New Application: Maternal Fetal Medicine

New Application: Maternal Fetal Medicine

Review Committee for Obstetrics and Gynecology

ACGME

Sponsoring Institution

1.Does the Sponsoring Institution also sponsor an ACGME-accredited residency program inobstetrics and gynecology? [PR I.A.1.] ☐ YES ☐ NO

a)Program Name and Number

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2.Describe how the program functions as an integral part of an ACGME-accredited residency in obstetrics and gynecology. [PR I.A.1.] (Limit response to 100 words)

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3.Briefly describe how the program director maintains a collaborative relationship with the program director of the sponsoring core residency program to ensure compliance with the ACGME’s accreditation standards. [PR I.A.1.b)]

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4.Does the program director have financial support for at least eight hours per week of protected time to conduct the educational and administrative aspects of the program? [PR I.A.2.)] ☐ YES ☐ NO

5.Does the program coordinator have financial support for time spent assisting with the administrative aspects of the program? [PR I.A.3.)] ☐ YES ☐ NO

If No, explain.

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Faculty

1.Are all core faculty members involved in continuing scholarly activity? [PR II.B.5.]...... ☐ YES ☐ NO

2.Does the faculty include a minimum of one full-time faculty member other than the program director who is American Board of Obstetrics and Gynecology (ABOG) subspecialty-certified, and current in the subspecialty maintenance of certification (MOC)? [PR II.B.6)] ☐ YES ☐ NO

If No, explain.

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3.In addition to the core faculty, does the program include faculty members in the following disciplines: [PR II.B.7.a)-f)]

a)Critical care medicine...... ☐ YES ☐ NO

b)Genetics...... ☐ YES ☐ NO

c)Infectious disease...... ☐ YES ☐ NO

d)Neonatology...... ☐ YES ☐ NO

e)Obstetrical anesthesiology...... ☐ YES ☐ NO

f)Perinatal pathology...... ☐ YES ☐ NO

4.Briefly explain the role of faculty members from other disciplines in the education of fellows. [PR.II.B.7.g] (Limit response to 200 words)

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Resources

1.Indicate whether the following resources are available at the primary clinical site and whether access to these resources is available at all times. [PR II.D.1., II.D.2.a)-e)]

Available at Primary
Clinical Site / Accessible at All Times
Operating rooms / ☐ YES ☐ NO / ☐ YES ☐ NO
Ambulatory care facilities / ☐ YES ☐ NO / ☐ YES ☐ NO
Recovery rooms / ☐ YES ☐ NO / ☐ YES ☐ NO
Intensive care units / ☐ YES ☐ NO / ☐ YES ☐ NO
Blood banks / ☐ YES ☐ NO / ☐ YES ☐ NO
Diagnostic laboratories / ☐ YES ☐ NO / ☐ YES ☐ NO
Imaging services / ☐ YES ☐ NO / ☐ YES ☐ NO
Labor and delivery unit / ☐ YES ☐ NO / ☐ YES ☐ NO
Antepartum and postpartum inpatient units / ☐ YES ☐ NO / ☐ YES ☐ NO
Level III or IV nursery / ☐ YES ☐ NO / ☐ YES ☐ NO
Intensive Care Unit (ICU)that cares for pregnant women in consultation with maternal-fetal medicine faculty physicians / ☐ YES ☐ NO / ☐ YES ☐ NO

2.Does the program have the infrastructure for research, and facilities equipped to enable fellowsto engage in scholarly activities? [PR. II.D.3.)] ☐ YES ☐ NO

3.Briefly explain the facilities and infrastructure for research available to fellows. Include the type oflaboratory space, equipment, database access, faculty resources, including statistical supportavailable, and other pertinent resources. [PR IV.B.1.] (Limit response to 200 words)

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4.Briefly explain how the program will ensure that the clinical experiences required to meet theeducational objectives of the fellowship will not adversely impact the educational experience ofresidents in the core obstetrics and gynecology program. [PR II.D.5.](Limit response to 200 words)

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Fellow Appointments

Are fellows informed, prior to entering the program, of the requirements for completing the program, including the criteria to qualify for the subspecialty board examination? [PR III.A.2] ☐ YES ☐ NO

Educational Program

At the beginning of the program, does each fellow receivean individual educational plan that includes a monthly block rotation diagram displaying the clinical, didactic, and research activities by rotation?
[PR IV.A.6.a)]...... ☐ YES ☐ NO

The Review Committee recommends use of either Option 1 or Option 2 of the sample block diagram.

Regularly Scheduled Didactic Sessions

1.Indicate whether fellows participate in the following activities: [PR IV.A.3., II.B.5.a)]

a)Journal clubs...... ☐ YES ☐ NO

Indicate frequency...... [Click here to enter text. ]

Who conducts these sessions? (Limit response to 100 words)

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b)Seminars...... ☐ YES ☐ NO

Indicate frequency...... [Click here to enter text. ]

Who conducts these sessions? (Limit response to 100 words)

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c)Didactics...... ☐ YES ☐ NO

Indicate frequency...... [Click here to enter text. ]

Who conducts these sessions? (Limit response to 100 words)

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d)Morbidity and mortality conferences...... ☐ YES ☐ NO

Indicate frequency...... [Click here to enter text. ]

Who conducts these sessions? (Limit response to 100 words)

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2.Indicate whether the didactic topics include:

a)Cesarean hysterectomy...... ☐ YES ☐ NO

b)Cervical cerclage...... ☐ YES ☐ NO

c)Antepartum fetal assessment...... ☐ YES ☐ NO

d)Targeted maternal and fetal imaging using ultrasonography...... ☐ YES ☐ NO

e)Pregnancy termination...... ☐ YES ☐ NO

f)Invasive fetal diagnostic and therapeutic procedures...... ☐ YES ☐ NO

g)External cephalic version...... ☐ YES ☐ NO

h)Intrapartum management of multiple gestations, including external or internal version of second twin ☐ YES ☐ NO

i)Non-vertex vaginal delivery...... ☐ YES ☐ NO

j)Operative vaginal delivery...... ☐ YES ☐ NO

k)Physiology and pathophysiology of diseases occurring in pregnancy...... ☐ YES ☐ NO

l)Normal and abnormal newborn physiology……………...... ☐ YES ☐ NO

m)Genetics, including prenatal screening and diagnosis...... ☐ YES ☐ NO

n)Obstetric critical care...... ☐ YES ☐ NO

o)Infectious diseases as they relate to pregnancy……………...... ☐ YES ☐ NO

Patient Care

Indicate the settings and activities in which fellows demonstrate competence in each of the following areas of patient care. Also indicate the method(s) used to assess competence.

Examples of assessment methods:

Direct observation, videotaped/recorded assessment, global assessment, simulations/models, record/chart review, multisource assessment, patient survey, structured case discussions, anatomic or animal models, formal oral or written exam, practice/billing audit, review of case or procedure log, review of patient outcomes, review of drug prescribing.

Competency Area / Settings/Activities / Assessment Method(s)
treatment of medical and surgical complications of pregnancy
[PR IV.A.5.a).(2).(a).(i)] / Click here to enter text. / Click here to enter text.
performing cervical cerclage
[PR IV.A.5.a).(2).(b).(i)] / Click here to enter text. / Click here to enter text.
performing antepartum fetal assessment (biophysical profile,
non-stress test (NST), etc.
[PR IV.A.5.a).(2).(b).(ii)] / Click here to enter text. / Click here to enter text.
performing amniocentesis at fewer than 24 weeks’ gestation
[PR IV.A.5.a).(2).(b).(iii)] / Click here to enter text. / Click here to enter text.
performing targeted maternal and fetal imaging using ultrasonography
[PR IV.A.5.a).(2).(b).(iv)] / Click here to enter text. / Click here to enter text.
performing external cephalic version
[PR IV.A.5.a).(2).(b).(v)] / Click here to enter text. / Click here to enter text.
performing intrapartum management of multiple gestations, including internal version of the second twin
[PR IV.A.5.a).(2).(b).(vi)] / Click here to enter text. / Click here to enter text.
performing non-vertex vaginal delivery
[PR IV.A.5.a).(2).(b).(vii)] / Click here to enter text. / Click here to enter text.
performing operative vaginal delivery
[PR IV.A.5.a).(2).(b).(viii)] / Click here to enter text. / Click here to enter text.
genetics, genomics and teratology, including: obtaining and interpreting pedigrees; providing genetic counseling to women and families; discussing the risks and benefits of different strategies for prenatal screening and invasive prenatal diagnosis; providing a differential diagnosis management of options, and prognosis for a fetus with abnormalities detected on ultrasound or with abnormal genetic testing
[PRs IV.A.5.a).(2).(c) – IV.A.5.a).(2).(c).(iv)] / Click here to enter text. / Click here to enter text.
obstetrical critical care, which must include the training in the management of acute peripartum medical and surgical complications
[PR IV.A.5.a).(2).(d)] / Click here to enter text. / Click here to enter text.
infectious diseases as relates to pregnancy and the puerperium, which must include the effects of maternal infection on the fetus and newborn
[PR IV.A.5.a).(2).(e)] / Click here to enter text. / Click here to enter text.

Medical Knowledge

Indicate the activities (lectures, conferences, journal clubs, clinical teaching rounds, etc.) in which fellows demonstrate competence in their knowledge of each of the following areas. Also indicate the method(s) used to assess fellow competence.

Competency Area / Settings/Activities / Assessment Method(s)
physiology and pathophysiology of diseases occurring in pregnancy
[PR IV.A.5.b).(2)] / Click here to enter text. / Click here to enter text.
normal and abnormal newborn physiology
[PR IV.A.5.b).(3)] / Click here to enter text. / Click here to enter text.
genetics (including prenatal screening and diagnosis), genomics, teratology, and dysmorphology
[PR IV.A.5.b).(4)] / Click here to enter text. / Click here to enter text.
obstetrical critical care, which must include the training in the management of acute peripartum medical and surgical complications
[PR IV.A.5.b).(5)] / Click here to enter text. / Click here to enter text.
infectious diseases as they relate to pregnancy and the puerperium, including the effects of maternal infection on the fetus and newborn
[PR IV.A.5.b).(6)] / Click here to enter text. / Click here to enter text.

Practice-based Learning and Improvement

1.Briefly describe one learning activity in which fellows demonstrate the ability to investigate and evaluate their care of patients, to appraise and assimilate scientific evidence, and to continuously improve patient care based on self-evaluation and life-long learning. [PR IV.A.5.c)] (Limit response to 400 words)

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2.Briefly describe one planned learning activity in which fellows engage to identify strengths, deficiencies, and limits in their knowledge and expertise (self-reflection and self-assessment); set learning and improvement goals; and identify and perform appropriate learning activities to achieve self-identified goals (life-long learning). [PR IV.A.5.c).(1)-(3)] (Limit response to 400 words)

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3.Briefly describe one planned quality improvement activity or project that will allow fellows to demonstrate an ability to analyze, improve, and change practice or patient care. Describe planning, implementation, evaluation, and provisions of faculty member support and supervision that will guide this process. [PR IV.A.5.c).(4)] (Limit response to 400 words)

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4.Briefly describe how fellows will receive and incorporate formative evaluation feedback into daily practice. (If a specific tool is used to evaluate these skillsplease provide a copy of it with the application.) [PR IV.A.5.c).(5)] (Limit response to 400 words)

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5.Briefly describe one example of a learning activity in which fellows engage to develop the skills needed to use information technology to locate, appraise, and assimilate evidence from scientific studies and apply it to their patients' health problems. [PR IV.A.5.c).(7)] (Limit response to 400 words)

The description should include:

Locating information
Using information technology
Appraising information
Assimilating evidence information (from scientific studies)
Applying information to patient care
Conducting a comprehensive literature search

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6.Briefly describe how fellows will participate in the education of patients, families, students, residents, and other health professionals. [PR IV.A.5.c).(8)] (Limit response to 400 words)

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7.Briefly describe the multidisciplinary inter-professional opportunities for fellows that are devoted to the care of the at-risk mother, fetus, and newborn. [PR IV.A.5.c).(9)] (Limit response to 400 words)

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Interpersonal and Communication Skills

1.Briefly describe one learning activity in which fellows demonstrate interpersonal and communication skills that result in the effective exchange of information and collaboration with patients, their families, and health professionals. [PR IV.A.5.d)] (Limit response to 400 words)

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2.Briefly describe one learning activity in which fellows develop competence in communicating effectively with patients and families across a broad range of socioeconomic and cultural backgrounds, and with physicians, other health professionals, and health-related agencies.
[PR IV.A.5.d).(1)] (Limit response to 400 words)

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3.Briefly describe one learning activity in which fellows develop their skills and habits to work effectively as members or leaders of a health care team or other professional group. In the example, identify the members of the team, responsibilities of the team members, and how team members communicate to accomplish responsibilities. [PR IV.A.5.d).(3)] (Limit response to 400 words)

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4.Briefly describe how fellows will be provided with opportunities to act in a consultative role to other physicians and health professionals. [PR IV.A.5.d).(4)] (Limit response to 400 words)

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5.Briefly describe how fellows will be provided with opportunities to maintain comprehensive, timely, and legible medical records, if applicable. [PR IV.A.5.d).(5)] (Limit response to 400 words)

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Professionalism

Briefly describe the learning activity(ies), other than lecture, by which fellows develop a commitment to carrying out professional responsibilities and an adherence to ethical principles, including: compassion, integrity, and respect for others; responsiveness to patient needs that supersedes self-interest; respect for patient privacy and autonomy; accountability to patients, society, and the profession; and sensitivity and responsiveness to a diverse patient population, including to diversity in gender, age, culture, race, religion, disabilities, and sexual orientation [PR IV.A.5.e)] (Limit response to 400 words)

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Systems-based Practice

1.Briefly describe the learning activity(ies) through which fellows demonstrate an awareness of and responsiveness to the larger context and system of health care, as well as the ability to call effectively on other resources in the system to provide optimal health care. [PR IV.A.5.f)] (Limit response to 400 words)

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2.Describe the learning activity(ies) through which fellows achieve competence in the elements of systems-based practice: working effectively in various health care delivery settings and systems, coordinating patient care within the health care system; incorporating considerations of cost-containment and risk-benefit analysis in patient care; advocating for quality patient care and optimal patient care systems; and working in interprofessional teams to enhance patient safety and care quality. [PR IV.A.5.f).(1)] (Limit response to 400 words)

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3.Describe an activity that fulfills the requirement for experiential learning in identifying system errors and implementing potential systems solutions. [PR IV.A.5.f).(6)] (Limit response to 400 words)

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Curriculum Organization and Fellow Experiences

1.Do fellows have supervised responsibility for the total care of the patient, including initial evaluation, establishment of diagnosis, selection of appropriate therapy, and management of complications? [PR IV.A.4] ☐ YES ☐ NO

If “NO,” explain. Limit response to 100 words.

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2.Briefly describe how fellows participate in continuity of patient care through the antepartum, intrapartum, and postpartum periods. [PR VI.D.2.]

Limit response to 100 words.

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3.Do fellows participate in the diagnosis and management of patients in the following areas[PR IV.A.6.a) -IV.A.6.a).(4)]:

a)Ultrasound...... ☐ YES ☐ NO

b)Outpatient maternal-fetal medicine...... ☐ YES ☐ NO

c)Inpatient maternal-fetal medicine...... ☐ YES ☐ NO

d)Labor and delivery...... ☐ YES ☐ NO

e)Medical or surgical intensive care...... ☐ YES ☐ NO

Explain any “NO” responses. Limit response to 200 words.

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Fellows’ Scholarly Activities

1.Describe the curriculum for fellows’ scholarly activities, to include research design, grant writing,research methodology, scientific writing, and presentation skills. [PR IV.B.1.]

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2.Describe the curriculum for fellows’ scholarly activities, including: [PR IV.B.2.b).(2)-(5)]

Knowledge of biostatics, epidemiology, research design, and research methods, including basic science techniques;
Enhancement of fellows’ understanding of the latest scientific techniques and encouragement of interaction with other scientists;
Opportunities for fellows to present their academic contributions to the maternal fetal medicine community;
Preparation of fellows to pursue research funding and academic positions; and,
Preparation of fellows to be independent investigators.

Limit response to 600 words.

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3.Is each fellow’s scholarly activity monitored by a faculty mentor? [PR IV.B.2.c).(2)]...... ☐ YES ☐ NO

4.Does each fellow give a presentation of his or her scholarly project (thesis)? [PR IV.B.2.d).(3)
...... ☐ YES ☐ NO

5.Do faculty members provide evaluations of these presentations? [PR IV.B.2.d).(3)]...... ☐ YES ☐ NO

Institutional Data

Include data from each institution in the maternal-fetal medicine program. The list should include all patients care for and procedures performed that were available for the education of maternal-fetal medicine fellows during the most recently-completed academic year. Add columns as needed for other participating sites.

Maternal Fetal Medicine04/2017

Site #1 / Site #2 / Site #3 / Site #4
Patient Population
Deliveries / # / # / # / # /
Primary Cesarean rate (%) / # / # / # / # /
Cervical cerclage / # / # / # / # /
NICU admissions > 37 weeks / # / # / # / # /
Infants < 1500 grams / # / # / # / # /
Infants 1501-2499 grams / # / # / # / # /
Antepartum admissions / # / # / # / # /
Maternal transports (incoming only) / # / # / # / # /
Critical care patients / # / # / # / # /
OB patients available to fellows (%) / # / # / # / # /
Medical Complications of Pregnancy
Pre-existing diabetes mellitus / # / # / # / # /
Autoimmune connective tissue disease / # / # / # / # /
Cardiac disease / # / # / # / # /
Hypertensive diseases, including both chronic hypertension and pregnancy associated hypertensive disease / # / # / # / # /
Pulmonary disease / # / # / # / # /
HIV / # / # / # / # /
Hematologic disorders / # / # / # / # /
Renal disease / # / # / # / # /
Substance abuse / # / # / # / # /
Psychiatric disease / # / # / # / # /
Neurologic disease / # / # / # / # /
GI disease / # / # / # / # /
Endocrine disease other than diabetes / # / # / # / # /
Fetal Disorders and Fetuses at Increased Risk for In-Utero Disease
Isoimmunization / # / # / # / # /
Fetal malformations / # / # / # / # /
Genetic disorders / # / # / # / # /
Congenital infections / # / # / # / # /
Obstetrical Complications
Placental abruption / # / # / # / # /
Placenta previa / # / # / # / # /
Multiple gestations / # / # / # / # /
Procedures
Ultrasounds for fetal anatomic surveys / # / # / # / # /
Ultrasounds for fetal growth assessment / # / # / # / # /
Nuchal translucency measurements / # / # / # / # /
Fetal echocardiograms / # / # / # / # /
Doppler assessments / # / # / # / # /
Genetic amniocentesis / # / # / # / # /
CVS (do not include mocks) / # / # / # / # /
Fetal blood sampling/transfusion / # / # / # / # /

Maternal Fetal Medicine04/2017