MFM Fellowship Block Diagram

What are your program’s strengths and weaknesses?

 

Our strengths:

  • Our greatest strength is our ability to train well-rounded, independent MFM clinicians.

  • The people! Compassion, collegiality, and collegiality define us.

  • The graduates - their success stories serve as proof of their experience, and exposure to a wide range of both early and advanced maternal and fetal pathology.

  • MFM fellows perform advanced ultrasonography themselves along with ultrasound sonographers, which improves skill dramatically in diagnostic quality and interpretation.

  • We are a county hospital- and care for women of socio-economic disadvantage, which allows for unique experiences in learning the system based practice of medicine, and clinical research opportunities.

  • Our faculty promotes autonomy of the fellow in practice of obstetrics and gynecology (time limits within ACGME standards).

  • We have a new medical school open on campus and hence, exciting new research and teaching opportunities.

  • We are a small program, and know and like working with each other and the obstetrics & gynecology residents and faculty.

 

Our weaknesses:

  • Our patients tend to decline genetic amniocentesis, and often continue pregnancies with lethal anomalies.

  • We do not offer training in fetal surgery (for example laser ablation for twin-to-twin transfusion syndrome).

  • We do not routinely offer CVS training, though opportunities for training can be arranged if a fellow is really interested.

  • Our hospital does not have pediatric surgery, and so if a pediatric surgical condition is diagnosed in a fetus, the patient is transferred for delivery. The complete work-up is performed by our group prior to transfer, so there is little lost in the learning of MFM relative to these cases.

 

What research have your faculty and fellows recently engaged in?

 

Here’s a list of research projects from our fellows, and research interests of our faculty.

  • Dr. Cao: Multiple pre-gestational diagnosis and synergistic effects of common combinations of disease on pregnancy outcomes.

  • Dr. Okekpe: Hyperoxygenation and effects on oxygen free radical formation in the feto-placental unit. Hyperoxygenation effects on Doppler measures in fetuses with growth restriction.

  • Dr. Dombrovsky: Is bigger better? Foley catheter size in combination with oxytocin and time to delivery, and patient pain and satisfaction scores.

 

  • Dr. Roloff: Outpatient induction of labor with misoprostol.  Cesarean delivery and obesity. Prevention of the first cesarean. Methamphetamine use in pregnancy.

  • Dr. Ogunyemi: Medical school, resident education. Diversity. Unconscious bias.

  • Dr. Valenzuela: Melatonin and circadian rhythm of the fetus. Preterm birth. Basic science and endocrinology of pregnancy.

 

Below is a listing of publications from our department, fellows, or faculty.

 

  • Neeki M, Dong F, Lowe L, Cerda M, Peace C, Roloff K. (June 04, 2020) Increasing Chlamydia and Gonorrhea Infections among Female Juveniles: The Need for Collaboration to Improve Treatment. Cureus 12(6): e8446. doi:10.7759/cureus.8446

  • Suchecki G, Tilden H, Roloff K, Chandwani D, Neeki M. (June 01, 2020) Management of Traumatic Uterine Rupture in Blunt Abdominal Trauma: A Case Report and Literature Review. Cureus 12(6): e8396. doi:10.7759/cureus.8396

  • Cao, S. Okekpe. C, Dombrovsky, I. Valenzuela G. Roloff, K. (May 24, 2020) Colorectal Cancer Diagnosed During Pregnancy With Delayed Treatment. Cureus 12(5): e8261. doi:10.7759/cureus.8261

  • Cao S, Dong F, Okekpe CC, Dombrovsky I, Valenzuela GJ, Roloff K. Prevalence of the number of pre-gestational diagnoses and trends in the United States in 2006 and 2016 [published online ahead of print, 2020 Apr 29]. J Matern Fetal Neonatal Med. 2020;1-6. doi:10.1080/14767058.2020.1757641

  • Cao S, Dong F, Okekpe CC, Dombrovsky I, Valenzuela GJ, Roloff K. Prevalence of the number of pre-gestational diagnoses and trends in the United States in 2006 and 2016 [published online ahead of print, 2020 Apr 29]. J Matern Fetal Neonatal Med. 2020;1-6. doi:10.1080/14767058.2020.1757641

  • Ogunyemi D, Hage N, Kim SK, Friedman P. A Multidisciplinary Model for Reviewing Severe Maternal Morbidity Cases and Teaching Residents Patient Safety Principles. Jt Comm J Qual Patient Saf. 2019;45(6):423-430. doi:10.1016/j.jcjq.2019.02.003

  • Cao, S. Walter, L. Valenzuela, GJ. Roloff, K. Delayed-Interval Delivery of Twin Gestation via Cesarean Section: A Case Report. Am J Case Rep. 2019 May 25; 20:739-742. PMID: 31127078.

  • Roloff, K. Stepanyan, G. Valenzuela, G. Prevalence of oropharyngeal group B Streptococcus colonization in mothers, family, and health care providers. PLoS One. 2018 Sep 28;13(9):e0204617. PMID: 30265687.

  • Ogunyemi D, Jovanovski A, Liu J, et al. The Contribution of Untreated and Treated Anxiety and Depression to Prenatal, Intrapartum, and Neonatal Outcomes. AJP Rep. 2018;8(3):e146-e157. doi:10.1055/s-0038-1661379

  • Richter HG, Mendez N, Abarzua-Catalan L, Valenzuela GJ, Seron-Ferre M, Torres-Farfan C. Developmental Programming of Capuchin Monkey Adrenal Dysfunction by Gestational Chronodisruption. Biomed Res Int. 2018;2018:9183053. Published 2018 Aug 13. doi:10.1155/2018/9183053

  • Cao, S. Dao, N. Roloff, K. Valenzuela, GJ. Pregnancies Complicated by Famillial Hypertriglyceridemia:  A Case Report. AJP Rep. 2018 Oct;8(4): Ee362-e364. PMID 30591842

  • Roloff, K. Stepanyan G, Valenzuela GJ. Methamphetamine use Increases Chances of Preeclampsia. J Fam Med Dis Prev 2015. 1:011. ISSN: 2469-5793

  • Roloff, K. Peng, S. Sanchez-Ramos, L. Valenzuela, GJ. Oxytocin dose during induction of labor according to maternal body mass index. International Journal of Obstetrics and Gynecology. 2015. Oct;131(1):54-8. PMID: 26210857.

Chapters in a Textbook

 

Where, and in what type of practice have your fellows ended up in?

 

Dr. Roloff – stayed as an MFM attending at ARMC.

Dr. Stepanyan – Kaiser Ontario, CA.

Dr. Challa – private practice in Phoenix, AZ.

Dr. Cao – Kaiser Fontana, CA.

 

Do you allow moonlighting?

 

Yes! We offer moonlighting opportunities on our service. This must be with the approval of the program director, and may be restricted if the fellow is not meeting milestones or goals of the MFM program. Also, moonlighting hours are monitored and contribute to work hours, and ACGME work-hour restrictions apply.

 

Is there elective time?

 

Yes, as noted in the MFM block diagram. Elective time is decided in collaboration and with the permission of the program director, and may be devoted to core activities if the fellow is not making sufficient progress in training. Many fellows choose to apply this time to additional MFM core or advanced ultrasound. Examples of other opportunities for electives include obstetric anesthesia, and infectious disease.

 

What is the call schedule like?

 

MFM Fellows take at home “MFM Call” in week-long blocks, with assigned MFM Faculty supervision. If there were an unstable high risk patient, the obstetrics team would contact the MFM fellow for telephone consultation and orders for stabilization. Overnight calls are rare. The MFM Fellow assigned to “MFM Call” for the week would also be in charge of completing or delegating any MFM consultations.

 

The MFM Fellow also takes in-house obstetrics/MFM call 4 times a month in the first year, and 3 times a month in the second and third years. They function as the obstetrics attending and work with a senior and junior resident, and physician assistant to run the labor and delivery service. 

 

Can you provide an overview of the benefits?

 

As an MFM Fellow at ARMC, you are an employee of the county, and contracted through the Graduate Medical Education office. All salary and benefits are arranged through the GME office – more information is available here: https://www.arrowheadregional.org/education-research/medical-residency-programs/

The salary for fiscal year 2020-2021 is as follows:

     Fellowship Year 1, $68,143

     Fellowship Year 2, $71,216

     Fellowship Year 3, $74,543

Do you sponsor work visas?

 

No, the county has chosen not to sponsor any type of visa. In order to be an MFM fellow at ARMC, you must eligible to work in the US as a citizen or have a green card.

Where are the training sites, and how much time do the fellows spend there?

1. Arrowhead Regional Medical Center - Core / Main site. Located in Colton, CA. 

2. Inland Faculty Specialists - ambulatory consultative and continuity care. MFM fellows rotate here 1 day per week for 1 - 1.5 years in years 2 - 3.

3. San Diego Perinatal Center. Multiple locations in San Diego County. MFM Fellows spend 1 - 3 months here in year 2-3.

MFM Fellowship Program Questions & Answers

© 2015 by Kristina Roloff DO MPH
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