Fellowship in Family Planning

Overview

The University of North Carolina at Chapel Hill Fellowship in Family Planning will be taking its first Fellow in July 2009.  The Fellowship will provide individualized mentorship and exceptional clinical, educational, and research training.  UNC-Chapel Hill is one of the top Universities in the country and thrives on interdisciplinary research and scholarship.  The Fellow, under the guidance of the Fellowship Director, will have the opportunity to pursue a wealth of experiences throughout the University, or at Family Health International where the Co-Director works three days a week.

Clinical Services in Abortion and Family Planning

1. UNC Women’s Hospital – clinic, outpatient surgery center, and hospital
   1. UNC Family Planning Services
   2. Newly established Ryan Family Planning rotation for PGY-2 Ob/Gyn residents
   3. Family Planning Clinic – patients with all contraceptive needs, including sterilization, are seen with the residents.
   4. Abortion Clinic – All evaluations and counseling for abortion and post abortion care occur in this clinic.  The clinic is primarily a referral clinic from other abortion clinics, or from practicing obstetricians at UNC and the surrounding community.  The clinic has been operating for more than 25 years and as a result has a well established referral base.  Abortions at estimated gestational age of 6w-12w6d are done under conscious sedation in the clinic. Both manual and electrical vacuum aspiration are performed.  Abortions for 13 weeks and beyond are performed at the outpatient surgery center.  Because this is a referral based clinic, often of high acuity, the volume of patients is low and ranges from 4-10 patients a week.  With the recent initiation of the Ryan Program at UNC we anticipate the clinic volume to increase to about 10 patients every week.
2. Planned Parenthood of Central North Carolina
   1. Abortion training – Medication and surgical abortions through 20w6d are done in a clinic setting at PPCNC with Dr. Monteith who is the medical director of  Planned Parenthood of Central North Carolina.  PPCNC currently provides about 2,000 abortions per year at this facility, of which about 500 are medication abortions, and 100-150 are second-trimester D&E’s.
   2. Vasectomy observation or participation depending upon the level of interest from the Fellow and the interest in obtaining outside vasectomy training.
   3. There will be clinical work on Saturdays at PPCNC (2 half days per month) during the first semester to ensure adequate clinical training and exposure while undertaking the Master’s curriculum courses.
3. To supplement late second trimester abortion training experience fellows may rotate to an out-of-state high volume second trimester abortion site.
4. Overall fellows can expect an average of 30-40% clinical time and the remainder educational and research through the duration of the fellowship.

Other Clinical Training and Expectations

Family Planning Services currently sits within the Division the Women’s Primary Healthcare Division, within the Department of Obstetrics and Gynecology.  The Fellow will be an Attending within this Division.  Other clinical responsibilities will include call from home 2 nights a month to cover gynecological surgical emergencies.  The Fellow will also act as Gyn Attending of the Week for 4 weeks a year.  Other opportunities for gynecologic patient care are available, but not required.  There are no opportunities for Obstetrics, either required or optional, at UNC during the Fellowship.

Masters Degree Options

The University of North Carolina at Chapel Hill is consistently ranked in the top three public health schools in the country.  The Masters programs are demanding, fulfilling and highly regarded throughout the world.  The Fellow will have many choices for a Masters degree and can choose what they feel best meets their needs.  Interested applicants are strongly encouraged to spend time navigating the UNC SPH website prior to coming for interview.  It is anticipated, but not required, that Fellows would enroll in one of the following degree granting programs: 1) Masters of Science in Clinical Research, this is a new program which sits within the Epidemiology Department.  The MSCR is particularly suited to clinical researchers who anticipate a career in academics; 2) Masters of Public Health in Epidemiology, this is a demanding Masters program with strong focus on the theory and methods of Epidemiology specifically.  Other Masters opportunities exist in Maternal Child Health or Health Policy.  In the event a Fellow already holds a Masters Degree he/she will enroll in the Core Clinical Research Curriculum which is a two year curriculum designed to train junior faculty or fellows who intend to be clinician researchers in research methods, ethics and grants preparation.

Research Opportunities

There are multiple research opportunities available to the Fellow throughout the UNC-CH campus and at Family Health International.  The Fellow can choose to work on a project with Dr. Stuart or Dr. Grimes, or the Fellow can seek out opportunities at the many other related Centers throughout the UNC Campus such as; The Carolina Population Center; The Center for AIDS Research; The Maternal Child Health Department at UNC SPH.  The goal is for every fellow to complete 2 research projects; 1) a secondary data analysis, meta-analysis or systematic review; 2) to complete an original clinical research project which will include data collection and analysis.  Fellows will be encouraged to consider their topics of interest prior to arrival and will review time lines soon after arrival to ensure completion.

Collaboration

UNC Chapel Hill prides itself on being a multidisciplinary campus.  It is one of only four public universities with schools of Medicine, Dentistry, Pharmacy, Nursing and Public Health on a single contiguous campus.  The proximity, and the enthusiasm of faculty in all disciplines, makes interdisciplinary scholarship and research a reality.  To that end a Fellow who is particularly interested in a multidisciplinary approach to family planning would thrive at UNC-CH.
Founded in 1971, Family Health International (http://www.fhi.org/en/index.htm) is a large research and technical assistance organization with close ties to UNC.   Family Health International (FHI), located 11 miles from UNC,  is among the largest nonprofit organizations active in international public health with a mission to improve lives worldwide through research, education, and services in family health.  Areas of activity include family planning, maternal and child health, STD and HIV prevention and treatment, tropical diseases, and emerging infections.  FHI’s staff includes about 400 in North Carolina and more than 1,000 stationed worldwide in country and regional offices.  The interested applicant is encouraged to explore the Family Health International website.

Mentorship

Mentorship will be provided for each fellow by the Directors of the fellowship.  Dr. Stuart will provide direct mentorship and rarely travels.  She will meet with fellows individually, or together, at least once a week to ensure all the competencies of the fellowship are being met, and to ensure the steps towards completion of the research projects are being met.  Because of the multidisciplinary nature of UNC-CH the Directors anticipate Fellows will find additional faculty whose interests best fit the fellows and therefore add them to the mentor team.

International Opportunities

All Fellows will have an international experience of 6-8 weeks duration.  This will likely be during the summer between their first and second year.  There are opportunities to work with ongoing projects at UNC through ongoing work at the UNC Project  in Lilongwe, Malawi where Dr. Stuart has ongoing research projects.  Other possibilities include working with IPAS in an international setting or utilizing any of the numerous opportunities available through the fellowship.

Program Faculty

About the Directors

Gretchen S. Stuart, MD, MPHTM is Director of the Fellowship.  Dr. Stuart completed her MD and MPHTM at Tulane University in 1994 and her residency in Obstetrics and Gynecology at Parkland Memorial Hospital (University of Texas Southwestern Medical Center) in 1998.  After two years in private practice in Vermont Dr. Stuart became faculty at Parkland.  While on faculty at University of Texas Southwestern Medical Center Dr. Stuart was Principal Investigator for the NICHD funded Contraceptive Clinical Trials Network.  She also mentored numerous residents and medical students who had interests in Family Planning and watched four graduated residents pursue Family Planning Fellowships.  Dr. Stuart has been at UNC-Chapel Hill since March 2006 when she was recruited to be a Women’s Reproductive Health Research Faculty Scholar, and to initiate a Ryan Program and a Fellowship in Family Planning.  The Ryan Program was started at UNC-CH July 1 2008 and the first Fellow will start July 1 2009.  Dr. Stuart is currently undertaking a PhD in Epidemiology program at UNC.  Dr. Stuart’s interest is primarily in contraception for HIV infected women especially in sub-Saharan Africa.  She has published on family planning topics, particularly related to HIV infected women and she currently is conducting clinical research in Malawi to evaluate oral contraception in HIV infected women.

David A. Grimes, MD is co-Director of the Fellowship in Family Planning.  Dr. Grimes is Clinical Professor of Obstetrics and Gynecology at UNC and Vice-President of Biomedical Affairs at FHI.   He is one of a small number of physicians Board-certified in both obstetrics/gynecology and preventive medicine.  He spent nine years at the Centers for Disease Control and Prevention, where he served as an epidemiologist. He has held dual appointments in academic obstetrics and gynecology and in epidemiology/preventive medicine for 35 years. Dr. Grimes has received teaching awards from four medical schools: Emory University, University of Southern California, the University of California at San Francisco, and the University of North Carolina. For his work in family planning, he has received the Carl Schultz Award from the Population and Family Planning Section of the American Public Health Association, the Christopher Tietze Award from the National Abortion Federation, the Alan Guttmacher Lectureship from the Association of Reproductive Health Professionals and the Outstanding Scientific Achievement Award from The National Family Planning and Reproductive Health Association.  In 2006, he was elected to the Institute of Medicine, and in 2007 he was elected an Honorary Fellow of the Royal College of Obstetricians and Gynaecologists.

Other Faculty

Charles Monteith, MD is the Medical Director of Planned Parenthood of Central North Carolina.  Dr. Monteith will be clinical faculty for the Fellowship.  He completed medical school at the University of California at San Francisco in 1997 and completed his residency in Obstetrics and Gynecology at UNC-Chapel Hill in 2001.

Research and clinical interests of the directors

• Contraception
• Office gynecology
• Contraception for HIV-infected women
• Contraception for women in resource poor countries
• Post-partum contraception
• Post-abortion contraception
• Cochrane reviews
• Emergency contraception in North Carolina pharmacies

Current Faculty Research Projects

• Hormonal contraception in HIV-infected women in Lilongwe, Malawi
• Post-partum IUD placement
• Emergency contraception availability in North Carolina pharmacies
• Contraception continuation in HIV-infected women in Malawi

Clinical Training Sites

• NC Women’s Hospital
• Planned Parenthood of Central North Carolina