Goals and Objectives - McGill University...3) Research skills and critical appraisal of the medical literature. B. Diagnose, evaluate and treat perinatal disorders using the various

Version February 2013 1

McGill University

Maternal-Fetal Medicine Subspecialty Training Program

Dr. Angela Mallozzi Maternal-Fetal Medicine Subspecialty Training Program Director Maternal-Fetal Medicine Division Department of Obstetrics and Gynecology, McGill University 687 Pine Avenue West, F2.07 Montreal, Quebec H3A 1A1 Tel 514-934-1934 ext 34062 Fax 514-843-1539 Fellowship Program Coordinator Isabelle Lalonde McGill Department of Obstetrics and Gynecology Teaching Office 687 Pine Avenue West, F4.46 Montreal, Quebec H3A 1A1 Tel 514-934-1934 ext 34669 Email: [email protected] Website: www.mcgill.ca/teaching/fellows/mfm

Goals and Objectives

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Table of Contents

1. Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3

2. General Educational Goals & Objectives . . . . . . . . . . . . . . . . . . . 4

3. Overview of Rotations . . . . . . . . . . . . . . . . . . . . . . . . . . 5

4. Rotation-based Objectives of Training . . . . . . . . . . . . . . . . . . . 5

• Maternal-Fetal Medicine . . . . . . . . . . . . . . . . . . . . 6

• Basic and Advanced Ultrasound . . . . . . . . . . . . . . . . . 11

• Medical Genetics . . . . . . . . . . . . . . . . . . . . . . . 19

• Neonatology and Pediatrics . . . . . . . . . . . . . . . . . . . 23

• Advanced Fetal Doppler and Echocardiography . . . . . . . . . . 28

• Obstetrical Medicine . . . . . . . . . . . . . . . . . . . . . . 33

• Research . . . . . . . . . . . . . . . . . . . . . . . . . . . 37


1. Introduction

As defined by the Royal College of Physicians and Surgeons of Canada (RCPSC) and the Collège des Médecins du Québec, Maternal-Fetal Medicine specialists are physicians trained in the prevention, diagnosis and treatment of those conditions implicated in the morbidity and mortality of the mother, fetus and early newborn. These physicians have special training in the identification and management of high-risk obstetrical problems. Specialists in maternal-fetal medicine are viewed primarily as consultants to the practicing obstetrician and other health care providers. During their clinical rotations and calls, trainees are expected to acquire competencies in the different CanMEDS domains.

This document describes the rotation specific objectives of the Maternal-Fetal Program at McGill University. The program is structured to train individuals who have successfully completed a Royal College accredited Obstetrics/Gynecology residency and International Graduates of other approved ObGyn programs and who wish to sub-specialize in Maternal-Fetal Medicine. This is a two-year program leading to Royal College accreditation with certification for Fellows of the Royal College and McGill accreditation for international graduates. The MFM program provides all components of as outlined in the following 2007 specialty-specific documents of the RCPSC, which can be found on their website, on the McGill website or by clicking on hyperlinks below:

• Objectives of Training in the Subspecialty of Maternal-Fetal Medicine • Subspecialty Training Requirements in Maternal-Fetal Medicine • Specific Standards of Accreditation for Residency Programs in Maternal-Fetal Medicine

The objectives are delineated according to the CanMEDS Framework. The CanMEDS framework was created by the Royal College of Physicians and Surgeons of Canada (RCSPC) to clearly define the essential competencies required of a physician. Clinical Training In order to gain experience in Maternal-Fetal Medicine, the candidate will manage patients in the Birthing Center, the in-hospital Antepartum Unit, the outpatient Ambulatory Maternal-Fetal Medicine (MFM)/Obstetrics Clinic, and the Women's Ultrasound Unit at both McGill teaching sites, the Royal Victoria Hospital and the Jewish General Hospital. Patients are referred from a total catchment area of approximately 20,000 live births per year. Patients are referred for various medical complications in pregnancy, as well as suspected fetal abnormalities, genetic issues, preterm labor, and maternal or fetal problems requiring ongoing fetal surveillance. Under the supervision of the attending staff of the Maternal-Fetal Medicine Division, the candidates will see consultations and follow patients in each of the clinical units. The responsibilities of the trainee will gradually increase throughout the course of the two-year training period. The trainee will also become increasingly acquainted and competent in the management of complications of pregnancy, ultrasound, fetal monitoring and diagnostic techniques. The trainee will be an active participant in the academic activities of the maternal-fetal medicine division including regular rounds, seminars and journal clubs. In addition, throughout the course of the two-year training

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program, the trainee will design and execute a research protocol in a clinical or basic science area under the supervision of an attending staff member. General Educational Goals & Objectives The Maternal-Fetal Medicine subspecialty-training program is designed to increase the depth of knowledge and clinical expertise in maternal-fetal medicine, to refine research goals and to develop leadership and managerial skills for the obstetrical community at large. As such, individuals entering the MFM program at McGill must have successfully completed at least five years of an accredited Obstetrics & Gynecology residency leading to a Royal College of Physicians and Surgeons specialist certification. The objectives of training in Maternal-Fetal Medicine at McGill University fulfill the subspecialty training requirements in Maternal-Fetal Medicine published by the Royal College of Physicians and Surgeons of Canada in 2007. Upon completion of the Subspecialty Training Program in Maternal-Fetal Medicine the trainee will:

A. Possess a solid knowledge base and understanding of the 1) Basic sciences relevant to perinatal medicine 2) Diagnosis, evaluation and treatment of perinatal problems 3) Research skills and critical appraisal of the medical literature.

B. Diagnose, evaluate and treat perinatal disorders using the various techniques and modalities currently available

C. Conduct research, including statistical and critical appraisal of the medical literature, design of a research protocol, data recording and analysis, computer-based study and publication in a peer-reviewed journal.

D. Establish and maintain an effective doctor-patient relationship

E. Act as a consultant to other obstetrician-gynecologists, family physicians and other health care professionals

F. Function as an educator to patients, medical students, residents, colleagues and other health care professionals

G. Be a leader and role model in the quality assurance and maintenance of obstetrical care and in the establishment of practice guidelines and protocols for the institution and the community.


2. Overview of Rotations Year Rotation Duration

(blocks) Teaching

Site(s) First

Maternal-Fetal Medicine 4 RVH, JGH Ultrasound - Basic and Advanced 3 RVH, JGH Medical Genetics 1 RVH, MCH Neonatology and Pediatrics 1 RVH, MCH Research 3 RVH / JGH Selectives: Obstetrical Medicine, Ultrasound, Genetics

1

Sub-total 13 Second

Maternal-Fetal Medicine 4 RVH, JGH Ultrasound- Basic and Advanced 2 RVH, JGH Advanced Fetal Doppler and Echocardiography 1 MCH, HSJ Obstetrical Medicine 1 SMHC, RVH Research 3 RVH / JGH Selectives or Elective: Perinatal Pathology, Obstetrical Anesthesiology, Advanced Fetal Doppler and Echocardiography, Obstetrical Medicine, Ultrasound, Genetics Examples previous Out-of-province Electives: Advanced and 3D Ultrasound, Columbia Presbyterian, New York (Dr Timor-Trisch); Fetal Medicine, University of London, England, FMM Unit (Dr Basky Thilaganathan).

2

TOTAL 26

NOTE: One block is comprised of 4 weeks; hence the 2 year program is comprised of 26 blocks RVH Royal Victoria Hospital JGH Jewish General Hospital MCH Montreal Children's Hospital SMHC St Mary's Hospital Centre HSJ Ste-Justine Hospital

3. Rotation-Based Objectives of Training The Objectives of Training for each rotation of the McGill MFM program were developed with the specialists involved in the training from each of the teaching sites. The objectives of this 24 month program are based on the following RCSPC guidelines: Subspecialty Training Requirements in

• Subspecialty Training Requirements in Maternal-Fetal Medicine 2007 • Objectives of Training in the Subspecialty of Maternal-Fetal Medicine 2007 • Specific Standards of Accreditation for Residency Programs in Maternal-Fetal Medicine 2007

The Objectives of Training have been reviewed and updated in 2012.


McGill University

Subspecialty Training Program in Maternal-Fetal Medicine Objectives of Training

Orientation to Rotation Rotation duration: Four 4-week blocks in 1st year; four 4-week blocks in 2nd year

Rotation supervisors: RVH: Dr Angela Mallozzi ([email protected] JGH: Dr Stephanie Klam ([email protected])

Service Requirement: Night call from home will be shared with other MFM Residents/Fellows, for patients admitted to the RVH or JGH MFM Service and transport calls.

Rotation Environment and Expectations The perinatal unit consists of all the inpatients admitted to the MFM service both in the Birthing Center and the Antepartum Unit. The perinatal team rounds on the unit daily. The MFM trainee is expected to monitor each patient’s status and to have a management plan for each case. The trainee is supervised by the attending on service, and must, in turn, supervise and delegate appropriately to the obstetrical trainees and medical students on service. The trainee manages acute complications in pregnancy and reviews test results during the day. He/She also manages any admission to the unit upon consultation with the attending on service. The trainee is involved in procedures and delivery of any patients on the MFM service. He/She is expected to attend the MFM/Obstetrics clinic. In these clinics the high-risk obstetrical patients are seen for an initial consultation after a referral by their midwife, family physician or obstetrician gynecologist. Patients with ongoing problems are seen for follow-up visits and testing of fetal well-being.

Specific Objectives and CanMEDS competencies On completion of the Maternal-Fetal Medicine rotations, the MFM trainee will have acquired the following competencies that will assist him in his/her future role as a consultant in maternal-fetal medicine. 1. Medical Expert A) Demonstrate the basic science and clinical knowledge relevant to the specialty

1. Normal fetal development including: • Immunology of pregnancy and fetus • Trophoblast biology and early placental development

Maternal-Fetal Medicine Rotation Royal Victoria Hospital and Jewish General Hospital


• Embryogenesis • Placental respiratory gas exchange, fetal oxygenation, transplacental nutrient transfer • Fetal acid-base status and behavioral activity • Fetal lung development and maturation • Role of maternal nutrition

2. Normal embryonic and fetal growth and development and transition from fetal to neonatal life 3. Fetal cardiovascular physiology, autonomic control of the fetal heart and fetal arrhythmia 4. Dynamics and disorders of amniotic fluid volume 5. Multiple gestations 6. Prenatal diagnosis and management of fetal growth aberrations 7. Fetal anomalies 8. Maternal diseases affecting fetal outcome:

• Diabetes • Hypertensive disorders • Immunological disorders • Infectious disorders • Hematological disorders • Cardiac disorders • Renal disease • Thyroid gland disorders • Connective tissue disorders • Neurological disorders • Malignancies • Maternal infection • Substance abuse of narcotics, alcohol and illicit drugs and their effect on the fetus and

newborn 9. Obstetrical complications of pregnancy

• Isoimmunization: diagnosis and management • Post term pregnancy • Antepartum, intrapartum and post partum hemorrhage • Preterm labor and delivery: etiology, diagnosis, treatment and prevention • Pre-term and prelabour rupture of membranes; early detection of infection and

prevention of fetal complications • Abnormal cervical length , funneling and pre-viable rupture of membranes • Risks, benefits and indications of both vaginal and abdominal cervical cerclage placement

10. Maternal trauma 11. Medical and surgical methods of pregnancy termination for genetic and structural anomalies. 12. The use of evidence–based medicine in effective decision making strategies.

B) Be able to elicit a complete history and perform a physical examination that conforming to the standards of Maternal –fetal Medicine consultant.

C) To select the appropriate investigative tools such as diagnostic imaging and genetic testing in a cost-effective, ethical and useful manner.

D) Demonstrate good clinical judgment in addressing the patient problems, interpreting the available information and generating a differential diagnosis and management plan.


E) Establish an appropriate treatment plan in consultation with the patient and her family and obtain informed consent for therapies.

F) Demonstrate proficiency and appropriate use of procedural skills both diagnostic and therapeutic: 1. Diagnostic amniocentesis in singleton and multiple pregnancies. 2. First trimester ultrasound 3. Detailed second trimester ultrasounds including anatomy and aneuploidy screening 4. Third trimester ultrasound including assessment of fetal growth and fetal health 5. Ultrasound of multifetal pregnancy. 6. Fetal Doppler studies to assess placental function and fetal anemia

G) Demonstrate effective and timely performance of the following procedures: 1. Difficult caesarean delivery 2. Elective cervical cerclage 3. Emergency cerclage 4. External cephalic version 5. Therapeutic amnioreduction 6. Cordocentesis and in-utero fetal transfusion

H) Ensure adequate post-procedure follow-up. 2. Communicator

a) Establish a therapeutic relationship with the patient and her family, understanding the unique impact of psychological, social and ethical issues associated with high-risk pregnancies.

b) Demonstrate good interpersonal skills when working with all members of the health care team c) Gather pertinent information about the patient, including the family’s beliefs, concerns and

expectations about the illness. Listen effectively d) Be able to explain abnormal results and pregnancy complications to the patient in a humane way

that is understandable and encourages discussion and participation in decision making by the patient and her family.

e) Be able to obtain informed consent. f) Be able to deliver bad news, addressing anger and misunderstanding that may arise. g) Be able to deliver a patients case presentation clearly and concisely. h) Be able to produce timely, meticulous and correct documentation, including consultation notes,

progress notes, operative reports and letters. 3. Collaborator

a) Demonstrate the ability to work effectively with a multidisciplinary team and respect the opinions of other team members.

b) Contribute effectively at multidisciplinary group meetings (e.g. Morbidity and mortality rounds, Neonatal-perinatal rounds, Fetal Diagnosis and Treatment Group)

c) Understand the role of other healthcare professionals in comprehensive patient care. d) Effectively work with other health professionals to prevent, negotiate and resolve

interprofessional conflict. 4. Manager


a) Understand indicators of quality assurance in the division of Obstetrics b) Coordinate of obstetrical Morbidity and Mortality Rounds effectively c) Utilize the Perinatal network (CCPQ), Telehealth, OACIS, Centricity, MOND etc. for optimal patient

care and communication d) Organization of work and time management e) Delegates clinical responsibilities appropriately f) Manage healthcare resources effectively

5. Health Advocate

a) Identify the important determinants of health in an individual patient and draw on the network of resources to facilitate patient access to care in a timely manner

b) Provide advocacy, health promotion and disease prevention through consultation and follow-up planning for the needs of the different communities of the McGill University integrated healthcare network, including remote Northern Quebec populations

6. Scholar

a) Maintain a personal continuing education strategy. b) Critically appraise sources of medical information and apply evidence-based medicine in MFM

practice c) Facilitate learning for patients, medical students, residents and other health professionals

7. Professional

a) Deliver the highest quality care with integrity, honesty and compassion; including recognizing limitations of their own professional competence and seeking advice as needed b) Exhibit appropriate professional behaviors

i. Punctuality ii. Respond to calls in a timely and respectful fashion

iii. Show appropriate demeanour with respect to appearance and language c) Practice medicine consistent with the ethical obligations of a physician, such as maintaining patient confidentiality d) Sensitive to ethical issues specific to MFM, such as termination of pregnancy, and arranges ethical

consultation and discussion, as required.

Evaluation of MFM Rotation

During his/her core rotation and calls, the trainee is expected to acquire competencies in each of the different CanMEDS domains. The MFM trainee is evaluated daily on an informal basis on presentation of cases, history taking, physical exam, ordering and interpretation of tests, and finally establishment of a management plan. Short-answer examinations covering topics presented at the weekly Academic Teaching Sessions are given every 4-6 weeks.


The MFM-rotation specific ITER is used every 4 weeks for the evaluation of CanMEDs competencies; it can be found on MRESone45.

Suggested Reading for MFM Rotation

Creasy and Resnik's Maternal-fetal medicine : principles and practice / Creasy, Robert K; Resnik, Robert; Iams, Jay D. -- Philadelphia: Saunders, 2009.6th ed. (Book) WQ 211 M41.6 2009 Reserve RVH - Women's Pavilion Library.

Fetal Therapy: State of the Art, by Mark I Evans, Lawrence D. Platt and F. De La Cruz. New York: Parthenon, 2001.

Medical complications during pregnancy, by Gerald N. Burrow and Thomas P.Duffy (5th Ed) Philadelphia: Saunders, 1999.

Other references

Clinical obstetrics : the fetus & mother / Reece, E. Albert; Hobbins, John C. -- Malden, Mass: Blackwell Pub, 2007.3d ed. (Book; CD-ROM) WQ 211 C64.3 2007 Reserve RVH -

Critical care obstetrics, by Gary Dildy (4th Ed.) New York: Blackwell Science, 2004

Drugs in Pregnancy and Lactation: A Reference Guide to Fetal and Neonatal Risk / Briggs.: Lippincott Williams & Wilkins, 2011. (Book) WQ 39 B85.9 2011 Reserve RVH - Women's Pavilion Library.

Ethical issues in maternal-fetal medicine / Dickenson, Donna L. -- Cambridge: Cambridge University Press, 2002. (Book) WQ 21 E83 2002 RVH - Women's Pavilion Library.

Fetal heart rate monitoring / Freeman, Roger K; Garite, Thomas J; Nageotte, Michael P. -- Philadelphia: Lippincott Williams & Wilkins, 2003.3rd ed. (Book) WQ 210.5 F85.3 2003 RVH - Women's Pavilion Library.

Fetal medicine : basic science and clinical practice / Rodeck, C. H.; Whittle, Martin J. -- New York: Churchill Livingstone, 2009.2th ed. (Book) WQ 211 R61.2 2009 Reserve RVH - Women's Pavilion Library.

High risk pregnancy: management options / James, D K; Steer, P J; Weiner, C P. -- Philadelphia: Elsevier, 2011.4rd ed. (Book) WQ 100 J23.4 2011 Reserve RVH - Women's Pavilion Library.

Hypertensive Disorders in Women, by Baha M. Sibai. Philadelphia: Saunders, 2001.

Management of high-risk pregnancy : an evidence-based approach / Queenan, John T.; Spong, Catherine Y.; Lockwood, Charles J. -- Malden, Mass: Blackwell Pub., 2007.5th ed. (Book) WQ 240 Q3.5 2007 RVH - Women's Pavilion Library.

Medical complications in pregnancy / Craigo, Sabrina D.; Baker, Emily R. -- New York: McGraw-Hill,, 2005. (Book) WQ 240 C84 2005 RVH - Women's Pavilion Library.

Obstetric and maternal-fetal evidence-based guidelines. / Berghella, Vincenzo.: Informa Healthcare, 2012.2nd. (Book) WQ 240 B35.2 2012 Reserve RVH - Women's Pavilion Library.

Obstetric intensive care manual / Foley, Michael R; Strong,Thomas H.Jr; Garite,Thomas J. -- New York: McGraw-Hill, 2011.3nd ed. (Book) WQ 240 O13.3 2011 RVH - Women's Pavilion Library.

Obstetrics: Normal and Problem Pregnancies, by Steven G. Gabbe, Jennifer R. Niebyl and Joe Leigh Simpson. (4th Ed.) New York: Churchill-Livingstone, 2002.

Protocols for high-risk pregnancies / Queenan, John T; Hobbins, John C; Spong, Catherine Y. -- Malden, MS: Blackwell Publishing, 2005.4th ed. (Book) WQ 240 P96.4 2005 RVH - Women's Pavilion Library.

Williams Obstetrics, by F. Gary Cunningham et al (21st Ed.) New York. McGraw-Hill, 2001.


McGill University Subspecialty Training Program in Maternal-Fetal Medicine

Objectives of Training

Orientation to Rotation Rotation duration: Five blocks total - Three 4-week blocks in the first year and two 4-week blocks in the second year Rotation supervisors:

RVH: Dr Richard Brown ([email protected]) JGH: Dr Marie-France Lachapelle ([email protected])

Service Requirement: Night call from home will be shared with other MFM Fellows, for patients admitted to the RVH or JGH MFM Service and transport calls. Rotation Environment and Expectations Twenty weeks are dedicated specifically to basic and advanced ultrasound training. However, when the trainee is on the core MFM rotations and also during night calls he/she will be required to use ultrasound for evaluation of patients to the best of their ability at that point in time. Attending supervision at all sessions will allow direct and regular feedback. Objectives are divided into Basic and Advanced ultrasound knowledge and skills. Timing of progression from one to the next will depend on the individual trainee and the set of ultrasound knowledge and skills he/she brings at the beginning of the training program. If, by the end of the third ultrasound block, the trainee has not progressed from Basic to Advanced knowledge and skills then he/she will be advised to use some elective time to achieve all required ultrasound skills.

Specific Objectives and CanMEDS competencies On completion of the Basic and Advanced Ultrasound Rotation, the MFM trainee will have acquired the following competencies that will assist him in his/her future role as a consultant in maternal-fetal medicine.

Basic and Advanced Ultrasound Rotation Royal Victoria Hospital and Jewish General Hospital


1. Medical Expert

A. KNOWLEDGE - Basic Ultrasound

1. Obtain an understanding of the physics underlying ultrasound imaging including Doppler, in order to obtain an optimal image.

a) Effects on human tissues of pulsed- and continuous-wave ultrasound beams b) Principles of attenuation, absorption, reflection, speed of sound, and thermal and

nonthermal biologic effects c) Interpretation of acoustic output information (including Doppler) and its clinical relevance d) Flow mapping (colour Doppler) e) Signal processing (gray scale, time gain compensation, dynamic range, focus) f) Artifacts: interpretation and avoidance g) Reverberation, side lobes, edge effects, shadowing, enhancement

2. Understand and utilize Doppler methodology appropriate to obstetrical investigation. a) Evaluation of fetal and utero-placental blood flow b) Appreciation of problems in blood flow and velocity measurements and waveform

analysis in normal and complicated pregnancies c) Clinical applications in the prediction of intrauterine growth retardation and preeclampsia d) Clinical applications in monitoring the small-for-dates fetus and pregnancies complicated

by Rh isoimmunization, diabetes, postmaturity, and fetal cardiac arrhythmias

3. Demonstrate comprehensive knowledge of sonoembryology and fetal development.

4. Understand feto-maternal physiology as applicable to ultrasound, for example, basic understanding of amniotic fluid dynamics and fetal biophysical parameters as well as vascular changes in states of normal fetal wellbeing and stress.

5. Understand the principles involved in an obstetrical evaluation a) Principles of ultrasound and biochemical investigation of ectopic pregnancy b) Fetal biometry (CRL, BPD, OFD, HC, AC, FL) c) Estimation of gestational age and ultrasound assessment of fetal growth - interpretation

and appreciation of limitations of standard measurements - fetal weight estimation d) Evaluation of biophysical parameters (fetal breathing, movement, tone and amniotic fluid

volume) e) To determine the suitability and understand the techniques involved in invasive fetal

testing.

6. Demonstrate comprehensive knowledge of sonographic pelvic anatomy.

B. SKILLS - Basic Ultrasound

1. Demonstrate competency in obtaining fetal and pelvic views and optimize the ultrasound image by adjusting the machine settings.

2. Perform a first trimester scan which involves identifying and documenting locations of the gestational sac, yolk sac, fetal number and determination of twin chorionicity, crown-rump


length, presence or absence of cardiac activity, evaluation of the uterus and adnexa. Identify fetal number and viability.

3. Obtain nuchal translucency (NT) measurements that fulfill the standard criteria and obtain the FMF certification for NT assessment.

4. Identify pathologies within the first trimester, early pregnancy failure, ectopic pregnancy, gross fetal abnormality (e.g., cystic hygroma, clearly abnormal nuchal translucency etc.)

5. Perform first and second trimester anatomical evaluations, assessing the following fetal structures: kidneys and bladder, abdomen, 4-chamber view of the heart, limbs, spine, cranium, cerebral ventricles, cerebellum and umbilical cord structure and insertion. Recognize normal fetal anatomy and be able to identify (but perhaps not fully understand) abnormal structures.

6. During second and third trimester examinations to be able to identify: fetal number and viability, fetal presentation and position, the grade of placenta, fetal heart rate and rhythm, and assess amniotic fluid volume

7. Perform biophysical profile with clear knowledge of standard criteria and interpretive skills

8. Assess the principle biometric parameters including: CRL, BPD, OFD, HC, AC, FL, humerus length. To be able to assess estimates fetal weight and interpret growth charts.

C. KNOWLEDGE - Advanced Ultrasound

1. To develop an understanding of fetal pathology and the pathophysiology of commonly encountered conditions.

a) Fetal aneuploidy b) Genetic conditions recognizable sonographically c) Structural defects and their implications, including:

• Cranial o Anencephaly o Holoprosencephaly o Ventriculomegaly o Posterior Fossa and Cerebellar abnormalities

• Facial o Clefting

• Thorax o Skeletal dystrophy o Cardiac abnormalities (Transposition, Fallot’s, hypoplastic left heart etc) o CCAM o Pleural effusions

• Abdomen o Diaphragmatic hernia o Hydronephosis / urinary obstruction o Ascites

• Spine o Neural tube defects

2. To develop an understanding of the impact of maternal disease on the fetus and evaluation of

the fetus in such circumstances.


3. To develop the ability to counsel patients regarding the risks of fetal abnormalities and the findings of a sonographic evaluation.

4. To understand the principles of invasive diagnostic and therapeutic procedures

a) Amniocentesis - Indications and complications b) Chorionic villus sampling - Indications and complications c) Cordocentesis - Indications and complications d) Fetal Transfusion – peritoneal, vascular, intra-hepatic e) Blood, platelets f) Drainage and shunting of fetal body cavities g) Fetoscopy

5. To develop an understanding of medical and surgical aspects of fetal therapy.

D. SKILLS - Advanced Ultrasound

1. Demonstrate competence in first trimester assessment of:

a) Nuchal translucency and nasal bone. b) Pathology, including abnormal NT, cranial and cerebral defects (e.g. exencephaly,

holoprosencephaly), lower urinary tract obstruction, limb abnormalities, GI tract anomalies etc.

c) Doppler findings (uterine artery, umbilical cord, ductus venosus, tricuspid regurgitation)

2. Demonstrate competence in assessment of normal and abnormal fetal anatomy at 18-20 weeks: a) Head

• Facial profile and facial anatomy • Brain • Cerebral cortex and cerebral ventricles, including corpus callosum • Posterior fossa and cerebellum • Cisterna magna • Nuchal skin fold

b) Spine • Longitudinal • Transverse

c) Limbs • Number • Movement • Hands and feet

d) Thorax • Heart Rate and rhythm • Four-chamber view • Cardiac axis and situs • Origins of the great vessels, the aortic arch • Lungs

e) Abdomen


• Situs • Stomach • Liver, gall bladder and GI tract • Kidneys and urinary bladder • Abdominal wall and umbilicus

f) Examination of the placenta and cord • Placental location and morphology • Number of cord vessels

g) Doppler Evaluation (Pulsed wave and colour) • Umbilical artery and vein • Uterine arteries • Middle Cerebral artery • Other vessels, including thoracic aorta, renal arteries, ductus venosus and cardiac

Doppler (for example assessment of cardiac morphology and valvular function)

The following CanMEDS competencies apply to the Basic and the Advanced ultrasound rotations

2. Communicator a) Demonstrate good interpersonal skills when working with all members of the health care

team b) Gather pertinent information about the patient, including the family’s beliefs, concerns and

expectations about the illness. Listen effectively c) Demonstrate sensitivity in the communication of the findings of ultrasound examinations,

being especially mindful of impact of psychological, social, and ethical problems associated with the diagnosis of fetal abnormality

d) Be able to obtain informed consent. e) Be able to deliver a patients case presentation clearly and concisely. f) Be able to produce timely, meticulous and correct documentation, including ultrasound

reports, consultation notes, and letters.

3. Collaborator

a) Demonstrate the ability to work effectively with a multidisciplinary team and respect the

opinions of other team members. b) Contribute effectively at multidisciplinary group meetings (e.g. Weekly Ultrasound rounds,

Fetal Diagnosis and Treatment Group meetings) c) Understand the role of other healthcare professionals in the provision of comprehensive

patient care. d) Effectively work with other health professionals to prevent, negotiate and resolve

interprofessional conflict.


4. Manager

a) Coordinates and/or presents at the weekly Ultrasound Rounds b) Effectively utilize the information systems (Telehealth, OACIS, Viewpoint, RadImage, PACS)

required for optimal patient care and communication of ultrasound findings c) Demonstrates organization of work and time management d) Delegates clinical responsibilities appropriately e) Executes appropriate allocation of ultrasound resources within the region and remote

communities, including community hospitals, private clinics and remote outposts f) Understand the principles of quality assurance and administration of an ultrasound unit

5. Health Advocate

a) Identify the important determinants of health in an individual patient b) Utilize the network of resources to facilitate patient access to care in a timely manner c) Provide advocacy for patients with abnormal ultrasound findings by coordinating and

expediting consultation with the necessary specialists, such as genetics, pediatric cardiology, pediatric radiology, pediatric surgery etc.

d) Enable patients to remain in their own communities without compromising quality of care through the use of Telehealth services coordinated by the MUHC, which includes both the review and reporting of ultrasound studies from remote areas in real and deferred time.

6. Scholar

a) Maintain a personal continuing education strategy. b) Complete ARDMS requirements for examination and certification c) Complete FMF certification for NT measurement d) Critically appraise sources of medical information and apply evidence-based medicine in

ultrasound e) Facilitate learning for patients, medical students, residents and other health professionals

7. Professional

a) Deliver the highest quality care with integrity, honesty and compassion; including recognizing limitations of their own professional competence and seeking advice as needed

b) Exhibit appropriate professional behaviors i. Punctuality

ii. Respond to calls in a timely and respectful fashion iii. Show appropriate demeanour with respect to appearance and language

c) Practice medicine consistent with the ethical obligations of a physician, such as maintaining patient confidentiality

d) Sensitive to ethical issues specific to MFM, such as termination of pregnancy, fetal reduction; arranges ethical consultation and discussion, as required.


Evaluation:

Evaluation of the MFM trainee regarding the acquisition of ultrasound skills is performed on an on-going basis during the training periods. The MFM attending supervising the ultrasound session and the sonographers/technicians directly observe the trainee performing every ultrasound examination in the first four weeks of the first MFM block. After this, if the trainee’s performance is deemed satisfactory, the trainee is allowed to perform the ultrasound examination alone. However, the attending reviews every examination. The trainee is thus given direct feedback on every patient. At the end of every block, an evaluation based on CanMeds roles is completed by the MFM faculty on MRESone45. By the end of the first three Ultrasound blocks, the MFM trainee will be expected to have obtained FMF Certification in the measurement of the fetal nuchal translucency. By the end of the 2-year program the trainee is expected to have completed the ARDMS examinations in Obstetrics/Gynecology and ultrasound physics.

Suggested Reading for Ultrasound Rotation

Diagnostic Imaging of Fetal Anomalies, by David A. Nyberg, John P. McGahan, Dolores H. Pretorius and Gianluigi Pilu. Philadelphia: Lippincott, Williams & Wilkins, 2003.

Fetology : diagnosis and management of the fetal patient / / Diana W. Bianchi ... [et al.]. -- New York: McGraw-Hill; McGraw-Hill Medical, 2010.2nd ed. (Book) WQ 211 F42.2 2010 RVH - Women's Pavilion Library.

Ultrasonography in obstetrics and gynecology / Callen, Peter W. -- Philadelphia, PA: Elsevier Saunders, 2008.5th ed. (Book) WQ 100 U47.5 2008 Reserve RVH -

Other References

A Practical Guide to Fetal Echocardiography: Normal and Abnormal Hearts [Hardcover] Alfred Z. Abuhamad (Author), Rabih Chaoui (Author) Lippincott Williams and Wilkins; 2nd Revised edition edition (1 Dec 2009) ISBN-10: 0781797578

Atlas of Ultrasound in Obstetrics and Gynecology Lippincott Williams & Wilkins; 2 edition (1 Jan 2011) Language: English ASIN: B005GETBSM

Clinical sonography : a practical guide / Sanders, Roger C; Miner, Nancy Smith. -- Philadelphia: Lippincott-Raven, 2007.4th ed. (Book) WN 208 C64.4 2007 Reserve RVH - Women's Pavilion Library.

Donald school textbook of ultrasound in obstetrics and gynecology -- New Delhi: Jaypee Brothers, 2011.3rd ed. (Book) WQ 209 D65.3 2011 RVH - Women's Pavilion Library.

Doppler Ultrasound in obstetrics and gynecology / Maulik, Dev. -- Berlin: Springer-Verlag, 2005.2nd ed. (Book) WQ 209 D69.2 2005 RVH

Embryo and fetal pathology: color atlas with ultrasound correlation / Gilbert-Barness, Enid; Debich-Spicer, Diane. -- Cambridge: University Press, 2004. (Book) WQ 17 G46e 2004 Reserve RVH - Women's Pavilion Library.


Fetal anomalies: ultrasound diagnosis and postnatal management / Maizels, Max; Cuneo, Bettina F; Sabbagha, Rudy E. -- New York: Wiley-Liss, 2002. (Book) WQ 209 F41 2002 RVH - Women's Pavilion Library.

Fetal Echocardiography: A Practical Guide Lindsey D. Allan Andrew C. Cook Ian C. Huggon Cambridge University Press; 1 Har/Dvdr edition (2 July 2009) ISBN-10: 0521695201

Obstetric and gynaecological ultrasound made easy / Smith, N. C.; Smith, A. Pat M. -- New York: Churchill Livingstone, 2006.2nd ed. (Book) WQ 209 S4.2 2006 Reserve RVH - Women's Pavilion Library.

Sonography in Obstetrics and Gynecology: Principles and Practice, by Arthur C. Fleischer, Frank A. Manning, Philippe Jeanty and Roberto Romero. (6th Ed.) New York: McGraw-Hill, 2001.

Textbook of Fetal Abnormalities Peter Twining Josephine M. McHugo David W. Pilling Churchill Livingstone; 2nd Revised edition edition (4 Dec 2006) ISBN-10: 044307416X

The fetus in three dimensions / Kurjak, Asim.; Azumendi, Guillermo. -- Boca Raton, FL: Informa Healthcare, 2007. (Book) WQ 209 K95 2007

Transvaginal Sonography of the Normal and Abnormal Fetus, by Moshe Bronshtein and Etan Z. Zimmer. New York: Parthenon

Ultrasound in obstetrics and gynecology / edited by Frank A. Chervenak, Glenn C. Isaacson, Stuart Campbell. -- -- Boston: Little, Brown, 1993. (Book) WQ 209 U468 1993 RVH - Women's Pavilion Library.

Ultrasound in Obstetrics and Gynecology: Vol 1 - Eberhard Merz TIS; 2 edition

Ultrasound markers for fetal chromosomal defects / Snijders, Rosalinde J. M; Nicolaides, Kypros H. -- New York: Parthenon, 1996. (Book) QS 677 S67 1996 RVH - Women's Pavilion Library.

Ultrasound of fetal syndromes / Benacerraf, Beryl R. -- Philadelphia: Churchill Livingstone / Elsevier, 2008.2nd. (Book; CD-ROM) WQ 211 B43.2 2008 RVH

Refer to the Websites of • SOGC (clinical practice guidelines for 2nd trimester assessment and aneuploidy screening) • ISUOG, RCOG, AIUM, BMUS, EFSUMB (for international standards and guidelines in ultrasound)

Journals

• Ultrasound in Obstetrics & Gynecology • Journal of Ultrasound in Medicine • Prenatal Diagnosis • Fetal Diagnosis and therapy




Orientation to Rotation Rotation duration: One 4-week rotation in the first year Rotation supervisor:

• RVH and MCH: Lola Cartier, MSc, Genetics counselor coordinator ([email protected]) Medical Genetics staff

• Andrea Secord, MSc, Genetics Counselor ([email protected]) • Rachel Vanneste, MSc, Genetics Counselor ([email protected]) • Dr Laura Russell, Geneticist ([email protected]) • Dr Josee Lavoie, Cytogenetics, ([email protected]) • Dr Isabelle De Bie, Geneticist - molecular genetics

Service Requirement: Night call from home will be shared with other MFM Fellows, for patients admitted to the RVH or JGH MFM Service and transport calls. Rotation Schedule During the four-week rotation in Medical Genetics, the trainee will spend time at both teaching sites in outpatient settings. Two weeks of the rotation are spent in the Cytogenetics and Molecular Labs, under the supervision of the lab technologists and directors. Two weeks will be spent in the clinic setting of prenatal diagnosis; with the genetics counselors and geneticist (extending this clinical part of the rotation to 4 weeks is currently under discussion).

Academic Half-day sessions take place on Fridays at the MCH: • 8:00 -9:00 am: Fetal Diagnosis and Treatment Group rounds (RVH, MCH & JGH videoconference) • 9:00 am - 12:00 pm: Medical Genetics Teaching sessions (MCH Room C417)

Rotation Overview Emphasis will be placed on genetics and pregnancy (prenatal diagnosis, teratogens, and embryo-fetopathology). While the trainee may be exposed to other areas of medical genetics during the rotation, at least 75% of the rotation will be dedicated to prenatal diagnosis. The trainee should keep a logbook of cases.

Medical Genetics Rotation Montreal Children's Hospital and Royal Victoria Hospital

mailto:[email protected]�






Educational Strategies The trainee will be expected to:

1. Attend assigned clinics; review patient charts and relevant literature prior to clinic 2. Complete chart notes and consultation letters, which must be reviewed by supervisor 3. Complete a set of problems (dysmorphology cases, pedigree-solving, etc), to be worked on

independently during the first month 4. Complete assigned reading and instruction on the use of various databases (OMIM, POSSUM,

GeneTests etc) 5. One week in each of the laboratories (cytogenetics, molecular); review cases and discuss testing

algorithms with lab directors, and observe basic lab testing procedures 6. Participate actively in genetics counseling at the RVH clinic and case review. Cases are reviewed

individually by Genetics Counselors with the Geneticist covering the clinic, as well as at the, bi-weekly fetal diagnosis and treatment meeting.

7. Do a formal presentation at Friday Academic Half-Day

Specific Objectives and CanMEDS competencies On completion of the Medical Genetics rotation, the trainee in Maternal-Fetal Medicine will have acquired the following competencies that will assist him/her in his/her future role as a consultant in Maternal-Fetal Medicine. In a high-risk pregnancy referral centre, the emphasis will be focused on fetal medicine, in particular, the prenatal diagnosis of congenital malformations and their genetic implications and the pre- and postnatal management of these babies. 1. Medical Expert

a) Gather medical and family history; construct a pedigree b) Recognize the various patterns of inheritance including, Mendelian, multifactorial, and new

mutations, as well as more complex modes such as, mitochondrial and uniparental disomy; analyze pedigrees, and calculate genetic risks

c) Have an in-depth knowledge of chromosomal abnormalities (aneuploidy and structural rearrangements), mechanisms of origin and clinical implications, including recurrence risk.

d) Carry out a comprehensive physical examination with special expertise in features of surface anatomy and anthropometric measurement; properly document findings

e) Follow a logical approach in syndrome identification including the use of diagnostic aids (e.g. computer assisted diagnosis, literature searches), especially in the context of the fetus/neonate with multiple anomalies

f) Have an understanding of the genetic implications of identifying fetal malformations on ultrasound; plan a course of investigation; this includes making appropriate referrals for perinatal management or for fetal pathology, the collection of appropriate fetal tissues for later studies, and planning/providing follow-up of patients, especially in cases of fetal demise or pregnancy termination.

g) Recognize the indications, limitations and turn-around-time of laboratory investigations that pertain to genetic disease, including prenatal screening, ethnic screening, cytogenetics and


molecular diagnosis; specifically have an in depth knowledge of the indications, contraindications and complications of the various prenatal diagnostic procedures including amniocentesis, chorionic villous sampling and cordocentesis, fetal echocardiogram, as well as preimplantation genetic diagnosis (PIGD) and ICSI.

h) Evaluate a history of teratogen exposure , including the use of appropriate databases i) Understand the impact of maternal disease on fetal development (e.g. maternal PKU)

2. Communicator

a) Identify the concerns of the patient/family with respect to a specific genetic condition/risk. b) Communicate effectively and empathetically with patients and their families; help them choose

an appropriate course of action for themselves, provide support during bereavement, and advise them regarding support agencies

c) Communicate clearly and effectively, verbally and in writing, with other physicians and health care providers,

d) Writes concise genetics consultation letter to referring physician containing information concerning the diagnosis, medical implications and prognosis, the reproductive risks, and the management options available

3. Collaborator

a) Interact and consult effectively with colleagues and allied health professionals, ensuring respect and courtesy

b) Recognize the limitations of his/her skills and expertise and be willing to seek consultation whenever indicated

c) Appreciate the role of genetics in the multidisciplinary management of high risk pregnancy 4. Manager

a) Demonstrate successful case management skills; including the writing of chart notes, consultation reports, letters to families, requesting and arranging any follow-up testing, appointments, etc.

b) Participate in the coordinated care of individuals with complex, chronic disorders, offered by a multidisciplinary team

5. Health advocate

a) Access information regarding community support groups as well as national and international resources to which patients can be referred

b) Access information regarding new services and testing as they become available; e.g. through on-line computer programs

c) Understand the need for promotion of public awareness of genetic disease, and potential for prevention of birth defects (e.g. preconception use of folate)

6. Scholar a) Make presentations at formal and informal educational settings


b) Appreciate the role of research in genetic practice c) Critically analyze current scientific developments related to the specialty

7. Professional

a) Have an understanding of the social, ethical, legal and cultural issues which are particular to genetics and genetic testing

b) Understand his/her own ethical standards and appreciate those of the patient; recognize the views and beliefs of the patient, be non-directive in most instances but be prepared to advise in certain situations

Evaluation Evaluation of the Maternal-Fetal Medicine trainee during the medical genetics rotation is based on day-to-day performance, including history-taking and physical examination skills, case reviews and participation during genetics rounds. The trainee will be informally assessed throughout the rotation by faculty, and will be given feedback. A mid-rotation evaluation will be completed by the rotation supervisor in consultation with other staff members, discussed with the trainee and communicated to the MFM Program Director. At the end of the rotation, rotation specific ITER will be completed on MRESone45 and discussed with the trainee.

Suggested Reading Genetics in Obstetrics and Gynecology, 3rd ed by Joe Leigh Simpson and Sherman Elias. Philadelphia: Saunders, 2003.

Smith’s Recognizable Patterns of Human Malformation, by Kenneth Lyons Jones. Philadelphia: Saunders, 1997

Prenatal Diagnosis. The human side. 2nd edition. Ed. By Lenore Abramsky and Jean Chapple

Thompson and Thompson Genetics in Medicine, 7th ed by Robert L. Nussbaum, Roderick R. McInnes, & Huntington F. Willard, 2007

Chromosome abnormalities and genetic counseling, by Gardner RJM and Sutherland GR. Oxford University press. Other Reading

Genetic disorders and the fetus : diagnosis, prevention, and treatment / Milunsky, Aubrey; Milunsky, Jeff M. -- Chichester, West Sussex: Wiley-Blackwell, 2010.6th ed. (Book) QZ 50 G32.6 2010 RVH - Women's Pavilion Library.

Genetics in obstetrics and gynecology / Simpson, Joe Leigh; Elias, Sherman. -- Philadelphia: Saunders, 2003.3rd ed. (Book) QZ 50 S61.3 2003 RVH - Women's Pavilion Library.

Prenatal diagnosis / Evans, Mark I. -- New York: McGraw-Hill Medical Pub. Division, 2006. (Book) WQ 209 P91 2007 RVH - Women's Pavilion Library.

Emery's Elements of medical genetics / Turnpenny, Peter; Ellard, Sian. -- Philadelphia, PA: Elsevier Churchill Livingstone, 2012.14th ed. (Book) QZ 50 T86.14 2012 MGH - Medical Library.

A list of additional recommended readings, including journal articles will be provided by the Genetics staff at the beginning of the rotation.




NOTE: This rotation is currently under ongoing evaluation by the Program Director and the Residency Training Committee and is subject to further modification.

Orientation to Rotation Rotation duration: One 4-week rotation in the first year Rotation supervisor:

MCH and RVH: Dr Alexandre Barbier ([email protected]) or Dr Louis Beaumier ([email protected])

Service Requirement: During his/her 4-week rotation in Neonatology, the Maternal-Fetal medicine trainee will have to do 6 in-house calls (2 weekend days/4 weekdays). Rotation Environment Within the context of the McGill Maternal-Fetal Medicine Training Program, there is one mandatory rotation in Neonatology Intensive Care Unit (NICU) during the first year of training which takes place at the Montreal Children’s Hospital. MCH has a 28 bed quaternary care NICU. In addition, the neonatology, pediatrics and MFM staff at the Montreal Children’s Hospital Royal Victoria Hospital and the Jewish General Hospital both hospitals actively participate in the Fetal Diagnostic and Treatment Centre (composed of neurosurgeons, general pediatric surgeons, geneticists, obstetricians, pediatric cardiologists and neonatologists), a multidisciplinary team where complex fetal problems are discussed. Educational Strategies for MFM Fellows include:

1. Gain exposure to tertiary and quaternary level care at both the RVH and MCH NICU, through the management of stable infants and the observation of management of more severely ill infants

2. Complete Neonatology consultation for women at risk of premature delivery 3. Participate in Mock Codes at RVH and MCH for neonatal resuscitation regularly 4. Participate in Pediatric Follow-up clinic for infants and children born prematurely 5. Attend weekly NICU Multidisciplinary meetings at the MCH 6. Attend NICU rounds at MCH and RVH, alternatively 7. Present a topic in Neonatology that is pertinent to MFM 8. Attend Neonatal Journal Club, every 2nd Tuesday 8-9 am: JGH, RVH & MCH videoconference 9. Attend Neonatology and Pediatric Surgical Rounds

Fellows will be exempt from the Neonatology rotation if they completed a Neonatology rotation in their ObGyn Residency.

Neonatology and Pediatrics Rotation Montreal Children's Hospital and Royal Victoria Hospital




Specific Objectives and CanMEDS competencies On completion of the Neonatology Rotation, the trainee in Maternal-Fetal Medicine will have acquired the following competencies that will assist him/her in his/her future role as a consultant in Maternal-Fetal Medicine. In a high-risk pregnancy referral centre, the emphasis will be focused on fetal medicine, neonatal resuscitation and post-natal management of extremely premature infants. 1. Medical Expert

The Maternal-Fetal Medicine trainee should: a) Demonstrate knowledge of the neonatology basic sciences applicable to the practice of

maternal-fetal medicine including: • Fetal growth, development and physiology including the role of the placenta • Aspects of pregnancy, labor and delivery, which affect the neonate • Effects of maternal systemic disease on the fetus and newborn • Demographic, medical and psychosocial factors which influence perinatal mortality

and morbidity (the high-risk pregnancy) • Psychology of pregnancy and maternal/infant interaction • Process of neonatal adaptation to extra-uterine life • Complications encountered In the premature infant and general approaches to

management • Generally the approaches to management of infants with congenital anomalies • Basic knowledge of neonatal growth, nutrition and feeding problems • Approach to dysmorphism and metabolic disorders • Problems encountered in the follow-up of the high-risk neonate, including

psychomotor development and outcome

b) Select medically appropriate investigative tools, such as diagnostic imaging and genetic testing, in a cost-effective, ethical and useful manner

c) Demonstrate competency in clinical assessment and management of critically ill newborn

infants including: • Initial assessment of the newborn, including APGAR scores and gestational age

assessment • Neonatal resuscitation and stabilization of the critically ill newborn based on the NRP

principles • Bag/Mask ventilation

d) Demonstrate competency in clinical assessment and management of critically ill newborn

infants – if opportunity arises (not mandatory) - including: • Insertion of umbilical venous lines • Thermoregulation • Recognition of the seriously ill newborn • Interpretation of chest x-rays • Significance of cranial ultrasounds results


2. Communicator

The Maternal-Fetal Medicine trainee must be able to: a) Gather information not only about the disease of the fetus and newborn but also about the

family’s beliefs, concerns and expectations about the illness while considering the influence of factors such as cultural and socioeconomic background and spiritual values

b) Discuss relevant issues around timing of preterm deliveries c) Present the patient’s problem(s) clearly, concisely and correctly, both verbally, in the clinical

setting or formal presentation, and in a written medical record or consultation report (in a standard or problem-oriented format)

d) Demonstrate the good interpersonal skills, cooperation and communication with health professionals of the neonatal-perinatal interdisciplinary team (obstetricians, nurses, social workers, etc.)

e) Establish an effective and empathetic physician/patient relationship with pregnant women facing challenging maternal and/or fetal complications of pregnancy

f) Formulate and discuss plans for non-interventional/palliative care of the fetus/neonate g) Deliver information to the family (including bad news) in a human manner and in such way

that it is understandable, encourages discussion and promotes their involvement in the decision-making processes, and demonstrate an ability to assist families dealing with perinatal loss

h) Handle upset or abusive patients and/or caretakers

3. Collaborator

The Maternal-Fetal Medicine trainee must be able to: a) Function as an effective consultant to, and when required, consult with other medical and

non-medical healthcare providers who collaborate regularly with neonatal-perinatal medicine

b) Communicate and coordinate care with all members of the inpatient antepartum high-risk team

c) Participate and contribute to interdisciplinary team meetings, recognizing and using each team member’s expertise, as well as taking on a leadership role when appropriate

d) Develop a patient care plan, including investigation, treatment and continuing care/preparation for discharge, in collaboration with the members of the interdisciplinary team and the primary community pediatrician/family physician

4. Manager

The Maternal-Fetal Medicine trainee must be able to: a) Understand the importance of shared responsibility for health care provision in a

multidisciplinary setting b) Organize work effectively, prioritizing urgent problems and delegating in a feasible and

timely manner c) Utilize health care resources wisely by avoiding unnecessary investigation


d) Utilize information technology to optimize patient care, life-long learning and other activities

e) Understand the importance of principles of cost-effectiveness and continuous quality assurance/improvement relevant to perinatal/neonatal care

f) Demonstrate ability to identify medico-legal risks and take steps to address them 5. Health Advocate

The Maternal-Fetal Medicine trainee should: a) Demonstrate leadership in clinical care and act as an advocate for further improvements in

outcome for the fetus and newborn b) Recognize determinants of maternal health that directly or indirectly affect fetal, newborn

or infant health (i.e. poverty, unemployment, education, social support system, communicable diseases, tobacco or substance abuse)

c) Identify “at risk” patients or families and assess the family’s ability to access various services in the health and social system

d) Exercise an advocacy role when allocating needed resources for patients and families, taking into account the context of societal needs

e) Demonstrate an awareness of legal, ethical, legal and professional obligations to protect women from suspicious circumstances

6. Scholar

The Maternal-Fetal Medicine trainee must be able to: a) Critically appraise sources of medical information b) Make clinical decisions and judgments based on evidence-based medicine for the benefit of

the patient and his family c) Demonstrate autonomy in learning and professional development through ongoing self-

directed acquisition of basic science, clinical knowledge and growth of professional roles d) Demonstrate the ability to teach, supervise and evaluate junior trainees and medical

students while actively promoting and contributing to the education of families 7. Professional

The Maternal-Fetal Medicine trainee must be able to: a) Deliver highest quality care with integrity, honesty and compassion b) Exhibit appropriate personal and interpersonal professional behaviors c) Demonstrate knowledge of and ability to obtained an informed consent (knowledge of the

ethical decision-making process) d) Understand the complex ethical issues related to perinatology and the ability to use this

understanding in facilitating appropriate patient care (reproductive technologies, initiation or withdrawal of life support)


e) Demonstrate tolerance for ambiguity and uncertainty and the possibility of error in ethical decision-making in addition to showing flexibility and willingness to adjust appropriately to changing circumstances

f) Demonstrate recognition of personal limitations and willingness to call upon others with special expertise

Evaluation During their clinical rotations and calls, trainees are expected to acquire competencies in the different CanMEDS domains. Evaluation of the Maternal-Fetal Medicine trainee during the neonatology rotation is based on day-to-day performance, including history taking and physical examination skills, case reviews and participation during neonatal/perinatal rounds. The Maternal-Fetal Medicine trainee will be required to successfully complete a neonatal resuscitation (NRP) course prior to this rotation and his/her performance will be assessed objectively at the completion of his/her rotation via an evaluation Mock Code.

Suggested Reading for Neonatology and Pediatrics Rotation

Avery’s diseases of the newborn 8th edition, H.W. Taeuschand and R.A. Ballard, Saunders, 2004.

Neonatology, T.L. Gomella and M.D. Cunningham, Lange clinical manual, 2003.

Other References

Comprehensive neonatal care : an interdisciplinary approach / Kenner, Carole. -- St. Louis, MO: Saunders Elsevier, c2007.4th ed. (Book) WY 157.3 C73.4 2007 RVH - Women's Pavilion Library.

Drugs in Pregnancy and Lactation : A Reference Guide to Fetal and Neonatal Risk / Briggs.: Lippincott Williams & Wilkins, 2011. (Book) WQ 39 B85.9 2011 Reserve RVH - Women's Pavilion Library.

Maternal, fetal and neonatal physiology: a clinical perspective / Blackburn, Susan Tucker. -- Edinburgh: Elsevier Saunders, 2007.3rd ed. (Book) WQ 205 B62.3 2007 RVH

Maternal, fetal and neonatal physiology: a clinical perspective / Blackburn, Susan Tucker. -- Edinburgh: Elsevier Saunders, 2007.3rd ed. (Book) WQ 205 B62.3 2007 RVH - Women's Pavilion Library

Neonatal encephalopathy and cerebral palsy: defining the pathogenesis and pathophysiology / American College of Obstetricians and Gynecologists; American Academy of Pediatrics. -- Washington, DC: ACOG, 2002. (Book) WS 342 N43 2002 RVH - Women's Pavilion Library.

Textbook of neonatal resuscitation / Kattwinkel, John.; Bloom, Ronald S. -- Elk Grove, IL: American Academy of Pediatrics, 2010.6th. (Book) WQ 18.2 T31.6 2011 RVH - Women's Pavilion Library. See MCH librarian for further suggested reading




Orientation to Rotation Rotation duration: One 4-week rotation in the second year Rotation supervisors:

MCH: Dr Luc Jutras ([email protected]) HSJ : Dr Jean-Claude Fouron ([email protected]) or

Dr Myriam Brassard ([email protected]) Service Requirement: Call from home will be shared with other MFM Fellows for patients admitted to the MFM Service of the Royal Victoria Hospital or Jewish General Hospital and transport calls,

Specific Objectives and CanMEDS competencies On completion of the rotation in Advanced Fetal Doppler and Echocardiography, the MFM trainee will have acquired the following competencies that will assist him in his/her future role as a consultant in maternal-fetal medicine.

1. Medical Expert

KNOWLEDGE By the end of the trainee’s rotation he/she will:

a) Know the indications for fetal echocardiography b) Understand the normal embryologic development of the fetal heart and fetal cardiac

physiology c) Know the principles of the obstetric management of the pregnancy complicated by fetal

heart disease d) Be able to identify fetal cardiac insufficiency e) Understand the role of fetal echocardiography in fetal diagnosis, such as in the assessment

of: fetal growth-restriction, diabetic mothers, fetal anemia, extra-cardiac malformations, eg. diaphragmatic hernia, monochorionic twins (twin-to-twin transfusion)

f) Understand the neonatal outcomes of various cardiac anomalies and principles of parental counseling

Advanced Fetal Doppler and Echocardiography Rotation Montreal Children’s Hospital (MCH)

Ste Justine's Hospital - University of Montreal (HSJ)





g) List the major cardiac signs associated with heterotaxy syndromes

SKILLS By the end of the trainee’s rotation he/she will:

a) Identify the detailed cardiac anatomy of a normal fetus and recognize both abnormalities and variations of normality, including:

i. Standard evaluations of apical and subcostal 4-chamber view, right and left ventricular outflow tracts,

ii. More detailed evaluations of systemic and pulmonary venous return and intracardiac color flow mapping)

b) Identify the principal cardiac anomalies, including: i. Septal defects: atrial septal defect, ventricular septal defect and endocardial

cushion defect, AVSD ii. Transposition of the great arteries iii. Tetralogy of Fallot iv. Left ventricular hypoplasia v. Mitral and tricuspid valve abnormalities vi. Atrioventricular discordance vii. Double outlet right ventricle viii. Double inlet ventricle ix. Aortic and pulmonary valve abnormalities x. Common arterial trunk xi. Aortic arch abnormalities, coarctation of the aorta xii. Valvular reguritation / atresia xiii. Abnormalities of systemic and pulmonary venous connections, eg. interrupted

inferior vena cava c) Assess and manage fetal arrhythmias d) Measure Doppler Velocity indices :

i. Aorta ii. Pulmonary Trunk iii. Ductus Arteriosus iv. Ductus venosus

e) Identify regurgitation across atrio-ventricular valves

2. Communicator

a) Demonstrate good interpersonal skills when working with all members of the health care team

b) Gather pertinent information about the patient, including the family’s beliefs, concerns and expectations about the illness. Listen effectively

c) Demonstrate sensitivity in the communication of the findings of ultrasound examinations, being especially mindful of impact of psychological, social, and ethical problems associated with the diagnosis of fetal abnormality

d) Be able to obtain informed consent. e) Be able to deliver a patients case presentation clearly and concisely. f) Be able to produce timely, meticulous and correct documentation, including ultrasound

reports, consultation notes, and letters.


3. Collaborator

a) Demonstrate the ability to work effectively with a multidisciplinary team and respect the opinions of other team members.

b) Contribute effectively at multidisciplinary group meetings c) Understand the role of other healthcare professionals in the provision of comprehensive

patient care. d) Effectively work with other health professionals to prevent, negotiate and resolve

interprofessional conflict.

4. Manager

a) Effectively utilize the information systems (Telehealth, OACIS, Viewpoint, RadImage, PACS) required for optimal patient care and communication of ultrasound findings

b) Demonstrates organization of work and time management c) Delegates clinical responsibilities appropriately d) Executes appropriate allocation of ultrasound resources within the region and remote

communities, including community hospitals, private clinics and remote outposts e) Understand the principles of quality assurance and administration of an ultrasound unit

5. Health Advocate

a) Identify the important determinants of health in an individual patient b) Utilize the network of resources to facilitate patient access to care in a timely manner c) Provide advocacy for patients with abnormal ultrasound findings by coordinating and

expediting consultation with the necessary specialists, such as genetics, pediatric cardiology, pediatric radiology, pediatric surgery etc.

d) Enable patients to remain in their own communities without compromising quality of care through the use of Telehealth services coordinated by the MUHC, which includes both the review and reporting of ultrasound studies from remote areas in real and deferred time.

6. Scholar

a) Maintain a personal continuing education strategy. b) Critically appraise sources of medical information and apply evidence-based medicine in

ultrasound c) Facilitate learning for patients, medical students, residents and other health professionals

7. Professional

a) Deliver the highest quality care with integrity, honesty and compassion; including recognizing limitations of their own professional competence and seeking advice as needed

b) Exhibit appropriate professional behaviors i. Punctuality


ii. Respond to calls in a timely and respectful fashion iii. Show appropriate demeanor with respect to appearance and language

c) Practice medicine consistent with the ethical obligations of a physician, such as maintaining patient confidentiality

d) Sensitive to ethical issues specific to MFM, such as termination of pregnancy, fetal reduction; arranges ethical consultation and discussion, as required.

Evaluation The MFM trainee’s performance is directly observed by the attending, who is a pediatric cardiologist, and by the sonographers on the unit. The trainee’s interpretation of the ultrasound findings is discussed with the attending after each case. The attendings and sonographers observe and keep track of the trainee’s progress throughout the four-week rotation. The written evaluation of the trainee at the end of the rotation is compiled by the sonographers and attendings based on their assessment of the trainee’s acquired skills in the performance of fetal echocardiography and Doppler studies. This evaluation is conducted using the rotation-specific ITER on MRESone45.

Suggested Reading

ECHOCARDIOGRAPHY texts

A practical guide to fetal echocardiography / Alfred Abuhamad; Rabih Chaoui. -- Philadelphia : Lippincott Williams & Wilkins, 2010. 2nd ed. (Book) WQ 210.5 A16.2 2010 RVH - Women's Pavilion Library.

Textbook of clinical echocardiography / Otto, Catherine M. -- Philadelphia : Elsevier Saunders, 2009. 4th ed. (Book) WG 141.5.E2 Ot8.4 2009 Reserve RVH - Medical Library.

Fetal cardiology: embryology, genetics, physiology, echocardiographic evaluation, diagnosis and perinatal management of cardiac diseases / Yagel, Simcha; Silverman, Norman H; Gembruch, Ulrich. -- London : Martin Dunitz, 2003. (Book) WQ 210.5 F44 2003 RVH - Women's Pavilion Library.

DOPPLER texts

Doppler Ultrasound in obstetrics and gynecology / Maulik, Dev. -- Berlin: Springer-Verlag, 2005.2nd ed. (Book) WQ 209 D69.2 2005 RVH - Women's Pavilion Library.

The fetus in three dimensions / Kurjak, Asim.; Azumendi, Guillermo. -- Boca Raton, FL: Informa Healthcare, 2007. (Book) WQ 209 K95 2007 RVH - Women's Pavilion Library.

Sonography in obstetrics and gynecology: principles and practice / Fleischer, Arthur C. -- New York , 2000 changed to Washington D.C: McGraw-Hill, 2011.7th ed. WQ 240 S69.7 2011 RVH - Women's Pavilion Library.


Fetal Cardiovascular Physiology: Baschat AA. The fetal circulation and essential organs-a new twist to an old tale. Ultrasound Obstet Gynecol. 2006 Apr; 27(4):349-54 Fouron JC, Skoll A: A fetal cardiovascular physiology and response to stress condition. In: Reece and Hobbins, Eds. Clinical Obstetrics, Blackwell Publishing; 2007:93-113. Kisured T et al: Blood flow and the degree of shunting through the ductus venosus in the human fetus. Am J Obstet & Gynecol, 2000; 182:147-153. Detection of Fetal Cardiac Malformations: Gembruch U, Geipel A: Indication for fetal echocardiography: screening in low – and high risk populations. In: Yagel S, Silverman NH, Gembruch U, Eds. Fetal cardiology. Martin Dunitz; 2003: 89-106. Chaoui R: The examination of the normal fetal heart using 2-dimensionnal echocardiography. In: Yagel S, Silverman NH, Gembruch U, Eds. Fetal cardiology. Martin Dunitz; 2003: 141-149. Ultrasonographic Evaluation of Fetal Wellbeing: Romero R et al. Timing the delivery of the preterm severely growth restricted fetus. Venous Doppler, cardio-thocography or biophysical profile? Ultrasound Obstet & Gynecol 2002; 19:118. Hecker K et al. Monitoring of fetuses with intra-uterine growth restriction: a longitudinal study. Ultrasound Obstet Gynecol 2001; 18:564. Bachat et al. The sequence of changes in Doppler and biophysical parameters as severe fetal growth restriction worsens. Ultrasound Obstet Gynecol 2001; 18:571. Sibai B et al. Pre-ecclampsia. Lancet 2005; 365 :785. Trudinger BJ. Doppler ultrasonography and fetal well-being. In: Reece and Hobbins, eds. Clinical obstetrics. 3eme Ed. Blackwell publishing; 2007:561-585. Baschat AA, Herman CR. Venous Doppler in the assessment of fetal cardiovascular status. Curr Opin Obstet Gynecol 2006; 18(2):156-63. Mari J et al. Ultrasound Obstet Gynecol 1995; 5:400. Fouron JC. The unrecognized physiological and clinical significance of the fetal aortic isthmus. Ultrasound Obstet Gynecol 2003; 22:441-447.




NOTE: The Obstetrical Medicine rotation is currently being restructured to accommodate the needs of the MFM Fellow along with changes in Internal Medicine staff at the teaching sites.

Orientation to Rotation Rotation duration: One 4-week rotation in the second year Rotation supervisors:

• RVH: Dr Khue Ly ([email protected]) or Dr Patrick Willemot ([email protected]) • SMHC: Dr Lucie Opatrny ([email protected]) 514-345-3511 ext 2610 • HSJ : Dr Evelyne Rey

Service Requirement: Night call from home will be shared with other MFM Fellows, for patients admitted to the RVH or JGH MFM Service and transport calls. Obstetrical medicine is can be taken as a selective in the first or second year, and is offered as a rotation in the second year of the program. Depending on the fellows’ strengths and weaknesses identified at the end of the first six months of training, the MFM Committee may make it mandatory for the trainee to take this rotation. The trainee may choose to take the rotation either at the Royal Victoria Hospital or at Hôpital Ste. Justine. At both institutions, the 4-week rotation is supervised by internists with special training in Obstetrical Medicine who run various clinics addressing the medical problems of the obstetrical population.

Specific Objectives and CanMEDS competencies On completion of the rotation in Obstetrical Medicine, the MFM trainee will have acquired the following competencies that will assist him in his/her future role as a consultant in maternal-fetal medicine. 1. Medical Expert

a) Gestational And Pregestational Diabetes: The MFM trainee should be knowledgeable regarding the appropriate diagnosis, detection and treatment of disease as well as description of its potential maternal and fetal complications. The trainee should be well versed in glucose monitoring, the appropriate use of diet, oral agents and insulin in the

Obstetrical Medicine Rotation

Royal Victoria Hospital and St. Mary's Hospital Centre (McGill) Ste Justine's Hospital (University of Montreal)



treatment of diabetes, as well as appropriate maternal and fetal following with optimal time and mode of delivery.

b) Hypertensive Diseases: The MFM trainee should be knowledgeable regarding appropriate diagnosis, detection and treatment of new-onset hypertensive diseases in pregnancy as well as the treatment of patients with chronic hypertension who become pregnant. Knowledge of potential maternal and fetal complications of hypertension is expected. The trainee should be familiar with appropriate maternal and fetal monitoring, follow-up and use of oral and intravenous antihypertensives and preventative agents. The trainee should be familiar with optimal time and mode of delivery as well as appropriate use of eclampsia prevention in appropriate settings.

c) Endocrine Diseases: The MFM trainee should be knowledgeable regarding appropriate diagnosis, detection and treatment of hyper- and hypothyroidism in pregnancy and the postpartum period as well as some knowledge regarding adenal and pituitary disorders. An approach to thyroid nodules in pregnancy is also expected.

d) Cardiac Disorders: The MFM trainee should be able to recognize non-physiologic heart murmurs and shortness of breath on examination, and develop an appropriate plan of management. An understanding of the pathophysiology for common valvular disorders, arrhythmias, coronary artery disease and cardiac failure with their effect on pregnancy and maternal and fetal health is expected.

e) Hematological Conditions: The MFM trainee is expected to be able to recognize, decide regarding appropriate screening, and have an appropriate plan of management for venous thromboembolic disease, thrombocytopenia, anemia, common bleeding disorders, and thrombophilias. A knowledge and appropriate use of blood products is expected.

f) Gastrointestinal Disorders: The MFM trainee is expected to evaluate and manage problems including nausea and vomiting of pregnancy, recognition and treatment of hyperemesis gravidarum, reflux and peptic ulcer disease. A working knowledge of inflammatory bowel disease with its maternal and fetal implications in pregnancy is also expected.

g) Liver Diseases: The MFM trainee is expected to evaluate and recognize disorders including acute fatty liver disease and cholestasis of pregnancy.

h) Connective Tissue Disease: The MFM trainee is expected to recognize the potential implications of systemic lupus erythematosis, rheumatoid arthritis and antiphospholipid antibody syndrome on maternal and fetal health. Knowledge of safe and effective medications for these indications in pregnancy is expected.

i) Transplantation: The MFM trainee should by aware of the maternal and fetal implications of maternal solid organ transplantation including the implications of residual disease and the use of anti-rejection medications.

j) Malignancies: The MFM trainee is expected to evaluate the pregnant patient with cancer in collaboration with the oncology team and establish a treatment plan, follow-up. An understanding of the impact of various types cancer treatment on the maternal-fetal unit is expected, as well as those that are contra-indicated during preganncy.


2. Communicator

a) Recognize that good communication is vital for an MFM subspecialist. Given fetal implications for many medical complications of pregnancy, effective communication of risks and benefits of treatment and withholding treatment are vital for effective clinical care and patient compliance.

b) Be aware and responsive to non-verbal cues, and listen effectively. There are socially unacceptable behaviors in pregnancy such as tobacco, alcohol or illicit drug consumption that require effective communication in order to gain trust and elucidate these behaviors in some patients in order to optimally address them.

c) Accurately convey relevant information and explanations to patients and their families.

3. Collaborator

a) Demonstrate effective collaboration with subspecialist colleagues as well as other health care professionals; recognize the role of collaboration often required in optimal care of patients

4. Manager

a) Understand the importance of shared responsibility for health care provision in a multidisciplinary setting

b) Organize work effectively, prioritizing urgent problems and delegating in a feasible and timely manner

c) Utilize health care resources wisely by avoiding unnecessary investigation d) Utilize information technology to optimize patient care, life-long learning and other

activities e) Appreciate the importance of principles of cost-effectiveness and continuous quality

assurance/improvement relevant to perinatal/neonatal care f) Demonstrate ability to identify medico-legal risks and take steps to address them

5. Health Advocate

a) Demonstrate leadership in clinical care and act as an advocate for further improvements in outcome for the fetus and newborn

b) Recognize determinants of maternal health that directly or indirectly affect fetal, newborn or infant health (i.e. poverty, unemployment, education, social support system, communicable diseases, tobacco or substance abuse)

c) Identify “at risk” patients or families and accessibility of various services in the health and social system

d) Exercise an advocacy role when allocating needed resources for patients and families, taking into account the context of societal needs

e) Demonstrate an awareness of legal, ethical and professional obligations to protect women from suspicious circumstances


6. Scholar

a) Commitment to a lifelong process of learning, updating personal knowledge in the field of medical complications of pregnancy.

b) Commitment to integrating new knowledge into practice. 7. Professional

a) Deliver the highest quality care with integrity, honesty and compassion; including

recognizing limitations of their own professional competence and seeking advice as needed b) Exhibit appropriate professional behaviors

i. Punctuality ii. Respond to calls in a timely and respectful fashion

iii. Show appropriate demeanor with respect to appearance and language c) Practice medicine consistent with the ethical obligations of a physician, such as maintaining

patient confidentiality d) Be sensitive to ethical issues specific to MFM, such as termination of pregnancy, fetal

reduction; arranges ethical consultation and discussion, as required

Evaluation Evaluation of the Maternal-Fetal Medicine trainee during the Obstetrical Medicine rotation is based on day-to-day performance, including history-taking and physical examination skills, case reviews and participation in ambulatory clinics. The trainee will be informally assessed throughout the rotation by faculty, and will be given feedback. A mid-rotation evaluation will be completed by the rotation supervisor in consultation with other staff members, discussed with the trainee and communicated to the MFM Program Director. At the end of the rotation, rotation specific ITER will be completed on MRESone45 and discussed with the trainee.

Suggested Reading for Obstetrical Medicine Rotation

Medical care of the pregnant patient / Rosene-Montella, Karen.; American College of Physicians. -- Philadelphia: ACP Press/American College of Physicians,, 2008.2nd ed. (Book; CD-ROM) WQ 240 R71.2 2008 RVH - Women's Pavilion Library.

Medical Complications during Pregnancy, 6 th ed. by G. N. Burrow, T. P. Duffy, J. Copel. Philadelphia: W. B. Saunders Ltd., 2004.

Medical Disorders in Obstetric Practice, 4th ed. Edited by M De Swiet. London: Blackwell Publishing, 2002.

Obstetric and maternal-fetal evidence-based guidelines. / Berghella, Vincenzo.: Informa Healthcare, 2012.2nd. (Book) WQ 240 B35.2 2012 Reserve RVH - Women's Pavilion Library.




Overview During his/her training, the trainee will undertake an independent research project. The project may focus on issues of basic science or on issues of more direct clinical relevance. Basic science research is done in the laboratory under the direction of a member of the Reproductive Biology Division of the department or in collaboration with a scientist from another department. Clinical research is done under the supervision of the MFM faculty. The Royal College (RCSPC) stipulates that one research project should be completed and a publishable manuscript should be prepared. This represents the minimal requirement; many aspects of research activities are strongly encouraged, widely supported and tailored to individual career plans.

Schedule Six 4-week blocks will be devoted to research within the 24 month fellowship: One month should be scheduled early on in the fellowship during which:

i) Research interests of the fellow are explored; ii) Plans for project and future course work are made; iii) An abstract to an upcoming meeting is prepared and submitted; and iv) The other 5 months will be scheduled in 1, 2 or 3 month blocks according to project needs and

availability of other electives. Supervision Supervision or co-supervision of MFM related projects may be undertaken under any of the Faculty over the course of the Fellowship. Supervision of the Research Rotation, including early planning of project(s) and establishing deadlines, ensuring objectives are being met will be done by either

o RVH: Dr Richard Brown o JGH: Dr Haim Abenhaim

Nature of the research project Fellows can acquire good research experience in several ways:

i) Databases that could be utilized for many clinical questions:

Research Rotations Royal Victoria Hospital and Jewish General Hospital


o US Birth Linked Database - All births certificates in the US; data from births linked to deaths within 1st year; database accrues about 40 M births/ 10yrs (60,000 SB)

o HCUP –NIS - 15% sample of all admissions to US hospitals; 15 ICD-9 codes and 15 procedural codes; demographic data and regional data

o Viewpoint ultrasound database – available at JGH and MUHC – need to improve data quality with more consistent entry

o GE Perinatal Information System will be installed shortly at the MUHC birthing centre and will eventually be linked with MOND

o IRNPQEO will eventually provide a wealth of info on exposures/outcomes from the pregnancy and postpartum biobank it is building on mothers, fathers, infants and children

o Other data sources: • Dr Phylis Zelkowitz – Cohort on psychological parameters and obstetrical outcomes • Dr N Chailet – Quarisma Cohort (180k births in Quebec) • Medical Records – Case Room - Chartmaxx

Fellows will have access to codebooks for databases - in order to grasp the wealth of data and their definitions - available for research projects.

ii) Writing a review article or a book chapter

iii) Develop research question involving a small survey or questionnaire which could be

implemented relatively easily, by applying feasible research ideas or hypotheses from: o Discussions arising with staff in clinical setting o Personal interest (biomedical / ultrasound / different practice style) o Reading the Green Journal or other relevant peer review journals

Research project resources Numerous resources will facilitate the MFM fellow’s research experience.

i) Epidemiology coursework through McGill dept of Epidemiology, Biostatistics and Occupational Health will be scheduled depending on previous formal coursework of individual trainees. McGill courses include:

o Clinical epidemiology or Reproductive Epidemiology (Dr. Olga Basso) o Basic Biostatistics

ii) Epidemiology seminars:

o RVH Thursdays 9:30 - 10:30 in Ross Pavilion R4.02 (http://www.clinepi.mcgill.ca/) o McGill seminars: Epidemiology on Mondays 4-5 pm in Purvis Hall room 25; Biostatistics

on Tuesdays 4-5 pm in Purvis Hall Room 24. o JGH – speak to Dr Abenhaim

iii) McGill Department of Obstetrics and Gynecology Clinical Research division

This recently created division headed by Epidemiologist Dr Olga Basso, will provide the infrastructure and guidance for research projects of Faculty and Trainees alike. Support offered will include epidemiological and statistical consultation, and guidance with Research Ethics Board submissions. Trainees may also find some of these resources through their project

http://www.clinepi.mcgill.ca/�


supervisors, such as in Perinatal research at the JGH, with Dr Haim Abenhaim or other MFM staff.

iv) Funding of Fellows Research Projects o MUHC’s Academic Enrichment Fund (AEF) Can provide up to $7,500 for study support

for projects which involve a MUHC ObGyn faculty member. For more information, including application form, go to : www.mcgill.ca/obgyn/funding

o Canadian Foundation for Women’s Health (CFWH) provides annual awards to the best resident research projects in women’s health (www.cfwh.org). Deadline in Feb or March

Research presentation and publication With faculty help and supervision a research topic will be identified for which fellows will write, submit and present an abstract (poster or oral presentation) at a professional scientific meeting over the course of their 2 year program. Meetings and abstract deadlines to consider:

a. SMFM meetings in February, abstracts due August https://www.smfm.org/ b. SOGC meeting in June, abstracts due in January http://www.sogc.org/ c. IUSOG meeting http://www.isuog.org/Events/

This abstract may be the basis of one of the Fellow’s manuscripts which will be prepared and submitted to a peer-review journal for publication.

Specific Objectives and CanMEDS competencies On completion of the Research Rotations, the MFM trainee will have acquired the following competencies that will assist him in his/her future role as a consultant in maternal-fetal medicine. 1. Medical Expert

a) Understand and demonstrate the process involved in conducting a thorough review of medical literature

b) Evaluate the quality of the scientific and medical literature relevant to the research project. c) Formulate a clear hypotheses

2. Communicator

a) Clearly explain study to patients if applicable, ethically and without coercion b) Establish a good rapport with study participants. c) Prepare clear concise documentation related to study, such as for informed consent, protocol

submission of ethics, funding, etc.

http://www.cfwh.org/�

https://www.smfm.org/�

http://www.sogc.org/�

http://www.isuog.org/Events/�


3. Collaborator

a) Recognize his/her own limitations b) Collaborate with others involved in research project - such as a statistician, assistants, clinic

staff, advisor

4. Manager

a) Manage time well in conducting research, setting goals and meeting deadlines as needed b) Be able to write a research protocol including completing forms for the Research Ethics Board. c) Record data thoroughly and in a systematic fashion d) Carry out study (data collection, patient recruitment etc) in an organized manner according to

protocol 5. Health Advocate

a) Advocate for ethical conduct of research. b) Advocate against plagiarism.

6. Scholar

a) Understand the limitations of research and evidence-based findings b) Describe the principles of research ethics c) Understand the importance of careful and complete data gathering d) Execute study protocol e) Know how to perform basics statistics and apply to own dataset, seeking help with functions and

interpretation as needed f) Write the manuscript and respond to journal queries.

7. Professional

a) Write an abstract for presentation. b) Present the results of their research at a national or international scientific meeting. c) Write a manuscript for publication in a peer-reviewed journal.


Evaluation Evaluation of the Maternal-Fetal Medicine trainee during the Research rotation rotation is based on the process and execution of a research project. The trainee will be informally assessed throughout the rotation by faculty involved, and will be given feedback. Evaluations will be completed by the rotation supervisor in consultation with other staff members, discussed with the trainee and communicated to the MFM Program Director. At the end of the rotation, rotation specific ITER will be completed on MRESone45 and discussed with the trainee.

Suggested Reading Introduction to the Practice of Statistics 5th ed. by D.S., and G.P. McCabe. New York: W.H. Freeman, 2005.

Life Sciences Humanities and Social Sciences Schulich Science & Engineering

Statistical Methods in Medical Research 4th ed. by P. Armitage and G. Berry. Malden: Blackwell Science Inc., 2002.

Life sciences Montreal Children’s – Library Jewish General - Health Sciences Library

Designing Clinical Research – An Epidemiologic Approach Ed. by SB Hulley, SR Cummings, Baltimore: Williams & Wilkins, 1988.

Life sciences Montreal Children’s – Library e-book, through McGill

Evidence-based practice manual: research and outcome measures in health and human services Edited by Albert R. Roberts, Kenneth R. Yeager. Oxford ; New York : Oxford University Press, c2004.

Humanities and Social Sciences - McLennan Bldg)

Epidemiology: An Introduction. By KJ Rothman. Oxford University Press; 1 edition, 2002 Life Sciences Macdonald Campus Schulich Science & Engineering

Fertility and Pregnancy: An Epidemiologic Perspective. By AJ Wilcox. Oxford University Press, 2010 Life Sciences

Documents

Goals and Objectives - McGill University...3) Research skills and critical appraisal of the medical literature. B. Diagnose, evaluate and treat perinatal disorders using the various