DESCRIPTION OF THE PROGRAM
Clinical Facilities:
A. In-Patient Facilities
All of the Obstetrics is performed at Forsyth Memorial Hospital.
Forsyth Memorial Hospital has 18 Labor and Delivery rooms, 13 antepartum beds and four triage beds (one of which is an isolation room). There are 57 mother/baby rooms, 24 NICU beds and 12 intermediate NICU beds.
Our Perinatal Assessment Center (PAC) area has a designated room for Genetic counseling, two rooms for NST/CST (total of four beds) and three procedure/ultrasound rooms. Each room has its own ultrasound equipment for sonograms, amniocentesis, CVS, and PUBS. Furthermore two of the machines are equipped with Doppler ultrasounds for assessment of umbilical and regional fetal circulation.
There is a central working area (workroom) available for physicians to consult, review, and complete each of the sonographic reports. These reports are generated immediately using two computer terminals. There is a monitor linked to Labor and Delivery which displays the fetal heart rate tracings of all patients in the Labor and Delivery suite.
There are five operating rooms on the same level as the Labor and Delivery suite (two C/S, two Gyn, and one swing OR). These operating rooms are staffed by our own group of anesthesiologists.
Morning rounds and students' lectures are held in one of the three conference rooms located on the 3rd or 4th floor. The attending and the Fellows share an "on-call" room located very close to the Labor and Delivery suite on the 4th floor. The chief residents and the medical students have three call rooms on the 3rd floor.
There are three modular offices for the Fellows at Forsyth Memorial Hospital and three in the Department of Obstetrics and Gynecology at Wake Forest University School of Medicine. There are a total of five computers [three desktops (two IBM compatible, one Apple), and two laptops (one IBM, one Apple)].
The research area consists of six offices for the research personnel and one research lab which has a refrigerated centrifuge, a tabletop centrifuge and a -70 freezer. The research personnel conducts the trials of the Maternal-Fetal Medicine Units (MFMU) Network funded by the National Institute of Child Health and Human Development, as well as other clinical trials.
B. Out-Patient Obstetrical Facilities
The Clinical Sciences Outpatient area consists of 7,841 sq. feet, with five consultative offices and 12 examining rooms.
We have an office for genetic counseling and three large procedure rooms in which amniocentesis, CVS, and ultrasound are done. This area provides the ability to do colposcopy, outpatient laser treatment and cryotherapy. The most advanced ultrasound equipment including 3D is available. A Fetal Diagnosis and Treatment Center Conference is held every other Tuesday afternoon where patients and their ultrasound videotapes are reviewed and discussed by a multidisciplinary team. Faculty in the Department of Obstetrics and Gynecology are national leaders in ultrasound and teach courses in the Center for Medical Ultrasound of Wake Forest University School of Medicine and elsewhere. Dr. Lewis Nelson is President-Elect of the 9,500 member American Institute of Ultrasound in Medicine.
We also have a fully equipped urodynamic procedure room. There were 25,865 patient visits to our Wake Forest University Physician Office during the academic year 1999-2000.
In the Prenatal Assessment Center at Forsyth Memorial Hospital we had 5,495 patient visits.
At Downtown Health Plaza, 10,872 patient visits were served by our residents, Fellows and faculty. A special high risk obstetrical clinic is held here on Monday mornings and attended by fellows and faculty.
Research:
Wake Forest University Maternal-Fetal Medicine Fellows are involved in a number of high quality clinical research projects. These projects include: a multicenter randomized controlled trial of antioxidants for women at risk for preeclampsia (Dr. Mertz, third year Fellow is the Principal Investigator), clinical studies of antepartum evaluation in high risk parturients, examinations of pregnancy outcomes using the Wake Forest University Perinatal Database, and secondary analyses of protocol databases of the National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network.
Clinical research of the Wake Forest University Section on Maternal-Fetal Medicine benefits from the following resources:
1. Six experienced obstetrical research nurses and support staff. These dedicated clinical research personnel are available for Fellow's clinical research projects, and assist in: design of study, design of data forms, consent forms and IRB submission forms, recruitment of subjects, and collection of outcome data.
2. A computerized database of births at our center is maintained and can be linked to the ongoing neonatal ICU database.
3. The unique opportunity exists to submit ideas for secondary analysis to the National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network. If accepted, these projects are supported by the Network's Biostatistical Center. Two current Maternal-Fetal Medicine Fellows have presented Network-derived analyses at national scientific meetings.
There is opportunity to obtain a Master's degree in Epidemiology or a Master's degree in Health Services Research in collaboration with the Department of Public Health Sciences. The coursework is done in the Department of Public Health Sciences with the thesis project being done in the Department of Obstetrics and Gynecology.
Basic research studies in fetal physiology and endocrinology as well as other research studies are conducted in our perinatal research laboratories. Most of the basic research activities are coordinated by James C. Rose, Ph.D., Professor of Obstetrics and Gynecology. Excellent facilities are available for large and small animal models.
Laboratory facilities are available for chronic fetal lamb preparations as well as newborn sheep studies. The total space devoted to perinatal research at WFUSM (independent of individual investigator laboratories) currently exceeds 5,000 square feet in the Gray Building. The animal facilities are located on the uppermost floor of the Hanes Building. There are extensive small animal (including a transgenic mouse) facilities available as well which are under the direction of full-time veterinarians who oversee the health of the animals.
The Perinatal Research Laboratory has its own dedicated sheep surgery area with instrument preparation area, heat and gas sterilization equipment, and several study rooms.
There are outstanding library and computer facilities present and the institution has a strong commitment to research.
There is excellent biostatistics support within the Department of Public Health Sciences. This department has 14 full-time faculty in the Section on Biostatistics and Computing.
A large primate colony at the institution's nearby research farm permits experiments in several monkey species.
Much of the basic research work now focuses on the regulation of gene expression during development with particular emphasis on the kidney brain and pituitary-adrenal systems. Facilities for research in molecular biology and regulation of gene expression in the Perinatal Research Laboratories are "state of the art."
The laboratory for uterine physiology under the supervision of Jorge Figueroa conducts both in vivo and in vitro experimentation in the understanding of the mechanisms of preterm labor. The sheep is the primary model of study.
In addition, the Section of Obstetrical and Gynecological Anesthesia has its own basic research effort in which our Fellows can potentially participate in a research project pertinent to obstetrical research. These activities are under the coordination of James C. Eisenach, M.D.
Emphasis is placed on careful experimental design of studies permitting the possibility to examine hypotheses with an appropriate number of subjects. Four research nurses assist in the conduct of clinical research. Thus, Fellows can conduct clinical research studies under faculty guidance.
Both basic and clinical research activity benefit from the guidance, support and advice of the Chairman, Dr. Eberhard Mueller-Heubach. Basic and clinical research projects in various stages of progress are presented and discussed in a weekly perinatal research conference under the guidance of Dr. James Rose and includes members from the Departments of Obstetrics and Gynecology, Pediatrics, Physiology and Pharmacology, and Anesthesia.
Research Time:
The main emphasis of this Fellowship program is to encourage the Fellow to do basic and clinical research. This is achieved by providing the Fellow with adequate protected time for research. The Section on Maternal-Fetal Medicine has been very supportive of this philosophical concept and as a result of this support the Fellow is able to have 50% of his/her time "protected" per year to do research.
We try to accommodate the Fellow's need for research time according to his/her research interest. For example, if the Fellow has a basic research project involving sheep, knowing that the "sheep season" typically runs from November to April/May, clinical activities will be tailored to accommodate the Fellow's interest.
Research Mentor:
Selection process of a Specific Research Mentor for the Fellow
The Director of Maternal-Fetal Medicine Program is responsible for ensuring the selection of a specific research mentor for each Fellow. We give a list of projects available to each Fellow by April-May prior to starting their Fellowship. Upon arrival the Fellow meets with the different active researchers in our department in the chosen area of research.
Mentorship Assignment:
Ideally the Fellow chooses an ongoing project(s) that meets his/her interest. This typically should occur during the first two months of the fellowship (July-August).
By September of the first year, the Fellow should have communicated and discussed his/her research project with the Program Director.
Once the Fellow has developed a research question, he/she presents the working hypothesis/aims and the general materials/methods to the research group during our regularly scheduled research conference on Wednesday afternoon. This will help them receive constructive feedback.
One of the researchers closely related to the "research question" is in turn assigned as the "mentor" and helps the Fellow carry the project to completion.
If by September the Fellow cannot find an appropriate research topic, he/she will be assigned to a mentor and to a project by the Director of the Maternal-Fetal Medicine Fellowship. The Director of the Maternal-Fetal Medicine Program is responsible for ensuring the progress of each Fellow's research project(s). We make certain that each fellow completes the program with a completed research project for the thesis required for the oral subspeciality board examination.
Research Conferences:
These are held every Wednesday afternoon from 4:00-5:00 p.m.
The Fellows are required to attend and to present their work. These conferences are interdisciplinary and involve all of the researchers (basic and clinical) involved in fetal/neonatal research. The Fellows can present either a research hypothesis or work in progress.
Immediate constructive criticisms are formulated which strengthen the Fellow's research proposal or work.