Family Medicine Centered Maternity Care Fellowship
It
has been well established that Family Physicians provide primary care on
a level comparable to other primary care providers; the added advantage
of having one provider who can care for the entire family across their
life course has been a foundation of Family Medicine. This is clearly
seen at the beginning with Maternity Care. At the IU/Methodist Family
Medicine Residency where Methodist Hospital is the sole OB training
site, it was noted through an extensive chart audit process that greater
than half of our OB patients were high-risk, based on either obstetric,
medical, or social risk factors. Many urban Family Medicine training
programs have seen a significant rise of high-risk patients in their
Obstetric population.
The work force shortages in the nation and specifically in primary care have created a shortage of skilled and competent Family Medicine faculty who actively participates in and teaches maternity care. Also, when it comes to providing maternity care, the limited training in most programs presents an additional challenge. Many training programs offer just two months of focused labor and delivery training, usually limited to routine care and normal deliveries. Large learner to teaching faculty ratio is also a problem faced by many training programs. Family Physicians who train in these settings rarely include maternity care in their practices, and those who do are limited by training and comfort to care primarily for the low risk obstetric patient.
The IU/Methodist Family Medicine Centered Maternity Care Fellowship was created to address these needs. Two notable strengths of the program are its comprehensive scope and its Family Medicine focus. The fellowship is designed to provide excellent training in the care of an underserved population, while also offering extraordinary educational opportunities for residents, fellows, and future faculty in Family Medicine.
Longitudinal 12 month Curriculum
Year 2010 Application Deadline
The maternity care fellow will experience maternity care from teaching faculty in Family Medicine who are privileged in operative deliveries and management of many high-risk obstetrical cases as well as from highly skilled and experience OB/GYN faculty at Methodist Hospital.
The fellow will spend time learning high-risk management in the out -patient setting at OB/GYN clinics as well in the Family Medicine clinic. Continued development of the fellows Family Medicine skills and identity are encouraged by participation in continuity clinics at the FMC. Procedural training in basic OB ultrasound (dating, anatomic screening, emergent US) are also a part of the curriculum. Surgical experience in Cesarean Sections, tubal ligations, D&Cs will also be key components of the fellow’s training. Formal small group teaching and learning with Maternal Child Health fellowship trained family medicine faculty will be a core part of the fellow’s year.
Academic growth is also encouraged as the fellow will participate in
the teaching of residents during supervised deliveries and cases, as
well as didactic presentations to the family medicine residents at the
IU/Methodist residency. The fellow will also actively participate in the
residency’s quality improvement chart auditing process which provides
additional learning in risk stratification and quality improvement. The
fellow will also be encouraged to do a scholarly project in the area of
quality improvement, curriculum development, or clinical inquiry. The
fellow’s training will equip them to be leaders in the field of Family
Medicine Obstetrics, provide comprehensive continuity care in
obstetrics, and enable them to address the shortage of ob faculty in
family medicine if they choose.
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Longitudinal 12 month Curriculum
Focused on the areas outlined in the Educational Objectives
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Educational Objectives
I. Patient Care
On completion of the OB fellowship, the OB fellow will
demonstrate an understanding of the biological and psychological impact
of pregnancy, delivery, and care of the newborn upon a woman and her
family by:
1. Diagnosing pregnancy based on history, physical examination, laboratory tests and/or confirmatory OB Ultrasound as evidenced in the OB chart.
2. Providing good prenatal care by documented discussion regarding diet, exercise, drugs, the emotional impact of pregnancy, and counseling the family about the impact of the birth of the child in the family.
3. Provide the mother and father (or relevant family member involved of the newborn with appropriate health education and a discharge plan including discussion of available resources for parenting, family planning, breastfeeding, general maternal education related to the baby, and contraception.
II. Medical Knowledge
The OB fellow will be able to recognize and demonstrate
competency in the management of low, moderate and high risk pregnancy as
outlined in the longitudinal curriculum. This includes primary
management, surgical intervention and appropriate consultation of the
following issues as noted by preceptor evaluations and post fellowship
exam:
1. Bleeding in early pregnancy
2. Ectopic pregnancy
3. Bleeding during, second and third trimester
4. Premature rupture of the membranes
5. Diabetes mellitus in the pregnant woman
6. PIH/Pre-eclampsia/eclampsia
7. Excess weight gain
8. Rh incompatibility
9. Multiple gestations
10. Hyeremesis gravidarum
11. Malpresentation of the fetus
12. Infections of the vagina and the urinary tract
13. Determine the stage of labor
14. Determine the presentation
15. Determine and assess the progress of labor
16. Help the patient select the appropriate type of anesthesia for
17. Manage the delivery process including the recognition of high risk situations such as:
a. Multiple births
b. Breech births
c. Posterior footling and hand presentations
d. Eclampsia
e. Premature rupture of the membranes
f. All abnormal labor patterns
g. Indications for cesarean section
h. Pelvic dystocia and the need for assisted vaginal delivery or operative delivery
18. Repair an episiotomy and laceration of the vagina, cervix, and perineum.
19. Manually remove the placenta and recognize the complications of this procedure.
20. Treat postpartum hemorrhage and understand the clotting mechanism.
21. Perform infant resuscitation if needed
III. Practice-Based Learning:
Fellows will:
1. Obtain the recommended general obstetrics text (Gabbe) for use and reading while on the service, following a case-based reading approach, fellows are expected to assimilate literature and evidence based materials for self education and identify opportunities for improvement in the areas of patient care and practice experience.
2. Demonstrate an understanding of information technology and its use in practice improvement through a fellow project determined by the fellow and the fellowship director.
IV. Interpersonal and Communication Skills:
Fellows will:
1. Work effectively with others as a member of the Obstetrics health provider team.
2. Display effective listening skills b providing information using effective, nonverbal, explanatory, questioning and writing skills through H&Ps, triage notes and communications during rounds.
3. Be expected to facilitate the learning of residents and students on the service as well as through informal case –based teaching as well as formal didactic lectures.
V. Professionalism:
Fellows will
1. Demonstrate a commitment to carrying out professional responsibilities by being punctual, completing all assigned tasks and documentation in a timely manner.
2. Adhere to ethical principles by working in the best interest of the patient and maintain patient confidentiality.
3. Demonstrate sensitivity to a diverse patient population by providing empathetic, respectful; quality care regardless of culture, age, gender and disability.
VI. Systems Based Practice:
Fellows will:
1. Demonstrate ability to practice cost-effective healthcare and the ability to partner with other professionals to provide quality healthcare.
2. Be advocates for their patients and work with other health care professionals to provide assistance with accessing system and community resources.
3. Recognize
the relationship of his/her patient care and its effects on other health
care professionals and the hospital system.
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Compensation
Current Salaries for 2009-10, effective July 1, 2009
for OB fellows is $65,000.
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- Eligibility Requirements:
- Must obtain an Indiana license before starting the Fellowship
- Have AAFP board certification (or eligible for certification) - Download application (please type information, do not hand-write)
- Include copy of current CV
- Prepare a one-page personal statement outlining your professional goals
- Send via certified mail with return receipt to:
IU/Methodist Family Medicine Center
Advanced Family Medicine Centered Maternity Care Fellowship
Attn: Melissa Ortolf, Fellowship coordinator
1520 N. Senate Avenue
Indianapolis, IN 46202
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Year 2010 Application Deadline
In order to apply for a Sports Medicine Fellowship, please follow these
directions:
- Application must be postmarked NO LATER THAN October 31, 2009.
- Interviews are invitation only and held between December 1, 2009 and January 15, 2010.
- Letter of Acceptance sent February 22, 2010.
- Start day is July 15, 2010.
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- Sagi V. Mathew M.D., Director Advanced Family Medicine Centered Maternity Care Fellowship; Assistant Professor of Clinical Family Medicine; Graduate, Maternal Child Health Fellowship, PCC/West Suburban Hospital. Privileged in C-Sections and High-Risk Obstetrics
- J. Brent Sneed M.D., Assistant Professor of Clinical Family Medicine; Assistant Residency Director IU/Methodist Family Medicine Residency. Privileged in C-Sections and High-Risk Obstetrics
- Claire Bernardin, M.D.
- Emily Bowsher, M.D.
- Karla Fehd, M.D.
- Selena Harris, M.D.
- Kendra Karner, D.O.
- Marshall Keltner M.D.
- Tamara Mendez, M.D.
- Arundathi Prasad, M.D.
- Judith Robinson, M.D.
- Mary-Beth Soper, M.D.
-
Polly Trainor, M.D.
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