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LLU School of Medicine Neonatology Fellowship

Curriculum 


During the first year of training,

Clinical: The fellows have 24 weeks of clinical on-service responsibility in the Loma Linda University Children's Hospital (LLUCH) NICU. Under the supervision of the attending faculty, fellows participate in teaching rounds with the attending neonatologist three times per week and felows conducts teaching rounds independently with the resident team twice a week.

Electives: The fellows have the option of taking a two week elective in pediatric cardiology, pediatric surgery, and/or perinatology during their non-NICU rotations.

Administative/Research: The fellows have 12 weeks of administrative responsibility during which the fellow attends the NICU follow-up clinic weekly. The fellows will actively participate in the long-term follow-up of infants at high risk for neurodevelopmental disability; become skilled in their evaluation and management; and become aware of the socioeconomic impact and the psychosocial stress that such infants may place on a family. In addition, the fellows prepare and participate in teaching conferences (e.g. Pathology Conference, Journal Club). The fellows also use this time to work on their scholarly project.

Research: The first year fellow has 12 weeks of research time without administrative responsibility. The fellow is expected to identify a scholarly project and to select a mentor and an individual scholarly oversight committee with guidance from the program directors. The fellows are encouraged to present a review of relevant background literature at Fellows' Conference, write a protocol, obtain IRB or ARC approval when necessary, and submit a grant for fudning. Faculaty and the Pediatric Department Scholarly Oversight Committee (SOC) meet frequently with the fellows to provide feedback and guidance.

During the second year of training.

Clinical: The fellows have 20 weeks of clinical on-service time in the LLUCH NICU. The fellows take an increasingly active role in supervising patient care, managing the team, and conducting daily teaching with the pediatric residents.

Electives: The fellows have the option of taking a two week elective in pediatric cardiology, pediatric surgery, and/or perinatology during their non-NICU rotations.

Administrative/Research: The fellows have 12 weeks of administrative time during which they participate in the NICU Follow-Up Clinic.  The fellows will actively participate in the long-term follow-up of infants at high risk for neurodevelopmental disability; become skilled in their evaluation and management; and become aware of the socioeconomic impact and the psychosocial stress that such infants may place on a family. In addition, the fellows will prepare and actively participate in the various teaching conferences in addition to working on their research project. The fellows will identify a QI question and will obtain experience in accessing a database to tabulate and evaluate institutional and regional neonatal morbity/mortality data. The fellow's project will culminate in a presentation to the faculty.

Research: The fellows have 16 weeks of research time with no administrative responsibilities. Research months are devoted to refining scholarly project protocols, applying for funding, and completing IRB or ARC approval under supervision of the mentor and SOC members. The fellows are expected to participate actively in their projects and collect data with an interim data analysis and presentation of the perliminary findings. Fellows are encouraged to attend a national reserach meeting and one other relevant meeting to enhance their education experience and research background.

During the third year of training,

Clinical:  The fellows have 16 weeks of clinical on-service time in the NICU. The fellows take a senior role in supervising patient care, managing the team and conducting rounds, teaching pediatric residents, triaging and managing transport calls, and directing patient flow.

Electives: The fellows have the option of taking an elective month in pediatric cardiology or pediatric surgery.

Administrative/Research: During the 12 weeks of administrative time, the fellows continue to attend NICU Follow-up clinic. The fellows will actively participate in the long-term follow-up care of infants at high risk for neurodevelopmental disability; become skilled in their evaluation and management; and become aware of the socioeconomic impact and the psychosocial stress that such infancts may place on a family.

In addition, the senior fellows prepare schedules for the fellows for on-service rotations, night and weekend call in conjunction with the program directors. Additionally, the senior fellow organizes various teaching conferences and journal club. The fellows are expected to participate in scheduled seminars, multidisciplinary conferences, courses, and develop outstanding presentation skills.

The fellows will identify a QI question and will obtain experience in accessing a database to tabulate and evaluate institutional and regional neonatal morbidity/mortality data. The fellow's project will culminate in a presentation to the faculty.

Research: During the third year, the fellows continue to work with their mentor and SOC to complete data collection and analysis and write up and present their work for peresentation at national meetings. Fellows are encouraged to submit their work for publication in a peer-reviewed journal before completing their fellowship (when appropriate).

Special Research-Track Neonatal Fellowship


This fellowship pathway is intended for applicants interested in a career as a clinician/scientist in Neonatology. In addition to preparation for Neonatal-Perinatal Sub-Board certification, this fellowship position includes an additional year of protected time and support for research. Research activities during this time will be targeted towards the career goal of obtaining independent funding upon completion of the fellowship program. Research-track Fellows will choose a research mentor from amongst the faculty of the Loma Linda School of Medicine.

During Year 1 and Year 2 of training:  The schedule for the first two years will be the same as for the three year fellowship.

Year 3, Research: Fellows have 12 months of research time free of clinical on-service time in the NICU. During this year, the fellows are expected to work pimarily with their research mentor. They will immerse themselves in every aspect of their reserach project, including protocol design, data collection and analysis, presentation of their results at meetings, and publication in peer-reviewed journals. Towards the goal of establishing research support upon completion of the fellowship, fellows are also encouraged to spend this year writing applications for career development awards such as NIH K23 mechanism, which would commence upon completion of Year 4.

Year 4,

Clinical: Fellows have 16 weeks of clinical on-service time in the NICU. The fellows take a senior role in supervising patient care, managing the team and conducting rounds, teaching pediatirc residents, triaging and managing transport calls, and directing patient flow.

Electives:  The fellows have the option of taking an elective month in pediatric cardiology or pediatric surgery.

Administrative/Research:   During the 12 weeks of administrative time, the fellows continue to attend NICU Follow-up clinig, prepare schedules for the fellows for on-service rotations, night and weekend call in conjunction with the program directors. The fellows are expected to participate in scheduled seminars, multidisciplinary conferences, courses, and develop outstanding presentation skills. Additionally, the senior fellows organize various teaching conferences and journal club.

Research: During the fourth year, the fellows continue to work with their mentor and SOC to complete data collection and analysis, write up and present their work for publication in a peer-reviewed journal before completeing their fellowship (when appropriate).

Night and Weekend Call

Fellows take in-house call with either another fellow or senior neonatal nurse practitioner.  On-average, fellows take call approximately five (5) nights per month, including weekends. Weekend call begins at 2:00 p.m. on Saturday or Sunday. The on-call fellow, NNP, and residents make midnight rounds with the on-call attending neonatologist. The post-call fellow is off the next day (usually by 9:00 a.m.) after sign-over to the on-service teams.

Conferences and Educational Meetings

Our program has regularly scheduled teaching conferences, journal clubs and guest lecturers. Fellows may conduct some of the teaching conferences with faculty supervision. Some of the regularly scheduled conferences include chief's rounds, pathology conference, genetics rounds, prenatal diagnosis conference, multidisciplinary conference and weekly fellows' conference that reviews a variety of clinical neonatology topics. In addition, we provide a pediatric subspecialty core curriculum that covers topics required by the ACGME for competency for all pediatric fellows whether in critical care medicine, child neurology or cardiothoracic surgery as well as in neonatal-perinatal medicine.

Chief’s Rounds

Each week, the fellows present complicated and interesting NICU cases and participate in discussion of possible different courses of management with faculty regarding diagnosis and treatment.

Simulation Center

The Medical Simulation Center is a state-of-the-art facility that includes several simulation labs, two multimedia conference rooms and a high tech communications and control room. Simulation sessions available to the fellows include diagnosis and management of ECMO emergencies, neonatal resuscitation and parent/staff interaction scenarios. During these sessions, the fellow is asked to assume care of one of the emergencies with realistic support and manikin simulation programmed to respond to the choices the trainee makes in providing care. The entire scene is videotaped and the trainees and staff involved are debriefed afterward, identifying areas of strength and weakness in the approach demonstrated.

Fellows’ Conference

Fellows attend lectures, participate in discussions and review assigned reading material. Formats include lectures, quizzes, Q & A, case reviews, and Neonatal Jeopardy. The three-year curriculum covers a broad variety of clinical, research and administrative subjects with an emphasis on preparation for taking the neonatal-perintal medicine boards.

Southern California Joint Fellows’ Conference

Loma Linda participates in a Southern California Joint Fellows’ Conference that is held three times a year and shared with the neonatology programs at U.C. San Diego, U.C. Irvine. Each facility takes a turn at hosting the meeting that provides fellows in training with opportunities to meet colleagues at similar stages of training in other institutions and to share their research as well as interesting clinical teaching cases.

Pediatric Subspecialty Fellowship Core Curriculum

The core curriculum program for pediatric subspecialty fellows meets quarterly and includes fellows from Neonatology, Critical Care Medicine and Pediatric Neurology. The program provides a structured curriculum that covers common topics of importance to all pediatric fellowship-training programs. This is a forum for collaboration with other pediatric fellowships to provide instruction in basic science required for all fellows in pediatric fellowship training programs. Some of the topics covered in these combined classes include biostatistics, clinical and laboratory research methodology, study design, preparation of applications for funding and/or approval of clinical research protocols, critical literature review, principles of evidence-based medicine, ethical principles involving clinical and animal research, and the achievement of proficiency in teaching.

Completion of the curriculum should lead to an understanding of the principles of adult learning, and provide skills to participate effectively in curriculum development, delivery of information, provision of feedback to learners, and assessment of educational outcomes. Fellows are expected to be effective teachers for individuals and groups of learners in clinical settings, classrooms, lectures, and seminars, and also by electronic and print modalities.