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Salud Rural Maternal Child Health Fellowship

Mission

The mission of the Salud Rural Maternal Child Health Fellowship is to prepare interested Family Physicians for practice in a rural or underserved setting through advanced training in low and high-risk obstetrics, surgical obstetrical skills, management of neonatal complications including resuscitation, and advanced office gynecologic procedures. Flexibility is also built in to foster development of the physician's ideal practice through elective rotations. 

Locations

The primary outpatient location is located at Salud Medical Center in Woodburn, Oregon. Additional time is spent with our sister clinic Lancaster Family Health Center in Salem, Oregon. The fellowship is affiliated with Yakima Valley Farm Workers Clinic, which has many additional urban and rural sites that would be available for elective rotations.

The principal site for training is Legacy Silverton Medical Center which is a 48-bed hospital in the heart of Oregon's Willamette Valley featuring a Family Birth Center, hospitalist service and emergency services. This rural access hospital serves the local community of Silverton with a population of roughly 10,000 and delivers roughly 1,200 babies a year. The hospital has a Level I Special Care Nursery. Inpatient newborn care is collaboratively provided by family physicians, pediatricians, and midwives. The hospital also has a direct link to neonatal nurse practitioners at the nearby Randall Children's Hospital.

Program Overview

Objectives

At the completion of the fellowship the fellow will be competent in the following:

  • Be able to appropriately perform fetal heart rate monitoring evaluation.
  • Proficiently triage common obstetric complaints such as abdominal pain, vaginal bleeding, decreased fetal movement, labor, preterm labor, rupture of membranes, or fetal compromise.
  • Perform uncomplicated spontaneous vaginal deliveries.
  • Repair vaginal lacerations.
  • Manage intrapartum complications such as intra-aminotic infection, non-reassuring fetal status, malpresentation, shoulder dystocia, and postpartum hemorrhage.
  • Induce labor using Pitocin, Dinoprostone, Misoprostol, or cervical ripening balloon. The fellow will have a thorough understanding of the indications and limitations of each intervention.
  • Perform cesarean sections by low transverse and vertical incision procedure. The fellow will know the know the indications for each
    • Manage post-operative complications such as endometritis, wound infection, delayed post-partum hemorrhage, and ileus.
  • Understand indications and complications of performing operative vacuum assisted vaginal deliveries.
  • Perform postpartum tubual ligations and understand indications, risks and complications.
  • Perform dilation and curettage with an understanding of indications, risks, and complications.
  • Manage hospitalized antepartum patients, including those with pre-term labor, premature rupture of membranes, pre-eclampsia, hypertension, diabetes, placental disorders, and pyelonephritis.
  • Perform appropriate resuscitation of the newborn
    • Demonstrate airway management, fluid management, hypoglycemia protocols, sepsis management, and initial stabilization for distressed newborns.
    • Fellow will be proficient in indications for intubation and umbilical artery and vein catheterizations.
  • Perform limited obstetrical ultrasound including dating, placenta localization, amniotic fluid index, and biophysical profile.
  • Demonstrate competence in managing high risk pregnancies including those complicated by preexisting and gestational diabetes, chronic hypertension, pregnancy induced hypertension, pre-eclampsia, advanced maternal age, low lying placenta or complete placenta previa, renal disease, prior cesarean section, and ability to co-manage more advanced chronic health conditions with maternal fetal medicine.
  • Diagnose and manage threatened, inevitable, or complete miscarriage via expectant, medical or surgical interventions.
  • Diagnose and manage fatal demise.
  • Evaluate and manage common gynecologic complaints including dysfunctional uterine bleeding, infertility, infection, menopausal symptoms, incontinence, and pelvic prolapse.
  • Perform LEEP, colposcopy, long-acting contraceptive insertion and removal, and endometrial biopsy.
  • Maintain and improve upon teaching skills in context of assisting our Advanced Practice Clinicians (NPs and PAs) and our visiting medical students, PA students, and NP students.
  • Maintain full spectrum family medicine management skills by working in a heavy volume, federally qualified health center in rural Oregon.

Core Rotations

  • 6 months - Salud OB Hospitalist service with regular outpatient medicine clinic days
  • 1 month - Legacy Salmon Creek NICU and newborn service
  • 1 month - Legacy Salmon Creek Maternal Fetal Medicine and high risk OB service
  • 1 month - Legacy Emanuel High risk OB hospitalist service
  • Longitudinal contact for scheduled and unscheduled elective LTCS, D&C, PP BTL's, and GYN procedures with the Salud service, Legacy Silverton OB/GYN group, and family physicians at Silverton Hospital.
  • 3-4 months - Elective time coordinated with fellowship director and fellow, dependent on clinic availabilty and interests of fellow.  May include:
    • Visiting rural clinical rotations
    • Research project
    • Targeted personal practice developments

How to Apply

Application

We will accept one fellow each year. Applicants must have completed a 3-year ACGME accredited Family Medicine Residency and be board certified in Family Medicine. At this time, we are not able to sponsor visas for the fellowship.

Please submit the following to apply:

  • A copy of your CV.
  • Concise personal statement detailing the following:
    • Reasons for pursuing additional training in Obstetrics, specifically Surgical Obstetrics.
    • Any previous experience with obstetrical care (both in residency and outside of residency.)
    • Future career goals.
  • Letter of support from your Program Director or colleague if remote from training.
  • Two additional letters of reference, preferably from Family Medicine faculty or colleagues.
  • Current list of OB & GYN procedural numbers.
  • Picture

Application deadline is on a rolling basis. Applicants ideally should submit applications in the fall, September to December.

Interviews will occur in winter: December to January.

Send applications to:

Please email any inquiries regarding the fellowship to Olluqui Miranda at Saludfellowship@yvfwc.org .

CME/Conferences

  • Advanced Life Support in Obstetrics
  • STABLE course
  • NRP
  • Centering pregnancy and newborn program

Vacation

  • 15 days (120 hours) of leave (combined vacation/sick)

Compensation

  • Salary: $65k annually
  • Standard benefits package through Yakima Valley Farm Workers Clinic including medical, dental, and vision coverage.