During the first year of training-
Clinical: Fellows do 24-26 weeks of clinical on-service responsibility at Loma Linda University Children's Hospital (LLUCH) NICU and Riverside University Health System (RUHS) NICU. Under the supervision of the attending faculty, fellows participate in teaching rounds with the attending neonatologist, attend deliveries and manage transports from outside hospitals.
Administrative/Research: Fellows have blocks of administrative responsibility during which they attend the NICU follow-up clinic weekly. 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, fellows prepare and participate in teaching conferences (e.g. Pathology Conference, Journal Club, Perinatal Conference). This time is also used to work on their scholarly project.
Research: Fellows have12 weeks of research time without administrative responsibility. They are expected to identify a scholarly project and to select a mentor and an individual scholarly oversight committee with guidance from the program director. Fellows are expected to present a review of relevant background literature associated with their project at the Scholarly Oversight Committee (SOC) meeting. They will then write a protocol, obtain IRB or ARC approval when necessary, and submit a grant for funding. Faculty mentors and the SOC meet frequently with the fellows to provide feedback and guidance.
During the second year of training-
Clinical: Fellows do 18-20 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.
Administrative/Research: Fellows continue to attend NICU follow-up clinic, prepare and participate in teaching conferences and work on their scholarly project. 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.
Research: Fellows have 16 weeks of research time with no administrative responsibilities. Research blocks 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 preliminary findings. Fellows are encouraged to attend a national research meeting and one other relevant meeting to enhance their education experience and research background.
During the third year of training-
Clinical: Fellows have 16-18 weeks of clinical on-service time in the NICU. Fellows take a senior role in supervising patient care, managing the team, conducting rounds, teaching pediatric residents, triaging and managing transport calls, and directing patient flow.
CTICU: Year 3 fellows do a two-week rotation in the CTICU.
Administrative/Research: Fellows continue to attend NICU Follow-up clinic, prepare and participate in teaching conferences and work on their scholarly project.
Fellows continue to work then complete their QI project. The fellow's project will culminate in a presentation during the monthly QI meeting.
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 presentation at national meetings. Fellows are encouraged to submit their work for publication in a peer-reviewed journal before completing their fellowship (when appropriate).
Prior to the pandemic a fellow would have the opportunity to do a rotation with one of our faculty members at the Zhejiang Children's Hospital in Hangzhou, China. Currently this rotation is to be determined.
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 block, including weekends. 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. Fellows may conduct some of the teaching conferences with faculty supervision. Some of the regularly scheduled conferences include Neo Monday, M&M/Pathology conference, NICU QI, Genetics Rounds, Prenatal Diagnosis Conference, Multidisciplinary Rounds, Vent Rounds, Journal Club, and weekly Fellows Didactic Conference that reviews a variety of clinical and board relevant 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.
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.
PRENATAL DIAGNOSES CONFERENCE(PDC)
PDC is a unique multidisciplinary conference held twice a month.
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 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 passing the neonatal-perinatal medicine board exam.
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, and Harbor-UCLA. Each facility takes a turn at hosting the meetings and inviting a guest speaker. These conferences provide 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 monthly and includes fellows from Neonatology and Critical Care Medicine. 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 by electronic and print modalities.