Neonatal-Perinatal Fellowship Program
Directed by Catherine M. Bendel, M.D., the Neonatal-Perinatal Medicine Fellowship, which is accredited by the Residency Review Committee for Pediatrics and includes the American Board of Pediatrics, is jointly sponsored by the University of Minnesota Medical School and Children's Hospitals and Clinics of Minnesota-St. Paul.
Fellows in our program train in the Neonatal Intensive Care Unit (NICU) at the University of Minnesota Masonic Children's Hospital (UMMCH) and Children's Hospitals and Clinics of Minnesota-St. Paul. The UMMCH NICU is ranked in the top cluster of four exceptional NICU sites, according to a national NICU organizational culture assessment conducted by The Wharton School at the University of Pennsylvania. For 2013, US News and World Report ranked UMMCH as one of the top 25 hospitals in the US for Neonatology. The ECMO center at the University of Minnesota Masonic Children's Hospital received the ELSO Award for Excellence in Life Support in 2013.
The Neonatal-Perinatal Fellowship Program consists of the following components as outlined by the Program Requirements for Education developed by the American Board of Pediatrics (ABP) and ACGME Resident Review Committee (RRC) for Neonatal‐Perinatal Medicine.
Fellows are assigned to these components in an educationally appropriate sequence over the usual 36 months of training. Overview of the Neonatal‐Perinatal Medicine Fellowship The NPM fellowship program, accredited by the ACGME Residency Review Committee for Pediatrics, which includes the American Board of Pediatrics, is jointly sponsored by the University of Minnesota (UMN) and Children’s Hospitals and Clinics of Minnesota — St. Paul (CHCM‐SP). The University NICU is located on the West Bank Campus in the University of Minnesota Masonic Children’s Hospital (UMMCH), and has ~750 annual admissions. CHCM‐SP has ~925 annual admissions. Twenty‐four neonatologists direct patient care and provide education at both institutions. Residents from the University of Minnesota Pediatric and Medicine-Pediatric Residency Program receive training in neonatology at both sites.
These hospitals serve a wide referral area geographically, with patients from all socioeconomic groups. The University NICU has a busy Level IV service providing all aspects of neonatal intensive care. The NICU and Maternal-Fetal Medicine (MFM) service at UMMCH receives patient referrals from throughout Minnesota, as well as North Dakota, South Dakota and western Wisconsin. The MFM service covers all types of referrals and has a large fetal echocardiography program in conjunction with the UMN pediatric cardiologists. The NICU serves as a referral source for other NICUs in the area, receiving patients with cardiac and surgical problems from the four‐state area. The NICU is also a national ECMO Center of Excellence, serving as a regional ECMO referral center, supporting 6‐10 ECMO patients per year. Additionally, the University service is involved in many collaborative clinical research projects with a dozen active clinical protocols enrolling at present. Approximately 25-30% of the annual admissions are transported either by ground ambulance or via fixed‐wing/helicopter air ambulance transport service. If interested, the neonatal‐perinatal medicine fellows may participate in the transport service.
The NICU at Children’s Hospitals and Clinics of Minnesota–St. Paul serves the eastern metropolitan area and hospitals located in St. Paul, eastern Minnesota and western Wisconsin. Approximately 20 percent of the admissions are transported from these hospitals. The remaining 80 percent are born at United Hospital, located adjacent to CHCM‐SP, an active perinatal referral center for Minnesota and western Wisconsin. This NICU is a referral source for infants requiring non‐conventional ventilation and for infants requiring diagnostic evaluations of apnea.
The clinical curriculum is based on providing PL‐4 fellows (1st year) with a high degree of direct patient contact and responsibility on the NICU, and providing PL‐4/5/6 fellows graded supervisory responsibility for the PL‐1/2/3 residents, medical students and their patients. The first year consists of predominately clinical activities and the second two years are primarily for scholarly activity, combined with ongoing clinical work.
The fellowship requires 12‐15 months of clinical rotations consisting of a minimum of 12 months assigned to the NICU critical service, one month on cardiology, one senior month on the UMMCH intermediate care service and additional elective time as desired. Five to six months of the first year are spent rotating between the two NICUs as a clinical fellow (functioning as a junior staff person in the supervision of the hour‐to‐ hour care of critically ill newborn infants), along with the cardiology rotation. Fellows generally have the remaining six to seven months of critical clinical experience spread out during the second and third years. During the third year of clinical service, the fellow is expected to function fully as a junior attending neonatologist and will have the additional month on the UMMCH intermediate care service. Formal training in NRP, transport of the critically ill newborn infant and ECMO will be provided. Participation in the NICU Follow‐up Clinic is required during all three years of the fellowship. Participation in the Vermont Oxford Network is required for 6 months during the second year, with additional participation available on an elective basis. Elective clinical rotations include Maternal‐Fetal Medicine, other Pediatric Subspecialties, and International rotations.
The Maternal‐Fetal Medicine rotation is a month‐long elective that many fellows take during the first year. Rotating with the UMMCH maternal‐fetal medicine physicians provides exposure to and an appreciation of the prenatal diagnostic tests available, as well as the management of high‐risk pregnancies and preterm labor. Fellows attend high‐risk clinics and are involved in prenatal counseling of high‐risk patients. They may also work with our prenatal palliative care and hospice team.
During the 2‐week International rotation, a 2nd or 3rd year neonatal fellow has the opportunity to travel to Cuzco, Peru to work in the Neonatal Intensive Care Unit at Cuzco Regional Hospital. The goals of this rotation are to gain an understanding of neonatology in a developing country and to learn to provide education in this setting.
This NICU contains 7 critical care beds and up to 20 mild/moderate acuity beds and cares for premature infants requiring mechanical ventilation and also has pediatric surgical services. The hospital serves a very diverse population both from the city of Cuzco and also many outlying highland communities of the Andes Mountains. Primary fellow responsibilities during this rotation including attending daily work rounds, assisting with admissions of new infants, and assisting with daily patient care duties. Supervision during this rotation is primarily from an attending neonatologist from the University of Minnesota Masonic Children’s Hospital, with input from attending neonatologists at the Cuzco Regional Hospital. Fellows are expected to take part in educational and teaching opportunities with the NICU staff including teaching the AAP Neonatal Resuscitation Program Course. This rotation provides a unique opportunity to use advanced Spanish language skills in speaking and writing. It is an expectation that fellows are proficient in the Spanish language prior to travel. There is also an opportunity to collaborate with several general pediatricians from Minnesota doing outreach at several local Peruvian orphanages. Fellows are expected to perform at the level of junior attending. This rotation provides a great deal of flexibility for an individualized learning plan based on interest in different international health topics. Participation in and funding for this rotation is not guaranteed and must be approved by the NPM program director.
The majority of the Neonatal‐Perinatal Medicine Fellowship consists of 18‐20 months of scholarly activity. As per the ABP, “all fellows will be expected to engage in projects in which they develop hypotheses or in projects of substantive scholarly exploration and analysis that require critical thinking. Areas in which scholarly activity may be pursued include, but are not limited to: basic, clinical or translational biomedicine; health services; quality improvement; bioethics; education; and public policy.” Traditional clinical/basic research or other scholarly activities, within neonatology, perinatology and developmental biology are facilitated by the mentors in neonatology or other related subspecialties. Neonatologists and subspecialists in other pediatric divisions supervise these studies and are instrumental in guiding the development of individual projects with appropriate specific curriculum (e.g., laboratory meetings, journal clubs, course work).
Once an area of interest is identified, fellows will work with the program director, in addition to their specific mentor and scholarship oversight committee, to develop an individualized learning plan (ILP) for scholarly activity. The goals and objectives will then be individualized to address the specific area of scholarly investigation.
The University of Minnesota and Children’s Hospitals and Clinics–St. Paul have been involved in many national collaborative trials including studies on surfactant, inhaled nitric oxide, fluconazole and the STOP‐ROP consortium. The primary venue for collaborative work has been through participation in the Center for Neurobehavioral Development. Dr. Michael Georgieff is the director of this unique multidisciplinary resource for training and research across disciplines.
Additional collaborative research is ongoing between division members and members of the Divisions of Cardiology (Lazaros Kochilas, M.D. and Jamie Lohr, M.D.) and Infectious Diseases (Mark Schleiss, M.D.) in the Department of Pediatrics; the Department of Laboratory Medicine and Pathology (Carol L. Wells, Ph.D.); the Institute of Child Development (Kathleen Thomas, M.D., and Megan Gunnar, Ph.D.); the Department of Neurosurgery & Neuroscience (Walter Low, PhD); the Center for Immunology (Marc Jenkins, PhD) and the Department of Veterinary Pathobiology (Mathur Kannan, Ph.D., and David R. Brown, Ph.D.). Several fellows have been supported on the Infectious Disease Training Grant and one completed a combined neonatal‐infectious disease fellowship. Opportunities to work with researchers in other areas at the University of Minnesota are also available. The following link provides a way to search for experts in your specific area of interest: http://experts.umn.edu
Fellows also have the opportunity to participate in graduate‐level coursework offered by The University and to obtain a Masters of Clinical Research, Masters of Public Health, Masters in Health Informatics or Masters in Bioethics. The specific curricula for these programs are listed at the respective websites (add general umn website link). Fellows have also obtained on-line certificate training in Quality Improvement and Pediatric Bioethics. The program is open to discussing options with each fellow for additional training. Participation and tuition payment cannot be guaranteed in advance and preapproval must be obtained from the program director.