The University of Maryland Neonatal-Perinatal fellowship training program provides fellows with a comprehensive educational experience in the care of the critically ill newborn. Emphasis is placed on the fundamentals of clinical diagnosis and management of problems seen in the continuum of development from the prenatal through the intrapartum and neonatal periods, including longitudinal follow-up. Protected time for scholarly work during the second and third year allows fellows time to focus on their research experience.
The University of Maryland Medical Center serves as the primary site for clinical training. Our 40 bed NICU is has approximately 500 admissions annually, including more than 100 surgical cases and 150 neonatal transports. A wide range of pediatric subspecialty care is available, including ECMO. The University of Maryland is the major referral center for high-risk maternal transports in the State, with more than 100 maternal transports annually. UMMC NICU is expanding to a new, state of the art, 52-bed, single room family centered unit in 2014!
Our clinical core curriculum of didactic conferences is focused on the ACGME program requirements and content specifications for the neonatal board exam provided by the American Board of Pediatrics. Our NICU Follow-up Program allows for longitudinal follow-up of NICU graduates and involvement with a multidisciplinary team.
Close mentoring of fellows by faculty is integral to the success of our program. Each fellow is provided direct feedback by clinical faculty after all clinical experiences and every 6 months with the program director throughout the course of training. Each fellow chooses a clinical mentor who serves as a source of support, a role model for professional development and practice improvement, and a resource for career counseling. Faculty and fellows meet together annually to provide an ongoing internal review of the fellowship training experience.
First year fellowship
Clinical training and acquisition of specialty-specific skills are the main objectives of the first year of training. The first year neonatal-perinatal fellow completes 6 clinical rotations (months), including orientation, 4 months assigned to a team of pediatric residents or NNPs, and one clinical elective month. Fellows participate in NICU Follow-Up Clinic as a member of the multidisciplinary team. Under direct supervision by the attending physician, first year fellow rotations in the NICU are focused on neonatal resuscitation and delivery room management, procedural experience, developing teaching and leadership skills, and management of disease processes common to the newborn and preterm infant. First year fellows learn to utilize various modes of respiratory support including synchronized intermittent mandatory ventilation and high frequency ventilation. They participate in new fellow “boot camp” in Philadelphia, procedure lab, and monthly simulations to gain experience in counseling families, and procedures such as intubation, umbilical line placement and chest tube insertion. During the first year of training, fellows are certificated as instructors for the American Academy of Pediatrics Neonatal Resuscitation Program. Under guidance by program leadership, each fellow selects a research topic and research mentor in the first half of the year. Fellows submit a formal proposal for scholarly activity for approval by the pediatric departmental scholarship oversight committee in the spring of the first year. Toward the end of the first year, fellows typically obtain IRB approval and begin scholarly work, under close supervision by their research mentor and scholarship oversight committee.
Second year fellowship
During the second year, clinical rotations are focused on management of complex clinical problems in the NICU. Second year fellows begin to independently formulate a differential diagnosis and treatment plan for critically ill newborns. Fellows continue to focus on leadership and teaching skills, supervision of the NICU team, and interactions with consultants and family members during clinical months. Fellows continue to participate in NICU Follow-Up Clinic as a member of the multidisciplinary team. Fellows complete two months in the NICU and one elective rotation, with an emphasis on scholarly activity during the second year (eight months). Fellows participate in scholarly core curriculum didactics that are helpful in understanding research methodology, and have eight months to conduct their approved scholarly activity under the supervision of their research mentor and scholarship oversight committee.
Third year fellowship
During the third year, skills necessary to practice neonatology competently and independently are emphasized. Fellows complete three months in the NICU, with one month as a “junior attending” supervising a NICU team. Third year fellows continue to participate in NICU Follow-Up Clinic. Third year fellows have the opportunity to spend eight months focused on scholarly activity, including presentation of their work at local and national meetings, and completion of their final work product, often a manuscript submitted for publication.
Maryland Regional Neonatal Transport Program
The University of Maryland shares with Johns Hopkins Hospital the responsibility of coordinating the Maryland Regional Neonatal Transport Program, which serves the entire state of Maryland and areas of the four adjoining states. The primary transport personnel are neonatal nurses, nurse practitioners, and EMT's. NICU fellows gain experience with the transport program while on-service and call, and spend 2 months rotating on the consult, delivery room, and transport team. For critically ill infants, or those with complex or multiple system disorders, the neonatal fellow may accompany the primary team on transport.
NICU Follow-up Program
The UMMS NICU Follow-Up Program is a multidisciplinary clinic that provides ongoing evaluation and guidance related to the development of high-risk children during the first three years of life. There are >1000 visits per year with referrals from NICUs throughout the state of Maryland. Each fellow attends ~10 clinic sessions per year. They have the opportunity to follow longitudinally the developmental progress of babies they cared for in the NICU. They participate in the assessment of these children using the Best Beginnings Development Screen, a developmental screening tool developed at the University of Maryland specifically for preterm infants. The fellows are part of a multidisciplinary team that includes a developmental pediatrician, early intervention service coordinator, infant specialist, occupational therapists, physical therapists, psychologist, and speech and language pathologist.
Call Schedule and Duty Hours
Our program is compliant with the ACGME and UMMC GME duty hours policy. Fellows take approximately 4 in-house calls per month. Each fellow has 2 call-free months per year.
Our program provides a comprehensive experience in scholarly activity that prepares fellows for a career in academic neonatology and meets requirements for certification in neonatology by the American Board of Pediatrics. Each fellow chooses an area of interest for research, and is closely supported by an experienced research mentor and scholarship oversight committee. All fellows complete a work product and have the opportunity to present their research at local and national meetings.
Scholarly Core Curriculum
Fellows participate in a scholarly core curriculum during their 3 years of training that includes topics such as biostatistics, basic science techniques, research study design and methodology, evidence-based medicine, ethics, teaching skills, and scientific writing. Curriculum formats include in-depth 1-2 week courses, one-day topic-specific conferences, and individual lectures.
A wide range of research opportunities are available at University of Maryland. With more than 15,000 square feet of research space, the Department of Pediatrics manages many active funded programs. Some of the active areas of research in the Division of Neonatology include brain and lung development, and the role of inflammation in neonatal brain, lung, and intestinal injury. The Department of Pediatrics is in the top 10 of state-funded schools for research grants. Please see faculty web page for research interests within the Division of Neonatology.
Each fellow completes a research project during their fellowship training (e.g. clinical, basic, translational research, educational curriculum development, or health services, to name some of the possibilities). Our fellowship has a structured curriculum in scholarly activity that allows fellows sufficient protected time to focus on their research, with emphasis on direct mentoring and support necessary for successful project completion. Fellows have the opportunity to present their work at regional and national meetings of professional societies. Clinical fellowship can be combined with a Masters in Clinical Sciences, Masters in Public Health, or PhD for Clinicians Program.