Clinical Experiences

2015 Rounding with Dmitry

Clinical rotations

The primary site for clinical training is the Doernbecher Neonatal Intensive Care Unit at OHSU and the adjacent Perinatal Center, as well as the Pediatric Intensive Care Unit.  The clinical in-patient experience is augmented by the only ACGME accredited longitudinal NICU follow-up experience in the country.  There is one year of clinical rotations, evenly divided between daytime 12 hour shifts, and night 12 hour shifts, over the three year fellowship.  The remaining two years are dedicated to research, and to the educational curriculum.  The program is front loaded, with approximately 60% of the service time in the first year of the training, and 20% for each year thereafter.

Neonatal Perinatal Medicine (NPM) fellows are involved in the entire course of the NICU patient experience at OHSU, from antenatal consultation, delivery room resuscitation, admission and care in the NICU and if needed, PICU, to outpatient clinic appointments with our neurodevelopment specialists.  The clinical curriculum ensures that our fellows are well-versed in managing the complexities of inpatient neonatal medicine and exposes them to the intricacies of neonatal outcome after discharge from the NICU. 

The Doernbecher Neonatal Intensive Care Unit at Oregon Health & Science University is a primary referral center for Oregon and Southwest Washington, as well as receiving patients from Alaska, Idaho, and Northern California.   The majority of infant patients cared for in this 46-bed quaternary care (Level IV) NICU have complex pathophysiology and/or surgical (cardiac and pediatric) diagnoses.  The DNCC admits approximately 800 Newborns per year, about 70% of whom are born in the University Hospital, with the remaining 30% transported from outside.   The DNICU is the only NICU in Oregon with full neonatal cardiology diagnostic services and neonatal cardiac surgery, and is one of only two NPM fellowship programs in the Pacific Northwest.  The clinical education includes experience with patients requiring extracorporeal membrane oxygenation (ECMO), most frequently due to congenital diaphragmatic hernia (CDH) or severe respiratory failure. 

In the coming year, the program will open a second clinical rotation experience at the Salem Hospital NICU, in the capital city of Oregon, Salem.  The Salem NICU is a nationally-recognized Level III NICU that is a leader in quality improvement efforts within the Vermont-Oxford Network (VON).  This will be an extremely valuable experience in fundamental, high quality neonatology in an outstanding community Neonatal ICU. 


Pediatric Cardiology Rotation
New to the fellowship is a week-long rotation in pediatric cardiology, in which the NPM fellow functions in the role of a pediatric cardiology fellow.  NPM fellows will have the opportunity to hone echocardiography skills, assist in the care of post-operative pediatric heart surgery patients in the PICU, as well as receive valuable one-on-one training with an attending cardiologist. 

Maternal-Fetal Medicine Rotation
The Maternal-Fetal Medicine experience is a two-week rotation in perinatology, including a week of outpatient perinatology clinic, followed by a week of inpatient care of complex maternal-fetal medicine patients.  This rotation is a high-yield exposure to the care of complex meternal-fetal patients with complicated pregnancies.


Clinical Time and Call

The curriculum for the OHSU Neonatology Fellowship in Neonatal-Perinatal Medicine is structured to provide a working environment that fosters camaraderie, research and educational excellence and outstanding patient care. To fulfill the requirements of the ABP, fellows complete 12 months of clinical service time throughout their 3-year education.  Approximately 60% of the service time is accomplished during the first year of the fellowship, with 20% of the service time during each subsequent year.  The schedule itself can be tailored to meet the requests and needs of the fellows in to support outside pursuit of further education such as advanced degrees.  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.

Transport and Telemedicine

OHSU Neonatal-Perinatal Medicine Fellowship Program trainees gain transport experience directly by receiving and directing all transport calls for any of the three NICUs in the OHSU Neonatology network:  OHSU/Doernbecher NICU (46 beds), Salem Hospital NICU (27 beds), and PeaceHealth Southwest NICU (26 beds) in Vancouver, WA.  Transports for OHSU/Doernbecher are performed by the PANDA transport team.  Fellows also serve as the medical control physician for any neonatal transport that is conducted by PANDA.  There are approximately 200 neonatal transports per year, not including back transports.  

OHSU also provides neonatal telemedicine services for 7 hospitals in Oregon, a number that continues to expand by several hospitals per year.  Network hospitals call for telemedicine support during resuscitations, stabilizations, and prior to and during transport.  Telemedicine calls are almost exclusively directed by fellows, providing an invaluable experience with remote virtual direction of the care of critically ill patients. 

NICU Follow-Up Experience

The OHSU Neonatal-Perinatal Medicine fellowship satisfies the American Board of Pediatrics requirement for neurodevelopmental follow-up experience in a unique way.  Rather than attend  monthly neurodevelopmental follow-up clinics, each fellow participates in longitudinal neurodevelopmental as well as general pediatric and subspecialty follow-up of high-risk neonates throughout the three years of training, providing the fellow with exposure to the issues of the NICU graduate and the important assessment of long-term outcomes.  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.  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 congenital heart disease, surgical, genetic, and organ system disorders. 

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.

2015 Doernbecher entrance