UCONN - Pediatric Residency Program

Overview of the Program
The neonatal fellowship program at the University of Connecticut School of Medicine in Farmington, CT is a 3 year training program.

The 5 fellows who participate in this program undergo their training at two main sites Ü The University of Connecticut Health Center NICU at John Dempsey Hospital (JDH), Farmington, CT and The Connecticut Children's Medical Center (CCMC) NICU at Hartford Hospital.

The program is administered by the University of Connecticut School of Medicine, Department of Pediatrics, Division of Neonatology.

Division Chief, Neonatology (JDH) Ted S. Rosenkrantz, MD (860) 679-4064

Medical Director, NICU and Newborn Services Naveed Hussain, MBBS (860) 679-4331

Fellowship Director (JDH) Aniruddha Vidwans, M.D. (860) 679-2254

Site Director at CCMC Leonard Eisenfeld, MD (860) 545-8950

Program Administrator Jacki Kozon (860) 679-4496

Program Assistant Keiko Broyles (860) 679-3105

Program Fax (860) 679-1403

The 36 month fellowship has the following components:

1. Clinical service rotations at John Dempsey Hospital NICU
2. Clinical service rotations at CCMC NICU
3. Clinical service rotations as Junior Attendings (JDH and/ or CCMC)
4. Night call; including functioning as a team leader for night time transports.
5. Research rotations in clinical and / or basic sciences.
6. Neonatal follow-up clinic.
7. Educational and Patient care related conferences.
8. Perinatal (High risk Maternal-Fetal Medicine) service rotation.
9. Genetics rotation.
10. Pulmonary / Chronic Infant Lung Disease Service elective.
11. Special Care Nursery elective.
12. Course in Statistical Methods and Research Design.
13. Presentations at Local, Regional and National Conferences.

Narrative Description of Neonatal - Perinatal Medicine Program

A. Program Goals and Objectives:
The goals are sent in writing to all program applicants and updates are provided to current neonatal fellows as changes are made. The goals and objectives are revised by faculty periodically and feedback is sought from current and former residents in this process.

The subspecialty fellows work toward achieving the goals and objectives in a three year progressive experience with independence that increases with developing competence. While the clinical rotations do not change, the subspecialty fellow's role in the care-giving team evolves.

B. Relationship To Other Programs:
At all levels of training (PGY4-6) neonatal fellows work in a supervisory capacity with pediatric residents. Neonatal fellows do not assume primary care for any neonatal patients and supervise all patients in each NICU, whether cared for by pediatric residents or nurse practitioners. Interaction between neonatal fellows and other pediatric subspecialties would occur only around NICU patients requiring consultation. The only other circumstance in which neonatal-perinatal residents interact with other clinics, departments and accredited residency programs occurs in the elective experiences. For example on the genetics and pulmonary rotations they would function as team members, seeing consults with subspecialty attendings.

The neonatal fellows participate substantially in the education of pediatric residents and medical students (fourth year critical care students). Neonatal fellows provide clinical supervision of patient care, and are the first-line supervisor. Neonatal fellows also participate in resident conferences, either as co-attendees or as conference leaders.

C. Specialty Experiences:
Description of Each Year of Training: During the first year of training, the subspecialty resident spends six months on service developing competence in the management of critically ill newborn infants, attempting all relevant procedures. The subspecialty resident supervises the pediatric resident and nurse practitioner staff in each NICU and makes daily rounds, sometimes as the team leader and sometimes with the faculty attending. In the course of clinical care, the subspecialty resident assumes responsibility for communication with the families of the infants and develops an appreciation of the social implications of neonatal illness. During the off-service months, the subspecialty resident meets with members of the faculty about possibilities for research projects and will choose a research advisor. The objective is that by the end of the first year, the subspecialty resident will have designed a project, sought approval from any relevant institutional committees, and begun to learn the necessary techniques. The subspecialty resident also spends several months attending weekly Neonatal Follow-up Clinic and participates in divisional and departmental conferences as both speaker and attendee.

During the second year, the clinical experience is similar (five months), except the subspecialty resident is given a greater degree of responsibility, as appropriate for his/her individual level of experience and competence. Work on the research project continues, as does the conference series and the Follow-up Clinic. Most Neonatal fellows schedule one or more electives (genetics, maternal-fetal medicine, and pulmonology) during the second year.

The third year involves four months of clinical service, one or two of which are as the Junior Attending. This experience differs from that of subspecialty resident in that the Junior Attending is given responsibility for all clinical decisions (with regular reports to the senior attending to ensure quality of care and to allow teaching). He/She also arranges transports and provides telephone consultations to community physicians under appropriate supervision. In the role of attending, the subspecialty resident also leads Discharge Planning Rounds, which is a multidisciplinary conference held weekly at which the medical, developmental and social status of each infant in the nursery is discussed. Any remaining electives are scheduled during the third year. The subspecialty resident continues to attend Follow-up Clinic and divisional and departmental conferences. Work on research projects continues with the goal of presenting research findings at regional and national meetings and preparing the results for publication.

Inpatient Experiences: Neonatal fellows in the neonatal-perinatal medicine training program when on clinical service have responsibilities to supervise the care of all NICU inpatients, both acute and chronic, who are assigned to primary caregivers (pediatric residents and neonatal nurse practitioners). Neonatal fellows are supervised by attending neonatology faculty who also examine every baby every day and participate in management decisions. Clinical rounds take approximately one to three hours per day. Depending on the level of training, the subspecialty resident will conduct rounds with the primary caregiving team from one to three times a week and will report the management decisions to the attending neonatologist at post-round rounds (which can last up to an hour). The other two to four days a week, the faculty do rounds with the subspecialty resident and the primary caregiving team (approximately 2-8 hours per week). The subspecialty resident is delegated increasing independence in decision-making as competence develops. In the first year, the subspecialty resident generally brings more questions, and the subspecialty resident and faculty jointly make the decisions to answer them. In the third year, rounds with the attending are usually more for the subspecialty resident to report his/her decisions and for the attending to agree with them (or make changes as necessary).

Neonatal fellows perform neonatal transports in all years of the program, assuming the role of team leaders. The team consists of the neonatal fellow, a NICU staff nurse and a respiratory therapist as needed.

Outpatient Experiences: Outpatient experience in the neonatal-perinatal medicine training program is in the Neonatal Follow-up Clinic. Neonatal fellows attend the weekly clinic in one-month blocks over three years. Their responsibility during the clinic session is to see patients and consult with the neurodevelopmental faculty member. Since Neonatal fellows cover at night throughout the three years and for both hospitals, they become acquainted with a large number of inpatients, and since most follow-up occurs in the first year of life there is ample opportunity for Neonatal fellows to see, as outpatients, patients that they treated on the inpatient service. In addition to the neonatal neurology faculty in the Follow-up Clinic, Neonatal fellows also learn from developmental specialists (occupational therapy trained) and a neonatal nutritionist.

Resident's Experience With High Risk Obstetrical/Fetal Medicine: The Maternal Fetal Medicine Division at the University of Connecticut has a fellowship program with two Perinatal fellows, one at each year of the two year program. The program is directed by Winston Campbell, M.D. Neonatal fellows spend a one month elective on the service and interact frequently with the service around cases and conferences throughout the program.

Monitoring The Development of Competence: The competence of Neonatal fellows in the management of critically ill newborn infants, including all procedures and principles listed, is monitored by individual neonatology faculty who work one-on-one with Neonatal fellows during clinical rotations and night call. In general, it involves three components: (1) There is an evaluation form that is filled out following each clinical rotation. These are reviewed by the program director and maintained in the subspecialty resident's file which is reviewed twice a year. (2) The second component works through critical incident reporting in which any problem or perceived deficiency is reported both verbally and in writing to the fellowship director, and appropriate action is taken. (3) The Subspecialty in-training examination is purchased each year and Neonatal fellows are required to take it.

Other: Neonatal fellows participate in the conference program of the division. In addition, the General Clinical Research Center at the University of Connecticut Health Center offers short courses for Neonatal fellows and junior faculty in research project design and statistical analysis. All fellows are encouraged to utilize these resources. The division has in the past, and will in the future as needed, run courses specifically for Neonatal fellows in research design. The bulk of the laboratory experiences are done by Neonatal fellows who choose to commit to their laboratory as the venue for their research project, although we encourage even Neonatal fellows doing clinical research to spend some time in the lab as well. A Masters in Public Health program is offered on-site by the University of Connecticut. There is a tuition subsidy for residents in the University of Connecticut's Residency Programs.

The program goals and objectives document outlines the program for Neonatal fellows' education in psychosocial and ethical issues in neonatology. In general, these issues arise and are discussed in the course of patient care and at monthly Infant Care Review Committee meetings, which address ethical/psychosocial/legal issues in the context of a clinical case or as a designated topic.

Neonatal fellows have opportunities to learn about several aspects of the administration of a neonatal-perinatal facility. During the third year in the Junior Attending rotation, the Neonatal fellows experience the role of the attending physician and the administration of the regional program, including the handling of consultation calls and transport requests by general pediatricians. Neonatal fellows participate in other critical aspects of the administration in the facility including morbidity and mortality conferences (as a component of the quality assurance program). Administrative issues commonly come up in the course of patient care and are discussed there and in divisional review of clinical care in conferences, particularly the Infant Care Review Committee meetings and Discharge Planning conference. Most importantly, through acquiring familiarity with and using the computerized databases in the NICU's, and through the use of the NICU care paths in clinical care, Neonatal fellows learn how to ensure and improve quality of care through outcome monitoring and how to systemize care to improve efficiency without sacrificing quality.

D. Research Program:
Program Faculty Research The Program Director is directly involved in a research program in the field of education. Other Division faculty are actively engaged in research programs. The titles of their research projects are included in the table below.

Research is a very strong component of the Neonatal/Perinatal Medicine Fellowship Program, beginning in the first year and extending throughout the training resulting in the completion of a research project. In the first months of the first year, the Neonatal fellows meet with various members of the Division who outline potential research projects that the residents could participate in. Usually a decision is made by the subspecialty resident about what projects they plan to become involved in within the first four to six months, and a research mentor is assigned. Rather than merely working on projects that were previously designed, small, doable and separate but related projects are chosen. The subspecialty resident then participates in the design of that project with mentorship mainly from the research mentor although consultations with and epidemiologists is also utilized if appropriate. At all steps along the way from design through data collection and analysis, learning of laboratory or either data collection techniques with Neonatal fellows are given primary responsibility for the project, and the teaching is done in that context. There are opportunities for formal instruction in research skills. Course through the General Clinical Research Center at the Health Center and through the Division are offered intermittently.

Neonatal fellows receive support and guidance in the preparation of manuscripts and presentation from their research member and from all Division faculty. Built into our conference schedule are opportunities for the resident to present research and progress, presentations and preparation and manuscripts and preparation to division faculty and fellows to receive feedback.

E. Service Duties:
Throughout the three year program the fellows are on-call every fifth night. Call is taken from home and involves supervision of care at both program sites with back-up by an attending on call for each site. Neonatal fellows can switch calls so they can take out of town electives if they so desire. Weekend call is taken with Saturday and Sunday as a block; this leaves six or more weekend days away from program duties for each fellow each month.

F. Library Facilities:
Each clinical site maintains a library of reference books and journals located close to the NICU. Each site has a complete library including subspecialty journals. The University of Connecticut School of Medicine library is available to Neonatal fellows. Both sites have information/reference librarians. Through the UConn Health Center website, computerized literature search tools are available; in addition, they are available on CCMC computers and at the Hartford Hospital library.