Fellowship Second Year

During the second year, fellows are expected to develop an advanced understanding of complex clinical problems and to be able to independently formulate an appropriate differential diagnosis, diagnostic evaluations, and initial treatment of ill newborns. They are scheduled to complete 5 clinical rotations (3 blocks in the NICU at University Hospital, 1 block on the delivery team at University Hospital, and 1 block on the Pediatric Cardiac Care Unit). They are expected to assume a more managerial role in the care of the patients, supervision of team members, and interactions with other consultants. They have the remainder of the year to conduct their approved scholarly activity and present their work in progress to their scholarship oversight committee. In the second year of fellowship, fellows participate in a workshop on preparing CV and writing a personal statement.

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.

Second Year NICU Blocks

UH NICU (PGY5)

The NICU rotation at University Hospital in the 2nd year will either be on the resident team or on the NNP team. During the second year the fellows will expand on the knowledge learned in the first year of training. The main objectives of these rotations in the second year of fellowship is to advance in clinical knowledge and procedural skills.  The fellows will be able to develop more autonomy and formulate plans for patient care more independently.  The fellows will act in a supervisory role to the pediatric resident when on the NICU team or to the NNPs when on that team.  Fellows will make daily work rounds with the NICU or NNP team and attending. Fellows will provide patient care discussions and teaching daily on rounds. 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 three to four times 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.

Delivery Team (PGY5)

Fellows will spend 4 weeks of second 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 second year the fellows will have and increased level of autonomy in the delivery room 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.

Pediatric Cardiac Care Unit (PGY5)

Fellows will do one 4-week block in the cardiac intensive care unit during their PGY5 year. The main purpose of this rotation is for fellows to further their understanding of both the diagnosis and management of congenital heart disease (CHD) in neonates. Fellows will be directly supervised by the pediatric critical care staff, and have multidisciplinary interaction with pediatric cardiology, cardiothoracic surgery, and anesthesia staff. Fellows will primarily follow and make decisions on all neonatal and infant patients with CHD admitted to the unit for surgical repair of their disease. Didactic teaching will be given during daily rounds with the pediatric critical care and cardiology staff. Fellows will participate in any procedures required for their patients both pre- and post- operatively while in the PCC. Fellows will also participate in diagnostic management of patients with cardiology to include involvement with pre-operative echocardiograms and cardiac catheterizations, as well as through attendance of a weekly cardiac care conference.

PREMIEre Clinic (PGY5)

Fellows continue to attend high-risk follow up clinics each year. The goals for the clinic remain the same throughout all 3 years of fellowship, 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. 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.