Most of the fellows’ first year is devoted to clinical activities, focusing on management of patients in three main areas:
Labor and Delivery
- High-risk service, including critical care obstetrics
- Consultant to low-risk service
Inpatient antepartum service and high-risk perinatal clinics
- Preterm labor and poor pregnancy outcome clinic
- Multiple pregnancies and fetal anomalies clinic
- Diabetes clinic
- Maternal medicine clinic (HIV clinic,infectious disease clinic)
Obstetric and gynecologic ultrasound
- Hands-on instruction in comprehensive ultrasound imaging
- Experience with invasive procedures
On all rotations, MFM faculty members directly supervise fellows, with the objective to develop decision-making, consultative, and leadership skills so that they can function independently upon graduation.
In the second year, fellows complete six months of advanced clinical training in critical care obstetrics, including cesarean hysterectomies for placenta accreta, reproductive and pediatric genetics, training in chorionic villus sampling, and fetal echocardiography, as well as advanced procedures such as multifetal reductions, radiofrequency ablation, shunt placement, cordocentesis, fetal blood transfusion, fetoscopy, and laser photocoagulation.
The fellows will complete 18 consecutive months of protected research time. Research facilities are available for MFM fellows in clinical medicine, ultrasonography, and the basic sciences. They may work in the MFM Division of the OB/GYN Department, in the laboratory facilities at CUMC, at Columbia’s Mailman School of Public Health, or in other clinical departments. Fellows design and structure their research projects with consistent guidance from the MFM faculty and mentors. They present their projects to the MFM faculty, residents, and their mentors as the research progresses.
The MFM Fellowship Program is structured to provide extensive clinical and research experience. Individuals who complete the program are able to work independently, managing complicated pregnancies using the most current diagnostic and treatment modalities available. The program graduates fellows who can appropriately interpret the literature for clinical applicability and research design. The management of a busy perinatal service, the provision of consultation to the clinical obstetrical service, the proximity of the strong basic science and clinical research environment at CUMC, and design and completion of an independent research project all prepare fellows for leadership roles in the specialty of MFM.
Simulation Curriculum for Fellowship Training
Simulation and team training have become essential components of training in the specialty of obstetrics and gynecology. The Division of Maternal-Fetal Medicine has developed a simulation curriculum to reinforce core learning objectives in subspecialty training. The fetal therapy portion of the simulation program uses innovative models to help fellows acquire facility with transvaginal and transabdominal CVS as well as needle-based procedures such as amniocentesis, PUBS, and shunt placement. The critical maternal care portion of the program focuses on developing fellows’ role as a team leader in the acute care of a pregnant patient. Simulations are often multidisciplinary and promote a team-based approach to managing scenarios such as hemorrhage, hypertensive crisis, eclampsia, cardiac arrest, and sepsis. Debriefs and focused didactic sessions ensure that fellows gain comfort with systems based practice and an in-depth understanding of the physiology of pregnancy that creates risks unique to obstetric patients.