Neonatal-Perinatal Medicine Fellowship Goals and Objectives

The LSU Health Shreveport Neonatal-Perinatal Medicine Fellowship Program is established with a primary intention of providing diverse clinical and high-quality educational and research experiences to individual fellows in training to enable them to become academic neonatologists who can further develop the essential field of pediatrics, the neonatal-perinatal medicine. This program is also designed to fulfill the needs of those trainees who anticipate their future activities to be solely the clinical practice as clinicians in this specialty or those who expect to function as clinician-educators. In addition, trainees who intend to pursue careers in the clinical and basic science research track (Physician-Scientist track) will also receive adequate training and education to successfully start their career pathway. The educational and clinical curriculum, and clinical environment, as detailed below, will enable them to become proficient in clinical care and academic activities.

GOALS

Providing superior quality clinical care to the neonates admitted to the NICU
Improving trust and satisfaction among parents and allied staff members of NICU
To promote the growth of both fellows and neonatologists to achieve overall excellence in academic and research domains.

OBJECTIVES

To provide high-quality training, instruction, and clinical and academic exposure to achieve proficiencies in the management of neonates with diverse clinical conditions
Providing sufficient supervision and mentorship to develop skills for acquiring advanced knowledge concerning practice-based learning, evidence-based practice, literature review, communication skills, team-leadership qualities, and professionalism
Providing supervision and mentorship for acquiring proficiencies in the field of neonatal procedural skills, including neonatal resuscitation, endotracheal intubation, central line placement, thoracocentesis, and paracentesis.
High-quality training and mentorship for performing clinical/basic science/translation research with the enhancement of skills in data collection, data interpretation, data analysis, and preparing presentations and manuscripts.

Learning and Educational Domain-specific and Training level - Specific Goals and Objectives

1. CORE DOMAIN: PATIENT CARE

1.a.) Fellowship Year 1

PATIENT CARE

FELLOWSHIP YEAR 1
Will assess the clinical status of the neonates accurately and recognize an acutely ill neonate.

Fellows shall understand basic management and monitoring principles of a high-risk pregnancy by Maternal-Fetal Medicine specialists by interacting and providing consultation services when requested.
Fellows shall attend and manage delivery room resuscitation of the preterm and full-term infant. Fellows will acquire proficiency in the basic principles of NRP, resuscitation leadership qualities, and rapid communication skills that are essential for the rapid stabilization of depressed preterm and term neonates.
Fellows shall provide initial stabilization of sick infants of any gestational age both in the delivery room and in the NICU
Resuscitate preterm and term neonates with a variety of common medical illnesses, including prematurity, perinatal asphyxia, acute respiratory failure, and acute development of hemodynamic instability
Develop proficiency in performing common procedures in the NICU.
Understanding the need for consultation with pediatric subspecialists and other allied subspecialties for additional care for neonates in the NICU. Fellows will effectively communicate and formulate evaluation and management plans in consultation with subspecialists whenever the need arises. Fellowes will develop experience and understanding of diverse neonatal surgical, cardiac, neurologic, gastrointestinal, and renal conditions.
Fellows will develop proficiency in the care of stable, feeding, and growing infants. They will deliver coordinated care in association with nutritionist and PT/OT/Speech therapist
Fellows will formulate the discharge plan in coordination with discharge planners.
Fellows will understand the need for transfer of the infant to other facilities if the need arises
Fellows will actively participate in rounds, contribute very significantly to the assessment of the infant, will coordinate with NNPs and residents for the implementation of evaluation and management plan. Fellows will also actively monitor the clinical progress.
Fellows also will develop proficiency towards an effective sign-out process.
Fellows are actively being supervised by the attending neonatologists. They will actively discuss management and evaluation-related decisions with the attending neonatologists for guidance before being executed.

1.b.) Fellowship year 2

PATIENT CARE

FELLOWSHIP YEAR 2:
Fellows will anticipate early any changes in neonate’s clinical status and act accordingly to ameliorate potential morbidity/mortality.

Be able focus on planning and executing long-term plans for neonates that need multidisciplinary team management and consultation and coordinated care-based management.
Be able to actively participate and conduct multidisciplinary team rounds on neonates with medical issues
Be able to work in parallel with NNPs, discuss assessment and management plans with them, and provide very well coordinated and evidence-based care to critically ill neonates and neonates with diverse clinical conditions.
Be able to conduct clinical teaching rounds with residents and medical students when the attending is also present during the rounds (supervised clinical teaching rounds)
Be able to perform pertinent discussion concerning clinical care and clinical progress of neonates with consultants and neonatologists
Be able to sign out during the transition of care with a greater emphasis on clinical prediction, early anticipation, and contingency plans.

1.c.) Fellowship Year 3

PATIENT CARE

FELLOWSHIP YEAR 3
Fellows will be able to manage a wide variety of neonatal clinical conditions and neonatal diseases with greater consistency and with greater independence.

Be able to function as a leader of the care team, with an active and leading role in decision making and executing management plans.
Be able to efficiently coordinate the care through inputs from different consultants, ancillary team members, and mid-level care providers
Will be able to conduct, supervise and teach intensive resuscitation and management skills to physicians in training.
Be able to teach resident and medical students and junior fellows physician exam skills and clinical skills.
Be more efficient and more independent in handling critically ill neonates and neonates with complex medical issues.
Be more efficient and pertinent in providing sign-out during the transition of care with a greater emphasis on anticipation of problems and clinical deterioration following the transition along with contingency plans with greater clarity.
Be able to acquire mastery over the goals and objectives of the first and second year of training along with a greater focus on supervisory and leadership, and teaching roles.

2. CORE DOMAIN: MEDICAL KNOWLEDGE

The American Board of Pediatrics (ABP) has laid out contents specific for neonatal-perinatal medicine board examination. All the fellows, by the end of their fellowship, will acquire sufficient knowledge on all the board-specific contents in order to function efficiently as independent neonatologists. All the board-specific contents will be covered during the three years of fellowship training using Neonatology Core Curriculum Seminar Series, perinatal grand rounds, self-study, and clinical teaching rounds.

2.a.) Fellowship Year 1

2.b.) Fellowship Year 2

2.c.) Fellowship Year 3

MEDICAL KNOWLEDGE

FELLOWSHIP YEAR 3

Be able to understand fetal interventions, fetal therapeutic options and intensive and complex fetal monitoring strategies, perinatal interventions to improve neonatal outcomes. Also, fellows will be able to understand and focus extensively on treatment and intervention strategies that are evidence-based. Fellows will also understand different interventional strategies for neonatal conditions and will be able to categorize them based on the level of evidence and will routinely utilize the available high-level evidence in the routine clinical practice to obtain the best possible neonatal short-term and long-term outcomes. Fellows will be able to keep themselves up to date with the ever-expanding current literature in the care of neonates.

3. Core domain: Practice-based learning and quality improvement

Core Objectives

PRACTICE-BASED LEARNING AND QUALITY IMPROVEMENT

Be able to develop an organized evidence-based approach and strategy to the evaluation and management of common neonatal conditions
Be able to develop, present and teach evidence-based guidance algorithms or protocols for neonatal conditions where clinical practice variations exist.
Be able to effectively utilize computerized EMR to locate information to track and interpret outcome data
Be able to understand their own strengths, deficiencies, knowledge gap and be able to seek help in order to improve the knowledge and skill base to provide efficient clinical care to the neonates.
Procedural skills: The following list represents skills that fellows must acquire in order to stabilize and manage critically ill neonates.
- Endotracheal Intubation
- Umbilical arterial and Venous catheterization
- Peripheral Arterial line placement
- Neonatal resuscitation, including mega-code
- Neonatal CPR
- Lumbar Puncture
- Peripherally inserted central catheter (PICC)
- Thoracentesis
- Chest tube placement
- Pericardiocentesis
- Abdominal Paracentesis
- Ventricular access device tap
- Double Volume Exchange Transfusion
- Partial Volume Exchange Transfusion
- ECMO Rounding and management infants on ECMO
Cognitive and knowledge-based skills: Fellows will be able to develop cognitive skills to understand the severity of clinical illness and be able to utilize these skills to improve neonatal outcomes. Fellows will be able to use these skills to closely monitor the impact of interventions on the clinical course of critically ill neonates with diverse cardiorespiratory and neurologic disorders.
- Assisted Thermoregulation
- Bedside X-ray interpretation of the chest and abdomen
- 12-lead EKG interpretation of common neonatal rhythm abnormalities
- Oxygen therapy-various modalities
- Ventilator Management, including conventional ventilation (various modes and modalities), high-frequency oscillator, high frequency jet ventilator, non-invasive ventilation (NIPPV, NIV NAVA), etc.
- Fluid and electrolyte management
- Nutritional assessment and aggressive nutritional management
- Arterial blood gas interpretation and management
- Point of care cranial sonography and Point of Care Echocardiography (functional echocardiography or TnECHO)

3.a.) Fellowship Year 1

PRACTICE-BASED LEARNING AND QUALITY IMPROVEMENT

FELLOWSHIP YEAR 1

Be able to understand the indications of various neonatal procedures and be able to sufficiently observe and closely assist all the procedures, including umbilical lines, airway, chest tubes, and arterial lines, etc. Fellows will be able to perform procedures while being supervised/assisted by the attending neonatologist or experienced NNPs.

3.b.) Fellowship Year 2

3.c.) Fellowship Year 3

PRACTICE-BASED LEARNING AND QUALITY IMPROVEMENT

FELLOWSHIP YEAR 3

Be able to evaluate the need for procedures more independently and be able to perform and teach the procedures independently with limited supervision and assistance from the attending neonatologists or NNPs. Be able to conduct and teach various simulation-based procedures to facilitate the acquisition of procedural skills among junior fellows and resident physicians.

4. Core Domain: Interpersonal & Communication Skills

Communication skills and interpersonal relations are very essential for the effective exchange of thoughts, knowledge, and skills. Furthermore, effective communication helps families to understand thoroughly the disease severity and therapeutic complexities involved in the care of preterm and sick term neonates.

Core Objectives

INTERPERSONAL AND COMMUNICATION SKILLS

Antenatal counseling
Daily communication with families and updating them with clinical progress
Effectively counseling families on risks of adverse neonatal outcomes, including death or major disabilities
Counseling parents on withdrawal of life-sustaining supports, including DNR, DNI, De-escalation, or non-escalation of life support, if a need arises
Consultation and effective communication with primary care physicians, consultants, and surgical subspecialists.
Communication with obstetricians, MFM specialists, nurses, nurse practitioners, Nurse manger, transport coordinators and transport nurses, multidisciplinary team members, respiratory therapists, and social workers to plan and deliver the multidisciplinary intervention to neonates with complex medical/surgical problems.

4.a.) Fellowship Year 1

INTERPERSONAL AND COMMUNICATION SKILLS

FELLOWSHIP YEAR 1

Be able to concentrate on establishing good working relations with all the members of the NICU team
Be able to communicate and establish a good working relationship with NNPs and attending neonatologists and be able to seek help whenever a need arises.
Be able to get attending approval and feedback before discussing short-term and long-term outcomes of preterm and critically ill neonates with parents.
Be able to communicate effectively during the clinical teaching rounds
Be able to develop good teaching skills
Be able to communicate effectively during the transition of care
During the conversation with the transport facility/transport physician, be able to collect sufficient and pertinent information that will guide the transport team and on-call team to anticipate and plan management strategies

4.b.) Fellowship Year 2

INTERPERSONAL AND COMMUNICATION SKILLS

FELLOWSHIP YEAR 2

Be able to effectively communicate and work in parallel with NICU care team members, including NNPs, RTs, nurses, and nutritionists.
Be able to effectively conduct teaching rounds with residents and medical students while attending will be passively participating in the rounds. Be able to gather information, interpret and effectively communicate assessment and management plans to the residents participating in the neonatal care.
Be able to teach evidence-based medicine and evidence-based practice during the clinical teaching rounds
Be able to conduct and efficiently communicate to families during family rounds.
Be able to communicate with parents effectively during the delivery of information on the impending poor prognosis of critically ill neonates
Be able to coordinate transport very efficiently with a major emphasis on providing recommendations to referring physicians and transport team for the initial stabilization before and during the neonatal transport.

4.c.) Fellowship Year 3

INTERPERSONAL AND COMMUNICATION SKILLS

FELLOWSHIP YEAR 3

Be able to project in a leadership role, in teaching, arranging interdisciplinary team meetings, and family meetings.
Able to conduct clinical teaching rounds with minimal help and assistance from the attending neonatologists. Be able to communicate very effectively to the members of the clinical care team during the rounds to carry out the management and monitoring plans effectively.
Be able to assume leadership roles while providing interpersonal communication in the domains of neonatal transportation, the transition of care, family counseling, and consultation services involving Pediatric subspecialists and surgical specialists.

5. Core Domain: Professionalism

PROFESSIONALISM

FELLOWSHIP YEARS 1 - 3

Be able to conduct interviews with parents and interdisciplinary team members to solicit inputs in developing evaluation and management plans.
Be able to explain the pros and cons while obtaining high-risk consents effectively and professionally
Be able to follow up after ordering laboratory tests and imaging studies and communicate to the parents concerning the results of lab and imaging studies.
Be able to demonstrate sensitivity and responsiveness to the parent’s cultural background.
Be able to lead the clinical care team in an organized manner with open communication utilizing professional values.
Be able to understand uncertainties and ambiguities in clinical outcomes, especially in sick neonates. Be able to make the family understand using professional behaviors.

6. Core Domain: Systems-based Practice

SYSTEMS-BASED PRACTICE

FELLOWSHIP YEARS 1 - 3

Be able to understand and utilize the cost-effectiveness concept and risk/benefit concept to the individual neonate and the population as a whole.
Be able to update medical records appropriately, utilizing different sections in medical records in order to effectively capture all the data related to medical illness, therapeutic interventions, clinical progress, and outcomes.
Be able to involve neonate’s parents and PCP in providing coordinated transitional care during the discharge process for effective follow-up and for the continuation of developmental interventions.