The Maternal-Fetal Medicine (MFM) Fellowship Program at Brigham and Women’s Hospital (BWH) combines the resources of the largest obstetrical service in the New England region with the research and teaching expertise of the Harvard medical complex. Annually, there are approximately 8,000 deliveries, 600 admissions to the high-risk antepartum service, and over 300 maternal transports. Facilities include a 27-bed high-risk antepartum/postpartum unit, 24 labor-delivery-recovery rooms, 4 dedicated operating rooms, a neonatal intensive care unit with 52 beds, and an ambulatory high-risk floor containing the Center for Fetal Medicine and Prenatal Genetics with ultrasound equipment, electronic fetal heart-rate monitoring capabilities, genetic counseling, and high-risk consultative services. Close multidisciplinary relationships exist among neonatology, obstetrical anesthesia, genetics, pathology, medicine, and surgery departments within the BWH and at Boston Children's Hospital. Division faculty and other selected subspecialists closely supervise all services in which fellows are involved.
During the majority of the first year, the fellow provides care for patients on the inpatient unit. Most of these patients are antepartum, although an in-depth experience in critically ill postpartum patients is also obtained during this rotation. Typically, this experience will include caring for patients with antepartum complications (preterm premature rupture of the membranes, preterm labor third-trimester bleeding, hypertension/preeclampsia,) as well as conditions of maternal and fetal disease which complicate pregnancy (maternal cardiac / rheumatologic / neurologic / oncologic diseases, intrauterine growth retardation and multifetal gestations ). The first year additionally includes time to initiate training in ultrasound and perinatal consultation as well as a dedicated research block. Each fellow begins continuity outpatient care with Special Obstetrics Clinic which enrolls patients with a wide variety of medical and obstetrical complications.
Second-year fellows enhance their ambulatory training through a dedicated outpatient ultrasound and consultation block provided in the Center for Fetal Medicine (CFM)). Patients with a current or anticipated pregnancy complication are seen by the fellow under the supervision of a member of the Maternal-Fetal Medicine staff. About 400 consultations are provided annually, many of which derive from recently diagnosed fetal conditions such as anomalies, arrhythmias, isoimmunization, and nonimmune hydrops. Additionally, over 1,400 women are seen per year by the genetic counselors for a range of concerns including aneuploidy risk, carrier screening, teratogen exposure or a significant family history. The fellows are active participants in these sessions as well. The fellow is responsible for the initial assessment of the patients and for ordering and performing diagnostic and therapeutic maneuvers, including chorionic villus sampling, amniocentesis, percutaneous umbilical blood sampling (PUBS), and intrauterine transfusions.
Additional time during the second year is spent in the critical care rotation between the surgical intensive care, obstetric anesthesia and cardiac anesthesia. Allocation of time as the lead clinician on labor and delivery is dispersed in two week intervals throughout the fellowship. Clinical elective time typically can be selected from obstetrical anesthesia, neonatal intensive care, adult intensive care, maternal subspecialty clinics such as those participating in our collaborative maternal care program and additional rotations in genetics, dysmorphology-teratology, and ultrasound.
Abundant informal and formal learning opportunities exist for fellows. A board-certified or board-eligible maternal-fetal medicine subspecialist conducts formal rounds on inpatient service with the first year fellow and two residents every day. During the first-year of training, fellows prepare a weekly multidisciplinary conference attended by obstetricians, neonatologists, geneticists, ultrasonographers, and interested medical subspecialists. The weekly Special Obstetrics Clinic begins with a clinical conference supervised by a maternal-fetal medicine subspecialist. Ob/Gyn Grand Rounds are presented weekly throughout the academic year, often on topics of interest in maternal-fetal medicine. Fellows have the opportunity to attend an annual postgraduate course in maternal-fetal medicine that is sponsored by the BWH Department of Obstetrics and Gynecology and Harvard Medical School. A didactic lecture series given weekly by the faculty is prepared for the fellows to cover the concepts of maternal fetal medicine on three year repeating cycle.
Fellows have 12 months for research distributed across the three years. This is intended to provide early and then continued growth for an individualized, in-depth research experience. Fellows select a research project based on their needs and long-term goals. Research supervisors can be selected from within or outside of the division to provide close mentoring. Statistical analysis remains a fundamental skill of research and statistical proficiency is required either through prior or current coursework. Educational attainment of research fundamentals including study design, analysis and scientific writing is tailored to the individual’s background with supplemental course work available through the Harvard School of Public Health. Several large data and specimen databases provide resources for fellow initiated research within the division.
An accredited combined maternal fetal medicine fellowship and genetics training program is available through Boston Children’s Hospital and Brigham and Women’s Hospital. Upon completion of this 4 year fellowship, the candidate is eligible for both the maternal fetal medicine and genetics boards. Expertise in genetics and MFM provides a unique opportunity for specialization in clinical care and research during fellowship as well as during subsequent career development.
The first year of training is begun with maternal fetal medicine inpatient care then six months in the second year of clinical rotations through the genetics subspecialty programs. These include Boston Children's Hospital, Massachusetts General Hospital and Brigham and Women's Hospital including Dana-Farber Cancer Institute. During the remainder of the second year and third year of fellowship, the MFM clinical rotations are completed including the intensive care rotation, and Labor and Delivery clinical lead and additional clinical genetic rotations are undertaken. The third and fourth year of training includes laboratory rotations in cytogenetics, molecular genetics, and biochemical genetics, and research. Research may be undertaken at any of the Harvard affiliated institutions. A continuity clinic is continued throughout the third and fourth years. Participation in a core didactic program is required.
The overall goals of the training program are to educate individuals in the science and clinical skills of maternal fetal medicine and clinical genetics with attention to the interface of these two specialties. Specifically the program is focused on providing trainees the opportunities to participate in research projects which are relevant to both subspecialties and to enable them to become leaders in this field.
Candidates may apply through ERAS Fellowships, an online application service. To be considered for an interview, your completed application form with all applicable supporting documents must be received by May 30, 2019. Interview dates are to be determined.
Program Length: 3 years
Number of Fellows: 1 per year
Fellowship Program Director: Katherine Economy, MD
This fellowship has been approved by the Accreditation Council for Graduate Medical Education (ACGME) and the Program ID is 2302422003.
If you have questions please contact the Fellowship Coordinator, Margie Ruiz at email@example.com or (617) 732-5452.
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