Clinical Training

Clinical training consists of clinical rotations supplemented by a robust series of conferences. This curriculum includes 12 months in the Level IV neonatal-intensive care unit at Monroe Carell Jr. Children's Hospital at Vanderbilt (Monroe Carell) with additional clinical experiences in the neonatal developmental clinic, The Fetal Center at Vanderbilt, medical transport and the pediatric cardiac intensive care unit. Night call is in-house, spread throughout the three years for around 55 calls per year (slightly less first year due to increased clinical service).

Sample Schedule (variations in distribution of clinical and research time based on individual fellow clinical and research goals)

Clinical Rotations

Approximately 1,500 newborns are admitted annually to the NICU, which consists of 118 intensive and intermediate beds. Medical teams care for a combined average daily census of around 100 patients.

NICU at Monroe Carell Jr. Children's Hospital at Vanderbilt

Fellows spend approximately two-thirds of their clinical experience in the state-of-the-art single patient room NICU, caring for critically ill infants with a wide range of medical and surgical conditions. Approximately two-thirds of infants are inborn. The full range of treatment modalities includes advanced respiratory support, ECMO, and therapeutic hypothermia. There is a high exposure to pre-operative congenital heart disease and surgical conditions. Babies with congenital heart disease are cared for in the NICU pre-operatively.

One-fourth of the clinical experience is spent on the Delivery Service. The delivery service is in Vanderbilt University Hospital, which is connected to Monroe Carell through an interior walkway. The delivery NICU provides neonatal support for an obstetrical service with more than 5,000 annual deliveries, including a substantial proportion of high-risk pregnancies (550 deliveries at less than 35 weeks' gestation each year). Fellows attend high-risk deliveries, become proficient in delivery room resuscitation and stabilization, and provide perinatal and newborn consultation.

The four teaching teams consist of an attending neonatologist, neonatal fellow, pediatric residents, neonatal nurse practitioners, physician assistants, and NICU hospitalists. Under attending supervision, the fellow directs patient care and provide bedside teaching for pediatric residents and medical students. Multidisciplinary rounds are conducted daily and include dieticians, pharmacists, respiratory therapists, lactation consultants, social workers, and case managers.

Neonatal Transport

Fellows provide medical control for neonatal transport. Fellows receive focused didactic and simulation education in transport physiology and management and participate in transports during their one-week transport rotation each year. Additional tailored experience in transport medicine is available for fellows who wish to pursue this as a career focus.

Maternal-Fetal Medicine

During this clinical experience rotation, fellows observe the evaluation and management of high-risk pregnancies in the ambulatory and inpatient settings, including labor and delivery; participate in the counseling of women with high-risk pregnancies in The Fetal Center at Vanderbilt; observe ultrasounds and fetal interventions; and attend a weekly multidisciplinary fetal conference. Additional tailored experience in fetal medicine is available for fellows who wish to pursue this as a career focus.

Neonatal Development

The Neonatal Development rotation includes one day per week caring for infants and young children in the pulmonary clinic with bronchopulmonary dysplasia. The other days of the week are spent in the Neonatal Development Clinic where fellows perform developmental assessments and recommend appropriate services.

Pediatric Cardiac Intensive Care

Third year fellows gain additional exposure to the postoperative care of newborns with congenital heart disease in the Pediatric Cardiac Intensive Care Unit rotation. The fellow has the opportunity to round with the pediatric cardiac intensivist and cardiologist in the PCICU, observe cardiac surgery, observe the post-operative management of newborns, and attend multidisciplinary conferences in which upcoming surgeries, clinical status, and complications are discussed. This rotation supplements robust cardiac management in the NICU, which includes delivery room stabilization and pre-operative management of more than 130 infants each year with congenital heart disease and management of infants with conditions including cardiac arrhythmias and patent ductus arteriosus.