Fellowship First Year
The first year neonatal-perinatal medicine fellow completes 2 rotations (4 week blocks) in the NICU at University Hospital. In addition, the first-year fellows will spend 1 block on the delivery team, 1 block on MFM, and 1 block at San Antonio Military Medical Center (SAMMC) NICU. Clinical training and acquisition of specialty-specific skills are the main objectives of the first year of training. The fellows learn pathophysiology of common newborn lung diseases and how to manage modes of respiratory support including synchronized intermittent mandatory ventilation and high frequency ventilation. To learn advanced resuscitation skills, they are certificated as an instructor for the American Academy of Pediatrics Neonatal Resuscitation Program. Each fellow selects a mentor and begins meeting with the Scholarly Oversight Committee to review proposal for a scholarly activity and begins the approved project. Fellows in the first year attend the PGMEC Training Seminars for First Year Fellows and complete the online learning modules for Sleep and Fatigue and Cultural Diversity. In February of the first year the fellows also attend an Introduction to Clinical Investigation Course.
Each of the 3 years of fellowship is divided into 13 4-week blocks. On average during the three years of fellowship there are 17.5 blocks of clinical training, (including clinical electives, call, and follow-up clinic) 19.25 blocks for research and 2.25 blocks of vacation.
First Year NICU Blocks
UH NICU (PGY4)
University Hospital is the program’s primary facility for fellowship training. The main objective of the first year of fellowship is to solidify clinical skills and provide the fellow with the foundation to competently care for the majority of neonatal problems in a Level 4 NICU setting. During the first months of fellowship, fellows will be directly involved in primary care of NICU patients. They will also supervise student and resident members of the NICU team. This opportunity allows the program director and other neonatal staff to become acquainted with the skills and knowledge level of the trainee, allows the trainee to become familiar with the nuances of patient care in our facility, and provides time and experience for the trainee in the management of special techniques such as high frequency ventilation and inhaled Nitric Oxide. In all rotations, the fellow will be directly in charge of overseeing all care provided by residents, nurse practitioners, and medical students on the intensive care service. Fellows will make daily work rounds with the NICU team and attending. Fellows will assist the attending staff in providing teaching and patient care discussions. Fellows will attend all surgical procedures performed in the NICU or operating room. Fellows will participate in the transport process, to include organizing the team and leading the transport team. Fellows will assist in the management of all ongoing clinical research studies in the NICU. As experience and skill levels improve, the fellow will be given increasing responsibility and autonomy, including supervising rounds once to twice weekly. Regardless of level of autonomy, staff should be notified as quickly as possible of all Neo4 admissions, transports and significant changes in status for infants currently admitted to the NICU service. Staff is to be notified of all non-urgent Neo3 admissions within 8 to 12 hours.
Fellows are responsible for writing 1) fellow admission notes, 2) transport notes, and 3) on-call notes for significant clinical events. Fellows are additionally responsible for arranging family meetings and assuring appropriate follow-up care for high-risk patients. Educational conferences (morning report, didactic lectures, journal clubs, board review conferences, discharge planning meetings) take priority over all but urgent patient care and unique training opportunities, and staff coverage will be arranged.
Competency with the following skills, but not limited to these, are expected in the PGY4 year of subspecialty training:
- Techniques of neonatal resuscitation
- Venous and arterial access
- Endotracheal intubation
- Preoperative and postoperative care of surgical patients
- Preparation for transport
- Ventilatory support
- Use of inhaled nitric oxide therapy
- Continuous cardiorespiratory monitoring
- Intravenous/enteral nutritional support
SAMMC NICU (PGY4)
San Antonio Military Medical Center (SAMMC) is the military medical facility in San Antonio. The NICU is staffed by both Air Force and Army Neonatologists and is the training site for military Neonatal fellows. Fellows will rotate through SAMMC in one 4-week block in the PGY-4 year. Fellows will participate in all NICU care when on service at the SAMMC in a similar manner to that described for the UH NICU, and the goals and objectives are similar for this rotation. However, this rotation offers the fellow exposure to a less indigent patient population with a higher compliance rate for their prenatal care. While at SAMMC, fellows will participate in all departmental conferences at SAMMC but also continue to attend core didactic lectures at UH. Fellows will also be required during this rotation to present admissions and discuss clinical care issues at AM report three times a week. Fellows will organize and participate in all didactic and family conferences involving patients on their service, at which time they will become familiar with multidisciplinary military discharge planning. Fellows participate in transport of high-risk newborns to SAMMC.
Delivery Team (PGY4)
Fellows will spend 4 weeks of first year on the delivery team. On this clinical service block the fellow will attend all high risk deliveries with a Neonatal nurse and Neonatal respiratory therapist. The fellow will lead the team in all delivery room resuscitations and procedures. In the first year the fellows will attend deliveries with either a nurse practitioner or neonatal faculty attending as outlined in the supervision policy. Fellows on the delivery team will be the fellow primarily involved in new NICU admissions and for procedures in the NICU throughout the day.
Maternal Fetal Medicine Rotation (PGY4)
Fellows will spend 4 weeks rotating with the Maternal Fetal Medicine group. In this rotation fellows will attend high risk pregnancy MFM clinics, ultrasound clinics, and genetics clinic. In addition, they will spend some time in L&D with the MFM doctors. Fellows will also attend the weekly antepartum conference.
PREMIEre Clinic (PGY4)
Fellows attend approximately 10-15 high-risk follow up clinics each year. The goal of this twice-weekly clinic is to provide health care management and maintenance to parents and their infants who were cared for at UH NICU and were born with a birth weight of <1500 grams and/or have a high risk for long term neurodevelopmental disability. The clinic provides patients with neurodevelopmental assessments using Bayley Scales of Infant Development as well as evaluation by a neonatologist and fellows for growth and neurodevelopment. The clinic follows patients from the time of discharge until they are 3 years old. Infants found to be at high risk for developmental delays are also referred to Early Childhood Intervention programs. Patients will be seen by the NICU fellow assigned to the clinic and supervised by a staff neonatologist. All management decisions and follow-up plans will be communicated with the patient’s primary care physician.