Fellowships: Maternal-Fetal Medicine

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.

2014 Application Information

Application Deadline: May 31, 2013

It is essential that candidates appear for an interview if they wish consideration for our fellowship. Interviews are one full day in length and are tentatively scheduled for July 17, August 14, and September 11. 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, 2013 for the fellowship training that will begin July 1, 2014.

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
  
  1. Your most meaningful experience(s) and how they have influenced your life, and
  2. 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 e-mail address is being protected from spambots. You need JavaScript enabled to view it , MFM Fellowship Coordinator
University of Washington
Department of Obstetrics & Gynecology
Division of Perinatal Medicine
1959 NE Pacific Street, Box 356460
Seattle, WA 98195-6460

Maternal-Fetal Medicine Faculty

	Michael Gravett, MD Professor and Director, Maternal-Fetal Medicine Vice Chair, Department of Obstetrics and Gynecology		Donald Barford, MD Clinical Professor Director, Center of Perinatal Medicine, Providence Everett Medical Center		Thomas Benedetti, MD, MHA Professor & Vice Chair, Department of Obstetrics and Gynecology Director, Education Division
	Zane Brown, MD Professor Associate Director, Residency Program		Justine Chang, MD Assistant Professor		Edith Cheng, MD, MS Professor Medical Director, Prenatal Genetics and Fetal Therapy Program Medical Director, Maternal and Infant Care Center
	Shani S Delaney, MD Acting Assistant Professor		Thomas Easterling, MD Professor		Hilary Gammill, MD Research Assistant Professor WRHR Scholar
	Jane Hitti, MD, MPH Professor Director, Maternal-Fetal Medicine Fellowship Program Adjunct Associate Professor, Epidemiology		Jennifer Jolley, MD Assistant Professor		Sophia Lannon, MD, MPH Acting Assistant Professor
	Emmanuelle Par?, MD, MSCE Assistant Professor Assistant Director, Maternal-Fetal Medicine Fellowship Program		Alyssa Stephenson-Famy, MD Assistant Professor
	Emily Holing, PhD, ARNP Teaching Associate Diabetes & Pregnancy Nurse Practitioner		Kathleen Anne Kenny, ARNP, CNM, MA Teaching Associate Women's Health Nurse Practitioner

Fellows

	Jeroen Vanderhoeven, MD Fellow, Acting Instructor		Kimberly Ma, MD		LaVone Simmons, MD Fellow, Acting Instructor
	Kara Hoppe, DO Fellow, Acting Instructor		Ashlie Tronnes, MD Fellow, Acting Instructor

Midwives

	Bonnie Bernstein, CNM, MSN, ARNP Teaching Associate Certified Midwife		Mary Bolles, CNM, MN, ARNP Teaching Associate Certified Nurse Midwife		Michelle Grandy, CNM, MN, ARNP Teaching Associate Midwifery Practice Manager Certified Nurse Midwife
	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
License in WA State required?	Yes
Faculty/staff appointment for Fellow:	Fellow, Acting Instructor
Courses Offered (Board Requirement):	Biostatistics/Epidemiology Physiology Embryology/Teratology
Program Emphasis: Laboratory/Animal Research Clinical Research Patient Care Teaching/Conferences	25% 25% 40% 10%
# Fellow graduated, past five years:	Six
Current # Fellows:	Two 1st year, two 2nd, one 3rd
ACOG-approved # of Fellows:	Six

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

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 and 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, anniocentesis, 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: ~$55,000.00
  MFM - 2: ~$57,000.00
  MFM - 3: ~$59,800.00

• 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.

• Staff Title
  Each Fellow is given an official staff 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.