Mission

To train qualified family physicians in the management of complicated pregnancies, operative obstetrics, and expanded women’s health procedures, with the expectation they will subsequently serve as teaching faculty in Family Medicine residencies or as physicians independently credentialed in advanced obstetrics in underserved locations to augment Obstetrics and Gynecology (OB-GYN) staff.

Vision

To be the premier training program in the DHA for full scope family physicians including surgical obstetrics

Aims

Inpatient Care

• Manage women on the antepartum inpatient service, under the supervision of OB-GYN and Maternal Fetal Medicine physicians, for conditions such as pyelonephritis, trauma, hyperemesis gravidarum, and early preterm premature rupture of membranes, preeclampsia, and diabetic glycemic control.
• Learn how to prioritize and multitask during the management of a busy Labor and Delivery ward with the assistance of OB-GYN and Family Medicine Obstetrics (FM OB) staff physicians.
• Determine when a cesarean delivery is indicated and perform a sufficient number to become independently credentialed in this common surgical procedure.

Outpatient Care

• Evaluate and treat patients commonly referred to Obstetricians for “high risk” issues (HROB) and determine who needs Maternal Fetal Medicine consultation or co-management.
• Evaluate and treat first trimester vaginal bleeding and pregnancy loss to include both medical and surgical uterine evacuation.
• Evaluate suspected ectopic pregnancy and determine appropriate candidates for medical management.
• Master the technique of first trimester dating ultrasound.
• Master the technique of ultrasound for the assessment of fetal growth.

Teaching

• Serve as supervising faculty for Family Medicine and Emergency Medicine residents, medical students, and other learners rotating on Labor and Delivery.
• Participate in and ultimately teach simulations (e.g. Mobile Obstetrics Simulator) and the Advanced Life Support in Obstetrics (ALSO) course for resident physicians and nursing.

Educational activities embedded within the 12-month rotation schedule include didactic education, simulation exercises, precepting, and outpatient prenatal and procedural care. Below are the hours devoted to these activities during the academic year.

Our rotation schedule consists of:  

• Labor and Delivery Orientation - 4 weeks
• Labor and Delivery - 4 blocks
• Night Float - 2 blocks
• Labor and Delivery Antepartum/Perinatal - also longitudinal experience
• Neonatal Intensive Care Unit
• Research - longitudinal experience
• Family Medicine Inpatient Service - 3 weeks
• Elective - 2 to 3 weeks
• Faculty Development and Transition to Practice
• Dysplasia

Fellows will have elective time, which can be used to address any deficiencies in training or special areas of interest. Electives can be done within CRDAMC, at Baylor Scott & White or other training institutions within the local community, or at distant locations if prior approval and funding are available. Fellows are responsible for submitting a plan for elective time, including goals and objectives, to the Program Director no later than 12 weeks in advance of the elective.

Fellow will perform one 24-hour call shift every other Saturday, except during approved leave, for the duration of the fellowship year.

Throughout the academic year fellows will become experts in the military aspects of pregnancy care and women’s health, including profiling, physical training and fitness, parental and convalescent leave. Fellows will have the opportunity to develop and lead a training lane at the post-wide Joint Medical Emergency Medicine Exercise, a large multinational and joint military medical training exercise on Fort Cavazos.

• Advanced Life Support in Obstetrics Course
• Neonatal Resuscitation Program Course
• Association of Women's Health, Obstetric and Neonatal Nurses (AWHONN) Fetal Monitoring Course

Multiple simulation workshops are employed during the fellowship year including 3rd and 4th degree perineal laceration repair, C-section simulation, and surgical hemorrhage management simulation among others.

Fellows will serve as adjunct faculty within the Family Medicine Residency Program, precepting in the outpatient clinic an also serving as attending on Labor & Delivery and during inpatient medicine weeks. Fellows will have the opportunity to attend Uniformed Services University of the Health Sciences faculty development workshops throughout the year, earning credit toward a USUHS faculty development certificate. Mentorship by seasoned active duty obstetricians and family physicians will afford fellows personalized professional development throughout the year.

Fellows will be expected to complete a scholarly activity during their fellowship in order to promote an understanding of research which can then be utilized throughout their career in Army Medicine. Projects must be approved by the Program Director. Suggestions for possible scholarly activities include case presentations, clinical inquiries or review articles accepted for publication, and/or clinical investigations with an approved Institutional Review Board protocol. Fellows will be required to present scholarly activity at CRDAMC Research Day in May, prior to graduation. Fellows are strongly encouraged to present either workshops or research at the Uniformed Services Academy of Family Physicians (USAFP) Annual Meeting.

Fellows will have the opportunity to be involved in quality improvement projects pertinent to obstetrical care delivery at CRDAMC. As an example, prior fellows have participated in a hospital-wide postpartum hemorrhage quality improvement designed to eliminate healthcare disparities related to this obstetric complication.

The fellowship provides professional development to family physicians through advanced specialized training in complicated and surgical obstetrics care, near daily opportunities to refine clinical leadership skills by leading multidisciplinary healthcare teams on Labor and Delivery, and experience and advancement as a faculty member of a residency program.

The program for professional mentorship of fellows by active-duty obstetricians and family physicians in clinical expertise, academic and clinical leadership, scholarship, and operational medicine.

Fellows may elect to pursue professional military education short courses to gain additional professional development and career advancement. Prior fellows have been nominated and selected for the Army Medical Department’s Junior Leadership Course, Iron Majors Week, and Female Physician Leadership Course.

Our fellowship rotates exclusively at Carl R. Darnall Army Medical Center.

Interested Family Medicine PGY-3 residents may complete a 2- or 4-week surgical obstetrics inpatient rotation with the fellowship.

Applicants are encouraged to complete an audition rotation in the summer of their PGY-3 residency year, which includes a program interview. Applicants unable to rotate in person are welcome to complete a phone or video interview in the summer of their PGY-3 year.

Family Medicine Obstetrics Board Certification is offered through the American Board of Physician Specialties. Certification isn't required, although the fellows may elect to take at their own expense. Graduating fellows may be eligible to apply for the May exam if the Program Director sends a letter attesting to satisfactory progress in fellowship. To be eligible for certification, graduates must have:

• Completed a Family Medicine Obstetrics fellowship program.
• Be board certified in Family Medicine by the ABMS, ABPS, or American Osteopathic Association.
• Submit a case log along with a letter summarizing the information on the log. The letter must indicate the number of deliveries the physician performed as “primary” by year and must be signed by one of the following: Medical Records, Medical Office Staff, Medical Director, Department Chair, or Program Director.
• Demonstrate evidence of ongoing obstetrical practice by having completed 60 vaginal deliveries, 15 of which must have been in the last two years (including those performed in residency and/or fellowship training).
• Graduates must have completed certification in Advanced Life Support in Obstetrics and Neonatal Resuscitation Provider programs or equivalent.
• Submit the contact information of an active Diplomate of an ABPS, ABMS, or AOA-recognized board of certification who has observed and can attest to the applicant’s competency to provide obstetrical care.

• The fellows will regularly supervise and teach Family Medicine and Emergency Medicine residents on Labor and Delivery as well as USUHS medical students and physician assistant students.
• The fellow will serve as adjunct faculty in the Family Medicine Residency Program throughout the year. Duties will include precepting residents in clinic, precepting resident procedure clinics, providing a minimum of two Continuing Medical Education lectures and workshops to residents during CME didactic series, evaluating residents during simulation and instructing the ALSO course. The fellow will also serve as the attending for the Family Medicine Inpatient Service for a total of three weeks during the year.

• Fellows may present lectures and workshops at conferences such as the USAFP.
• Fellows have the opportunity teach other healthcare professional trainees at CRDAMC, including nurse practitioner students and Army labor and delivery nurses.

• Family Medicine Obstetrics
• Obstetrics Gynecology
• Maternal Fetal Medicine
• International Board-Certified Lactation Consultant

Fellows are assigned a faculty advisee mentor during the fellowship year.

While the fellowship year is an intensive year of training, the Family Medicine Obstetrics (FMOB) Fellowship Program is positioned within a supportive community of family physician faculty and residents that comprise the Family Medicine Residency Program and the Department of Family and Community Medicine. Fellows regularly participate in residency social activities (social dinners, family retreat, holiday parties, graduation banquet). Fellows are also scheduled to participate in quarterly Family Medicine (FM) residency wellness days and opportunities. The fellowship prides itself on caring for its fellows and will modify schedules appropriately to ensure fellow well-being, and patient and fellow safety.