New Application: Maternal Fetal Medicine

Review Committee for Obstetrics and Gynecology

ACGME
OVERSIGHT

Sponsoring Institution

1. Does the Sponsoring Institution also sponsor an ACGME-accredited residency program in

obstetrics and gynecology? [PR I.B.1.a)]....................................................................... ☐ YES ☐ NO

a) Residency 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 and how the fellowship and residency complement and enrich one
another. [PR I.B.1.a).(1-2)] (Limit response to 100 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 I.D.1.a); I.D.1.b); I.D.1.b).(1)-(5)]

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
☐ YES ☐ NO ☐ YES ☐ NO
inpatient units
Level III or IV nursery ☐ YES ☐ NO ☐ YES ☐ NO
Intensive Care Unit (ICU) that
cares for pregnant women in
☐ YES ☐ NO ☐ YES ☐ NO
consultation with maternal-fetal
medicine faculty physicians

2. Briefly explain the facilities and infrastructure for research available to fellows. Include the type of
laboratory space, equipment, database access, faculty resources, including statistical support
available, and other pertinent resources. [PR I.D.1.c)] (Limit response to 200 words)

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

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4. Enter the total number of procedures/patients for the most recent academic or calendar year at
each participating site. The site number must match the participating site number listed on the
Sites tab in ADS. If the count is zero, enter 0. [PR I.D.4.a)-I.D.4.a).(2)]

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

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 Site #1 Site #2 Site #3 Site #4
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 # # # #

PERSONNEL

Program Director

1. 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 II.A.2.a)] .. ☐ YES ☐ NO

2. Does the program director provide applicants who are invited to an interview with information
related to eligibility for the subspecialty board examination? [PR II.A.4.a).(9)] ☐ YES ☐ NO

Faculty

1. In addition to the core faculty, does the program include faculty members in the following
disciplines: [PR II.B.3.d).(1).(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

2. Describe the role of faculty members from other disciplines in the education of fellows. [PR
II.B.3.d).(1-2)] (Limit response to 400 words)

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3. Does the faculty include a minimum of one core faculty member other than the program director
who is American Board of Obstetrics and Gynecology (ABOG) or the American Osteopathic Board
of Obstetrics and Gynecology (AOBOG) subspecialty-certified? [PR II.B.4.c)] .............. ☐ YES ☐ NO

If No, explain.
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Program Coordinator

1. Is the program coordinator provided with support adequate for administration of the program? [PR
II.C.2.a)] ........................................................................................................................ ☐ YES ☐ NO

If No, explain.
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EDUCATIONAL PROGRAM

ACGME Competencies

Professionalism

1. 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 diversity in
gender, age, culture, race, religion, disabilities, and sexual orientation [PR IV.B.1.a)] (Limit
response to 400 words)

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Patient Care and Procedural Skills

1. 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. [PR
IV.B.1.b).(1-2).(a).(viii)]

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 Click here to enter text. Click here to enter text.
complications of pregnancy
[PR IV.B.1.b).(1).(a)]
performing cervical cerclage Click here to enter text. Click here to enter text.
[PR IV.B.1.b).(2).(a).(i)]
performing antepartum fetal Click here to enter text. Click here to enter text.
assessment (biophysical profile,
non-stress test (NST), etc.)
[PR IV.B.1.b).(2).(a).(ii)]
performing amniocentesis at Click here to enter text. Click here to enter text.
fewer than 24 weeks’ gestation
[PR IV.B.1.b).(2).(a).(iii)]

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Competency Area Settings/Activities Assessment Method(s)
performing targeted maternal and Click here to enter text. Click here to enter text.
fetal imaging using
ultrasonography
[PR IV.B.1.b).(2).(a).(iv)]
performing external cephalic Click here to enter text. Click here to enter text.
version
[PR IV.B.1.b).(2).(a).(v)]
performing intrapartum Click here to enter text. Click here to enter text.
management of multiple
gestations, including internal
version of the second twin
[PR IV.B.1.b).(2).(a).(vi)]
performing non-vertex vaginal Click here to enter text. Click here to enter text.
delivery
[PR IV.B.1.b).(2).(a).(vii)]
performing operative vaginal Click here to enter text. Click here to enter text.
delivery
[PR IV.B.1.b).(2).(a).(viii)]
genetics, genomics and Click here to enter text. Click here to enter text.
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.B.1.b).(1).(b) –
IV.B.1.b).(1).(b).(iv)]
obstetrical critical care, which Click here to enter text. Click here to enter text.
must include the training in the
management of acute peripartum
medical and surgical
complications
[PR IV.B.1.b).(1).(c)]
infectious diseases as relates to Click here to enter text. Click here to enter text.
pregnancy and the puerperium,
which must include the effects of
maternal infection on the fetus
and newborn
[PR IV.B.1.b).(1).(d)]

Medical Knowledge

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1. 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. [PR IV.B.1.c)]

Competency Area Settings/Activities Assessment Method(s)

physiology and pathophysiology Click here to enter text. Click here to enter text.
of diseases occurring in
pregnancy
[PR IV.B.1.c).(1).(b)]
normal and abnormal newborn Click here to enter text. Click here to enter text.
physiology
[PR IV.B.1.c).(1).(c)]
genetics (including prenatal Click here to enter text. Click here to enter text.
screening and diagnosis),
genomics, teratology, and
dysmorphology
[PR IV.B.1.c).(1).(d)]
obstetrical critical care, which Click here to enter text. Click here to enter text.
must include the training in the
management of acute peripartum
medical and surgical
complications
[PR IV.B.1.c).(1).(e)]
infectious diseases as they relate Click here to enter text. Click here to enter text.
to pregnancy and the puerperium,
including the effects of maternal
infection on the fetus and
newborn
[PR IV.B.1.c).(1).(f)]

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.B.1.d)] (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.B.1.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.B.1.f)] (Limit

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 response to 400 words)

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Curriculum Organization and Fellow Experiences

1. Indicate whether the didactic topics include:[PR IV.C.3.]

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

2. Indicate whether fellows participate in the following activities: [PR IV.C.3.-3.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) Lectures .................................................................................................................. ☐ YES ☐ NO

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

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

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 e) 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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3. 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.C.4.] (Limit response to 400 words)

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4. Do fellows participate in the diagnosis and management of patients in the following areas [PR
IV.C.6.a)-IV.C.6.c).(1)]:

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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Scholarship

1. Describe the curriculum for fellows’ scholarly activities, including: [PR IV.D.3.b).(1)-(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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2. Is each fellow’s scholarly activity monitored by a faculty mentor? [PR IV.D.3.c).(2)] ...... ☐ YES ☐ NO

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

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

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