Thomas Jefferson UniversitySidney Kimmel Medical College

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MFM Resident Rotation

This is how maternal-fetal medicine rotation works and what is expected of you.

In addition to the two residents, the clinical team includes a fellow (on service for the month) and an attending (usually on service for a week at a time.) There may be resident rotators from another program and/or medical students for varying periods of time. Because both attendings and fellows have a day off after in-house call, there may be situations when the service is covered for a single day by someone else. If you have any uncertainty about the schedule, Lynn Stierle (5-9200) can clear it up. The MFM service pager is 6954, and during the week one of you should have it at all times.

You are responsible for work rounds before any morning conference. See the patients and write the notes. You are expected to know the details about the patients. This includes vital signs, laboratory data, results of imaging studies and consultations; in the case of postpartum patients you would be expected to have basic information about the baby as well as patient’s contraceptive plans. For patients being discharged home with pain medications, have the narcotic prescription pulled and ready for the attending’s signature. For antepartum patients who have NSTs (and this will be most of them), the completed NST form should be on the chart prior to attending rounds as well.

MFM Attendings
Jason Baxter, MD, MSCP
Vincenzo Berghella, MD
Stuart Weiner, MD

MFM Fellows
Maria Giraldo-Isaza, MD
Dhanya Mackeen, MD, MPH
Sushma Potti, MD
Sara Nicholas, MD
Erica Berggren, MD
Kelly Orzechowski, MD

You are expected to attend the morning conferences, on time and prepared. What else is there to say about that? If a clinical emergency will prevent your attendance, you must clear it with the fellow or attending on service. On Thursday morning from 8-10 AM, we understand you will be at formal educational sessions with the rest of the residents; you should hand off the MFM service pager to the fellow on service at that time so that your protected time is not constantly interrupted. Needless to say, the fellows will appreciate your having dealt with predictable inpatient issues that morning before handing off the beeper, because they too have educational time on Thursday mornings.

Formal rounds occur with the attending and fellow. These will go most smoothly if everyone is prepared. The style of rounds will vary attending by attending: some sit and paper-round, and write notes based on what you tell them; some walk to each room and write the notes afterward. Flexibility is important, as sometimes the fellow will lead rounds and sometimes the attending, or you may be asked to do so. If the press of clinical duties requires, we may split up the team (for example, if morning rounds are not finished by the time clinic starts, one may be sent to clinic.) Therefore, both of you must know all the patients.

You are expected to be on time for clinic, which starts either at 8:30AM or at 1:00PM. Please pull the charts the day before and review them: this maximizes clinical efficiency and allows you to read up on the situations you will encounter. In two of the three MFM clinics you will have a fellow as well as an attending, to whom you may present patients; ultimately, however, the attending will have to know about all of the patients you see in clinic.

Toward the end of the work day, the fellow on service should contact you and review the patients once again. The fellow will determine what to sign out to the night attending; you will sign out to the night resident team. You are responsible for making this a complete and accurate sign-out, and they are responsible for updating your list correctly at night.

Weekend rounds are made by a resident from the team and an MFM attending. A fellow is only involved if one happens to be in-house. It is your responsibility to assign the resident who rounds on any given weekend. Timing for weekend rounds is worked out between that resident and the weekend attending, and should be clear to all before the weekend starts.

By Friday, you should be able to look ahead and plan the schedule for the next week. This means you should know what procedures are scheduled for MFM in the upcoming week. These include planned cesareans, scheduled inductions, scheduled cerclage or pregnancy terminations, amniocentesis (for lung maturity), PUBS, external cephalic version, etc. They should appear on your rounding sheet. Transvaginal cerclage and third-trimester amniocentesis are resident procedures, as are surgical terminations of pregnancy for those residents willing to participate.

Consultations come unpredictably. You will get the initial call and should see the patient in a reasonable period of time, then present to the fellow, who may go and see her with you. The attending should see a consult within 24 hours of the time it is called: the exact way in which this happens will vary.

Generally, the MFM residents have few L&D responsibilities. You will not usually be called to a delivery or CS. You may, however, be called for an L&D consult, and there will be procedures you may be involved in. The fellow will be responsible for communication between the L&D and MFM teams.

Suggested texts for this rotation are Gabbe’s Normal and Problem Pregnancies and Berghella’s Maternal-Fetal Evidence-based Guidelines and Obstetric Evidence-Based Guidelines. If you don’t happen to own them, there are copies in JOGA and on L&D from which you can read. The ACOG Compendium is also useful. Electronic resources include Up-To-Date, Reprotox (Jeffline MicroMedex)  and electronic journals.

Your evaluation will depend on criteria which are uniform across the residency program. We are specifically asked to evaluate you regarding patient care (history-taking, physical examination, test ordering/interpretation, case synthesis , procedural/technical skills), medical knowledge/scholarship (fund of knowledge; reading; contribution on rounds to others’ education), practice-based learning (self-evaluation, response to feedback, use of information technology), communication (case presentations, chart notes, problem lists, orders, legibility; effective & appropriate communications with patients & family; education & counseling), professionalism, and systems-based learning (access/mobilization of outside resources, systematic approaches to error reduction.) There is some thought of instituting an actual examination at the end of the block; we have not yet done so and will give you fair warning if it’s to happen.

Formal Educational Goals & Objectives

These are available in detail from Dr. Sultana and Debbie Cini as part of the overall objectives for the residency program, which you all should have, but are summarized below. They should shortly also be available on the division’s website.

  • Diabetes in pregnancy
  • Other endocrinologic disorders in pregnancy
  • Collagen vascular disorders in pregnancy
  • Gastrointestinal disease in pregnancy
  • Neurologic disease in pregnancy
  • Infectious disease in pregnancy (including HIV)
  • Hematologic disease
  • Cardiac disease in pregnancy
  • Pulmonary disorders in pregnancy
  • Substance abuse
  • Psychiatric disorders
  • Isoimmunization and alloimmune thrombocytopenia
  • Multiple pregnancy
  • Preterm labor
  • Preterm premature rupture of membranes
  • Antepartum fetal monitoring

In addition, several of the residency goals & objectives for the obstetrics rotation are pertinent here, including:

  • Diseases of the urinary system
  • Second-trimester pregnancy loss
  • Intrauterine growth restriction
  • Fetal death

As you know, there is a range of interests and expertise among the faculty, which is to say, we may also broach other topics for discussion.

Finally: everyone here is approachable. Do not hesitate to ask questions or bring matters up as needed.

  Monday Tuesday Wednesday Thursday Friday
Morning Conference (7AM) Morning report Usually: coffee shop review * Morning report
(MFM every
other week)
Grand Rounds Resident Journal Club
OR Chapter Review
Morning     Methadone clinic
(no fellow)

Resident Lectures 8-10AM;

MFM Clinical Meeting 10-11:30AM

MFM Clinic
Noon Conference Once/month: Perinatal M&M   Every other: combined w peds (fellows arrange)    
Afternoon   MFM Clinic PGY-4 Clinic PGY-2 Clinic  

* Drs. Baxter/Berghella/Weiner do this at 7AM on Tuesdays (exact time depends on the clinical workload)

Revised November 2009