Maternal child health fellowship.

Overview

The Salud Rural Maternal Child Health Fellowship prepares 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 the development of the physician’s ideal practice through elective rotations.

Philosophy

We believe in the right to wellness for all in a comprehensive, and preventative approach to health. We value cultural diversity, teamwork, and respect the dignity of our clients, patients, and fellows. The selection process for our program is in compliance with federal, state, and local non-discrimination policies. All candidates are judged according to the merits of their own application packages.

Program Goals

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 indications for each.
  • Manage post-operative complications such as endometritis, wound infection, delayed post-partum hemorrhage, and ileus.
• Understand the indications and complications of performing operative vacuum-assisted vaginal deliveries.
• Perform postpartum tubal 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.
  • The 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 fetal 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 the 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.

Patients

The patient population varies by elective location, but the predominance of patients can be broadly defined as low-income and underserved patients of all ages. Our patients are primarily Hispanic, Spanish-speaking migrant/seasonal farmworkers, and their family members. However, Yakima Valley Farm Workers Clinics serve patients from a wide variety of races, ethnicities, and cultures. The patients served at our clinics often cannot access medical care anywhere else. The majority of our patients are on Medicaid or have no medical insurance, many of whom are living below the federal poverty level. For more information about our patients, view patient information in our Community Report.

Compensation

Compensation is $65,000 annually. Benefits include 15 days (120 hours) of combined vacation and sick time, plus a standard package through Yakima Valley Farm Workers Clinic – medical, dental, and vision coverage.