FELLOWSHIP IN OBSTETRICS AND WOMEN'S
HEALTH FOR THE FAMILY PRACTITIONER

Huntsville Hospital Birthing Suite

Introduction

The University of Alabama School of Medicine Huntsville Regional Medical Campus Family Practice Residency Program offers a one-year Fellowship in Obstetrics and Women's Health.  The purpose of this fellowship is to provide training and experience for the family practitioner who requires a broader base knowledge and experience than is provided in traditional family practice residency training in order to maintain an obstetrical and women's health portion of their practice.

Service Obligation

Family physicians have traditionally played a significant role in providing health care to pregnant women, especially in rural areas.  This is the primary focus of our fellowship.  The Alabama Family Practice Rural Health Board funds this fellowship.  Therefore, it is required that the fellow agree to practice in Alabama in a area with a population of less than 25,000 for a period of one year after completion of the fellowship or to teach obstetrics in a medical school setting.  Should the physician fail to complete this graduate and/or post-graduate commitment a repayment three times the accrued amount will be imposed.

Eligibility and Requirements

1. Applicants must be graduates of accredited family practice residency programs. 
2. Applicants must be board certified or board eligible.
3. Applicants will be required to obtain medical licensure in Alabama and a Federal DEA certificate prior to the beginning of the fellowship. (The fellowship program will be responsible for expenses related to licensure.)
4. Applicants are required to submit
   • USMLE scores.
   • Curriculum vitae and personal statement.
   • Three letters of recommendation from three active members of the American Academy of Family Physicians, including the program director and the faculty member/preceptor responsible for obstetrical training at the applicant's residency program.
   • A letter of recommendation from an OB/GYN physician who has direct knowledge of the fellow's clinical OB skills is advisable.

Preference for admission to the fellowship program will be given to the graduates of the Huntsville residency program and those individuals who plan to practice in rural Alabama.

Curriculum

The fellowship is one-year in duration.  During this period the fellow will function as a junior faculty member with appropriate teaching opportunities (medical students and residents).  While three-fourths of the program will be devoted to OB and women's health, the fellow will spend one-fourth of his/her time in family meidicine clinic in order to keep current with family medicine clinic skills.  In accordance with the needs of the individual fellow, the acquisition of knowledge, skills and attitudes should occur during all curriculum elements.  The curriculum specifics for each individual fellow will be developed in conjunction with the Program Co-Directors, and representatives from the OB/GYN and Family Practice Faculty.

The curricular elements of Fellowship in Obstetrics and Women's Health include:

• Routine obstetrical care
• Uncomplicated pregnancy with/without the uses of vacuums/forceps
• Minor gynecological surgery
• Infertility evaluation
• Sexual function disorders
• Primary genetic counseling
• Teaching
• Working with physician extenders
• Osteoporosis evaluation
• Cardiovascular risk factors evaluation in the post-menopausal female

Full time FP/OB faculty or attending physicians will directly supervise all OB/GYN activities as designated by the program.  There are currently 4 family medicine faculty who attend obstetrics patients (two of whom perform surgical obstetrics), 2 full-time OB/GYN faculty members, and numerous community OB/GYN physicians with whom the fellow may work at times.

Specific Objectives and Responsibilities

OB Objectives:

• Learn techniques for management of routine and operative vaginal delivery (including low outlet forceps and vacuum extraction) as well as complications of vaginal delivery (including dystocia, vaginal and cervical lacerations, and postpartum hemorrhage).
• Diagnose, manage and/or referral of high-risk pregnancies (PIH, preclampsia eclampsia, gestational diabetes, etc).
• Diagnose, manage and/or referral of non-pregnancy illness affecting pregnancy (thyroid problems, connective tissue diseases, pulmonary problems, etc). 
• Gain clinical competence at performing low transverse and vertical cesarean sections and understand the indications for each.
• Develop an ability and strategy for managing complications of cesarean section including, but not limited to, simple bladder injuries and incisional extensions.
• Learn techniques for postpartum tubal ligations as well as risks and benefits.
• Learn basic techniques for routine ultrasound scanning including biometry and biophysical assessment.  Advance training in OB ultrasound is provided via local perineonatology.
  Develop an understanding for methods of intrapartum fetal evaluation.
  NICU-one month rotation associated with acute/subacute management of the high-risk neonates.

OB Responsibilities:

• Clinic attendance (new, routine and high-risk OB).
• Call per designated by the Co-Directors.
• Act as a consultant to the resident service.
• Once clinical competence is demonstrated, supervise residents in the delivery room for vaginal delivery and episiotomy repair.

GYN Objectives:

• Gain competency in evaluation and management of common ambulatory gynecologic problems including vaginitis, menstrual disorders, menopause, post-menopausal bleeding, osteoporosis, basic infertility, contraception, pelvis pain and sexual dysfunction.
• Gain competence in minor GYN procedures including D&C, colposcopy, endometrial biopsy, ultrasounds, treatment of Bartholin's gland abscess, cryocautery, LLETZ/LEEP.
• Develop an ability to diagnose and medically manage ectopic pregnancies.
• Develop an ability to diagnose and medically manage pelvis infection.

GYN Responsibilities:

• Clinic attendance  (routine GYN, Colposcopy and Tumor Clinic)
• Act as a consultant to the family medicine resident on the gynecology service each month in managing gynecological problems for inpatients and emergency room patients.

The evaluations will be handled through adequate documentation of gained expertise on each individual's program. It is strongly recommended that the fellow complete the NRP and ALSO courses prior to beginning the fellowship.

• Stipend at the PGY-4 position  ($54,000/year)
• Epidural training allowance ($500.00)
• ALSO Course allowance ($336.00)
• 15 vacation days
• 10 sick leave days
• Moving expense reimbursement
• CME reimbursement
• Health and disability insurance