Clinical Training

 

During the first year of fellowship, each fellow at Duke is exposed to delivery room resuscitation, ventilatory management, and intensive care of sick neonates, as well as the convalescent care of recovering infants. In addition, the fellow jointly manages neonatal surgical patients and patients referred to Duke from outside pediatricians, perinatologists and obstetricians. These skills are enhanced as the fellow becomes more independent during the second and third years.

Excellent clinical care depends on a broad knowledge of the underlying physiology, pathophysiology, and clinical literature. Weekly lectures, journal clubs, clinical conferences, core readings, and discussions help build a broad based fund of knowledge in neonatal medicine. During clinical training, the fellow learns the leadership skills needed to supervise a busy intensive care unit with house staff, neonatal nurse practitioners, and respiratory care specialists. In addition, the fellow participates in unit administration which includes problem identification and solutions. 

There is a broad range of lectures & seminar series available to more than meet Board and ACGME Core Curriculum requirements including Curriculum Design, Teaching Skills, Comprehensive Introduction to Clinical Research, Molecular Biology Techniques, Introduction to Evidence-Based Medicine, Grant Writing Seminar, and Medical Ethics. Master's-level programs are available to our fellows and include the Clinical Research & Medical Genomics Training Programs, and master's program in Biomedical Engineering.

Clinical Environment

The Intensive Care Nursery at Duke provides care for babies who are admitted with a wide variety of illnesses and congenital abnormalities. As of July 2022, there are 85 intensive care beds spread between Duke and its affiliate Durham Regional Hospital, with an anticipated addition of 14 beds at Duke in the near future.

All pediatric medical and surgical subspecialties are available at Duke. During the clinical rotations, fellows provide leadership and oversight of the bedside care team under the direct guidance of a faculty member. The fellows assist in the training of more junior residents and interns during their ICN rotations, and provide consultations for prenatal visits arranged with obstetrical colleagues.

All fellows participate in the administrative activities of the division. As fellows become more senior in training, they are given more clinical leadership responsibilities. The first and second year fellows coordinate joint conferences and lead discussions at patient care conferences. The senior fellows attend the weekly executive administrative meeting in the Unit and actively participate in the development of health care plans and problem solving activities. One or two  months of the senior year are spent as "junior attending" on resident team. During that time, the fellow rounds with the team and later a faculty member.

Neurodevelopmental Follow-Up and Outcomes

Fellows attend the multidisciplinary neonatal follow-up clinic (Special Infant Care Clinic) during their fellowship. During this clinical experience, fellows become familiar with the expected outcomes of various groups of high risk infants. In addition, they learn to determine whether a child's neurologic and/or developmental outcome is consistent with his/her neonatal course and whether further evaluations are indicated (i.e. neuroimaging studies, neurology consultations, genetics and metabolism consultations, etc.). Each fellow learns to perform a detailed neurologic examination of an infant through two years of age, including the careful evaluation of muscle tone and primitive reflexes. One of the goals of the training experience is learning to distinguish transient neurologic abnormalities seen commonly in premature and sick full term infants from the early precursors of cerebral palsy. Fellows are taught how to discuss the diagnosis of cerebral palsy and developmental disabilities with families. They also become familiar with various types of intervention services and their indications. Board certified physical therapists, occupational therapists, speech therapists and psychologists work hand in hand with physicians and assist in determining the need for interventional services as well as provide parent education.

Early in training, and throughout the fellowship, trainees are given the opportunity to identify infants in the NICU who they would like to follow in clinic. The distribution of patients should include extremely low birthweight infants, infants with known intracranial injury and full term infants with respiratory failure.

For fellows interested in more extensive training in neurodevelopmental follow-up and outcome research, a specialized clinical research track is available. This track of the training program includes electives in neuroimaging, pulmonary, neurology, rehabilitation, PT/OT, speech/feeding and fetal maternal medicine. It also includes the opportunity to participate in ongoing outcome research and original follow-up studies in the Special Infant Care Clinic. For more information, read about the Neurodevelopmental Follow-up and Outcomes Research Track.

• Neurodevelopmental Follow-up and Outcomes Research Track

Cardiac Intensive Care and ECMO

The neonatology fellows also have a rotation in the Cardiac Intensive Care Unit. This rotation is primarily to provide the experience and oversight of the care of postoperative cardiac surgery and ECMO patients. There are over three hundred pediatric cardiac operations performed per year at Duke. During this rotation, the fellow manages care of pediatric intensive care patients under the direction of senior Cardiac/PICU faculty. Fellows further their central vascular access skills and ventilatory management of neonates with cardiac disorders.

There is a strong relationship between Pediatric Cardiology & Neonatology, and fellows can alos have an elective rotation. This includes a seminar series & postoperative cardiac surgery experience with joint management of cardiology patients admitted to the ICN pre and postoperatively.

Maternal-Fetal Medicine 

During the fellowship years, there is a rotation within the Division of Maternal-Fetal Medicine in order to gain expertise in prenatal diagnosis, diagnostic ultrasound, prenatal genetic counseling, and multi-disciplinary consultations for complex cases. There is a weekly case conference held between Neonatal Medicine, Maternal-Fetal Medicine, and Obstetric Anesthesiology to discuss upcoming cases and management. In addition, fellows attend a monthly fetal board case review and are responsible for perinatal counseling under the direction of the neonatal and obstetric faculty.