Neonatal-Perinatal Medicine Fellowship Curriculum

The three-year program comprises clinical and didactic training as well as a guided scholarly project to meet ACGME Program Requirements and ABP Competency expectations.

Overall Schedule

Off-Service time is for research and vacation.

Fellowship training begins with a Block-long orientation, affectionately referred to as Summer School.  During July of their first year, fellows attend a lecture series entitled Introduction to Clinical Neonatology, designed to provide an evidence basis for common clinical problems. Other training and experiences during Summer School include:

• Neonatal Resuscitation Program Certification and Pediatric Advanced Life Support Training Course
• Clinical Procedure Labs (e.g., intubation, chest tube insertion, umbilical line placement, paracentesis, pericardiocentesis, exchange transfusion)
• Delivering Bad News – Simulation with Trained Patients
• Orientation to the NICUs and Labor & Delivery services
• Orientation to the Kangaroo Crew^® air transportation service
• ECMO Training and Boot Camp Simulation
• Respiratory Physiology Review accompanied by Ventilator Wet Lab
• Meet and Greet with Ancillary Services Team
• Introduction to Research and Writing IRBs

Starting during Summer School and continuing through the first few months of the academic year, with guidance from the program director and other faculty members, fellows identify an area of interest for research and meet with prospective mentors.  It is preferred that fellows identify a mentor by the end of October of the first year. The emphasis during the first year is clinical training in preparation for increased autonomy at BTGH during second and third year of training. 

First-Year Fellowship Schedule

During the second year of training, three blocks are spent on NICU rotations: one in the Texas Children’s Hospital level three Pavilion for Women NICU, one in the Texas Children’s Hospital West Tower level four NICU and one at the Ben Taub Hospital. One block of the second year is also devoted to an experience in the Cardiovascular Intensive Care Unit, caring for critically ill perioperative neonates. The remaining eight blocks during this year are devoted to Scholarship and Low Frequency Call.

Second-Year Fellowship Schedule

***During the third year of training fellows serve a supervisory role on the team closely simulating being an independent attending to prepare them for practice after fellowship. They lead rounds, provide teaching to residents and NNPs and manage the patients with advisory mentorship from the service attending. In addition to clinical service, third-year fellows gain experience with a 2-week Elective of their choice, 2-week experience in WT Level 2 NICU Care, and 2-weeks with the High-Risk Obstetrical Team at the Texas Children’s Hospital Pavilion for Women.

Third-Year Fellowship Schedule

Our "Holiday Block" and is split into two two-week halves. Fellows are scheduled on service with call for one-half of the block, with the remaining two weeks for off-service/call-free scholarship or to submit vacation. Fellows submit requests for which half of this block they would prefer to be on-service to be accommodated as best as possible by the scheduling committee.

The schedule is created by a scheduling committee composed of one fellow from each class, led by the third-year fellow with oversight and approval from Dr. Melissa Carbajal. Fellows submit their block schedule requests to the scheduling committee in the spring. After the block schedule is published, fellows have the opportunity to submit specific requests for specific nights or weekends without calls.

Morning Report is led by the post-call fellow every morning. Overnight admissions are presented and review of relevant pathophysiology, mechanisms of disease, evidence–based decision making and teaching points are reviewed. The participation of numerous on-service attendings, fellows, and APPs makes for a rich discussion group with interactive learning from each other. A teaching radiologist frequently accompanies Morning Report to review images on any patients the group requests.

Our fellows see patients for neurodevelopmental follow-up in the Desmond Neonatal Follow-Up or Blue Bird Clinics during the third year of fellowship. Fellows have access to the clinic patient schedule and see a minimum of 20 patients during their second and third year. This allows fellows to attend visits for the patients that were on their primary team, provides perspective for their patients’ outcomes, and promotes continuity.

Fellows College is an innovative and collaborative approach to address the ACGME non-specialty specific requirements for subspecialty pediatric training. It was implemented at Baylor College of Medicine in 2011. The program has expanded from approximately 11 sessions in the first year to now about two sessions per month.

Expanded curricular opportunities provided by Fellows' College, help to prepare subspecialty fellows for their future careers. Furthermore, fellows have a wider range of opportunities to network and interact with an extended community of learners and leaders from other divisions participating in Fellows' College.

Fellows College also dedicates a series of sessions to developing quality improvement skills through the implementation of longitudinal projects within each fellowship subspecialty. Within the Neonatology division, the second and third-year classes participate in Newborn Center quality improvement projects of their choosing. Faculty mentors with formal quality improvement training foster collaboration within the newborn center and advise fellows through each PDSA cycle.

In total, the Baylor College of Medicine Department of Pediatrics has about 180 subspecialty fellows that all meet together during the Fellows College sessions. This offers an opportunity for networking and comradery with fellows of other subspecialties.

The Simulation Center at Texas Children's Hospital is a multidisciplinary, hospital-based center, providing hands-on pediatric and obstetric simulation training in a realistic environment to improve patient safety and patient care. Dr. Mona Khattab is the Director of Neonatal Simulation and organizes the annual Summer School procedural sessions for our fellows.  

Throughout the year Dr. Nathan Sundgren and Dr. Nicole Neveln run additional in-situ simulation trainings.  Fellows have the opportunity to become NRP instructors and teach these educational sessions if they desire. Additionally, some fellows have chosen to do simulation research for their scholarly work.

Traditionally our core curriculum was centered around the division’s noon conference schedule.  Each noon conference lecture series have a designated faculty champion(s) and fellow representative(s).  Fellow representatives work with the faculty champions to review conference content, structure, educational objectives and possible future directions. Fellows have a significant role in collaborating with the curriculum committee to ensure conferences are meeting the educational needs of the fellows and covering the neonatology board content specifications. While the noon conference lecture series will continue to be integrated into the fellows core curriculum, we are moving toward focusing on a half academic day of education for our fellows. Development of this new curriculum structure will be made in collaboration with our fellows, faculty, and division leadership to ensure the change considers systems-based practice and effects on all stakeholders who attend noon conference.

Fellows have opportunities to teach learners across a variety of training levels and specialties. In the Texas Children’s Hospital, West Tower rounding teams often include neonatal nurse practitioner, nurse practitioner students, pharmacy interns, nursing students, respiratory therapist students, and residents who have declared an intereste in neonatology.

In the Texas Children’s Hospital Pavilion for Women NICU teams are composed of second-year pediatric residents or combined medicine-pediatrics residents and Nurse Practitioners. Second and third-year medical students also join these teams as part of their selected elective or Acting Internship. A unique group of learners in this unit are the Texas Children’s Hospital Nutrition Fellows, who join rounds and help design individualized nutrition plans for each patient.

At Ben Taub Hospital, teams are composed of the attending neonatologist, one fellow and two-three pediatric residents and medical students. In addition to teaching during rounds and conference lectures, fellows lead the labor and delivery resuscitation teams consisting of a nurse, respiratory therapist and resident.