Clinical Experiences

2015 Rounding with Dmitry

Clinical rotations

The primary site for clinical training is the Doernbecher Neonatal Intensive Care Unit at Oregon Health & Science University (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 50% of the service time in the first year of the training, and 25% 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 OHSU is the only academic center in Oregon and is a primary referral center for Oregon and Southwest Washington, as well as receiving patients from Alaska, Hawaii, 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 NICU admits approximately 600 Newborns per year, about 75% of whom are born in the University Hospital, with the remaining 25% transported from outside.  OHSU 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.

Electives

There are multiple opportunities for elective rotations for the NPM fellows, including Cardiology, Maternal-Fetal Medicine, Palliative Care, Critical Care Transport, among others. The electives can be developed on an individual basis to help meet the fellow's experience and goals.

Electives

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 at least 12 months of clinical service time throughout their 3-year education. Approximately 50% of the service time is accomplished during the first year of the fellowship, with 25% 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 thePANDA 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. In addition to attending regular 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.

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