Neonatology

Fellowship Curriculum

The fellowship curriculum encompasses the areas of clinical medicine, research and career development, and supports our mission to train the next generation of academic neonatologists. The academic year is divided into 13 four-week blocks in accordance with ACGME training requirements. Over the three years of training, each fellow will complete one block of orientation, 13 clinical blocks and 22 research blocks. Each fellow may take up to four weeks of vacation each year.

Orientation program

The new fellow has a four-week clinical orientation program. The program includes:

• Introduction to the clinical services at the Children's Hospital of Philadelphia (CHOP) and the Hospital of the University of Pennsylvania (HUP)
• ECMO course (two-day)
• Introduction to transport
• Skills Fair (two-day), including procedure training and neonatal resuscitation program training
• Short courses on ventilators and pulmonary functioning testing
• Simulation training in resuscitation, fielding transport calls and perinatal consult

First-year fellows also participate in shadowing senior fellows on the clinical services during this period.

Research orientation is focused into a common research block for all first-year fellows. In addition to overviews of research options in the Division of Neonatology, Department of Pediatrics, and Medical School, fellows receive introductory seminars in biostatistics, epidemiology, study design and developing a research hypothesis.

Clinical curriculum

The clinical curriculum consists of practical clinical experiences and didactic seminars that supplement bedside learning. The clinical rotations include:

• Practice in an inborn neonatal intensive care unit at HUP where approximately 4,000 infants are delivered annually. Teaching teams consist of attending neonatologist, neonatology fellow, senior pediatric resident, pediatric interns and other frontline clinicians (NNP, PA and hospitalist). Fellows on-service prepare conferences with the maternal-fetal medicine fellows for a weekly HUP Perinatal Conference, including morbidity and mortality review, review of current journal articles, and presentation of interesting cases.
• Practice in an outborn, tertiary referral Newborn/Infant Intensive Care Unit (N/IICU) at CHOP with an average daily census of 61 infants ranging from newly born through 1 year of age. This unit receives more than 600 transports annually and fellows participate in the most critically ill transports. Teaching teams consist of attending neonatologist, neonatology fellow, second-year pediatric residents and other frontline clinicians (NNP, PA and hospitalist). Fellows on-service prepare conferences for a weekly CHOP Clinical Conference, including morbidity and mortality review, and presentation of interesting cases.
• Collaborative care of surgical neonates on the Neonatal Surgery Service at The Children's Hospital of Philadelphia. Teaching teams consist of attending neonatologist and surgeon, neonatology and pediatric surgery fellows and surgical nurse practitioners. Neonatology fellows have opportunities to participate in the transport of neonates with surgical problems and to participate in the Special Delivery Unit, part of the Center for Fetal Diagnosis and Treatment at CHOP, the first birth facility created for moms expecting babies with known birth defects. The high-risk fetuses with surgical and cardiac malformations are delivered in close proximity to the OR and cath lab services.
• Maternal-Fetal Medicine at the Hospital of the University of Pennsylvania. First-year fellows participate in the counseling of women with high-risk pregnancies, observe the management of high-risk pregnancies on the Labor and Delivery unit, and attend fetal HR tracing, ultrasound and genetics clinics to facilitate the development of a close, collaborative relationship between neonatologist and obstetrician/perinatologist.
• Neonatal Follow-up Clinics and CHOP and HUP. The follow-up experience for fellows is a road, cross-sectional experience in the second year. Fellows attend the CHOP Neonatal Follow-up Clinic under the supervision of Judy Bernbaum, MD, and the HUP Special Babies Clinic under the supervision of Hallam Hurt, MD, and Alicia Burnham, MD. These multidisciplinary clinics are focused on providing guidance to pediatricians caring for NIICU graduates with complex medical needs, and providing long-term neurodevelopmental assessment of NIICU graduates to maximize potential and access to services. Fellows also identify patients during their first year that they can follow longitudinally through these clinics.
• Clinical practice and observation in the Cardiac Intensive Care Unit of The Children's Hospital of Philadelphia. Third-year fellows attend fetal echocardiography clinic, observe cardiac catheterizations and surgeries, and participate in the management of neonates in the CICU. This supplements the participation in delivery room management of infants with cardiac malformations and/or arrhythmias during HUP and NeoSurgery rotations.

Clinical rotations are supplemented by a rich series of didactic experiences. Every Wednesday afternoon, fellows are relieved of their clinical and research responsibilities to attend Wednesday Didactics. The clinical components of this schedule include:

• Fellows Physiology Conference — This is a two-year curriculum of fetal and neonatal physiology and pathophysiology taught by neonatology and other subspecialty attendings. The course content outline for the American Board of Pediatrics subspecialty examination in Neonatal-Perinatal Medicine.
• Cardiology Bedside Teaching Rounds — CICU attendings participate in a monthly discussion of relevant cases in the CHOP NIICU or the Cardiac Intensive Care Unit.
• Surgery Bedside Teaching Rounds — Surgery and neonatology attendings participate in a monthly discussion of relevant cases in the CHOP NIICU
• Neonatal Radiology Rounds — Monica Epelman, MD, from the Radiology Department at CHOP has developed a one-year rotating curriculum emphasizing radiology techniques in the diagnosis and management of neonates.

Research curriculum

In addition to meeting the subspecialty training requirements for scholarly work, the program strives to provide an in-depth research experience for each fellow in keeping with our mission to train the next generation of academic neonatologists. A high quality experience may provide a foundation for a career in laboratory or clinical investigation. It also serves to develop an evidence-based approach to patient care, and establishes approaches for the life-long assimilation of future research into clinical practices.

The most meaningful research comes from within each fellow, yet incoming fellows are often ill-equipped to identify their research interests, either by topic or methodology (clinical, translational or basic). Research orientation as described above provides a directed approach for fellows to identify a topic for research, develop a hypothesis to be tested, and develop a research plan for years two and three of training. 

Each year fellows participate in an annual review by the Scholarship Oversight Committee. The committee consists of the director of Neonatology Research, Harry Ischiropoulos, PhD; the director of Neonatal Clinical Research, Barbara Schmidt, MD; an ad hoc member of the Division of Neonatology; and an external member from the medical school campus.

Fellows Journal Club

Fellows Journal Club is a monthly seminar in Wednesday Didactics that supports acquisition of tools necessary to complete a research project, and promotes an evidence-based approach to clinical care. Directed by Scott Lorch, MD, this seminar provides didactic and practical experience in biostatistics, clinical epidemiology and clinical study design. To reinforce concepts, the group reviews a current paper in clinical research which is presented by one of the fellows.

Career development curriculum

There are diverse academic paths in neonatology, including but not limited to physician-scientist, program director, division chief, NIICU director, site investigator for multicenter trials. Despite differences in job description, they all contribute to the evolution of neonatology towards improving the care and outcomes of our patients and their families. It is difficult in the busy clinical rotations to identify for fellows the components of an academic career.

Life After Fellowship

Life After Fellowship is a seminar series in Wednesday Didactics that was pioneered by  Roberta Ballard, MD, during her tenure as program director. The topics covered in this series have included:

• Life as a N/IICU director
• How to do clinical research in an affiliate N/IICU: How to be a good site investigator
• Medicolegal topics for neonatology attendings
• N/IICU care, billing and collections: How are they connected?
• So you want to be a neonatology program director?
• Work-life balance with two academic careers
• Teaching in a clinical setting

Because teaching and communication are integral parts of a career in academic neonatology, we require fellows to participate in seminars offered by the Offices of Faculty and Professional Development at CHOP and the Perelman School of Medicine at the University of Pennsylvania that are designed to foster these skills. Each fellow is encouraged to take at least one writing seminar focused on clinical manuscript, basic science manuscript or grant writing. Other seminars are chosen based on each fellow's strengths and weaknesses, and have included:

• Providing feedback in a clinical setting
• Conducting an effective Q&A session
• Developing effective presentations
• Abstract preparation
• Effective poster and platform presentations
• Introduction to Advanced Powerpoint

For more fellowship information, see conference schedules.

Updated April 2012