fetal monitors
  • Non-invasive cardiac output monitors

Salary and Benefits

  • Salary (effective 7/1/2008)
    MFM 1 ~$55,000
    MFM 2 ~$57,000
    MFM 3 ~$59,800
  • Vacation
    Fellows receive three weeks of vacation (15 working days) per year at all levels of training.
  • Sick Leave
    Cumulative during the period of employment, sick leave is accrued at the rate of one day per month.
  • Insurance
    Fellows are eligible for health, dental, and life insurance which are provided to the fellow at no cost. Dependent coverage is available at low rates.
  • Professional Liability (Malpractice) Insurance
    The University of Washington Medical Center and all affiliated hospitals provide professional liability insurance coverage for activities which are an integral part of the training program conducted in properly accredited settings.
  • Uniforms
    White coats are provided for all fellows.
  • Faculty Title
    Each fellow is given an official faculty title: Fellow, Acting Instructor in Obstetrics and Gynecology, which affords University staff privileges, including tickets to University athletic events at reduced rates and institution-wide library use.