Fellowship in Maternal Fetal Medicine

Program Description

Clinical ProgramResearch TrainingDidactic

Clinical Program

 

Our MFM fellowship program provides for an outstanding academic environment for training the next generation of academic Maternal-Fetal Medicine specialists grounded in a thorough understanding of maternal and fetal physiology and pathophysiology. The ABOG Guideline to Learning in Maternal-Fetal Medicine serves as the foundation for the fellowship learning goals and objectives. The clinical facilities available for training in Maternal-Fetal Medicine include the UT Health San Antonio Medical Arts and Research Center (MARC), UT Health MFM clinic in Seguin TX, Robert B. Green University Health Center Downtown, andUniversity Hospital. Additional clinical experiences are available in conjunction with Methodist and St. Luke’s Hospital which are immediately adjacent in the area.

 

The Robert B. Green University Health Center Downtown clinic, UT Health MFM clinic in Seguin, and the UT Health San Antonio MARC clinic are primary referral centers for Maternal-Fetal Medicine in San Antonio and most of South Texas. These sites contain ancillary staffing procedure rooms with state of the art ultrasound machines and storage systems, and antepartum testing suites. Emphasis is placed upon treatment of difficult medical and genetic complications of pregnancy as well as an array of fetal anomalies. Fellows will gain experience in basic evaluation of the high risk pregnant patient, ultrasonography and related sonographic tools, invasive prenatal diagnosis techniques, amnioreduction, cordocentesis, fetal echocardiography, and training in nuchal translucency. Preconceptional and genetic counseling is also the basis of many consultations.

 

The 12 months of outpatient clinical MFM emphasize genetics, ultrasound, and maternal/surgical complications of pregnancy, including diabetes, infectious disease, and hypertensive disorders of pregnancy. Within these 12 months, the fellow will receive a total of 3 months of training in perinatal ultrasound. During this ultrasound time, fellows will accomplish educational modules on nuchal translucency (NTQR), cervical length (CLEAR) and fetal echocardiography (Fetal Medicine Foundation) and attain respective certification. The required 2 months of labor and delivery are divided into four 2 week blocks spaced throughout the fellowship. One month will be spent in the University Hospital surgical critical care unit under the direction of the Department of Surgery. One month of elective is required in the neonatal intensive care unit to provide the fellow with an appreciation of the complexities related to the care and followup of babies born prematurerly. The remaining 8 months of elective are at the discretion of the fellow and fellowship program director. These elective rotations allow programmatic flexibility for the fellow to focus on areas of interest and hone clinical/research skills.

 

Our fellowship program offers a robust training experience in ultrasound. Ultrasound training occurs throughout the fellowship program and is acquired through both hands-on scanning, simulation, and online educational modules. Fellows completing our program will be highly competent sonographers with nuchal translucency, cervical length, and fetal echocardiography assessments.

 

Simulation is also an integral part of the fellowship training program. A high fidelity simulation laboratory is available at the institution for medical student, resident, and fellow training. Fellows participate as faculty in the resident/nursing simulation sessions. Advanced simulations are available to accent fellow education related to the management of the critically ill gravida. The University Center for Clinical Ultrasound Education is available to fellows for advanced procedural simulations (eg. amniocentesis, cordocentesis, shunt placement, etc).

 
 

Research Training

 

Our MFM fellowship program provides for an outstanding opportunities for research training and conduct of basic science, translational and clinical research. The academic facility of the Department of Obstetrics and Gynecology houses over 12,000 square feet of laboratory space. Specific laboratories are dedicated to molecular biology, cell biology, neuroendocrinology, reproductive immunology, electron microscopy, radioimmunoassays, and infectious disease. The Fellows may utilize any or all of these facilities, in order to acquire specific laboratory skills. A major feature of the research program will be the opportunity for fellows interested in basic science to work with several different animal models, including the baboon. We have ongoing research programs into a variety of maternal and fetal disorders using different animals models. For fellows with interest in clinical research, the institution has substantial clinical volume to accommodate clinical studies and trials of interest. Numerous databases are available for fellow use from recent studies our center has participated in including trials /studies involving preterm birth (NICHD MFMU) and dental hygiene (MOTOR), stillbirth (Stillbirth Network), and diabetes in pregnancy.

 

Depending on the research area of interest and planned thesis project, the 12 months of required research can be allocated into large multi-month blocks, or smaller blocks. The fellow will have access an extensive number of highly qualified potential mentors, both within and outside our department,from which to choose for their research training. Faculty and fellows in our program have full access to the Influuent web portal to assist with identification of potential collaborators for research endeavors. The full faculty and laboratory assets of the Department and Center for Pregnancy and Newborn Research are available to the fellows to promote their research endeavors.

 

Training in both basic science and clinical research occurs throughout the fellowship program. Fellows will gain core training in study design, feasibility assessment and animal/human subjects protections. Fellows are encouraged and supported to attend the Exxcellence in Clinical Research course offered by the
Foundation for Exxcellence in Women’s Health, as well as the NICHD Young Investigators Conference on Maternal-Fetal-Neonatal-Reproductive Medicine. . In addition to the core research training, individualized training is available to teach Fellows research techniques, experimental design, data evaluation, and manuscript submission for publication of their research project. The Center for Pregnancy and Newborn Research is an integral part in the fellow’s research experience and the generation and completion of the thesis project.

 

The institutional RIA/Cell and Molecular Biology laboratoriesare available to provide fellows training in standard molecular biology techniques including in situ hybridization, RNA/DNA isolation and Northern and Southern blotting, polymerase chain reaction (PCR), RNA estimation using reverse transcription PCR and other methods.

 

The fellowship director will work with the fellow to identify areas of interest and potential research opportunities in the first few months of the fellowship to allow for early research engagement during the program. Fellows are actively encouraged to submit research abstracts to the Society for Maternal-Fetal Medicine, Society of Reproductive Investigation, Infectious Disease Society for Obstetrics & Gynecology and other national meetings. Completion of thesis project and defense is a requirement for the fellowship. It is anticipated that the fellow will completed and submitted a manuscript for publication before completion of the fellowship training program.

 
 
 

Didactic

 

The fellowship educational program includes formal course in biostatistics and numerous weekly conferences. Didactic instruction involves both basic science and clinical aspects of maternal and fetal medicine.

 

A graduate level course in biostatistics (Medi 5072- Patient Oriented Clinical Investigation Biostatistics) is required required. The biostatistics course covers material germane to medical research: 1) descriptive statistics, 2) use of computers, 3) confidence intervals, 4) t-tests, 5) p values, 6) chi-square analysis, 7) analysis of variance, 8) regression and correlation analysis, 9) multiple regression analysis and 10) time series analysis. Numerous additional opportunities are also available to the fellows on campus.

 

The graduate school offers several courses pertinent to Fellowship training. They include 1) Computer Science, 2) Developmental Genetics, 3) Methods in Cell and Molecular Biology, 4) Endocrinology of Reproduction, 5) Experimental Immunology and Immunopathology, 6) Immunobiology, 7) Neuroendocrinology, 8) Molecular Genetics and 9) Reproductive Physiology.

 

The Maternal-Fetal Medicine Didactic Conference is held each week and presentations on selected topics are given by the Faculty. Topics are selected to review fundamental and current information on Maternal-Fetal Medicine as outlined in the ABOG"A Guide to Learning in Maternal-Fetal Medicine." MFM journal clubs are held in the basic science and clinical areas. A journal Club format is utilized periodically to discuss recently published articles of special significance. Topics and articles are selected from major areas of interest in Maternal-Fetal Medicine. The Journal Club encourages fellows to keep abreast of new ideas and technical development, and often generates novel research investigations.

 

Other fellow-level conferences include the Multidisciplinary Prenatal Diagnosis Conference and Perinatal Mortality Conference both held monthly and led by the fellows. A Quarterly Placenta Accreta/Percerta conference is also part of the fellowship curriculum. Mini-lecture series on genetics /reproductive medicine, ultrasonography, and research design/statistics are also held annually during the fellowship. In addition, all fellows are expected to enroll in, and complete, online and imaging requirements to attain certification for nuchal translucency (NTQR), cervical length (CLEAR), and fetal echocardiography (Fetal Medicine Foundation) assessments. The Society of Maternal Fetal Medicine Lecture Series is also integrated into the fellow’s education.

 

In addition to the fellow level didactics, the fellows attend and sometimes lead the Antepartum Care Conference (held twice weekly on Tuesdays and Fridays), C-Stats M&M Conference (held Wednesdays), Maternal Morbidity Common Cause Analysis Conference (held quarterly), and resident didactics/journal clubs.

 

Other Experiences

 

A core philosophy for the fellowship training program is to provide the fellow with a robust educational environment to prepare them to both be an effective academic MFM consultant and serve as a leader for women’s health advocacy. To accomplish this philosophical goal, fellows in our program participate in several other unique opportunities. These include participation in at least 2 institutional root cause analysis (RCA) meetings, attendance at one IRB meeting, becoming a reviewer one of the major OB/GYN journals, and completion of the Institute for Healthcare Improvement (IHI) Open School Course,. In addition, fellows are encouraged to mentor a resident on at least one departmental quality improvement project during their fellowship. Fellows as also encouraged to attend at least one State Perinatal Advisory Council meeting and one Regional Perinatal Committee (STRAC Perinatal Committee) meeting during their fellowship program. The composite of these experiences provide the fellow with an enriched understanding of the important role that a MFM specialist plays in the health care system.

 

Weekly Schedule

 

The tables below illustrate the weekly schedule for the three years of fellowship training. During the clinical months (6 in year 1, 6 in year 3) the rotations are spent in the various high-risk clinics (Tuesday/Friday – diabetes in pregnancy clinic; Thursday – Genetics and MFM clinic; Monday/Tuesday/Wednesday/Friday – ultrasound/prenatal diagnosis clinic). Time not spent in clinic is spent on labor and delivery and the inpatient antepartum service. During the inpatient experience time is spent with the obstetrical anesthesia service as well as the neonatology service. One month during the clinical months is spent in the trauma intensive care unit. Teaching residents and medical students is an integral part of the fellowship. During the research months (6 in year 1, 12 in year 2) time is spent in the Center for Pregnancy and Newborn Research where the fellow’s thesis is developed. Clinical research is ongoing and also available for the fellow to pursue (see research section). During the research months the fellow attends the Genetics and MFM clinic or continuity and ultrasound clinic _ day per week. Call responsibilities continue during the research months as well. The final 6 months of year 3 is elective time to complete the thesis and/or obtain further clinical experience particular to the fellow’s interests.

 
  Schedule for Fellows - Year I – clinical (July –September, April - June)
  Monday Tuesday Wednesday Thursday Friday
7:30 am Division meeting Antepartum conf. C-section conf. Basic science journal club Antepartum conf.
9:00 am  Ultrasound clinic Diabetes and ultrasound clinic Ultrasound clinic Genetics and MFM clinic Diabetes and ultrasound clinic
12:30 pm     Grand Rounds Dept of Ob/Gyn    
1:00 pm Ultrasound clinic Ultrasound clinic High risk continuity clinic Ultrasound clinic

 

  Schedule for Fellows - Year I – research - (October – March)
  Monday Tuesday Wednesday Thursday Friday

7:30 am

Division meeting  Antepartum conf.  C-section conf. Basic science journal club  Antepartum conf.
8:30 am Research Research Research Genetics and MFM clinic Research

12:30 pm

    Grand Rounds Dept of Ob/Gyn    

1:00 pm

 Research  Research High risk continuity and ultrasound clinic  Research

Research

 

  Schedule for Fellows - Year II – research - (July - June)
  Monday Tuesday Wednesday Thursday Friday

7:30 am

Division meeting Antepartum conf.  C-section conf. Basic science journal club Antepartum conf.
8:30 am Research Research Research Genetics and MFM clinic Research
12:30 pm     Grand Rounds Dept of Ob/Gyn    
1:00 pm Research Research High risk continuity and ultrasound clinic Research Research

 

  Schedule for Fellows - Year III – clinical (July –December); elective (January – June)
  Monday Tuesday Wednesday Thursday Friday
7:30 am Division meeting Antepartum conf. C-section conf. Basic science journal club Antepartum conf.
9:00 am Ultrasound clinic Diabetes and ultrasound clinic Ultrasound clinic Genetics and MFM clinic Diabetes and ultrasound clinic
12:30 pm   Grand Rounds Dept of Ob/Gyn    
1:00 pm Ultrasound clinic Ultrasound clinic High risk continuity clinic   Ultrasound clinic