SUNY STONY BROOK Neonatal/Perinatal Fellowship Program ... and... · 3) Journal Club and Therapeutic Protocol evaluations 3. Understand the basics of evidence-based medicine and literature

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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:



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:



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


2. Understand and properly interpret results of fetal surveillance testing

Assessment tools:




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:




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


5. Understand what fetal conditions are amenable to fetal surgery

Assessment tools:

1) NI evaluations of conferences



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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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


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:



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


2) NI evaluations of faculty, NNPs, and nurse educators

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3) Fully developed Teaching Portfolio


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:


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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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


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


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:


2) NI evaluations

3) Ethics conference attendance

2. Develop short and long-term professional goals

Assessment Tools:

1) ILP



1. Demonstrate mature professionalism in all aspects of practice at all times

Assessment Tools:

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1) NI Junior Attending evaluation


3) Other NI evaluations

2. Have a professional plan for the short and long term

Assessment Tools:

1) Portfolio


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


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


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

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SUNY STONY BROOK Neonatal/Perinatal Fellowship Program ... and... · 3) Journal Club and Therapeutic Protocol evaluations 3. Understand the basics of evidence-based medicine and literature