| Rural Fellowship |
General Fellowship Information
Scheduling
The Scheduling Coordinator is responsible for setting up the call and clinic schedules. When making the schedule the following items are taken into account: Residents’ call schedule for the year (this already has the R2 call schedules), R2 vacations (usually only 1 week during their 8 week OB rotation), TFM Family Practice clinic schedule (when the R1 and R2 are in clinic), Residents/Fellows day off post-call, schedule needs for OBAC, Colpo Clinic, Ultrasound Clinic, Procedure Clinic and Precepting TFM residents.
The Fellowship Coordinator will provide a copy of the call schedule to all relevant parties.
Faculty Advisors
All fellows will be assigned both a family medicine and an obstetric advisor from Multicare Obstetrics and Gynecology Associates (MOGA). The family practice advisor’s role is one of support. They will act as a liaison with other faculty, community attendings and fellows. They can offer guidance with respect to:
- Electives
- Future practice opportunities
- Understanding medical politics in the community
- Hospital policy and privileging
- Rural health projects
- Understanding policy and procedure at TFM and MultiCare
All fellows are expected to meet with both advisors quarterly. Evaluations will be reviewed and any other pertinent issues will be discussed. A report of this meeting will be placed in each fellow’s file and will remain confidential. Should a fellow and their advisor have an irresolvable conflict, the Fellowship Director will act as a liaison to address the issues at hand.
The MOGA advisor will provide feedback on development of operative and general obstetrics skills. Formal meetings will be arranged quarterly to review progress toward future practice goals and to make any needed training adjustments to achieve these goals.
Evaluations
All fellows will be evaluated on their performance on their rotations. Evaluation forms will be sent to all attendings and residents who worked with you. Your faculty advisor will meet with you on a quarterly basis to review your evaluations and general progress. Your evaluations will be kept in your personnel file and you are encouraged to review them. In turn, you will also be asked to evaluate faculty and residents, as this will be valuable information for future fellows. Your cooperation will certainly be appreciated!
Hospital Privileges
All fellows will have active staff privileges at Tacoma General Hospital and will initially be placed on probationary status. Fellows will be proctored by the MOGA Obstetric Faculty and/or the Family Medicine Faculty during the first month of their OB Rotation. Fellows will not be released to independently perform or supervise resident vaginal deliveries until each fellow has demonstrated their competency in the management and technical skills of the following:
- Vaginal delivery (5 cases)
- Episiotomy and repair - 1st & 2nd degree
- Circumcision (5 cases)
At least two MOGA/TFM Faculty members or community OB’s are required to evaluate the fellow’s competency level. Fellows are provided with cards to record proctored cases with faculty signature verifying adequate performance. Completed cards are delivered to the program coordinator when 5 cases have been accumulated. All procedures should also be logged in our computer logging system (New Innovations). The OB Curriculum Liaison will review the compiled data and present the fellow to the monthly faculty meeting for release from proctoring.
The OB Curriculum Liaison will notify the fellow, labor & delivery, residents, community OB attendings, & all faculty of the faculty’s decision regarding proctoring status.
If it is decided that the Fellow requires further proctoring, the fellow will be made aware of those particular areas that the faculty require improvement. The OB Curriculum Liaison will follow the progress of the fellow and periodically report back to the faculty regarding the fellow’s status. Once the areas of concern have been corrected, the fellow will be eligible for a second review for release.
The following procedures will require ongoing direct supervision by the MOGA/TFM Faculty (or the OB consultant) throughout the fewllowship to allow ongoing feedback to optimize the fellow's skills.
- Vacuum extraction
- Forceps deliveries - low and outlet
- D&C
- Third trimester amniocentesis
- Postpartum/interval tubals
- C-sections (as technical operator)
- Surgical Management of Ectopic Pregnancy
- External Version
- High Risk Labor and Delivery
Malpractice Coverage
Your professional liability insurance carrier is provided by Multicare. It will not cover moonlighting at other facilities. You will be responsible for obtaining your own malpractice coverage if you decide to work in other facilities. Moonlighting within Multicare is covered, but requires specific approval through Multicare Medical Associates (MMA).
Moonlighting
All fellows are allowed to moonlight and opportunities are available within Multicare and at other sites in Pierce County. See Fellowship Director for more information regarding moonlighting opportunities. It is imperative that moonlighting is only done during off hours. Moonlighting is not allowed during the regular operating hours/call hours for the OB Rotation or during the regular hours of electives.
Fellowship Retreat
Midway through the year a fellowship retreat will be held for the fellows and their families along with the fellowship faculty away from the work environment. The purpose of this retreat is to provide a needed break and to strengthening the group relationships. There will be a short work session before dinner Saturday. The residents will provide coverage for patient services. The retreat is planned for a weekend in January or February, and will begin on a Friday night and end Sunday, with return to work the following Monday morning. All fellows are expected to attend.
Vacation
There are fifteen days of paid vacation per year for each fellow. Each fellow is also given one birthday holiday.
A "Time Off Request Form" must be filled out, signed, dated, and given to the Fellowship Coordinator who will submit them to the Fellowship Director and TFM scheduler for approval.
Vacations must be scheduled at least two months in advance or request will be denied (unless there is an emergency).
No vacation will be scheduled the first two weeks of August or the last two weeks of July. Vacation is not allowed during an OB month unless coverage is specifically arranged with another fellow with approval from the Fellowship Director.
Vacations are generally scheduled on a first-come, first-serve basis. Clinic and call coverage must be adequate. No more than 1 fellow will be allowed to be away from the program at any given time except in special circumstances with specific approval from the Fellowship Director. The Director reserves the right to settle conflicts in an equitable manner if fellows are unable to settle a conflict.
Holidays
The OB Access Clinic will not be open during the following holidays days. However, the fellows and residents are still responsible for call coverage on Labor & Delivery.
- New Year’s Day
- Christmas Day
- Labor Day
- President’s Day
- Thanksgiving
- Memorial Day
- Fourth of July
Sick Leave
Fellows have a total of 12 sick days. If the fellow exhausts his/her sick leave, the fellow can submit a request for unpaid leave of absence to the Fellowship Director for approval. Any unpaid leave in excess of standard sick leave will require like time be added to the fellows’ year in order to satisfy graduation requirements. For any questions regarding this policy, please see the Fellowship Director.
Continuing Medical Education
There are five days of CME leave per year for each fellow to attend meetings or conferences. A “Time Off Request Form” must be filled out, signed, dated, and then given to the Fellowship Coordinator who will submit it to the Fellowship Director and the clinic scheduler for approval of any CME leave. The CME must be scheduled at least one month in advance or will otherwise be denied.
No CME should be scheduled during the following times:
- During the first two weeks of August or last two weeks of July.
- During an OB month (unless coverage is arranged and approved by the Director).
- Not more then 1 fellow away from the program at a time.
Reimbursement for CME
Fellows receive $1500 for CME expenses. Fellows pay for their own CME expenses in advance and are then reimbursed by Multicare. Submit receipts with an Expense Report to the Fellowship Coordinator. You will not be reimbursed if you do not have receipts. Please give approximately two-weeks to receive your reimbursement check.
Your CME funds can also be used to purchase medical texts and/or pay for subscriptions to journals. CME funds can be used to purchase educational software for your computer, but cannot be used to purchase computer hardware.
You are strongly encouraged to attend a regional or national conference on Rural Health.
Practice Search
Fellows have up to five days of practice search available for seeking practice opportunities. Time-off request procedures apply. Practice search must be scheduled at least one month in advance or will otherwise be denied. Clinic duties must be covered.
Practice search can only be scheduled during your elective time.
Fellowship Graduation
In July, there will be an opportunity for the fellows and their significant others to celebrate the end of a long year. The fellowship program offers each fellowship class one night to celebrate with resident in-house coverage. The tradition has been for the Fellowship Coordinator and the fellows to plan the events in the evening.
All fellows are expected to participate.