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Woman And Infants
Woman And Infants

Program Curriculum - MFM Fellowship

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Conferences:

Block Time

The three-year fellowship is structured as an integrated experience. The time is focused on specific areas of MFM - in-patient care, consultation, prenatal diagnosis, and research, in which the fellow is exposed to the various aspects of maternal-fetal medicine. During each year, the fellow will spend months running the consultation and in-patient high-risk service. The remaining six months are committed to research and didactics. Each fellow spends a half day of every week in the Women's Primary Care Center providing antenatal care to women with high-risk pregnancies. Fellows share night call responsibility with the MFM faculty taking an average of five night calls a month in which they are responsible for transports, emergency consultations, and the MFM in-patient service.

The fellows are supervised by the MFM faculty throughout their fellowship. A MFM faculty member provides supervision of antenatal care. The fellow is assigned an MFM backup attending while covering the in-patient service or consultation service. Laboring patients are managed by the individual assigned to the in-patient service with the MFM attending backup when a fellow is covering. Prenatal diagnosis training is supervised by one of the MFM faculty members assigned to the Prenatal Diagnosis Center. A MFM attending is assigned as backup when fellows are covering night call. Research project supervision is provided by the research mentor and fellowship director.

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Graduate Education Courses

Fellows are required to take a minimum of two graduate level courses during their fellowship. Graduate Courses courses are provided through Brown University. Fellows are required to take a graduate level statistics course to fulfill the fellowship requirement of the ABOG. The second course is at the discretion of the fellow with approval by of the fellowship director and should be selected to assist in career goals. Additional arrangements can be made for other courses if necessary.

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In-Patient Service

Women & Infants is the tertiary care center for Rhode Island, eastern Connecticut and southeastern Massachusetts. Maternal transports within the referral area are brought in for antepartum and labor and delivery management. There are more than 300 transports per year.

The inpatient service varies in size throughout the year. The MFM service covers more than 700 deliveries each year, including the full range of medical complications. The MFM attending staff holds teaching rounds every morning with the fellows, MFM residents and 4th year medical students. Emphasis is on physiology of the maternal conditions and accepted management protocols. Discussion is led by the primary in-patient service physician with the MFM staff. In-patient consultation service is provided by the in-patient MFM service.

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Consultation Service

The consultation service provides out-patient consultation to referring providers for management of fetal anomalies, prenatal diagnosis, management of chronic medical disorders in relationship to pregnancy, and pre-pregnancy counseling. Consults are reviewed with the backup attending to discuss nuances of management. Fellows provide management recommendations and assist the referring physicians in obtaining necessary diagnostic tests. Consults are provided in a timely manner to the referring physicians after discussion with the backup attending.

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Antenatal Office Service

The Division provides a continuity clinic for the MFM patients. The fellows follow their own assigned patients with back up by the MFM attending, based on diagnosis and degree of complication, to provide for depth and breadth in clinical exposure during their fellowship. Fellows determine and execute management plans for their own patients.

The Antenatal Office provides antenatal care and management for patients with pregestational and gestational diabetes. The clinic provides nutritional counseling, diabetes nurse educators, and perinatal nurse coordinators who assist in pregnancy management. The Division provides diabetes in pregnancy educational programs to patients as a service for referring physicians. These include instruction in glucose monitoring, insulin administration, and nutrition management. These services are scheduled through the MFM administrative offices.

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Genetics

Women & Infants' Genetic Counseling Program provides fellows with clinical training in genetic counseling by direct observation of the genetic counseling staff during prenatal diagnosis rotations. Genetic counseling training is also provided by faculty who are trained and board certified in MFM and genetics. Fellows are encouraged to participate in the counseling of patients with both common and uncommon disorders.

Certified genetic counselors provide the majority of the counseling for advanced maternal age, abnormal serum screening results, cystic fibrosis, inherited diseases, drug exposures, and testing alternatives. Preconception counseling and pregnancy-related genetic counseling is provided by MFM, MFM-genetics, or genetic counselors, depending on the consultation request.

The Prenatal and Special Testing Program, under the direction of Jacob Canick, PhD, covers the state and is internationally-renowned for developing new serum screening methods. The Division provides genetic counseling and evaluation for both low and high alpha-fetoprotein tests. This facility provided first- and second-trimester serum screening as well as many other specialized tests.

The cytogenetic laboratory, under the direction of Umadevi Tantravahi, MD, in within the hospital's Department of Laboratory and Pathology Medicine. The laboratory provides cytogenetic analysis, FISH, microarrays, and specialized molecular probe analysis, including selected biochemical assays.
Genetics is discussed at many of the specialized conferences including MADAM, perinatal management and perinatal pathology. A wide variety of genetic issues are discussed including prenatal diagnosis, genetic screening, current issues in genetics and ongoing evaluations.

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Fetal Imaging

Targeted obstetrical ultrasound is provided by the Division of Maternal-Fetal Medicine at its Prenatal Diagnosis Center (PDC), which is a comprehensive counseling, diagnosis and testing unit. Screening ultrasound examinations are provided in the general community and through the hospital Department of Diagnostic Imaging. The PDC is a referral-based practice.

Ultrasound training involves both hands-on acquisition and image review. Training is integrated into clinical rotations and special didactic sessions. Screening fetal echocardiography is performed by MFM. Identified abnormalities are referred to pediatric cardiology for consultation. During this time, fellows are exposed to second 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 on counseling parents facing newly identified and previously identified abnormalities.

In the first year, the fellow has four-week didactic session at the beginning of the year to concentrate on prenatal ultrasound examinations. CVS training is provided on a limited basis.

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Research and Didactics

Six months of each year are devoted to research and didactic activities. Research and didactic time is scheduled in blocks of no less then four weeks. Block time is tailored to the individual fellow's project needs. During this research time, one half day a week is spent in the Antenatal Office. The statistics course and second graduate level course are taken during this time. Educational programs occur throughout the week on a regularly scheduled basis and are described below.

Fellows are encouraged to pursue both clinical and basic science research projects during their fellowship. The fellow's research project is determined individually. Fellows are encouraged to design projects that are interdisciplinary within Women & Infants and across the university. A research mentor is selected based on the project focus. Mentors provide guidance to project development, research administration, internal and external funding, project execution, manuscript preparation and review, and career development. Fellows are encouraged to apply for internal and external funding for research projects to learn how to develop a research program and learn the grant process. Fellows receive mentorship from both faculty and project advisors.

Fellowship didactic lectures occur weekly. The lectures are focused on advances within MFM as well as outside the field. This program also covers topics such as research design and informatics. Speakers from other sub-specialties such as pediatric cardiology, diagnostic imaging, laboratory medicine, immunology, anesthesiology, and genetics present on a regular basis. Fellows are expected to have their own independent study program for basic issues in MFM.

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MADAM Conference

Multidisciplinary Antenatal Diagnosis & Management Conference (MADAM) is an integrated conference focused on antenatal management and post-hoc review of prenatally identified abnormalities. The conference occurs twice a month and involves the participation of fetal and pediatric surgery, MFM, neonatology, diagnostic imaging, pathology, pediatric sub-specialties, and genetics. The conference typically involves three presentations from different disciplines related to specific topic or case. The goal is to provide a multidisciplinary approach to clinical management, taking into account all related perspectives.

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Perinatal Pathology Conference

This twice monthly conference, is directed by Pathology, and focuses on fetal and neonatal mortalities. This is a twice monthly conference, reviewing interesting cases treated at Women & Infants. We use a multi-disciplinary conference format involving case presentations, pathology review, and subspecialty input.

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Perinatal Management Conference

This is a weekly conference directed by Neonatology involving research presentations, clinical reviews and clinical case presentations. This conference focuses on neonatal management with relevant obstetrical management issues.

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Reproductive Biology Seminar Series

This is a monthly conference coordinated by the COBRE in Perinatal Biology. This is a is research conference held at the Kilguss Research Building Institute. It focused focuses on basic and translational research related to obstetric and neonatal medicine. Presentations are made by local and nationally-recognized investigators.

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The fellows are supervised by the MFM faculty throughout their fellowship. An MFM faculty provides antenatal care alongside each fellow. The fellow is assigned an MFM backup attending while covering the in-patient service or consultation service. Laboring patients are managed by the individual assigned to the in-patient service with MFM attending backup when a fellow is covering. An MFM attending is assigned as back up when fellows are covering night call. Research project supervision is provided by the research mentor and fellowship director.

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