Peter S. Bernstein, MD, MPH
The program of medical education in Maternal-Fetal Medicine of the Department of Obstetrics and Gynecology at the Albert Einstein College of Medicine and the Montefiore Medical Center trains physicians for subspecialty board certification and provides the basis for career development in clinical maternal fetal medicine, clinical investigation, and basic science research. In addition, the program offers fellows the opportunity to obtain additional training in one of the following specialty tracks: ICU/critical care, global women’s health, laboratory or translational research, clinical research, ultrasound/prenatal diagnosis, or public health/community health.
During the three year Fellowship, clinical time is divided between two major teaching hospitals: the Jacobi Medical Center and the Jack D. Weiler Hospital Division of Montefiore Medical Center. Because the population served is an unusually high risk one, the Fellow sees a broad spectrum of pregnancy related pathology in both institutions. Amniocentesis, chorionic villus sampling, and other diagnostic services are performed within the department's own Division of Reproductive Genetics, well equipped with modern diagnostic and research technology. At the Jack D. Weiler Hospital of the Albert Einstein College of Medicine, a division of Montefiore Medical Center, the Fellow acts as a consultant to the general ob/gyn staff with maternal-fetal attending support. The fellow is also responsible for a busy antepartum service and cares of a wide array of patients with medical and obstetrical conditions under the supervision of a maternal-fetal medicine attending. Additionally, Fellows manage the care of women with high risk pregnancies at the Comprehensive Family Care Center, an outpatient facility of Montefiore. At this site, fellows have their own office hours (one session each week) giving them the opportunity to have continuity of care with their patients throughout the course of their fellowship. The Fellow also covers the labor and delivery suite both as a primary provider and as a consultant, should the need arise for perinatal evaluation.
At Jacobi Medical Center, the Fellows are primary consultants for the labor and delivery suite, and for the antepartum testing unit. They participate in outpatient clinics: the High Risk Obstetric Clinic, which provides care for patients with medical and obstetric complications of pregnancy, the Diabetes in Pregnancy Clinic, and the Genetics Clinic. The Fellows also serve on the antepartum high-risk inpatient services, where each acts as the direct supervisor of a resident and works in conjunction with an attending physician. The attending takes an active role in both patient care and in teaching on the service. MFM Fellows are trained to become expert in the clinical management of the complicated pregnancy at The Woman's Health Center at Jacobi, which offers the full range of general and specialty obstetrical services to this inner city, minority population. Special obstetrical sessions attended by the MFM Fellow include Diabetes in Pregnancy, High Risk Obstetrics, Adolescent Obstetrics, HIV/Substance Abuse, and Genetics clinics. Tertiary level neonatal intensive care and obstetric anesthesia services are available at both clinical sites.
The Department of Obstetrics & Gynecology and Women's Health of the Albert Einstein College of Medicine and Montefiore Medical Center, directed by Irwin R. Merkatz, MD, is part of an academic community that ranks among the best in the country in the quality of its clinical, research, and educational programs.
Over six months of the MFM fellowship is dedicated to ultrasound training. The rotations are divided into two-month blocks, for a minimum of one ultrasound rotation per year of training, with an increasing level of responsibility awarded every year. The ultrasound training includes:
- First trimester screening for Down syndrome (nuchal translucency)
- Second trimester detailed anatomy scans
- Cervical length assessment
- Fetal echocardiography
- Doppler studies of umbilical, uterine and mid-cerebral arteries and of ductus venosus
- 3D and 4D scanning including the STIC technology to evaluate cardiac structure
- Diagnostic procedures as Chorionic Villus Sampling (CVS), Amniocentesis and Cordocentesis
- Therapeutic and interventional procedures such as intrauterine fetal blood transfusion, multifetal selective reduction and vesico-amniotic shunts for obstructive urinary anomalies
- Gynecological transvaginal scanning and 3D sonohysterograms.
As part of his/her academic responsibilities, the fellow on the ultrasound rotation takes a leading part in one of the most important academic activities in our department - the Fetal Diagnosis Rounds. In these bi-weekly CME accredited multidisciplinary rounds, newly diagnosed fetal anomalies are presented by the fellow, and management is discussed. Experts participating in this meeting include specialists in maternal fetal medicine, reproductive genetics, neonatal intensive care, internal medicine, pediatric cardiology and a cardio-thoracic surgery. The fellow is responsible for managing and following up on the patients, based on recommendations determined in these rounds. In addition, each year we have several case reports from our fetal diagnosis rounds which are presented at national and international meetings.
The Fellow is encouraged to participate in the many conferences on various aspects of perinatal care held within the department and elsewhere in the medical center. Departmental grand rounds lectures are renowned for the quality and the breadth of their presentations. Graduate courses are available at the Medical College and several nearby universities to meet the subspecialty board requirements.
Our Department has a long track record of interdisciplinary collaboration and training of fellows within the basic sciences departments of Albert Einstein College of Medicine. For instance, the Diabetes Research Center (DRC) at Einstein has been a NIH designated and funded center for its outstanding program of biomedical research in the area of diabetes since 1977. Since 2001, at least one of our fellows has had ongoing successful laboratory experiences in the DRC with Dr. Nir Barzilai. The Department provides 2 full-time salaried technicians to support fellow work in the lab and the DRC provides strong leadership for creative basic and translational research related to maternal molecular metabolism and its impact on the fetus. Additionally, fellows have worked in the molecular genetics and biochemistry laboratory of Dr. Maureen Charron, the genetics laboratory of Dr. Bernice Morrow, and the thrombosis and hemostasis research laboratory of Dr. Jacob Rand. Numerous clinical research opportunities are also available for Maternal-Fetal Medicine fellows. The diverse and high risk nature of our
obstetric population provides ample opportunity for clinical studies, and fellows are required to participate in at least one clinical project of their choice. Their work is presented formally to the department each June at the Annual Science Day for residents and fellows. The breadth of opportunity and activity available in the department is exemplified by the numerous abstracts and peer-reviewed publications of our fellows and faculty. Fellows have participated in a large number of clinical studies, including prospective clinical trials and retrospective case control analyses. The fellows have actively presented research at the annual meetings of the SMFM, SGI, and ACOG. Clinical research is conducted at both JMC and at Montefiore Medical Center, with a particular opportunity for fellows to conduct research through the use of our electronic prenatal medical record/fetal testing/ultrasound reporting system (AS OBGYNTM) and our hospital-wide clinical database (CareCastTM).
Clinically, fellows have participated in several multisite studies, including a multicenter international study of Multiple Use of Antenatal CorticoSteroids (MACS trial); recruitment of obstetric patients as a subsite for the Pediatric AIDS clinical trials grant funded by the NIH; the First And Second Trimester Evaluation of Risk) Trial; and the PROCHIEVE trial of a vaginal preparation of progesterone for the prevention of preterm delivery. The Department is currently participating in the next phase of the PROCHIEVE trial which is focusing on the usefulness of the same preparation of vaginal progesterone for the prevention of preterm delivery among women with shortened cervical lengths.
Fellows have also had the opportunity to actively participate several ongoing research initiatives in our Department, including: an active program of simulations of obstetric emergencies as a way to improve patient safety; utilization of Clinical Looking Glass, a software package that allows sophisticated analyses of all Montefiore Medical Center clinical databases; participation in trials arising out of the Medical Center’s designation as a Diabetes Center of Excellence; and utilization of clinical materials arising from our participation with New York Blood Centers Cord Blood program in which all patients delivering at Montefiore are invited to donate their newborn’s cord blood to a public cord blood bank.
Fellows may also participate in another multicenter trial underway in the Department being led locally by Dr. Kafui Demasio and sponsored by Ortho Diagnostic Laboratories, Inc. This trial is investigating Soluble fms-like tyrosine kinase 1 (sFlt-1), and Placental Growth Factor (PlGF) levels as predictors of preeclampsia prior to onset of symptoms.
Advanced Women’s Health Center- Clinical Trials and Research Unit
The Department of Obstetrics & Gynecology and Women’s Health’s commitment to clinical research is demonstrated by its providing the division with dedicated space for clinical research, the Advanced Women’s Health Center- Clinical Trials and Research Unit.
Inquiries and Applications for the Fellowship
Fellowship applications are available at the ERAS website: http://www.aamc.org/students/eras/ The ERAS deadline for applications is May 31 for the Fall match.
Applicants who are graduates of United States or Canadian medical schools must document having successfully completed at least four years of Accreditation Council for Graduate Medical Education (ACGME)-accredited residency training with not less than 36 months of clinical obstetrics and gynecology. Foreign medical graduates will be eligible for appointment if they provide written confirmation from the American Board of Obstetrics and Gynecology that their residency training qualifies them as active candidates in obstetrics and gynecology, and if they have passed the Education Council for Foreign Medical Graduates (ECFMG) examination or its equivalent. All applicants must demonstrate that they are fully qualified for medical licensure in New York State.
Applicants selected for interviews will be interviewed during July of each year for the Fall match.
Requests for additional information should be addressed to:
Peter S. Bernstein, MD, MPH, Program Director
c/o La'Tenya T. Newton, Assistant to the Program Director
Department of Obstetrics & Gynecology and Women's Health
Albert Einstein College of Medicine
Belfer Educational Center, Room 501
1300 Morris Park Avenue
Bronx, New York 10461