The Doernbecher Neonatal Care Center (DNCC) at Oregon Health and Science University is a primary referral center for Oregon and Southwest Washington. The majority of infant patients cared for in this 46-bed tertiary care NICU have complex pathophysiology and or surgical (cardiac and pediatric) needs. The DNCC admits approximately 800 Newborns per year, about 70% of whom are born in the University Hospital. The DNCC is the only NICU in Oregon with full neonatal cardiology diagnostic services and neonatal cardiac surgery, and the only unit with a fellowship program.
Curriculum and Call
The curriculum for the Neonatology Fellowship in Neonatal-Perinatal Medicine at Doernbecher Children's is structured to provide a working environment that fosters camaraderie, educational excellence and outstanding patient care. To fulfill the requirements of the ABP, fellows complete 12 months of clinical service time throughout their three-year education. Clinical time is spread out through the three year fellowship. The schedule itself is tailored to meet the requests and needs of the fellows in to support outside pursuit of further education such as advanced degrees. Currently, fellows do not take call, rather they engage in clinical activities through a day or night service rotation (one week of days or one week of nights), allowing large blocks of protecting time for research endeavors. Our fellows have opportunities to participate in transport, ECMO, post-operative cardiac care, perinatal, and global health electives, these are customized to meet the educational objectives of the individual fellow.
Throughout fellowship training, neonatal fellows are involved in the care of critically ill neonates transported to and from Doernbecher Neonatal Care Center. There are approximately 200 neonatal transports per year. Neonatology Fellows lead neonatal transports in person, over the phone and via telemedicine."These experiences should enable fellows to understand the relationship between neonatal illnesses and later health and development, and to become aware of the socioeconomic impact and psychosocial stress that such infants may place on a family". To do this we have designed a "patient focused" longitudinal follow-up curriculum. Our fellows select patients to follow from prenatal consult through the NICU admission and then in various outpatient clinics. Seventy percent of follow-up patients are selected from our premature infant population. The other 30% are comprised of patients with any of the following issues; cardiac, craniofacial, genetic, term respiratory failure, hypoxic ischemic encephalopathy, spina bifida, renal disorders resulting in dialysis and eventual transplant, or other disorders necessitating prolonged outpatient follow-up. Fellows follow their patients through various inpatient and outpatient clinics. For example, a fellow provides prenatal consultation for a mother at 24-weeks gestation and documents the conversation in a journal. The mother delivers at 25-weeks gestation; the fellow follows the patients throughout the NICU stay, documenting the infant's course and interactions with the family. The infant develops severe bronchopulmonary dysplasia, is has poor oral feeding skills and requires a g-tube for growth, has a perimembraneous ventriculoseptal defect, and has retinopathy of prematurity. The fellow attends clinics held on campus, including feeding clinic, OT/PT clinic, neurodevelopment clinic, cardiology follow-up clinic and ophthalmology clinic. If the patient is followed by one of the OHSU pediatricians, the fellow will attend that clinic as well. The fellow's experience for patient with a congenital cardiovascular malformation would look for similar. For example, the fellow meets with the family antenatally (in conjunction with the cardiologists), the fellow follows the patient's course in the NICU, attends the Pediatric Cardiology-CT Surgery conference where they discuss the surgical plans, and follows the infant during surgery and post-operatively in the PICU. When the patient is discharged the fellow attends cardiology follow up clinic, ECMO follow up clinic, and OT/PT clinics for this patient. All experiences with the patients are documented in journal format, the expectation is that the fellow will reflect on all narratives for a patient and write a summary of how well they understood the relationship between neonatal illnesses and later health and development, and the socioeconomic impact and psychosocial stress placed on the family, including thoughts on how they might provide better counseling for families in similar situations in the future.