Post on 17-Feb-2019
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SUNY STONY BROOK
Neonatal/Perinatal Fellowship Program
Specific Goals and Objectives
Perinatal Medicine Rotation
(Labor and Delivery, Perinatal Consults and Transitional Care)
I. Patient Care
Overall Goals:
- See Appendix 1 (a typical day);
- To gather essential and accurate antenatal information about the patient in a timely
manner;
- To make informed and reasonable decisions about diagnostic and therapeutic
interventions based on patient information, current scientific evidence, and sound
clinical judgment in the transitional period;
- To demonstrate team leadership in the DR;
- To provide an effective and meticulous hand off to the NICU team on a transitional
neonate as well as compassionate and accurate communication to families.
Patient Care Goals Specific to Year
Year 1: Develop expertise, with close attending supervision, in the following:
1. Perinatal consults for parents and the OB service when prematurity is anticipated as
well as short term and long term morbidity. Statistics in semi-quantitative terms.
2. To provide perinatal consults for parents and the OB service when a non-critical
congenital malformation is detected.
3. Delivery room care of the normal and high-risk neonate .
a. Assessment tools:
b. Current NRP certification; attainment of NRP Instructor status by the end of Year
1.
c. Simulation lab evaluations. Must attend four Sim Labs in Year 1.
d. New Innovations (NI) evaluations of resuscitation skills in the DR.
4. Performance of invasive procedures essential for care of the sick transitional neonate
a. Assessment tools:
b. Certification for competency, New Innovations.
c. On-the-fly and end-of-rotation evaluations by NNPs and faculty.
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Year 2: Develop expertise, with intermittent supervision, in the following:
1. All Year 1 Goals, with Assessment Tools as above
2. Consultation of more complex disease of the fetus including extreme prematurity and
complex congenital disorders.
Assessment tools:
1) NI evaluations, on-the-fly and end of rotation (attendings, NNPs, nurse educators)
2) In-training exam scores
3. Initiation and maintenance of less frequently required therapies.
Assessment tools:
1) NI evaluations, on-the-fly and end of rotation (attendings, NNPs, nurse educators)
2) In-training exam scores
Year 3: Develop expertise, with minimal supervision, in the following:
1. All Year 1 and 2 Goals, with Assessment Tools as above
2. Recognition that modifications of standard treatment plans may be required.
Assessment tools:
1) NI evaluations, on-the-fly and end of rotation (attendings, NNPs, nurse educators)
2) In-training exam scores
3. Ability to function as a Junior Attending
Assessment tools:
1) NI Junior Attending evaluation
2) 360-evaluations in NI
3) Parent evaluations
II. Medical Knowledge
Overall Goals:
- To develop an analytic approach to clinical situations;
- To appropriately use on-line library resources and the internet to access
information and search the literature and texts especially Maternal-Fetal
Medicine, Fetology and AAP Guidelines for Perinatal Care.
- To know the risks and complications of neonatal therapies and procedures;
- To have a basic knowledge base that allows immediate application in
emergent or critical situations;
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- To know one’s areas of deficiency.
Medical Knowledge Goals Specific to Year
Year 1: Attain the following skills:
1. Understand the pathophysiology of common fetal conditions
Assessment tools:
1) NI evaluations from faculty, NNPs, and nurse educators
2) “Pop” quizzes given during teaching conferences
3) In-training exam scores
2. Understand and properly interpret results of fetal surveillance testing
Assessment tools:
1) NI evaluations from faculty, NNPs, and nurse educators
2) “Pop” quizzes given during teaching conferences
3) In-training exam scores
3. Develop a basic understanding of the transition from intrauterine to extrauterine life,
the physiology of the term and premature neonate, and the pathophysiology of
common neonatal conditions
Assessment tools:
1) NI evaluations from faculty, NNPs, and nurse educators
2) “Pop” quizzes given during teaching conferences
3) In-training exam scores
4. Provide two case conferences per monthly rotation in collaboration with the MFM
service on recent or upcoming patients who will need NICU care
Assessment tools:
1) NI evaluations of conferences
2) In-training exam scores
5. Understand what fetal conditions are amenable to fetal surgery
Assessment tools:
1) NI evaluations of conferences
2) In-training exam scores
Year 2: Attain the following skills:
1. Mastery of Year 1 skills with Assessment Tools as above.
2. Understand the pathophysiology of more complex fetal and transitional neonatal
conditions and the use and interpretation of more complex diagnostic tools.
Assessment tools:
1) NI evaluations
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2) In-training exam scores
Year 3: Attain the following skills:
1. Mastery of Year 1 and Year 2 skills with Assessment Tools as noted.
2. Enhance knowledge on fetal echocardiography and the translational circulation as part
of the senior year cardiology curriculum.
3. Knowledge level sufficient to function to become an independent practitioner by
graduation.
Assessment tools:
1) Annual fellow evaluation and summary
2) In-training exam scores
III. Practice-based Learning and Improvement
Overall Goals:
- To develop a system for keeping current with the maternal-fetal and
neonatal literature and recommended guidelines;
- To acquire skills to appraise evidence from scientific studies and other
appropriate literature;
- To understand and use local and national perinatal data base information; to
use information technology to assist in managing information for both
patients and families.
- To facilitate one’s own learning by teaching others in labor and delivery room
skills.
Year 1: Attain the following:
1. Development of an Individual Learning Plan will include perinatology and the
transitional period and take advantage of learning opportunities
Assessment Tools:
1. On-line ILP will be begun and reviewed with the Program Director semi-annually,
and the Clinical Mentor as needed.
2. Portfolio will be started and reviewed as above
3. Conference attendance of minimum 70%
2. Become comfortable with literature searches
Assessment Tools:
1) Neonatal- MFM biweekly presentation evaluations
2) Documentation of conference attendance
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3) Journal Club and Therapeutic Protocol evaluations
3. Understand the basics of evidence-based medicine and literature interpretation
Assessment Tools:
1) Conference evaluations, particularly biweekly Neonatal-MFM conference
2) Documentation of conference attendance
3) Journal Club evaluations
4. Begin to develop the role of effective teacher; add Neonatal-MFM conferences to
Teaching Portfolio
Assessment Tools:
1) Resident evaluations in NI
2) Conference evaluations
3) Faculty, NNP, nurse educator evaluations in NI
4) Review of Teaching Portfolio
5. Become credentialed in neonatal procedures using the NICU skills lab including:
1) NRP including intubation
2) Chest tubes
3) PICC lines
4) UA/UV lines
5) Various ventilation modes including T-piece resuscitator
Year 2: Attain the following, in addition to the Year 1 Goals:
1. Develop further expertise as an effective teacher in the DR and during transitional care
Assessment Tools:
1) Resident evaluations in NI
2) Conference evaluations
3) Review of Teaching Portfolio
2. Further develop the ILP which will focus on fetology, genetics and genetic counseling
Assessment Tool:
Review of ILP by PD and Clinical Mentor
Year 3 Goals, in addition to the above:
1. Fully develop ILP with a focus on perinatology and transitional care
Assessment Tool:
On-line ILP which is reviewed semi-annually by PD and as needed by Clinical Mentor
2. Refine expertise as teacher
Assessment Tools
1) Resident evaluations in NI
2) NI evaluations of faculty, NNPs, and nurse educators
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3) Fully developed Teaching Portfolio
4) Conference evaluations
IV. Communication
Overall Goals:
- To use effective verbal skills in order provide succinct information and work
effectively with all members of the health care team across the departments
of Obstetrics and Neonatology;
- To use good listening skills;
- To communicate compassionately and effectively with families during
perinatal consults, the time of birth and;
- To maintain accurate, timely, and appropriate medical records including our
perinatal consult book and handoff to the rest of our team.
Year 1 Goals:
1. Interact with other professionals in an appropriate, collegial manner with accurate
exchange of information in the antepartum unit and labor and delivery.
Assessment Tool:
NI evaluations, 360
2. Prepare effective talks using PowerPoint presentations in collaboration with the MFM
service that are accurate and professional, twice a year.
Assessment Tools:
1) Conference evaluations
2) NI evaluations
3. Interact well and effectively with families during the antenatal and transitional periods.
Assessment Tool:
Parent evaluations
4. Maintain timely and accurate medical records and the perinatal consult book.
Assessment Tools:
1) Progress notes in charts
2) NI evaluations.
5. Demonstrate meticulous sign out communication using TeamSTEPPS methodology e.g.
briefs, huddles, SBAR, CUS, checkbacks, especially across professional and departmental
personnel and venues.
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Year 2 Goals, in addition to the above:
1. Develop expertise in PowerPoint presentations
Assessment Tools:
1) Conference evaluations, use of guidelines for best PowerPoint presentations.
2) NI evaluations
2. Develop supervisory communication skills with first year fellows during orientation
Assessment Tool:
NI evaluations
Year 3 Goals, in addition to the above:
1. Supervise, communicate, and interact as a near independently competent clinician in
the DR with more junior fellows, NNPs and respiratory
Assessment Tool:
NI evaluation
2. Teach others PowerPoint skills and good communication skills
Assessment Tool:
NI evaluations
V. Professionalism
Overall Goals:
- To develop responsible work habits and professional responsibility;
- To show respect, compassion, and integrity at all times;
- To be accountable to patients, society, and the profession with a commitment to
excellence and on-going professional development;
- To create and sustain a therapeutic and ethically sound relationship with patients
and families when predicting outcome during consults and in the transitional period;
- To demonstrate a commitment to ethical principles pertaining to provision of or
withholding of clinical care, to confidentiality of patient information, and informed
consent;
- To demonstrate sensitivity and responsiveness to patients’ cultures, gender, and
disabilities.
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Year 1 Goals:
1. Develop the habits of professional responsibility during perinatal consults and
handoff
Assessment Tools:
1) Duty hour logs
2) NI evaluations
2. Understand the legal and ethical dilemmas and implications in perinatology especially
for the babies born on the borderline of viability or babies known to have severe
congenital anomalies that may not be compatible with survival
Assessment Tools:
1) Ethics conference attendance
2) Use of ethical principles as they apply to particular cases
3) NI evaluations
4) Parent evaluations
3. Understand the basic tenets of professionalism
Assessment Tools:
1) Attendance at retreat on Professionalism
2) NI evaluations
3) Monthly meetings with Clinical Mentor
Year 2 Goals, in addition to above:
1. Develop further understanding of ethical issues
Assessment Tools:
1) Parent evaluations
2) NI evaluations
3) Ethics conference attendance
2. Develop short and long-term professional goals
Assessment Tools:
1) ILP
2) Monthly meetings with Clinical Mentor
Year 3 Goals, in addition to above:
1. Demonstrate mature professionalism in all aspects of practice at all times
Assessment Tools:
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1) NI Junior Attending evaluation
2) Parent evaluations
3) Other NI evaluations
2. Have a professional plan for the short and long term
Assessment Tools:
1) Portfolio
2) Monthly meetings with Clinical Mentor
VI. Systems-based Practice
Overall Goals:
- To understand different types of medical practices and delivery systems,
including the complexities of controlling health care costs and allocating
perinatal resources;
- To practice cost-effective health care and resource allocation that does not
compromise quality of perinatal care;
- To advocate for quality patient care and to assist patients in dealing with
system complexities;
- To understand and practice systems-based patient safety;
- To understand that patient care is a team effort requiring partnership with all
health care provider, especially across OB and Neonatal services;
- To teach others at all professional levels, and to learn from others
throughout one’s career.
Year 1 Goals:
1. Begin to understand the importance of Systems-based Practice
Assessment Tools:
1) Present at Neonatal-MFM conference and integrate how TeamSTEPPS could foster
best outcomes and safety across disciplines
2) Participation in all Neonatal MFM conferences
Year 2 Goals, in addition to above:
1) Become proficient at use of TeamSTEPPS across disciplines
2) Organize roles of all team members attending complex or emergent deliveries
Assessment Tools:
1) Same as year 1 but more evidence of management
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2) NI on the fly evaluation
Year 3 Goals, in addition to above:
1) Ability to manage the L&D/Perinatal Consult/Transitional Care Service as a Junior
Attending, and understanding hospital policies and administration.
Assessment Tool:
NI, on the fly, demonstration of characteristics of a manager and educator.
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Appendix 1
Perinatology Rotation
(Labor & Delivery/ Perinatal Consult and Transitional Care Service Rotation)
0700 Participate in Brief – either post call fellow or day fellow presents
DR status.
0745 Attend OB Brief with DR attending.
0800-1730 (end of sign-out)
1. Serve as go to person for all delivery calls from OB and assign neonatal team. Be
proactive and prepared. Assign roles. Request NNP as replacement for residents during
Grand Rounds and Monday, Tuesday, Thursday, NICU lectures and Tuesday, Thursday
2:00 p.m. resident lectures.
2. Attend all deliveries with intern first week. Emphasize proactive escalation policy to
house staff. Review 2nd and 3rd years x 2 days.
3. Instruct NRP in Neonatal Sim Lab (adjacent to unit) with mock demonstrations by all
house staff during first week of rotation. Include RTs and RNs who have passed NRP
exam. Leave no evidence you have used the lab! Debrief as instructor-required.
4. Run one mock “surprise” code in Neonatal Sim Lab (when opened) in 2nd or 3rd week of
rotation. Organize with Dr. Davidson (or Dr. Sridhar) and Head RN (or designee) on
“light” afternoons.
5. Sign out to Red Team fellow if you go on transport. Red Team attending will decide on
NNP and/or fellow for transport.
6. Orient new fellows.
7. Organize Neonatal Team to attend any “ad hoc” OB huddles.
8. Extramural births (bring code team and DR or Red attending).
9. NNP will hold fellow phone for noon conference.
10. OB-Neonatal Attending DR task force meeting the first Tuesday of the month at 1:15
p.m.
11. Biweekly case presentations in collaboration with the MFM fellow and the neonatal
attending covering L&D.
12. Bring consult book with new templates to both OB conferences and record information
on new patients discussed at perinatal meeting
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13. Sign out DR to on call staff at end of NICU rounds.
14. Keep consult book in shape. Discard consult records one month after EDC and/or before
you leave service. Consults go in by alphabetical order.
15. Know our mortality and morbidity statistics, as well as long term follow-up prognosis by
GA and BW. Use semi-quantitative terms in discussions and write ups *
16. First year fellows will go on all consults with DR or Green Attending.
17. You are the backup procedure fellow for the entire NICU (e.g. lines) and the transport
fellow during the day, if there are no impending procedures or high risk deliveries.
References: Texts stay in fellow office
*1 Creasey and Resnik, Maternal Fetal Medicine, 5th Edition
Fanaroff and Martin, Neonatal – Perinatal Medicine, 9th Edition
Bianchi, Fetology
Smith’s Recognizable patterns of Human Malformation
Volpe, Neonatal Neurology
Pub Med
Cochrane Database