Frequently Asked Questions

The curriculum consists of 13 four-week block rotations over the one-year fellowship. The blocks consist of dedicated OB labor deck time and four elective blocks. The OB curriculum emphasizes recognition, management, and stabilization/transport of high-risk obstetrical patients. It also emphasizes the development of procedural skills including vacuum assisted deliveries, operative obstetrics (C-sections), and gynecologic office procedures.  Fellows provide low and high-risk prenatal care with direct supervision from our own obstetric faculty through the dedicated service of the OB Access clinic (OBAC).

Fellows spend the majority of their training at the Tacoma General Hospital Birth Center, the regional referral center for Southwest Washington, with approximately 3,500 deliveries annually. The Birth Center offers comprehensive obstetrical services, including an antepartum unit, a Level IV NICU, an OB Emergency Department, and a 24 hour in house laborist program. Family medicine fellows and residents work unopposed on the labor and delivery unit, with strong interdisciplinary support from MOGA OB/GYN attendings, a laborist team of physicians and midwives, family medicine faculty, and local community attendings. This full complement of services and supervision makes Tacoma General Hospital an outstanding environment for obstetrical training.

The fellows are involved in nearly 100% of all cesarean deliveries at Tacoma General Hospital which include both assisting and serving as the primary operator. For the past several years our fellows have, on average, performed 160-200 cesarean deliveries as the primary operator during their fellowship year. This includes both low-risk and high-risk cesarean sections, such as multiple repeats, preterm classical deliveries, and other complex surgical cases.

Our unique Obstetric Access Clinic (OBAC) allows fellows and residents to provide high risk prenatal care with direct supervision from our own MOGA OB/GYN faculty and consultation support from MultiCare’s Maternal Fetal Medicine specialists. The OBAC clinic includes routine OB care for both low and high-risk OB patients, NST/DVP/AFI monitoring, first trimester US dating, postpartum contraceptive management in addition to GYN services such as colposcopy.

Examples of high-risk OB cases managed in OBAC include caring for pregnant patients with medically high-risk conditions such as diabetes, hypertensive disorders, twin gestations, high BMI, and substance use disorders. OBAC also serves as a community safety net clinic providing care to patients with social determinants of health needs including food insecurity, low income, transportation needs, and housing instability. The OBAC clinic works closely with an in-house Maternal Support Services group (Answers) that provide social work resources, home visits, nutrition and lactation services.

Elective rotations are available in almost any pediatric, medical or surgical sub-specialty and are tailored by the fellow to augment individual strengths, address weaknesses or develop new skills.

Elective months are designated as protected (Elective-P) or clinic electives (Elective-C). On clinic electives, fellows participate in the fellow GYN procedure clinic, precepting in the family medicine residency clinic, covering some OBAC prenatal clinics, in addition to serving as back-up to the labor deck for cesarean sections. The remaining time on clinic electives can be used to participate in additional experiences such as ultrasound training, procedures in interventional radiology, ED shifts, and specialty experiences such as sports medicine. The protected elective allows more time intensive experiences without any additional clinic obligations. This elective is frequently used for inpatient experiences such as pediatrics, trauma surgery, serving as attending on our inpatient family medicine service or rural away rotations.

The OB rotation consists of daytime and nighttime labor deck shifts and does not require any 24-hour call coverage. On the OB rotation block, fellows alternate between coverage of the labor deck and OB clinic duties. This includes a 7-day stretch of night labor deck shift coverage followed by a three-day weekend break.

Teaching and supervision of fellows are delivered through an interdisciplinary team that includes MOGA OB/GYN attendings who are integral members of the Tacoma Family Medicine Residency and Fellowship faculty, 24 hour in house OB/GYN laborists, family medicine physicians, maternal–fetal medicine specialists, and several local attending providers. As a tertiary care center, the hospital offers comprehensive delivery services for both low risk and high risk obstetric patients, including TOLAC, preterm deliveries, and medically complex cases. This collaborative clinical environment and breadth of specialty expertise create an exceptional setting for advanced obstetrical training.

Fellows are considered junior faculty and play a critical role in the training of family medicine residents and medical students in both the outpatient and inpatient settings.  On the labor deck, they are the attending physician for interns performing low risk vaginal deliveries. Fellows also support senior residents on the labor deck as back up for cesarean deliveries and assisting as needed for high-risk obstetric cases and volume.

They periodically serve as preceptors in our family medicine clinic. This experience fosters the development of teaching skills and serves to keep family medicine skills current.

Elective experiences as an attending on the family medicine inpatient service are available. In all settings, obstetric and/or family medicine faculty are immediately available to support the fellows in teaching and clinical care.

You do not need to have done any cesarean sections as the primary operator prior to starting the fellowship. We do expect that you have done assisting at cesarean deliveries to ensure that it is a skill you are interested in and committed to.  Participating in cesarean sections prior to starting the fellowship will allow you to progress more quickly in your surgical skills and is highly encouraged if that option is available at your institution.

We do expect our incoming fellows to have enough vaginal deliveries and OB rotation blocks to obtain privileges for routine family medicine OB care at our hospital. Per current ACGME Family Medicine Residency guidelines, the required number of experiences for competency for obstetric care are 80 deliveries (combined vaginal and cesarean) and four blocks or 400 hours of OB experience in residency.

We offer select opportunities for external residents who plan to join our program to complete a rotation prior to the start of fellowship. This allows them to gain additional skills, increase delivery experience, and become familiar with our system.

The fellowship includes a series of both Rural Workshops and Cesarean Section Workshops throughout the year. Our OB curriculum includes daily 10-minute talks Monday through Friday at OB rounds with the residents and faculty. Fellows are also invited to participate in the Thursday afternoon resident didactic sessions, if interested and available.

Fellows run monthly OB Journal Club conferences for the fellowship and residency. The fellows also choose a fellowship project each year. Past fellowship projects have included designing high risk OB chart review, establishing a hospital M&M OB conference, participating in a QI project on the labor deck, presenting at the OB Grand Rounds, and developing a curriculum in an area of family medicine or obstetrics.

No. The American Board of Family Medicine does not offer a CAQ in Obstetrics, and ACGME does not certify family medicine OB or rural fellowships. Our graduates are eligible to take the Family Medicine Obstetrics Board offered by the American Board of Physician Specialties.

Yes. The AAFP certifies the fellowship for 150 hours of prescribed CME credits for our fellows upon program completion.

Fellows are commensurate as a PGY-4. Malpractice insurance is provided by MultiCare on an occurrence basis.

In addition, TFM offers three weeks of vacation, one week of CME with a CME stipend, one week of practice search, health and dental insurance for the fellow and his/her family, stipends for meals when on call, and other standard benefits for MultiCare employees.