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Fellowship Curriculum and Information

What is the curriculum of the fellowship?

The Fellowship consists of seven months of intensive training in high risk and operative obstetrics and five months of electives. Fellows are encouraged to spend one elective month in a rural practice.

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 consultation support from MultiCare's maternal fetal medicine specialists.

The Elective curriculum consists of five months spread throughout year in one month increments. Elective rotations are available in almost any pediatric, medical, or surgical sub-specialty and are tailored by the fellow in order 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.

One month may be spent away from TFM without clinic duties. This may be a rural rotation or other approved elective.

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 every year.

How long has the program been in operation?

The Fellowship Program has been successfully in operation since 1989 and will start its 28th class of fellows on August 1, 2016. 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.

Our OB faculty provide in-house coverage 24 hours a day along with TFM fellows and residents. OB anesthesia is also available 24 hours a day. The OB faculty 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. Our program will be integrated with a new laborist programbeginning in 2016.

TGH serves as the referral center for the Southwest region of Washington State with a perinatal special care unit and 6 maternal Fetal Medicine specialists, who are active teachers of our residents and fellows.

TGH hasthe 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?

The fellows are 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. 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.

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 function as junior family medicine faculty and are scheduled to precept the residents in the family medicine clinic two to four half days per month during their elective months. This experience fosters the development of teaching skills and also serves to keep family medicine skills current.

The fellows also 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.

The fellows lead our monthly Evidence Based OB Journal Club during the resident didactic conferences, and have additional opportunities for formal teaching in resident conferences and our High Risk OB conference.

Elective experiences as an attending on the family medicine inpatient service are available.  In all settings, senior 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 weeklong night float rotations. Interested fellows and residents provide night and weekend backup coverage for additional C-Section experience when labor deck volume is high. There is an OB attending in-house at all times for back-up.

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 $62,628, 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 certainly 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. At this time, the American Board of Family Medicine only offers certificates in geriatrics, adolescent medicine, sports medicine, sleep medicine, and hospice and palliative care. 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.