The Department of Obstetrics & Gynecology and Women's Health

Fellowship in Maternal-Fetal Medicine

ImagePeter S. Bernstein, MD, MPH  

The program of medical education in Maternal-Fetal Medicine of the Department of Obstetrics and Gynecology at the Albert Einstein College of Medicine and the Montefiore Medical Center trains physicians for subspecialty board certification and provides the basis for career development in clinical maternal fetal medicine, clinical investigation, and basic science research. In addition, the program offers fellows the opportunity to obtain additional training in one of the following specialty tracks: ICU/critical care, global women’s health, laboratory or translational research, clinical research, ultrasound/prenatal diagnosis, or public health/community health.

 

 

Clinical Work

During the three year Fellowship, clinical time is divided between three major teaching hospitals: two of the hospitals that are part of Montefiore Medical Center (the Jack D. Weiler Hospital and the Wakefield Division of Montefiore) and Jacobi Medical Center. Because the population served is an unusually high risk one, the Fellow sees a broad spectrum of pregnancy related pathology in both institutions. Amniocentesis, chorionic villus sampling, and other diagnostic services are offered within the department's own Division of Reproductive Genetics, well equipped with modern diagnostic and research technology. Fellows have the opportunity to become experienced in all the services offered in Reproductive Genetics. At the two Montefiore sites and at Jacobi, the Fellow acts as a consultant to the general ob/gyn staff with maternal-fetal attending support. The fellow is also responsible for busy antepartum services and cares of a wide array of patients with medical and obstetrical conditions under the supervision of a maternal-fetal medicine attending. Fellows are responsible for teaching residents on the antepartum services at all three sites as well. Additionally, Fellows manage the care of women with high risk pregnancies at the Comprehensive Family Care Center, an outpatient facility of Montefiore. At this site, fellows have their own office hours (one session each week) giving them the opportunity to have continuity of care with their patients throughout the course of their fellowship. The Fellow also covers the labor and delivery suite both as a primary provider and as a consultant, should the need arise for perinatal evaluation.

In particular fellows receive considerable experience in the care of pregnant and preconception women at risk of complications as a result of the following conditions:
  • Diabetes
  • Hypertension
  • HIV infection
  • Autoimmune diseases
Also considerable exposure to the following obstetrical issues are provided:
  • Women at risk for preterm delivery
  • Women at risk of surgical complications during delivery
  • Management of abnormal labor
  • Management of concerning fetal heart rate patterns

All three institutions are tertiary care facilities with obstetrical anesthesia services available at all times and level 3 neonatal intensive care units.

The Department of Obstetrics & Gynecology and Women's Health of the Albert Einstein College of Medicine and Montefiore Medical Center, directed by Irwin R. Merkatz, MD, is part of an academic community that ranks among the best in the country in the quality of its clinical, research, and educational programs.

 

Maternal Medicine, Complex and Critical Care Obstetrics

Throughout their training our MFM fellows are exposed to a wide array of maternal pathology. Fellows are actively involved in the care of our complex mother’s in the outpatient setting, on the inpatient antepartum service, on Labor and Delivery and in our intensive care unit when necessary. We care for patients in our division with multiple preexisting illnesses including congenital heart disease, autoimmune disease, organ transplant recipients and malignancies. Additionally, fellows are involved in the care of patients with significant acquired pregnancy complications including adherent placental disease, severe preeclampsia with end organ involvement and surgical complications. There are three clinical sites that fellows will learn from, Montefiore’s Weiler Hospital and Wakefied Hospital , and Jacobi Medical Center. All three sites have opportunity to manage critically ill obstetric patients on the antepartum services, with ICU capabilities within the institution. Several Maternal Fetal Medicine faculty are extremely experienced in critical care obstetric medicine, and offer expert guidance in helping the fellow learn and manage these complex cases. All fellows will participate in the care of critically ill pregnant and postpartum patients with supervision and bedside teaching by one of our MFM faculty, and there are opportunities for additional critical care/intensive care unit exposure for those with an identified interest.

We have a bi-weekly multidisciplinary maternal medicine conference, which serves as both a practical planning and valuable teaching conference. We keep an active list of our most complex maternal patients for all fellows and faculty to learn from and participate in safe delivery planning. As part of his/her academic responsibilities, the fellow on the antepartum rotation prepares and presents cases at this conference.

 

The Fetal Medicine Rotation

Over six months of the MFM fellowship is dedicated to Fetal Medicine. The rotation is divided into one and two month blocks, with a minimum of one rotation per year of training, with an increasing level of responsibility awarded every year. The rotations include a combination of training and clinical exposure in prenatal diagnosis and genetics, ultrasound and fetal therapy.

Prenatal Diagnosis and genetics includes:
  • First trimester screening for Down syndrome (nuchal translucency)
  • Genetic counseling
  • Bi-Weekly Fetal Diagnosis Rounds
  • Diagnostic procedures as Chorionic Villus Sampling (CVS), Amniocentesis and Cordocentesis
Ultrasound training includes:
  • First trimester scans
  • Detailed anatomy scans
  • Multiple gestation scanning
  • Cervical length assessment
  • Fetal echocardiography
  • Neurosonography
  • Doppler studies of umbilical, uterine, mid-cerebral arteries and of the ductus venosus
  • 3D and 4D scanning including the STIC technology to evaluate cardiac structure
  • Gynecological transvaginal scanning and 3D sonohysterograms.
  • Sonographic guided management of interstitial and scar ectopic pregnancies
Fetal Therapy includes:
  • Weekly Fetal Medicine practice
  • Monthly Fetal Medicine Management rounds
  • Therapeutic and interventional procedures such as intrauterine fetal blood transfusion, multifetal selective reduction, vesico- and thoraco-amniotic shunting
  • Radio-Frequency Ablation (RFA) for TRAP and selective reduction in Mono-chorionic gestations
  • Fetoscopic Laser photo-coagulation for Twin-to-Twin Transfusion syndrome
  • EXIT (EX-utero Intrapartum Treatment) procedures

As part of his/her academic responsibilities, the fellow on the ultrasound rotation takes a leading part in one of the most important academic activities in our department - the Fetal Diagnosis Rounds. In these bi-weekly CME accredited multidisciplinary rounds, newly diagnosed fetal anomalies are presented by the fellow, and management is discussed. Experts participating in this meeting include specialists in maternal fetal medicine, reproductive genetics, neonatal intensive care, internal medicine, pediatric cardiology and a cardio-thoracic surgery. The fellow is responsible for managing and following up on the patients, based on recommendations determined in these rounds. In addition, each year we have several case reports from our fetal diagnosis rounds which are presented at national and international meetings.

 

Formal Teaching

The Fellow is encouraged to participate in the many conferences on various aspects of perinatal care held within the department and elsewhere in the medical center. Departmental grand rounds lectures are renowned for the quality and the breadth of their presentations. Graduate courses are available at the Medical College and several nearby universities. Fellows are encouraged to take courses in genetics, clinical research and statistics.

 

Research Activity

Our Department has a long track record of clinical, basic and translational research and interdisciplinary collaboration for training of fellows. The breadth of opportunity and activity available in the department is exemplified by the numerous abstracts and peer-reviewed publications of our fellows and faculty. We have a broad range of on going research projects to support a diversity of fellow interests. Fellows are expected to present their research at national meetings, such as SMFM, SGI, and ACOG. Upon completion of fellowship, our fellows present their work formally to the department each June at the Annual Science Day for residents and fellows. With support and mentoring from the Department and faculty, fellows are enabled to develop a strong foundation in the investigative process, study design and manuscript preparation.

The Department’s commitment to clinical research is demonstrated with the creation of the Advanced Women’s Health Center- Clinical Trials and Research Unit, which provides dedicated space, infrastructure and support for clinical research. The unit includes support from study coordinators and clinical statisticians. The diverse and high risk nature of our obstetric population provides ample opportunity for clinical studies and fellows are required to participate in at least one clinical project of their choice. Fellows have had the opportunity to participate in a number of large clinical studies, including multi-center prospective clinical trials (e.g. Multiple Use of Antenatal Cortico Steroids (MACS trial) and First And Second Trimester Evaluation of Risk study). The Department was also the largest U.S. recruitment site for two large multicenter trials of vaginal progesterone that demonstrated its utility in reducing the rate of preterm birth among women findings of a short cervical length. Interdisciplinary collaboration is ongoing with the Einstein Center for AIDS Research and the Hispanic Community Health Study/Study of Latinos.

Clinical studies have the additional resource of an electronic prenatal medical record/fetal testing/ultrasound reporting system (AS OBGYNTM) and a hospital-wide clinical database (CareCastTM). Fellows have the opportunity to actively participate several ongoing research initiatives in our Department, including: an active program of simulations of obstetric emergencies as a way to improve patient safety; utilization of Clinical Looking Glass, a software package that allows sophisticated analyses of all Montefiore Medical Center clinical databases; participation in trials arising out of the Medical Center’s designation as a Diabetes Center of Excellence; and utilization of clinical materials arising from our participation with New York Blood Centers Cord Blood program in which all patients delivering at Montefiore are invited to donate their newborn’s cord blood to a public cord blood bank. Fellows also have the opportunity to collaborate with the Einstein Center for AIDS Research on projects related to HIV in pregnancy. Over 400 HIV infected pregnant women are included in an easily searchable database that includes both maternal and neonatal data.

The Albert Einstein College of Medicine is one of the top 25 medical schools for NIH funded research in the country and has a strong history of trans-disciplinary research. For those fellows interested in basic science research, we can provide the opportunity to work with some world-renowned experts in a variety of fields. For instance, the Diabetes Research Center (DRC) at Einstein has been a NIH designated Center of Excellence for its outstanding program of biomedical research in the area of diabetes since 1977. Since 2001, at least one of our fellows has had ongoing successful laboratory experiences in DRC laboratories. The Department provides 2 full-time salaried technicians to support fellow work in the lab and the DRC provides strong leadership for creative basic and translational research related to maternal molecular metabolism and its impact on the fetus. Additionally, fellows have worked in the areas of genomics/epigenomics, molecular biology and biochemistry related to congenital malformations, fetal exposure to adverse intrauterine

 

Inquiries and Applications for the Fellowship

Fellowship applications are available at the ERAS website. The ERAS deadline for applications is May 31 for the Fall match.

Applicants who are graduates of United States or Canadian medical schools must document having successfully completed at least four years of Accreditation Council for Graduate Medical Education (ACGME)-accredited residency training with not less than 36 months of clinical obstetrics and gynecology. Foreign medical graduates will be eligible for appointment if they provide written confirmation from the American Board of Obstetrics and Gynecology that their residency training qualifies them as active candidates in obstetrics and gynecology, and if they have passed the Education Council for Foreign Medical Graduates (ECFMG) examination or its equivalent. All applicants must demonstrate that they are fully qualified for medical licensure in New York State.

Applicants selected for interviews will be interviewed during July of each year for the Fall match.

 

Requests for additional information should be addressed to:

Peter S. Bernstein, MD, MPH, Program Director
c/o Andrew Baez, Assistant to the Program Director
Department of Obstetrics & Gynecology and Women's Health
Jack D. Weiler Hospital
Montefiore Medical Center/Albert Einstein College of Medicine
1825 Eastchester Road
Bronx, New York 10461

Phone: 718.904.2767
Fax: 718.904.2799
E-mail: abaez@montefiore.org 

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