DIVISION OF NEONATOLOGY

Neonatal-Perinatal Medicine Fellowship

Fellowship Second Year

During the second year, fellows are expected to develop an advanced understanding of complex clinical problems and to be able to independently formulate an appropriate differential diagnosis, diagnostic evaluations, and initial treatment of ill newborns. They are scheduled to complete 4 clinical rotations (3 blocks in the NICU at University Hospital, 1 block in the NICU at SAMMC, and 1 block on Maternal-fetal Medicine). They are expected to assume a more managerial role in the care of the patients, supervision of team members, and interactions with other consultants. They have the remainder of the year to conduct their approved scholarly activity and present their work in progress to their scholarship oversight committee. In the second year of fellowship, fellows participate in a Continuous Quality Improvement Lecture as well as a workshop on preparing CV and writing a personal statement.

Each of the 3 years of fellowship is divided into 13 4-week blocks. On average during the three years of fellowship there are 17.5 blocks of clinical training, (including clinical electives, call, and follow-up clinic) 19.25 blocks for research and 2.25 blocks of vacation.

Second Year NICU Blocks

UH NICU (PGY5)
University Hospital is the program’s primary facility for fellowship training. The main objective of the first year of fellowship is to solidify clinical skills and provide the fellow with the foundation to competently care for the majority of neonatal problems in a tertiary care NICU setting. During the first months of fellowship, fellows will be directly involved in primary care of NICU patients. They will also supervise student and resident members of the NICU team. This opportunity allows the program director and other neonatal staff to become acquainted with the skills and knowledge level of the trainee, allows the trainee to become familiar with the nuances of patient care in our facility, and provides time and experience for the trainee in the management of special techniques such as high frequency ventilation and inhaled Nitric Oxide. In all rotations, the fellow will be directly in charge of overseeing all care provided by residents, nurse practitioners, and medical students on the intensive care service. Fellows will make daily work rounds with the NICU team and attending. Fellows will assist the attending staff in providing teaching and patient care discussions. Fellows will attend all surgical procedures performed in the NICU or operating room. Fellows will participate in the transport process, to include taking initial calls, organizing the team and leading the transport team. Fellows will assist in the management of all ongoing clinical research studies in the NICU. As experience and skill levels improve, the fellow will be given increasing responsibility and autonomy, including supervising rounds once to twice weekly. Regardless of level of autonomy, staff should be notified as quickly as possible of all level III admissions, transports and significant changes in status for infants currently admitted to the NICU service. Staff is to be notified of all non-urgent level II admissions within 8 to 12 hours.

Fellows are responsible for writing 1) fellow admission notes, 2) transport notes, and 3) on-call notes for significant clinical events. Fellows are additionally responsible for arranging family meetings and assuring appropriate follow-up care for high-risk patients. Educational conferences (morning report, didactic lectures, journal clubs, board review conferences, discharge planning meetings) take priority over all but urgent patient care and unique training opportunities, and staff coverage will be arranged.

PGY5 fellows will advance and refine the skills they acquired in the PGY4 year while increasing their research activity.

SAMMC NICU (PGY5)
San Antonio Military Medical Center (SAMMC) is the military medical facility in San Antonio. The NICU is staffed by both Air Force and Army Neonatologists and is the training site for military Neonatal fellows. Fellows will rotate through SAMMC in one 4-week block in the PGY-5 year. Fellows will participate in all NICU care when on service at the SAMMC in a similar manner to that described for the UH NICU, and the goals and objectives are similar for this rotation. However, this rotation offers the fellow exposure to a less indigent patient population with a higher compliance rate for their prenatal care. While at SAMMC, fellows will participate in all departmental conferences at SAMMC but also continue to attend core didactic lectures at UH. Fellows will also be required during this rotation to present admissions and discuss clinical care issues at AM report three times a week. Fellows will organize and participate in all didactic and family conferences involving patients on their service, at which time they will become familiar with multidisciplinary military discharge planning. Fellows participate in transport of high-risk newborns to SAMMC and in the care of all ECMO patients admitted to the NICU service.

PREMIEre Clinic (PGY5)
Fellows attend approximately 28-32 high-risk follow up clinics each year. The goal of this twice-weekly clinic is to provide health care management and maintenance to parents and their infants who were cared for at UH NICU and were born with a birth weight of <1500 grams and/or have a high risk for long term neurodevelopmental disability. The clinic provides patients with neurodevelopmental assessments using Bayley Scales of Infant Development as well as evaluation by a neonatologist and fellows for growth and neurodevelopment. The clinic follows patients from the time of discharge until they are 3 years old. Infants found to be at high risk for developmental delays are also referred to Early Childhood Intervention programs. Patients will be seen by the NICU fellow assigned to the clinic and supervised by a staff neonatologist. All management decisions and follow-up plans will be communicated with the patient’s primary care physician.