Educational Perspectives: Boot Camps for Neonatal-Perinatal Medicine Fellows

Fellowship training is a required component of the transformation of a pediatrician into an independent practitioner of neonatal-perinatal medicine (NPM). Exposure to neonatal intensive care, experience in the management of neonatal patients, and successful performance of neonatal procedures is lower in trainees entering NPM fellowship today as compared with the past. To address this change in the baseline competency of incoming fellows, many NPM fellowship programs have begun to conduct intensive, simulation-based training sessions at the beginning of fellowship, commonly called “boot camps.” In this article, we explore the concept of boot camps, examine curriculum design elements of boot camps for NPM fellows, provide examples of collaborative and regional NPM boot camps, explore challenges to conducting a boot camp for NPM fellows, and discuss future directions for NPM fellowship boot camps, on a national and international level.

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Milestone Level Changes From Residency to Fellowship: A Multicenter Cohort Study

Journal of Graduate Medical Education ◽

10.4300/jgme-d-20-00954.1 ◽

2021 ◽

Vol 13 (3) ◽

pp. 377-384

Author(s):

Taylor Sawyer ◽

Megan Gray ◽

Shilpi Chabra ◽

Lindsay C. Johnston ◽

Melissa M. Carbajal ◽

...

Keyword(s):

Professional Development ◽

Medical Knowledge ◽

Fellowship Training ◽

Multicenter Cohort Study ◽

Perinatal Medicine ◽

Linear Trajectory ◽

Next Accreditation System ◽

Fellowship Programs ◽

The Individual ◽

Vital Element

ABSTRACT Background A vital element of the Next Accreditation System is measuring and reporting educational Milestones. Little is known about changes in Milestones levels during the transition from residency to fellowship training. Objective Evaluate the Accreditation Council for Graduate Medical Education (ACGME) Milestones' ability to provide a linear trajectory of professional development from general pediatrics residency to neonatal-perinatal medicine (NPM) fellowship training. Methods We identified 11 subcompetencies that were the same for general pediatrics residency and NPM fellowship. We then extracted the last residency Milestone level and the first fellowship Milestone level for each subcompetency from the ACGME's Accreditation Data System on 89 subjects who started fellowship training between 2014 and 2018 at 6 NPM fellowship programs. Mixed-effects models were used to examine the intra-individual changes in Milestone scores between residency and fellowship after adjusting for the effects of the individual programs. Results A total of 1905 subcompetency Milestone levels were analyzed. The average first fellowship Milestone levels were significantly lower than the last residency Milestone levels (residency, mean 3.99 [SD = 0.48] vs fellowship 2.51 [SD = 0.56]; P < .001). Milestone levels decreased by an average of -1.49 (SD = 0.65) from the last residency to the first fellowship evaluation. Significant differences in Milestone levels were seen in both context-dependent subcompetencies (patient care and medical knowledge) and context-independent subcompetencies (professionalism). Conclusions Contrary to providing a linear trajectory of professional development, we found that Milestone levels were reset when trainees transitioned from general pediatrics residency to NPM fellowship.

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Boot camps in neonatal-perinatal medicine fellowship programs: A national survey

Journal of Neonatal-Perinatal Medicine ◽

10.3233/npm-18117 ◽

2019 ◽

Vol 12 (2) ◽

pp. 231-237

Author(s):

D. Kumar ◽

A.J. Vachharajani ◽

F. Wertheimer ◽

B. Vergales ◽

K. Glass ◽

...

Keyword(s):

National Survey ◽

Perinatal Medicine ◽

Boot Camps ◽

Fellowship Programs

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Ten Commandments for Neonatal-Perinatal Medicine Fellows

Journal of Medical Education and Curricular Development ◽

10.1177/2382120518798639 ◽

2018 ◽

Vol 5 ◽

pp. 238212051879863

Author(s):

Shilpi Chabra ◽

Taylor Sawyer

Keyword(s):

Neonatal Intensive Care ◽

Core Competencies ◽

Newborn Infants ◽

Neonatal Resuscitation ◽

Perinatal Medicine ◽

Diverse Range ◽

Team Members ◽

Learning Plan ◽

Fellowship Programs ◽

Competency Based

The transformation of a general pediatrician into a neonatologist requires rigorous training in a diverse range of core skills during neonatal-perinatal medicine fellowship. This training includes the care of high-risk newborn infants, as well as interdisciplinary communication with care team members and families in the neonatal intensive care unit. In addition, neonatal-perinatal medicine fellows need to acquire competency in key procedurals skills, including neonatal resuscitation techniques, to be able to safely practice neonatology without direct supervision on graduation. Although there is much general advice available to help residents and fellows navigate training, there is little specific advice or guidance for neonatal fellows. In this Perspective, we present 10 commandments for neonatal fellows. The commandments include (1) cherish your patients and their families, (2) know your limits and seek help when needed, (3) understand competency-based medical education, (4) remember the 6 core competencies, (5) review your specialty milestones, (6) have an individualized learning plan, (7) seek out feedback, (8) honor your attendings and nurses, (9) appreciate the importance of teamwork, and (10) do not take thyself in vain. These commandments were developed based on the experience of the authors, working closely with neonatal fellows over several decades. The commandments are present not as unbreakable rules, but rather as words of advice from 2 neonatologists who, having completed their neonatal fellowship, want to help guide others do the same. We believe that this resource will be useful to fellowship programs and neonatal-perinatal fellows.

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Neonatal – Perinatal Medicine Fellowship Training in Long-Term Outcomes of Neonatal Intensive Care Unit Graduates

Journal of Perinatology ◽

10.1038/sj.jp.7211331 ◽

2005 ◽

Vol 25 (6) ◽

pp. 423-425 ◽

Cited By ~ 1

Author(s):

Raye-Ann deRegnier ◽

Roberta Ballard ◽

T Michael O'Shea ◽

Robert Piecuch ◽

Michele Walsh ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Neonatal Intensive Care Unit ◽

Neonatal Intensive Care ◽

Fellowship Training ◽

Long Term Outcomes ◽

Perinatal Medicine

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The Association of Pediatric Critical Care Medicine Training Programs with Research Publication Productivity and Employment Outcomes of Their Graduates

Journal of Pediatric Intensive Care ◽

10.1055/s-0040-1721732 ◽

2020 ◽

Author(s):

Sonali Basu ◽

Robin Horak ◽

Murray M. Pollack

Keyword(s):

Critical Care ◽

Intensive Care ◽

Medical School ◽

Training Programs ◽

Fellowship Training ◽

Publication Productivity ◽

Research Publication ◽

Pediatric Critical Care ◽

Publication Success ◽

Fellowship Programs

AbstractOur objective was to associate characteristics of pediatric critical care medicine (PCCM) fellowship training programs with career outcomes of PCCM physicians, including research publication productivity and employment characteristics. This is a descriptive study using publicly available data from 2557 PCCM physicians from the National Provider Index registry. We analyzed data on a systematic sample of 690 PCCM physicians representing 62 fellowship programs. There was substantial diversity in the characteristics of fellowship training programs in terms of fellowship size, intensive care unit (ICU) bed numbers, age of program, location, research rank of affiliated medical school, and academic metrics based on publication productivity of their graduates standardized over time. The clinical and academic attributes of fellowship training programs were associated with publication success and characteristics of their graduates' employment hospital. Programs with greater publication rate per graduate had more ICU beds and were associated with higher ranked medical schools. At the physician level, training program attributes including larger size, older program, and higher academic metrics were associated with graduates with greater publication productivity. There were varied characteristics of current employment hospitals, with graduates from larger, more academic fellowship training programs more likely to work in larger pediatric intensive care units (24 [interquartile range, IQR: 16–35] vs. 19 [IQR: 12–24] beds; p < 0.001), freestanding children's hospitals (52.6 vs. 26.3%; p < 0.001), hospitals with fellowship programs (57.3 vs. 40.3%; p = 0.01), and higher affiliated medical school research ranks (35.5 [IQR: 14–72] vs. 62 [IQR: 32, unranked]; p < 0.001). Large programs with higher academic metrics train physicians with greater publication success (H index 3 [IQR: 1–7] vs. 2 [IQR: 0–6]; p < 0.001) and greater likelihood of working in large academic centers. These associations may guide prospective trainees as they choose training programs that may foster their career values.

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Limitation of Private Attending Pediatricians' Neonatal Intensive Care Privileges in Level III Institutions Throughout the United States

PEDIATRICS ◽

10.1542/peds.94.2.190 ◽

1994 ◽

Vol 94 (2) ◽

pp. 190-193

Author(s):

Rita G. Harper ◽

Concepcion G. Sia ◽

Regina Spinazzola ◽

Raul A. Wapnir ◽

Shahnaz Orner ◽

...

Keyword(s):

United States ◽

Intensive Care ◽

Health Care Providers ◽

Curriculum Design ◽

Neonatal Intensive Care ◽

District Of Columbia ◽

The United States ◽

Geographic Region ◽

Neonatal Intensive Care Units ◽

Care Providers

Objective. To determine the privileges of Private Attending Pediatricians (PAP) in caring for newborns requiring intensive (ITC), intermediate (IMC), or continuing (CC) care in Level III neonatal intensive care units (NICUs) throughout the United States. Design. A two-page mail questionnaire was sent to 429 Level III NICUs to obtain the statement best describing the PAPs' privileges, the number of PAP, and some of the PAPs' functions. Level III NICUs were classified by geographic region as Eastern, Central, or Western United States. Results. Responses were received from 301 NICUs (70%) representing 48 states, the District of Columbia, and >9000 PAP. Twenty-two institutions had no PAP. In the remaining 279 institutions, 96% (267/279) had restricted the PAPs' privileges partially or completely. In 32% (88/279), the PAP were not allowed to render any type of NICU care. In 18% (51/279) of the institutions, the PAP were allowed to render CC only. In 27% (76/279) of the institutions, the PAP were allowed to render IMC and CC only. Limitation of PAPs' privileges were reported in all geographic areas in the U.S., were more pronounced in the Eastern than the Central or Western sections of the country, and were noted in institutions with small (≤10) as well as large (≥60) numbers of PAP. Limitation of PAPs' privileges was determined by the PAP him/herself in many institutions. Proficiency in resuscitation was considered to be a needed skill. Communication with parents of an infant under the care of a neonatologist was encouraged. Conclusions. The PAPs' privileges were limited partially or completely in most Level III NICUs. Knowledge of this restricted role impacts significantly on curriculum design for pediatric house officers, number and type of health care providers required for Level III NICUs and future house officer's career choices.

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Statement on Pediatric Fellowship Training

PEDIATRICS ◽

10.1542/peds.87.2.265 ◽

1991 ◽

Vol 87 (2) ◽

pp. 265-265

Author(s):

Keyword(s):

Research Training ◽

Clinical Care ◽

Fellowship Training ◽

The Body ◽

Pediatric Residents ◽

Pediatric Society ◽

Research Fellowship ◽

Research Activities ◽

Fellowship Programs ◽

Interest In Research

The following statement was adopted by the Federation of Pediatric Organizations in February, 1990. The Federation consists of the following pediatric organizations: Ambulatory Pediatric Association, American Academy of Pediatrics, American Board of Pediatrics, American Pediatric Society, Association of Medical School Pediatric Department Chairmen, Association of Pediatric Program Directors, Society for Pediatric Research. The Federation supports the concept that "the principal goal of fellowship training should be the development of future academic pediatricians." Graduates of pediatric fellowship programs usually work in academic centers with significant time set aside for research. Some fellowship-trained pediatricians, particularly neonatologists, allergists, and neurologists, may not work in hospitals or ambulatory settings that are associated closely with academic programs. Fellowship-trained pediatricians in all settings should be encouraged to continue their interest in research to add to the body of pediatric knowledge. To achieve the goal of training pediatric scientists, the following guidelines for fellowship education are recommended: 1. Upon completion of a pediatric fellowship, the trainee should be proficient in clinical care, teaching, and research. Fellowship training should prepare a pediatrician to care for children with complex illnesses within his/her area of special expertise and to serve as a consultant for the general pediatrician. In addition, the fellowship-trained pediatrician should be responsible for the education of pediatric residents and the continuing education of practicing pediatricians. For this reason, fellowship training should include interpersonal skills and pedagogical techniques. 2. Research training should begin as soon as possible; premedical students, medical students, and pediatric residents should be encouraged strongly to participate in meaningful research, and research activities should be carried out throughout fellowship training.

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STATEMENT OF PEDIATRIC FELLOWSHIP TRAINING

PEDIATRICS ◽

10.1542/peds.98.2.a8 ◽

1996 ◽

Vol 98 (2) ◽

pp. A8-A8

Keyword(s):

Clinical Care ◽

Fellowship Training ◽

The Body ◽

Current Position ◽

Pediatric Residents ◽

Body Of Knowledge ◽

Area Of Interest ◽

Fellowship Programs ◽

Special Expertise ◽

Research Mentor

In 1990, the Federation of Pediatric Organizations adopted a statement on pediatric fellowship training.1 This revised statement represents the current position of the federation regarding the purpose and objectives of fellowship training. The federation continues to support the concept that "the principal goal of fellowship training should be the development of future academic pediatricians." Within academic and teaching centers, there is a need for master clinicians, skilled teachers, and productive investigators who conduct research with varied interests. Graduates of pediatric fellowship programs should be proficient in both direct and consultative clinical care, teaching, and a selected area of research. Thereafter, differentiation of interests and activities should be expected and encouraged, but graduates of the fellowship programs in all settings should continue their involvement in research, whether collaborative or direct, to add to the body of knowledge in their area of interest. The following guidelines for fellowships are recommended: 1. Fellowship training should prepare pediatricians to care for children with complex problems within their areas of special expertise and to serve as consultants. Fellows should participate directly in the care of patients and should serve as consultants, with guidance and supervision provided by senior clinical mentors. 2. Fellowship training should include the development of skills as an educator, including presentation skills, curriculum development, and evaluation. Fellows should participate in the education of pediatric residents and the continuing education of practicing pediatricians. 3. Each fellow should have a mutually agreed on research mentor(s). It is essential for the fellow to have mentor(s) capable of fostering the trainee's career development.

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The Impact of Design Elements on Undergraduate Nursing Students’ Educational Outcomes in Simulation Education: Protocol for a Systematic Review

10.21203/rs.3.rs-861274/v1 ◽

2021 ◽

Author(s):

Matthew Jackson ◽

Lauren McTier ◽

Laura A Brooks ◽

Rochelle Wynne

Keyword(s):

Systematic Review ◽

Nursing Students ◽

Learning Outcomes ◽

Educational Outcomes ◽

Undergraduate Nursing Students ◽

Design Elements ◽

Undergraduate Nursing ◽

Search Terms ◽

Simulation Based ◽

The Impact

Abstract Background: Although simulation-based education (SBE) has become increasingly popular as a mode of teaching in undergraduate nursing courses its effect on associated student learning outcomes remains ambiguous. Educational outcomes are influenced by SBE quality that is governed by technology, training, resources and SBE design elements. This paper reports the protocol for a systematic review to identify, appraise and synthesise the best available evidence regarding the impact of SBE on undergraduate nurses’ learning outcomes. Methods: Databases to be searched from 1st of January 1990 include the Cumulative Index to Nursing and Allied Health Literature (CINAHL), the Medical Literature Analysis and Retrieval System Online (MEDLINE), American Psychological Association (APA) PsycInfo and the Education Resources Information Centre (ERIC) via the EBSCO host platform. The Excerpta Medica database (EMBASE) will be searched via the OVID platform. We will review the reference lists of relevant articles for additional citations. A combination of search terms including ‘nursing students’, ‘simulation training, ‘patient simulation’, and ‘immersive simulation’ with common Boolean operators will be used. Specific search terms will be combined with either MeSH or Emtree terms and appropriate permutations for each database. Search findings will be imported into reference management software (Endnote© Version.X9) then uploaded into Covidence where two reviewers will independently screen titles, abstracts and retrieved full text. A third reviewer will be available to resolve conflicts and moderate consensus discussions. Quantitative primary research studies evaluating the effect of SBE on undergraduate nursing students’ educational outcomes will be included. The Mixed Methods Appraisal Tool (MMAT) will be used for quality assessment of core criteria, in addition to the Cochrane RoB 2 and ROBINS-I to assess risk of bias for randomised and non-randomised studies, respectively. Primary outcomes are any measure of knowledge, skills, or attitude. Discussion: SBE has been widely adopted by healthcare disciplines in tertiary teaching settings. This systematic review will reveal (i) the effect of SBE on learning outcomes, (ii) SBE element variability, and (iii) interplay between SBE elements and learning outcome. Findings will specify SBE design elements to inform the design and implementation of future strategies for simulation-based undergraduate nursing education.Systematic Review Registration: PROSPERO CRD42021244530

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13 Impact of Catheter Choice on Procedural Success of Minimally Invasive Surfactant Therapy

Paediatrics & Child Health ◽

10.1093/pch/pxab061.009 ◽

2021 ◽

Vol 26 (Supplement_1) ◽

pp. e8-e9

Author(s):

Soume Bhattacharya ◽

Brooke Read ◽

Michael Miller ◽

Orlando daSilva

Keyword(s):

Adverse Effects ◽

Minimally Invasive ◽

Neonatal Intensive Care ◽

Tertiary Care ◽

Surfactant Therapy ◽

P Value ◽

Perinatal Medicine ◽

Procedural Success ◽

Multi Access ◽

The Impact

Abstract Primary Subject area Neonatal-Perinatal Medicine Background Surfactant delivery via a thin endotracheal catheter during spontaneous breathing, a technique called minimally invasive surfactant therapy (MIST), is an alternative to intubation and surfactant administration. Procedural details among different centres vary, with marked differences in the choice of catheter to instill surfactant. Studies report use of feeding catheters, multi-access catheters, vascular catheters and, recently, custom-designed catheters for this purpose. The impact of choice of catheter on procedural success and adverse effects has not been reported. Objectives The objective of the present study was to compare the procedural success and adverse effects of MIST, using a semi-rigid vascular catheter (16G Angiocath-Hobart Method) versus a flexible multi-access catheter (MAC). Design/Methods This was a retrospective review of prospectively collected data at a tertiary care neonatal intensive care unit in southwestern Ontario. All neonates who received surfactant via MIST between May 1, 2016 and September 30, 2020 were included in the study. Relevant baseline characteristics, data on procedural details (premedication, type of catheter) were collected. The procedural success, number of attempts, and adverse effects between neonates who received MIST via MAC and 16G Angiocath were compared using a Chi Square test or Fisher’s test, as appropriate. A P value of less than 0.05 was considered significant. Results A total of 139 neonates received surfactant via MIST method during the study period. 93 neonates received the surfactant via MAC, while 46 received it via Angiocath. The baseline demographic characteristics in the two groups were similar (Table 1). A higher proportion of neonates in the Angiocath group received atropine (100% vs. 76%, P =.002] and fentanyl (98% vs. 36%; p<0.001) than the MAC group. The procedural success was 91% in the Angiocath group and 89% in the MAC group (p >.99). Multiple attempts were needed in 24% of neonates in the Angiocath group, and 37% in the MAC group (p=0.158). More episodes of desaturations were noted in the Angiocath group (89%) than the MAC group (69%) (P=0.012). Other rates of common adverse effects were similar between the two groups (Table 2). Conclusion The overall procedural success of MIST was similar in both catheter groups. The proportion of neonates requiring multiple attempts was lower with Angiocath use, though this difference was not statistically significant. Desaturation episodes were seen more frequently in the Angiocath group, possibly related to higher use of procedural sedation in this group.

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