Family Medicine Obstetrics Fellowship

Overview

The Dignity Health Methodist Hospital of Sacramento Family Medicine Residency Program, offers a year-long Fellowship in Obstetrics available to graduates of Family Medicine programs in the United States. The Fellowship’s goal is to provide enhanced full-spectrum obstetrical experiences for Family Medicine physicians, to increase access to care for rural, and urban underserved obstetrical patients in the inpatient and outpatient settings. 

Approximately 50% of the fellow’s time is dedicated to the care of inpatient obstetrical patients at the Dignity Methodist Hospital of Sacramento with the remaining time divided amongst outpatient OB/GYN clinics, or outpatient Family Medicine clinics. The OB fellow functions as a teacher within the obstetrical inpatient service at the Dignity Methodist Hospital of Sacramento with  teaching opportunities for family medicine residents, and medical students. One month of the year will be dedicated to the care of rural populations in the Sierra foothills of Nevada County in Grass Valley, California, at Sierra Nevada Memorial Hospital, and Chapa-De Indian Health clinic.

Curricular 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, pre-eclampsia and postpartum hemorrhage).
• Diagnose, manage and/or referral of high-risk pregnancies (Alloimmunization, preeclampsia, eclampsia, gestational diabetes, gestational hypertension, placenta previa, breech deliveries, multifetal gestation, opioid use disorder, etc.).
• Diagnose, manage and/or referral of non-pregnancy illness affecting pregnancy (thyroid disease, autoimmune disease, connective tissue diseases, pulmonary problems, etc.).
• Gain clinical competence at performing external cephalic version, low transverse 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. Advanced training in OB ultrasound is provided via local perinatology.
• Develop an understanding for methods of intrapartum fetal evaluation.
• Gain competency in evaluation and management of common ambulatory gynecologic problems including vaginitis, menstrual disorders, menopause, post-menopausal bleeding, osteoporosis, basic infertility, contraception, pelvic pain, family planning, and sexual dysfunction.
• Gain competence in minor GYN procedures including D&C, colposcopy, endometrial biopsy, ultrasounds, treatment of Bartholin's gland abscess, cryocautery, EMB, LEEP.
• Gain competence in common GYN procedures such as hysterectomy, oophorectomy, ovarian cystectomy, D&C, tubal ligation
• Develop an ability to diagnose and medically manage ectopic pregnancies.
• Develop an ability to diagnose and medically manage pelvic infection.

Facilities

• Methodist Hospital of Sacramento
• Mercy Medical Group OB/GYN
• Sierra Nevada Memorial Hospital 
• Mercy Family Health Center
• Chapa-De Indian Health
• California Maternal Fetal Medicine

Procedural Expectations

• Cesarean Deliveries as Primary Surgeon: 145
• Vaginal Deliveries: 100
• Vacuum-assisted deliveries: 5
• 3rd and 4th degree perineal lacerations repairs: 5
• Postpartum Bilateral Tubal Ligation: 12
• LEEP: 10
• Colposcopies with biopsies: 24
• First assist on open Total Abdominal Hysterectomy/C-Hys: 5
• D&C: 5
• Obstetrical ultrasound: In the first trimester, confirm an intrauterine pregnancy, fetal viability, number of fetuses (twins/triplets) and gestational age - 10. Second and third trimesters to assess fetal lie, placental position, measure the cervical length and determine the level of amniotic fluid - 10
• Nexplanon insertion and removal - 10
• IUD insertion and removal - 10
• EMB - 10

Fellowship Training

Fellows will participate in approximately three, 12-hour shifts on Labor and Delivery, one ½ day of Family medicine outpatient clinic, one ½ day of Perinatology clinic, three ½ days of OB/GYN outpatient clinic, and one ½ day of OB/GYN procedures per week. At least one of the Labor and Delivery shifts each month will be a night shift. 

Fellows will be provided time and reimbursement for CME, as well as a housing stipend for their month in Grass Valley, CA. Fellows will be provided access to Sonosim Ultrasound Training modules, as well as multiple obstetrical textbooks. Four weeks of vacation is allotted during fellowship training.

Obstetrical fellows will be expected to attend OB/GYN department meetings, provide didactic presentations for Family Medicine residents, and complete a scholarly project during the fellowship year. 

Fellows will receive regular formative and summative feedback. Fellows will additionally evaluate their colleagues, and attendings. Information obtained from the evaluations will be used to provide feedback to the teaching faculty, and to improve the Fellowship Program.

Eligibility and Requirements

• Applicants must be a graduate of an accredited Family Medicine residency program in the United States.
• Applicants must be board certified or board eligible in Family Medicine.
• Applicants will be required to have a California medical license, and a Federal DEA certificate prior to the beginning of the fellowship.
• Applicants are required to submit to [email protected]:
  • Curriculum vitae
  • Personal statement
  • Procedure/Case Logs
  • At least two letters of recommendation including one from their Program Director and a faculty member/preceptor/colleague.
  • A letter of recommendation from a Family Medicine or OB/GYN physician who has direct knowledge of the applicant's clinical obstetrical skills is advisable.

It is recommended that the fellow complete training in Advanced Cardiovascular Life Support (ACLS),  and Advanced Life Support in Obstetrics (ALSO) prior to starting the fellowship.

Application Process

For additional information or to apply please contact: 

Mary Jane Lopez
Administrative Secretary 
Methodist Family Medicine Residency Program

Email: [email protected]
Tel: (916) 681-3456