The Division of Neonatal-Perinatal Medicine at UT Southwestern Medical Center offers an accredited 3-year training program in Neonatal-Perinatal Medicine. The program's primary goal is to prepare physicians for a career in academic medicine. As such, the training program integrates a strong background in basic and/or clinical research with excellent clinical training in neonatal medicine. Positions are available for 3-4 trainees each year; generally starting in July, but start dates are flexible.
Applicants for a position starting in July 2009 and beyond should use ERAS and the Neonatal-Perinatal Match Program, as explained on the web site of the Organization of Neonatal-Perinatal Medicine Training Program Directors (ONTPD). Applicants will need to provide a Curriculum Vitae, an overview of long term goals, 3 letters of recommendation, and USMLE scores and evidence of ECFMG certification when applicable.
For pictures and biographical sketches of our current Fellows and recent graduates, please click here.
Faculty
The Division consists of 20 faculty, including 12 neonatologists and 8 general pediatricians. Areas of interest and research include fetal and neonatal cardiovascular development and physiology, pulmonary vascular development and function, etiology of chronic lung disease, delivery room resuscitation, neonatal infection, randomized trails in neonatal care (NIH Neonatal Network) and follow-up of the high-risk infant. Since our program is closely integrated with the Departments of Biochemistry, Obstetrics/Gynecology, Pharmacology, Physiology, Cell Biology, and Neuroscience, additional research opportunities are available.
Clinical Training Program
- Recent Honors and Awards received by Neonatology Fellows:
- Clinical Investigator Award (AAP Section on Perinatal Pediatrics): Kimberly Stewart, Walid Salhab; Prameela Karimi (2005)
- Travel Awards (AAP and APS-SPR): Lena Shalak, Kimberly Stewart, Prameela Karimi , Chad Barber, Hlwelekazi Bomela
- NRP Young Investigator Award. Chad Barber (2006): Randomized Controlled Trial of Endotracheal versus Intravenous Administration of Epinephrine During Neonatal Cardiopulmonary Resuscitation in Asphyxiated Piglets. Research Mentor: Myra Wyckoff, MD.
- Teaching Fellow of the Year Award. Arpitha Chiruvolu (2005-06): Dept. of Pediatrics, University of Texas Southwestern Medical Center, Children’s Medical Center:
- 2005-06 Klaus Perinatal Research Award from the American Academy of Pediatrics: Becky Ennis
- 2007-08 Klaus Perinatal Research Award from the American Academy of Pediatrics for her project entitled “Effects of very low birth weight, prematurity and postnatal growth on blood pressure during the first 3 years of life:” Andrea Duncan
Facility: Parkland Memorial Hospital - ~ 16,000 deliveries per year, predominantly inborn population
- Intensive Care Nursery: 72 beds - ~ 1500 admissions yearly
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- Intensive Care: 24 beds - ~ 500 admissions yearly
- Intermediate Care: 46 beds
- Surgical Intensive Care: 6 beds
- Continuing Care: 25 beds (staffed by PNP's)
Facility: Children’s Medical Center of Dallas
- Low-Birth-Weight Follow-Up Clinic: staffed by 2 Pediatric Nurse Practitioners, 1 Physician Assistant, 1 Follow-Up Physician, 1 Developmental Specialist, 1 Dietician, 1 Social Worker, and research staff and provides primary care up to 3 years as
needed.
- Neonatal Intensive Care Unit: referral center, predominantly for surgery
- Opened March 2007, staffed by neonatologists and NNPs
- 5 beds, increasing to 10 beds in the Fall 2007 and 15 beds in January 2008
- Cardiovascular Unit
- Exposure to cardiac surgery (~ 25 infants per rotation)
Clinical Rotation Schedule: 15 rotations in 4-week blocks
Year 1: 1 rotation at Term Nursery
3 rotations at NICU at Parkland NICU
1 rotation at High-Risk Obstetrics
1 rotation at Labor and Delivery
1 rotation at NICU at Children’s NICU
Year 2: 2-3 rotations at NICU at Parkland
1-2 rotations at Children’s NICU
Year 3: 1 rotation at NICU at Parkland NICU
1 rotation at NICU at Children’s NICU
1 rotation at NICU at Children’s CVICU
Year 2 or 3: 1 rotation at LBW Follow-up
To see a detailed review of Fellow guidelines and responsibilities while at CMC, please click here.
Research Training Program
- Peer-Reviewed Grant Funding
- NIH: 6 grants
- American Academy of Pediatrics: 2 grants (NRP)
- American Heart Association: 1 grant
- Klaus Perinatal Research Award: 2 grants
- NRP Young Investigator Award: 1 grant
- Areas of Research:
- Maternal and fetal placental blood flow, cardiovascular development, smooth muscle development and function
- Control of pulmonary vascular development and function and pathogenesis of chronic lung disease
- Cardiovascular changes associated with delivery
- Controlled clinical trials in neonatology (original member of NIH NICHD Multicenter Network of Neonatal Intensive Care Units)
- Effects of care on long term outcome
- Mechanisms modulating blood pressure
- Neurologic sequelae in high-risk infants
- Relationship between antepartum events and neonatal outcome
- Mechanisms of lung injury and novel therapies to prevent BPD
- Growth factor signaling
Required Coursework
Fellows' Physiology Course
(Thur 07:45-09:00, first and third Thursdays of each month)
Presentations by fellows and faculty covering all aspects of development, physiology and pathology relative to the fetus and neonate. The curriculum is designed to be completed over a 3 year period. Directed by Dr. Charles Rosenfeld.
Biomedical Statistics
Formal course in introductory statistics, taken during the second and/or third year. Directed by faculty in Department of Clinical Sciences.
Epidemiology and Evidence-Based Medicine
(Thur 07:45-09:00, 2nd and/or 4th Thursday of each month)
Designed to facilitate understanding of experimental design, conduct of clinical trials, and evaluation of pertinent medical literature. This course runs parallel with the Physiology Course and addresses therapeutic alternatives specifically related to the pathologic problem under discussion. Directed by Dr. Myra Wyckoff.
Teaching Conferences
- High Risk Obstetrics*
(Mon 08:00-09:15, 5 South-South Conference Room)
Maternal-Fetal Medicine fellows present and discuss cases on the High-Risk Pregnancy ward. Attended by faculty, fellows and housestaff in Obstetrics and Pediatrics.
- Resuscitation Conference
(Mon 12:00-13:00, 5 South-South Conference Room, 2nd and 4th Monday)
Delivery room and NICU resuscitations from the preceding weeks are critiqued and discussed. Attended by fellows, housestaff, nurse practitioners and nurses from Labor and Delivery and the NICU. Directed by Dr. Myra Wyckoff.
-
Department Faculty Research Conference**
(Tues 07:30–08:00, F3.112, September through June)
Current research projects by pediatric faculty members are presented for interactive comment and suggestions
- Children's Medical Center NICU Case Presentations, Morbidity and Mortality
(Tues 12:00-13:00, CMC NICU)
Multidisciplinary review of unique patient cases are discussed
- Pediatric Grand Rounds**
(Wed 08:00-09:00, Moore Auditorium, CMC)
Current pediatric topics are presented by invited speakers or faculty
- Physiology/Pathology Course
(1st and 3rd Thursday, 07:45-08:45, F3.112, September through June)
Fellows present updates on neonatal topics (see above under "Required Coursework")
- Evidence Based Medicine Conference
(2nd and 4th Thursday, 07:45-08:45, F3.112, September through June)
Teleconference session to review existing evidence for therapy of neonatal diseases (see above under "Required Coursework")
- Morbidity-Mortality Conference
( 2nd and 4th Thursday, 12:00-13:00, 5 South-South Conference Room,of each month)
Neonatology fellows and faculty, faculty in Pediatrics, Obstetrics, Surgery, and Pathology present and discuss casess from the preceding months. Supervised by Dr. Prameela Karimi.
- Course for Postdoctoral Fellows#
(Thur 17:00-18:00, F3.112)
Faculty present lectures and discussions regarding need for continuing education, career choices, animal and human experimentation, experimental design, writing grants, use of molecular and cellular biology in research. Attended by Pediatric fellows from all Divisions.
- Division Research Conference
(Fri 07:45-08:45, F3.112, September through June)
Neonatology faculty and fellows and other UT faculty present completed research and work in progress three weeks of each month. Once a month, a Journal Club is held in which the Division faculty present recent literature regarding clinical or basic research relevant to the neonate. Critically appraised topics (Neo-CAT) are presented every quarter.
- Prenatal Diagnosis
(2nd and 4th Friday, 12:00-13:00, G6.200)
Obstetrical Staff present cases with prenatally diagnosed abnormalities for discussion of planned delivery and care. Discussion of methods for prenatal diagnosis. Directed by Dr. Jodi Dashe, Department of OB/Gyn.
* Not for fellows on clinical service at Children’s Medical Center NICU
** Elective, except for those relevant to subspecialty
# Excused if on clinical service or post-call
All positions for July 2008 have been filled.
Applications for July 2009 must be done via NRMP and ERAS.
If you have any questions, please do not hesitate to call Diane Cockrell, Fellowship Training Program Coordinator at (214) 648-2835, or to email her at diane.cockrell@utsouthwestern.edu.
For pictures and biographical sketches of our current Fellows and recent graduates, please click here.
EDUCATIONAL GOALS
FOR TRAINEES IN NEONATAL-PERINATAL MEDICINE
THE UNIVERSITY OF TEXAS SOUTHWESTERN MEDICAL CENTER at DALLAS
The overall goals of the postdoctoral training program in Neonatal-Perinatal Medicine at the University of Texas Southwestern Medical Center are to provide an environment that will permit each trainee to develop their skills in the clinical care of the neonate to the highest level of excellence possible based on a knowledge of fetal and neonatal physiology and evidenced-based approaches to therapy and to have sufficient protected time to develop their skills in the design, understanding and performance of clinical and/or laboratory research that will result in a better understanding of fetal and/or neonatal development, physiology and pathology. The clinical rotations are outlined below.
The curriculum contains several conferences and courses described below that are held throughout each academic year and serve to provide an enhancement of each trainee's understanding of developmental physiology and pathology and clinical management.
General points regarding the Fellowship:
Core Curriculum
The ACGME and RRC for Neonatal-Perinatal Medicine have mandated that all trainees complete their education by addressing 6 core competencies. These include: Patient Care, Medical Knowledge, Interpersonal and Communication Skills, Practice-based Learning and Improvement, Professionalism, and Systems-based Practice.
To accomplish this goal, various topics must be covered and include Bioethics, Biostatistics, Evidenced-based medicine, Achievement in education and teaching, Critical review of the literature, preparation of grants, and understanding experimental design. To achieve this, the Department of Pediatrics at UT Southwestern Medical School has established a conference for all postdoctoral subspecialty trainees that will address in part the core competencies.
Although several of these requirements will be achieved through Division activities, e.g., Journal Club, Research Conferences, Course on Evidence-based Medicine, etc, others require that the trainee attend the Fellows’ Conference and sign in to receive credit during the 3 year training program. Satisfactory completion of the training program requires that the core competencies be completed.
In House Call
Since the schedule for patient coverage is limited to a maximum of 80 hr per week with no continuous period of patient care greater than 30 hr, a program using a night float system has been instituted and will be strictly adhered to in order to abide by the rules of the ACGME and the RRC of the Sub-Board of Neonatal-Perinatal Medicine.
Trainees assigned to the NICU will share night call with at least two trainees assigned to night float. All night call will be in the hospital unless discussed with the attending and approved beforehand, this is generally for short periods. When a trainee assigned to the NICU is not on-call, they are expected to be in the NICU between 7:00 am and 5:00 pm. Sign out to the on-call trainee will start at 4 PM, who will make evening rounds with the attending faculty between 4 pm and 5 pm.
If a trainee assigned to the NICU is on-call, they will no longer be assigned new patients after 7:00 am the morning after in-house call and will complete their patient care assignments by 1:00 pm after completing patient care rounds. The night float is expected to conduct the resident evening sign out rounds at 3:00 pm and will complete their call at 7:00 am the next morning, at which time they can return to their laboratory assignments.
Weekend night call will end at 7:00 am on Saturday, Sunday and Monday, generally extending for 24 hrs. The "goal" on Saturday and Sunday is to complete patient care rounds by 12:00 pm. The trainee will be responsible for determining the order of work rounds, seeing patients on both patient-care teams, and making plans for the next 24 hrs.
For further information, please contact Diane Cockrell, Fellowship Training Program Coordinator at (214) 648-2835, or to email her at diane.cockrell@utsouthwestern.edu.
For pictures and biographical sketches of our current Fellows and recent graduates, please click here.
DETAILS OF OUR FELLOWSHIP'S 3-YEAR CURRICULUM:
Year #1:
Term and Late Preterm Newborn Nursery at Parkland (one 4-week block)
Goal: During the rotation the trainee will
1) be introduced to the broad spectrum of clinical problems seen in the term neonate that may not require admission to the Neonatal Intensive Care Unit (NICU), e.g., maternal chorioamnionitis, transient tachypnea of the newborn, neonatal abstinence syndrome, and infant feeding problems;
2) begin learning about and assuming responsibility for resident-medical student education under attending supervision;
3) learn appropriate triage criteria to and from the newborn nursery, and
4) have the opportunity to refresh NRP skills at lower risk deliveries under the supervision of nurse practitioners. During this rotation the trainee will be assigned to the NICU every 4th night from 3:00 PM to 12:00 am. This will introduce the trainee to the functions of the NICU, which may be new to the trainee, and allow him/her to assist in the care of neonates in the NICU, perform procedures when indicated, and attend higher risk deliveries, under the guidance of a senior fellow and/or Neonatal Nurse Practitioner (NNP). He/she will provide clinical care under the supervision of a 2nd or 3rd year fellowship trainee. This will prepare the trainee for subsequent rotations in the NICU.
Neonatal Intensive Care Nursery at Parkland (three to four 4-week blocks)
Goal: To introduce the trainee to the physiology, pathophysiology and unique problems of the sick preterm and term neonate and the well preterm low-birth-weight neonate, to begin development of expertise in resuscitation, stabilization and care of the at-risk neonate from birth to discharge, and to permit the trainee to develop skills in performing procedures and supervising and teaching pediatric residents and 4th year medical students on electives. In initial rotations the attending physician will conduct teaching and patient care rounds. The trainee will gradually assume this role as he/she shows evidence of increasing expertise and confidence. The trainee is expected to demonstrate the ability to interact with all members of the patient care team, e.g., nurses, respiratory therapist, and dieticians.
By the end of year one, the trainee should:
1) understand the pathophysiology for problems commonly seen in the NICU and be capable of diagnosing and providing care for these problems, e.g., respiratory distress syndrome, patent ductus arteriosus, apnea of prematurity, neonatal sepsis, preterm anemia, necrotizing enterocolitis, neonatal nutrition, feeding intolerance, and basic fluid and electrolyte therapy;
2) develop skills in the placement of umbilical catheters and chest tubes, thoracentesis, intubation and peripheral percutaneous central catheters (PIC lines); and
3) acquire knowledge in the use of conventional mechanical ventilation and NCPAP. If the trainee is considered deficient in any area of clinical care, as determined in the faculty biannual assessments, the trainee will be assigned additional clinical months in the NICU during the second year.
Neonatal Intensive Care Nursery at Children's Medical Center (one 4-week block)
Goal: To introduce the trainee to the physiology, pathophysiology and unique problems of the pre- and postoperative neonate, stabilization and care of the at-risk neonate before, during and after transport, and to permit the trainee to develop skills in performing procedures and to collaborate with a multidisciplinary team involving surgical disciplines. In initial rotations the attending physician will conduct teaching and patient care rounds. The trainee will gradually assume this role as he/she shows evidence of increasing expertise and confidence. The trainee is expected to demonstrate the ability to interact with all members of the patient care team, e.g., nurse practitioners, nurses, respiratory therapist, dieticians, surgeons, and anesthesiologists. Because of the complexity of the patients, first year fellows will rotate in the CMC NICU only during the second half of the year.
The CMC NICU admits exclusively outborn neonates, who are being transferred predominantly for specialized surgery that is not available in other NICUs in the region. Thus, this rotation is designed to expose trainees to transports and to the perioperative care of the most complex patients. Daytime and nighttime teams at the CMC NICU include one or more advanced practitioners and one fellow, but no house officers. As at the PMH NICU, the fellow in neonatal-perinatal medicine serves as leader of the team. Night coverage is assured by either one or two advanced practitioner(s) or one advanced practitioner and one fellow.
To see a detailed review of Fellow guidelines and responsibilities while at CMC, please click here.
High-Risk Obstetrics at Parkland (one 4-week block)
Goal: To develop an appreciation for and an understanding of the problems encountered by the obstetrician in the care of the high-risk pregnancy, to learn how they are addressed as out-patients using prenatal diagnostic techniques and in-patients using the High-Risk Pregnancy Ward, and to understand how the Neonatal-Perinatal Physician participates in this care as a consultant.
Resuscitation at Parkland (one 4-week block)
Goal: To develop an understanding of the principles of stabilization at birth, assessment in the delivery room, use and assignment of Apgar Scores, and when and how to initiate measures necessary to maintain respirations, heart rate and "adequate" oxygenation (resuscitation). Each trainee will be NRP certified in the first month and will use these skills during the month. Each Trainee will assist in the consultation of high-risk pregnancies and assist in the admission of neonates to the NICU and their stabilization.
Research (five 4-week blocks)
Goal: In the first year, the research experience is primarily directed toward developing a clinical- or laboratory-based research project under the supervision of a faculty mentor at the Medical School that will provide an initial research experience. The trainee is expected to participate in the development and design of the project in the first year, to learn investigative methods, and to present the background, rational and initial experimental design at a Division Research Conference by the end of the first year. An Oversight Committee, made up of 3 persons including the mentor and up to 2 faculty outside of the Division, will participate in the evaluation of the research project throughout the training program.
Year #2:
Neonatal Intensive Care at Parkland (two to four 4-week blocks)
Goal: To continue to build upon the clinical care and teaching skills acquired in the first year of training and to permit a greater role in conducting teaching and patient care rounds with residents and medical students.
The trainee is expected to demonstrate:
1) additional understanding of the complexities of fetal/neonatal physiology and the pathophysiology of neonatal problems, which now include more complex entities, including fetal/neonatal growth abnormalities, hypoxic-ischemic encephalopathy, seizures, persistent pulmonary hypertension, chronic lung disease, hypotension and the use of pressors, and care of neonates with congenital anomalies;
2) an increased ability to supervise and direct a patient care team;
3) continued professionalism as it related to interactions with parents and all members of the patient care team; and
4) continued development of skills related to the procedures outlined in year 1 plus placement of percutaneous arterial catheters and use of high frequency ventilation.
If deficiencies are noted in the trainee's ability to understand the mechanisms associated with the sick neonate, to provide adequate care, to perform essential procedures, or to interact with members of the patient care team, as determined by biannual assessments, which may be more frequent in this case, the trainee will be assigned additional clinical months in the NICU during the second and/or third years of training.
Neonatal Intensive Care Nursery at Children's Medical Center (one 4-week block)
Goal: To build on knowledge and experience acquired during the first year. The trainee will continue to learn the physiology, pathophysiology and unique problems of the pre- and postoperative neonate, stabilization and care of the at-risk neonate before, during and after transport, and further develop skills in performing procedures and collaborating with a multidisciplinary team involving surgical disciplines. The trainee will start to assume the role of team leader as he/she shows evidence of increasing expertise and confidence. The trainee is expected to demonstrate the ability to interact with all members of the patient care team, e.g., nurse practitioners, nurses, respiratory therapist, dieticians, surgeons, and anesthesiologists.
To see a detailed review of Fellow guidelines and responsibilities while at CMC, please click here.
Research (eight to nine 4-week blocks)
Goal: In the second year, the trainee is expected to continue to develop expertise in the design and conduct of clinical or laboratory research. The trainee is expected to demonstrate an increased understanding of the principles used in research and to demonstrate progress from the first year.
Each trainee will present a progress report at the Division Research Conference at mid-year of the second year of training, and the trainee is expected to meet with the Oversight Committee every 6 months to determine progress. A course in biomedical statistics and/or experimental design is required at this time to facilitate the understanding of experimental design and analysis.
Biomedical Statistics
Goal: To understand the basic use and limitations of statistical analyses commonly employed in the evaluation of clinical and/or laboratory research in order to be able to complete their research project and to critically evaluate the research literature. The trainee is expected to pass a formal introductory course in biomedical statistics.
Year #2- Year #3
Long-Term Follow-up at Children's Medical Center (one 4-week block)
Goal: To develop an understanding of normal and abnormal development, the complexities of care often required by the very-low-birth-weight neonate after discharge from the hospital, and the issues that must be addressed by the parents or care givers. The trainee will be expected to be available to see these patients in conjunction with the staff in the Clinic and to develop an understanding of the tools used to assess outcome and development. Each trainee will spend a 4-week rotation (in one block or in the equivalent time in shorter periods) in the Clinic working with the staff.
To see a detailed review of Fellow guidelines and responsibilities while at CMC, please click here.
Year #3
Neonatal Intensive Care at Parkland (one 4-week block)
Goal: To continue to build upon the clinical and interpersonal skills acquired in the first two years and to develop a greater role in conducting teaching and patient care rounds with the pediatric residents and medical students.
The third year trainee is expected to be:
1) capable of assuming full responsibility for all teaching and clinical decision making by the end of the third year and
2) to be able to justify all approaches to care, using an understanding of the disease processes and the available literature, i.e., evidence-based medicine.
The rotation will vary from 1–4 mon depending on the skills and progress of the trainee. Trainees that have not made adequate progress will be required to have more clinical months in the NICU.
Neonatal Intensive Care Nursery at Children's Medical Center (one 4-week block)
Goal: To complete the development of knowledge and experience acquired during previous years. The trainee will continue to learn and teach the physiology, pathophysiology and unique problems of the pre- and postoperative neonate, stabilization and care of the at-risk neonate before, during and after transport, and further develop skills in performing procedures and collaborating with a multidisciplinary team involving surgical disciplines.
The trainee will start to assume the role of team leader as he/she shows evidence of increasing expertise and confidence. The trainee is expected to demonstrate the ability to interact with all members of the patient care team, e.g., nurse practitioners, nurses, respiratory therapist, dieticians, surgeons, and anesthesiologists.
To see a detailed review of Fellow guidelines and responsibilities while at CMC, please click here.
Research (eight to nine 4-week blocks)
Goal: To further develop expertise in the design, conduct and now analysis of clinical or laboratory research, and to be able to apply to the appropriate institutional committees for permission to perform a research project. The trainee is expected to demonstrate continuing progress in understanding the basic principles employed in research and demonstrate adequate progress in their project from the first and second years. Each trainee will present two research conferences in the third year.
The first is early in the year and serves as an update and to identify any new areas of investigation. The second presentation is given at the end of the third year as a standup, formal presentation followed by questions and answers. Each trainee will complete at least one "primary" research project during the three years and be able to prepare that project for presentation at national and/or international scientific meetings and ultimately for publication. The latter must be accomplished before applying for Sub-Board eligibility. Several of these research months may be call free. The trainees are expected to continue to meet with their respective Oversight Committees in order to determine progress and to assess the research project for Sub-Board approval.
To see a detailed review of Fellow guidelines and responsibilities, please click here.
Cardiovascular Intensive Care Unit (CVICU) at Children's Medical Center (one 4-week block)
Goal: The main goal of the rotation is to assure exposure of the fellows in Neonatal-Perinatal Medicine to pre- and post-operative cardiac patients, primarily neonates and infants, so as to focus learning on congenital heart disease physiology and mechanical circulatory support (particularly extracorporeal membrane oxygenation or ECMO). Thus the experience will include direct clinical management of cardiac patients to facilitate acquisition of the knowledge and skills required to care for them. During the rotation in the CVICU at CMC, the fellow in Neonatal-Perinatal Medicine will take in-house call at CMC on at least an every 4th night basis with the ICU/Cardiology fellow or cardiac nurse practitioner.. The fellow in Neonatal-Perinatal Medicine will have no calls at Parkland Memorial Hospital or in the CMC NICU during this rotation and will participate in all educational activities of the CVICU.
If you have any questions, please do not hesitate to call Diane Cockrell, Fellowship Training Program Coordinator at (214) 648-2835, or to email her at diane.cockrell@utsouthwestern.edu.
For pictures and biographical sketches of our current Fellows and recent graduates, please click here.
