USC/LAC+USC Neonatal-Perinatal Medicine
Fellowship Curriculum
Overview
The USC/LAC+USC Medical Center Neonatal-Perinatal Medicine Fellowship is a three year program designed to prepare the fellow for sub-specialty certification by the American Board of Pediatrics and train the next generation of leaders in Neonatal-Perinatal Medicine, within an innovative, collaborative, personalized, learner-centric, and safe environment to improve the health of the community.
Our program is one of the largest programs with 18 fellows; six fellow positions for each of the three years.
Our fellows rotate through 4 sites:
Los Angeles General Medical Center,
Children’s Hospital Los Angeles (CHLA),
PIH Health Good Samaritan Hospital (GSH), and
Memorial Care Miller Children’s and Women’s Hospital Long Beach.
Each fellow has approximately 12-14 months of service; 4-5 service months per year. [1st year: 2 months each at Los Angeles General Medical Center and CHLA and 2 weeks at Memorial Care Miller Children’s and Women’s Hospital Long Beach. 2nd and 3rd year: 1 month at Los Angeles General Medical Center, 1 month at GSH, 2 months at CHLA and 2 weeks at Memorial Care Miller Children’s and Women’s Hospital Long Beach].
Each fellow has up to a maximum of 60 calls per year. The calls are no more than every 3rd night. The number of calls decreases each year. [At present, 1st year: 54 calls; 2nd year: 50 calls; 3rd year: 48 calls]
Clinical Experience - Inpatient Experience
The clinical experience comprises of rotating through the Divisions’ four sites: Los Angeles General Medical Center, Children’s Hospital Los Angeles, PIH Health Good Samaritan Hospital, and Memorial Care Miller Children’s and Women’s Hospital Long Beach.
On-service faculty neonatologists conduct bedside clinical and teaching rounds in the NICUs at each of the hospitals with 24 hours a day and 7 days a week clinical coverage. These neonatal units have available advanced technologies for the treatment of complex neonatal medical conditions, including persistent pulmonary hypertension of the newborn, hypoxic ischemic encephalopathy, the spectrum of surgical cases and extreme prematurity. Nitric oxide therapy and high frequency ventilation are available at each hospital. Additionally, the NICCU at Children’s Hospital Los Angeles provides ECMO services. These represent a few examples of the many state-of-the-art technical tools available to our faculty to aid in the treatment of the sickest neonates. Importantly, clinical management practices that include the use of the latest innovative tools in the field are structured and aided by the monthly evidence-based, faculty-consensus physicians’ clinical integration meetings, by the combined effort of many years of experience from the Divisions’ neonatologists, and by the faculty’s commitment to state-of-the-art basic, translational and clinical research, resident and fellow teaching and continuing medical education through regular reviews of the research literature and attendance at local, national and international conferences.
Clinical Experience - Outpatient Experience
High Risk Infant Follow-up (HRIF) Clinic at Los Angeles General Medical Center and CHLA
BPD / Pulmonary Clinic at Los Angeles General Medical Center and CHLA
Educational experience
Fellows on inpatient rotation
Throughout the training program the fellow attends and helps (with faculty supervision) direct daily bedside teaching- and work-rounds and patient care decisions while on clinical service. At the Los Angeles General Medical Center site, he/she attends weekly fellows' conferences where topics are prepared and presented by the faculty, visiting guest speakers or the fellows themselves. The fellows also attend the morning case conferences two times a week (Monday and Wednesday), where they present clinical cases and their management for review by faculty and for academic and research-associated discourse. The fellows also participate in monthly journal club meetings; weekly neonatal-perinatal statistics rounds and high risk Obstetrics conferences; bioethics and discharge planning conferences. Third year fellows also participate in pretending attending rotations taking on supervised faculty responsibilities in all units. At Children’s Hospital Los Angeles NICCU fellows additionally actively participate in Pediatric surgery rounds, CT surgery rounds, pulmonary and or neurocritical care rounds. Program Director Lecture Series (PDLEC) occurs once a month where Program Director or a Faculty presents up to date information on current topics of interest in neonatology. Core Curriculum Enhancement Lecture Series (CORELS) occurs once a month where a Faculty presents cases within the systems-based lecture series with didactic and interactive discussion.
Core Curriculum
All Fellows have protected time to attend the weekly Core Curriculum lecture series on Thursdays. Series is typically taught by variety of Neonatology as well as subspecialty faculty at Los Angeles General Medical Center and Children’s Hospital of Los Angeles. The core curriculum is structured by systems and emphasizes specifically reviewing contents specifications for Neonatal-Perinatal Medicine sub-board of American Board of Pediatrics in an interactive fashion. Series also includes monthly GME meeting, monthly journal club, and board review.
Morning Case Conference
· Los Angeles General Morning Case Conference takes place every Monday and Wednesday.
· Fellows present a case or topic with interactive discussion and board questions.
ECMO Conference
· ECMO conference takes place once a month.
· Fellows present an ECMO topic with didactic and interactive discussion.
Core Curriculum Enhancement Lecture Series (CORELS)
· CORELS takes place once a month.
· Faculty present 2 cases within the systems-based lecture series with didactic and interactive discussion.
Mortality & Morbidity (M&M)
· M&M takes place once a month at each site.
Neonatology-Surgery Joint Conference
· Joint conference between CHLA Pediatric Surgery team and CHLA NICCU team takes place once a month.
· Fellows present a surgically-related topic with a didactic and interactive discussion.
Multidisciplinary ECMO Conference
· Joint conference between CHLA Pediatric Surgery team, CHLA NICCU team, and CHLA Critical Care team takes place once a month.
· Fellows present a recent ECMO case with interactive discussion
Maternal-Fetal Medicine/Neonatal-Perinatal Medicine Conference
· Joint conference between USC Maternal-Fetal Medicine and LAC+USC Medical Center Neonatal-Perinatal Medicine Divisions takes place weekly.
Transport/Consult Rotation
· Each fellow is involved in transport with the CHLA transport team and outpatient Maternal Fetal Medicine consults with the CHLA Fetal and Neonatal Institute.
Critical Care Journal Club
Life After Fellowship Workshop
NRP and Simulation Program
Neonatal Resuscitation Program (NRP) and neonatal simulation training programs are conducted regularly at both the Children’s Hospital of Los Angeles as well as Los Angeles General Medical Center sites of our program. Both facilities are equipped with state of the art high fidelity and low fidelity simulators as well as task trainers. SimNewB, a high fidelity mannequin used at both sites provides interactive experience with hands on training including various procedures performed during neonatal resuscitation. In addition task trainers are utilized with an emphasis on enhancing individual procedural skills of the fellows in a simulation setting.
The principal components of our simulation training program offered to Neonatal-Perinatal Medicine fellows include NRP provider courses, NRP instructor courses, boot camp training, mock codes, and Skills labs. In addition interested fellows have ample opportunities to actively participate as instructors in the simulation training for pediatric residents, nurses and other staff members. Fellows are also encouraged to join the faculty performing innovative research related to the simulation activities and outreach programs. At the Children’s Hospital of Los Angeles, the neonatal simulation program is an integral part of Las Madrinas Pediatric Simulation Research Laboratory. The laboratory also provides training and education for all pediatric subspecialties including PALS courses, ECMO simulation and various other competencies.
STABLE Course
The S.T.A.B.L.E. Program™ focuses on sick newborn care management in the gap between post-resuscitation in the delivery room and pre-transport (to a higher level of care). Six interactive learning modules comprise the S.T.A.B.L.E. Program™:
Sugar and Safe Care: fluid management and glycemic control
Temperature: methods to maintain the neutral thermal environment and minimal metabolic expense
Airway: anatomical and artificial airway maintenance, ventilation, and blood gas analysis
Blood Pressure: assessment and support of blood volume and circulation
Laboratory Work: hematology, chemistries and septic work-up studies
Emotional Support and Quality Improvement: support of the new parents and their families along with the legalities of interfacility transport and hospital admission to the NICU
S.T.A.B.L.E. Program™ Instructors at LAC+USC Medical Center include attending neonatologists, neonatal nurse practitioners, registered nurses, and respiratory care practitioners. Students in the program are Neonatal-Perinatal Medicine fellows as well as faculty, nurses, respiratory therapists and emergency medical first responders. Certification in the S.T.A.B.L.E. Program™ lasts for two years. Keck School of Medicine provides this S.T.A.B.L.E. Program™ annually for all interested care providers at LAC+USC Medical Center and Children’s Hospital Los Angeles.
Along with Neonatal Resuscitation Provider™ training, the American Academy of Pediatrics and the March of Dimes endorse the S.T.A.B.L.E. Program™ for all care team providers in the delivery room and nursery.
Ultrasound Course
Head ultrasound scans are an integral part of the care of sick newborn infants. This is the imaging mode of first choice because of ease of access. Sequential scans are now standard, and the results are used to assist in diagnosis (e.g. hypoxic ischemic encephalopathy, stroke), to aid decision making in possible withdrawal of intensive care and monitor complications and interventions (e.g. ventriculo-peritoneal shunt).
The course focuses on the identification of normal anatomical landmarks of the newborn brain as well as recognition and interpretation of common abnormal findings on ultrasound. It includes series of didactic lectures and hands on experience involving ultrasonography techniques with neonatal sonographer as well as Doppler use. The course is a part of elective radiology rotation offered at Los Angeles General Medical Center.
Objectives of the course
Identify the indications for cranial ultrasound examination
Interpret and differentiate normal as well as abnormal cranial ultrasound findings
Apprehend the factors that influence the prognosis and long term outcomes of head ultrasound findings
Understand the limitations and prognostic value of ultrasound findings
Develop expertise with obtaining evidence based medical information and review literature pertinent to central nervous system
Training for point-of-care ultrasound for Lung, abdomen, spine and other areas is also available for interested fellows.
Annual Biostatistics Course
Course Director: Dr. Cynthia Gong
An innovative Core Curriculum in Biostatistics has been developed and offered to all fellows on an annual basis. This course is taught in an interactive format with minimal didactics and by application of material learned. Each fellow receives course materials at the beginning of the lecture series including biostatistical software (STATA). At the beginning of each lecture, lessons taught in the previous class are reviewed and fellows are asked to report the results of their homework. Fellows are introduced to concepts in study design and epidemiology. They learn to propose research aims, methods and to complete an analysis during the course from a sample database provided to the fellows by the course director. Fellows do not just listen to lectures about how to do research. They learn by active participation. To optimize their learning experience, course is set up as a "graduate course". Fellows have weekly homework and a final project. Fellows’ attendance, homework and final project are submitted to the program director by the Course director at the end of this course. In addition, material reviewing the content specifications for biostatistics from the American Board of Pediatrics (ABP) is integrated into every session.
Other Courses for fellows
Procedural Boot Camp
ECMO Course
PICC Line Course
Annual Point of Care Echocardiography in the Neonate Course
Point of Care Echocardiography in the Neonate Rotation
High-Fidelity Neonatal Simulation
Multiple Electives