What is the curriculum of the fellowship?
We currently accept 5 fellows for a one year fellowship, which consists of 13 four week blocks. Seven blocks are intensive training in high risk and operative obstetrics and 6 blocks are electives. One fellow will have 8 blocks of OB and 5 electives.
The OB curriculum emphasizes recognition, management, and stabilization/transport of high-risk obstetrical patients. It also emphasizes the development of procedural skills including (but not limited to) vacuum assisted deliveries, operative obstetrics (C-sections), and gynecologic office procedures. Our unique Obstetric Access Clinic allows residents and fellows to provide high risk prenatal care with direct supervision from our own obstetric faculty, and with consultation support from MultiCare's maternal fetal medicine specialists.
The Elective curriculum consists of five or six blocks spread throughout year. Elective rotations are available in almost any pediatric, medical, or surgical sub-specialty and are tailored by the fellow to augment individual strengths, address weaknesses, or develop new skills. Specific procedural skills are typically pursued on a longitudinal basis over the year.
One month of elective time can be spent at a rural practice site working closely with a successful rural family physician. This rotation emphasizes the development of special practice management skills that are needed for practice in a rural setting.
Elective months are designated as “protected” or “unprotected”. On unprotected months, the fellow will cover a fellows gyn clinic to obtain additional procedural and evaluation and management skills, any openings in the high-risk OB clinic, and choose other experiences like US training, procedures in interventional radiology, ED shifts, and specialty experiences like sports medicine which can be pursued on open days/half days. Protected months allow more time intensive experiences like inpatient pediatrics or trauma surgery.
Finally, every fellow is expected to develop and complete a scholarly project during the year. Each project will be presented by the end of the year.
As a reminder, we distinguish ourselves from obstetrics fellowship programs with a rural focused curriculum and expanded elective time. We do provide excellent expanded scope obstetric training in a uniquely supportive setting, and our graduates have been highly successful in obtaining hospital credentials for cesarean section deliveries.
When does the Fellowship start?
Required orientation is the last two weeks of July. Start date will vary slightly year to year. Clinical rotations begin August 1.
How long has the program been in operation?
The Fellowship Program has been successfully in operation since 1989 and will start its 30th class of fellows on August 1, 2018. The TFM residency program has been in existence since 1979.
What are the OB Facilities like in the hospital?
The OB rotations are at Tacoma General Hospital (TGH). The L&D suite has been completely replaced in 2015 with a new birth center with spacious birth suites, including jacuzzi tubs, expanded OR space and triage rooms.
We have a laborist program that provides 24 hour in house coverage and runs the OB emergency department. Our OB faculty supervise the TFM fellows and residents in management of their patients and the fellow patients from the high-risk OBAC clinic. They are in house during the day and on call from home at night. OB anesthesia is present 24 hours a day. The OB faculty and laborists are the primary teachers of our fellows. Our family medicine faculty supervise resident deliveries. Morning report brings together fellows, residents, students, and obstetric and family medicine faculty. Fellows also work closely with private obstetricians, who are a major source of surgical cases.
TGH serves as the referral center for Southwest Washington with a perinatal special care unit and 6 maternal Fetal Medicine specialists, who are active teachers of our residents and fellows.
TGH has the region's only Level 4 NICU, fully staffed and coordinated by Neonatologists. Fellows may work with NICU staff on neonatal resuscitation skills. This entire complement of services makes this facility an excellent training ground for obstetrics.
What Family Medicine experiences do the fellows have?
Fellows are fully credentialed with core family medicine privileges at Tacoma General Hospital.
Fellows may choose a rural family medicine elective for intensive hands-on experience in full spectrum practice. Fellows have frequently used elective time to be the attending for our residents on the TFM inpatient service. Electives can address any other desired aspect of family medicine.
Fellows may seek moonlighting opportunities outside expected fellowship work hours for additional acute care or emergency medicine experience. Multicare Urgent Care has been a good experience for many fellows.
We have chosen not to have a dedicated fellow's family medicine clinic to preserve elective time for development of additional skills.
What teaching experiences do the fellows have?
The fellows are junior family medicine faculty, and are scheduled to precept the residents in the family medicine clinic two to four half days per month during elective months. This experience fosters development of teaching skills, and serves to keep family medicine skills current. Fellows may opt out of this experience to meet other elective needs.
Fellows supervise and teach medical students and interns on the labor deck, in the Obstetric Access Clinic, and our residency clinic, Tacoma Family Medicine. On the labor deck, they will be the attending physician for interns performing low risk vaginal deliveries. Fellows also support R2s who are on their first month running the labor deck.
The fellows lead our monthly Evidence Based OB Journal Club during the resident didactic conferences, and our High Risk OB conference, which is attended by our Maternal Fetal Medicine colleagues. Additional opportunities for formal teaching are available in resident conferences.
Elective experiences as an attending on the family medicine inpatient service are available. In all settings, obstetric and/or family medicine faculty are immediately available to support the fellows in teaching and clinical care.
What is the call system?
We have a night float call system with rotating day coverage and week long night float rotations. Fellows coordinate with senior residents to create a separate night and weekend backup schedule for additional C-section experience when labor deck volume is high. There is a laborist attending in house 24/7, with TFM and MOGA faculty on call from home at night.
Some elective choices will have associated call responsibilities.
What about salary and benefits?
Fellows are commensurate with the R5 level in the University of Washington’s system (currently $65,957, adjusted annually). Malpractice insurance is provided by MultiCare on an occurrence basis.
In addition, TFM offers three weeks of vacation, one week of CME with a CME stipend, one week of practice search, health and dental insurance for the fellow and his/her family, stipends for meals when on call, and other standard benefits for MultiCare employees.
Is an interview required?
The interview plays a central part in our selection process. Interviews are granted by invitation only. The interviews usually begin in September and continue through December. This may vary by year, so later inquiries are welcome. The interview will consist of a half day spent in interviews with our family medicine and obstetric faculty and our fellows and residents, lunch with Dr. Alan Gill, our program director; and a tour of our facilities. Your significant other is welcome (and encouraged) to join you during the interview process.
Will my travel expenses for an interview be reimbursed?
Unfortunately, we do not have funding to reimburse our candidates.
Does the fellowship use the National Resident Matching Program (NRMP)?
No, this is a post-residency program which is not certified by ACGME. Positions are offered by the program director on a rolling basis.
Does the fellowship offer a “Certificate of Added Qualification”?
No. The American Board of Family Medicine does not offer a CAQ in Obstetrics, and ACGME does not certify family medicine OB or rural fellowships. Our graduates are eligible to take the Family Medicine Obstetrics Board offered by the American Board of Physician Specialties.
Can I get any prescribed or elective CME credits for being in this program?
Yes. The AAFP certifies the fellowship for 150 hours of prescribed CME credits for our fellows upon program completion.
Does the fellowship support J1 visas?
No. Our sponsor, MultiCare, does not currently support J1 visas.