Neonatal Perinatal Medicine Fellowship Program

The program emphasizes the fundamentals through the intrapartum and neonatal periods– including assessment of outcomes. Fellows have ample opportunities for clinical and basic science research. A special effort is also made to help fellows acquire and practice formal teaching skills. Graduates of the program will be well prepared for an academic as well as clinical career.

This three-year program includes in-depth clinical training as well as a robust schedule of didactic lectures and conferences and involvement in clinical or laboratory research, which is intended to lead to presentation at a national or international meeting and/or publication in a peer-reviewed journal.

The first year of training involves approximately five months of clinical time in the NICU working closely with the attending neonatologist. Fellows gain experience in the assessment of high-risk pregnancies, antenatal consults, delivery room care and resuscitation, transportation of the critically ill neonate by ambulance or helicopter, all aspects of care of extremely low birth weight infants, and high technology therapy such as high frequency ventilation (Jet and Oscillator), extracorporeal membrane oxygenation (ECMO), nitric oxide therapy, and whole body cooling for neonatal hypoxic ischemic encephalopathy.

Fellows supervise and perform a variety of procedures, including umbilical venous and arterial catheterization insertion of peripheral arterial catheters, percutaneous central venous catheters, and thoracostomy tubes. They supervise residents and medical students, and work with nurse practitioners and physician assistance during their clinical rotations.

During a two-week rotation in the Maternal Fetal Medicine Service, fellows learn to assess high-risk pregnancies via antenatal testing, genetic amniocentesis, and fetal ultrasonography. Fellows provide consultations for high-risk obstetrical patients, discuss management of high-risk deliveries and fetal monitoring, and participate in perinatal-neonatal conferences throughout the three years of fellowship. They attend 16 High-Risk Follow-up and four Developmental Outpatient clinic sessions, in order to learn the outpatient management of NICU graduates.

The balance of their time in the first year is spent on research and scholarly activity, learning the essentials of study design and statistics. They are encouraged to develop their own projects under the guidance of the research mentor. They participate in all departmental and divisional teaching activities.

The second year of training includes approximately four months of clinical service in the NICU, where fellows further refine their clinical and supervisory skills. Fellows continue to participate in the outpatient High-Risk and Developmental follow-up clinics. Pediatric cardiology and cardiovascular surgery training at Children’s National Medical Center in Washington, D.C is provided during a four-week rotation in either the second or third year of the fellowship program. In either the second or third year of the fellowship program, fellows will round four-weeks at MedStar Washington Hospital Center NICU (level IIIB NICU), part of the MedStar Health system, and round three weeks at Sibley Memorial Hospital NICU (level II). There is increased emphasis on research during the second year with time spent in laboratory or clinical research. Close involvement with research mentors during this time is essential to ensure appropriate progress toward the goal of a completed research project, leading to a peer-reviewed publication by the end of the period of training.

The third year is primarily devoted to research, with three months of NICU inpatient service and one month of high-risk outpatient/developmental follow-up. The research time in the second and third year are tailored to the individual needs and goals of the fellow, depending on the type of research preference. There are opportunities for clinical and basic science research at the Georgetown University Medical Center and at the National Institutes of Health.

Call schedule

Night and weekend calls continue throughout the three-year period, are in-house, and average to one in six nights. The program conforms to the ACGME requirements for duty hours.

Vacation

Fellows are allowed four weeks of vacation in each year of training.

All division members are actively involved in clinical or laboratory research. Research opportunities are not restricted to the Division of Neonatology, and the fellows are encouraged to explore avenues of research with any faculty member at MedStar Health Georgetown University Hospital, Georgetown University Medical Center, or the National Institutes of Health.

Clinical research may be conducted in the Neonatal Intensive Care Unit, which receives about 400 admissions per year, or in the high-risk follow-up clinic, which receives about 600 patients each year. The laboratory facilities include 400 square feet of dry and wet laboratory space. A large simulation laboratory is also under development.

A Scholarship Oversight Committee (composed of the research mentor and two or more individuals, at least one of whom is outside the subspecialty discipline of Neonatology) is appointed in the first year to monitor the fellow’s progress. The research mentor guides the fellow in developing the research hypotheses, designing the study, and developing the protocol. 

Four to five months of research time are provided in the first year of training to allow the residents to initiate the process of protocol development and to allow sufficient time for the various approval processes (Institutional Review Board or Animal Care and Use Committee) to take place so that data collection may begin in a timely fashion.

The division has a research coordinator available to assist in clinical research. Fellows receive assistance with data analysis and manuscript preparation by the senior author/faculty member. There is a formal research methodology course, which emphasizes study design, formulating the right question, data collection and analysis, as well as data presentation. Additional teaching of research methodology occurs as part of Journal Club discussions, where each fellow critiques a published paper on the basis of validity of the research, the study design, methodology, and appropriateness of conclusions.

There are also scheduled scholarship oversight committee (SOC) meetings, where proposed research protocols by fellows are presented and discussed in detail with constructive critique provided by faculty and subspecialty residents. Material learned in the didactic course is put to practical use and reinforced during the design and implementation of each fellow’s research project. 

Fellows are encouraged to present their work at national and international meetings.