Fellowship in Maternal Fetal Medicine

Program Description

Clinical ProgramResearch Didactic

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)-Main Campus Clinic, UT Health San Antonio MARC Hill Country MFM Clinic, UT Health MFM Clinic in Seguin TX, Robert B. Green University Health Center Downtown, and University 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, UT Health MARC Hill Country MFM Clinic in Boerne, and the UT Health San Antonio MARC MFM Clinic on our main campus 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. Preconception and genetic counseling is also the basis of many consultations.

 

All deliveries and inpatient care occur at the University Hospital and outpatient experiences cover several central and outreach locations. Our delivery base is approximately 3300 deliveries annually of which over 60% is high-risk. Our center is the region’s only combined level 1 Adult /Pediatric trauma units in the setting of a level IV maternal/neonatal units. Our capture area for referrals, transports (nearly 300 maternal transports annually) and deliveries is vast covering an area 200 miles surrounding San Antonio (area extending to the western and southern borders with Mexico, east to the Gulf of Mexico, and northward towards central Texas) and provides our fellows with unique experiences with a multitude of complex medical-surgical complications of pregnancy, fetal diagnosis and therapy, and maternal critical intensive care. Fellows in our program readily assume the role as consultants for our labor and delivery unit early in their training.

 

The 12 months of 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. The fellows also serve as co-attendings on the antepartum service during parts of their clinical blocks. 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. Our fellows are required to complete a total of 4 months (divided into eight 2 week blocks) of labor and delivery during their fellowship. One month is 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 follow-up of babies born prematurely. The remaining 6 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 hands-on scanning, simulation, and online educational modules. Fellows completing our program will be highly competent sonographers with fetal anatomic, 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. Monthly in-situ obstetric emergency simulations are also held to facilitate optimization of team-based care. 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). Fellows in our program can also participate in MFM outreach activities (presentations, simulations, etc) and in our maternal transport service (Stork One) which serves all of South Texas.

 
 
 

Research

 

Our MFM fellowship program provides for 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. Our fellows may utilize any 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 animal 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 (NICHD 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. Our fellows will have access to 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 our 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 laboratories are 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 works with the fellows 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(IDSOG), American College of Obstetricians and Gynecologists (ACOG), Association of Professors of Gynecology and Obstetrics (APGO), and other national meetings. Completion of thesis project and defense is a requirement for the fellowship. It is anticipated that our fellows will have completed and submitted a manuscript for publication before completion of the fellowship training program.

 
 
 

Didactic

 

Our fellowship educational program includes a 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. 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 our fellows on campus.

 

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's "Guide to Learning in Maternal-Fetal Medicine”. MFM journal clubs are held quarterly 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. Our fellows also lead quarterly OB/MFM journal club for the core OB/GYN residency.

 

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/Percreta conference and OB Critical Care 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), Maternal Morbidity and Mortality Conference (held Wednesdays), Maternal Morbidity Common Cause Analysis Conference (held quarterly), and resident didactics/journal clubs.

 

Other Experiences

 

A core philosophy for our fellowship training program is to provide fellows 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 provides the fellow with an enriched understanding of the important role that an MFM specialist plays in the health care system.

 

Fellow wellness is an important focus of our program. Multiple opportunities wellness outlets are available for the fellows to participate in activities with the core OB/GYN residency and though MFM division specific activities (social hours, dinner get-togethers, etc).

Weekly Schedule

 

The tables below illustrate the weekly schedule for the three years of fellowship training. During the clinical months, 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 research blocks, fellow participate in only ½ day per week of clinical duties. When fellows are on the SICU and NICU blocks, fellows are excluded from all call and MFM clinical and administrative duties to ensure continuity of the SICU experience.

 

Teaching residents and medical students is an integral part of the fellowship. During the research months’ 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).


 Representative Clinical Block Schedule:
  Monday Tuesday Wednesday Thursday Friday
7:30 am Division meeting/Fellow Didactics Antepartum conf. OB/GYN M&M Conference Antepartum conf.
9:00 am  Ultrasound clinic Diabetes and ultrasound clinic Ultrasound clinic/Seguin Clinic Genetics and MFM clinic Diabetes and ultrasound clinic
12:30 pm     OB/GYN Grand Rounds    
1:00 pm Ultrasound clinic Ultrasound clinic Seguin Clinic/Admin Admin/Research Ultrasound clinic

 

 

  Representative Research Block Schedule:
  Monday Tuesday Wednesday Thursday Friday
7:30 am Division meeting/Fellow Didactics Antepartum conf. OB/GYN M&M Conference Antepartum conf.
8:30 am Research Research Research/Seguin Clinic Research Research
12:30 pm     OB/GYN Grand Rounds    
1:00 pm Research Research Research/Seguin Clinic Research Research