Neonatal-Perinatal Medicine Fellowship Program

Neonatal-perinatal medicine fellowship curriculum + clinical training at Tufts Medical Center

Our fellowship is designed to help you become an excellent clinician, researcher and teacher while providing top-quality care for newborns. The program lasts three years, with 14 months focused on clinical work, including time in the Cardiac Intensive Care Unit (CICU). As you progress, your clinical duties will decrease so you can spend more time on research and scholarly activities, especially in the third year.

First year

Build a strong foundation of knowledge.
Improve clinical, technical, teaching, and leadership skills.
Work closely with attending neonatologists to care for all NICU infants, including those needing surgery or specialty care.
Learn to handle ethical issues and support families during difficult times.
Participate in the Quality Improvement (QI) committee to help improve patient care.

Second year

Focus more on research and developing independence as a clinician.
Clinical duties decrease to allow more time for research projects.
Lead a Quality Improvement (QI) project as part of your training.

Third year

Work more independently in the NICU.
Serve as an attending physician during the “pretending” service block to gain leadership experience.

This structure ensures you grow your clinical skills while also developing as a scholar and leader.

Clinical schedule

Neonatal-Perinatal Medicine Fellows spend approximately thirteen months on clinical service and rest of the time is dedicated to research/scholarly activities.

	First year (PGY 4)	Second Year (PGY 5)	Third Year (PGY 6)
Tufts NICU Service	18 weeks	12 weeks	10 weeks
BCH NICU Service	4 weeks	4 weeks	4 weeks
NICU F/U Clinic	2 weeks	1 week
CICU		4 weeks

Clinical NICU service time occurs at Tufts NICU and Boston Children's Hospital (BCH) NICU. Tufts NICU service is divided equally between team A and B. Fellows spend 4 weeks each year at BCH NICU.

Team A carries about 2/3rd of the NICU census where the patient load is divided between pediatric residents, advanced practitioners and medical students (sub-Is and 3rd year medical students). The fellow on Team A develops autonomy, mentorship to residents, advanced practitioners and medical students; and teaching skills while under the guidance of an attending physician.
Team B fellow carries the rest of NICU patients and provides coverage for high-risk deliveries, critical neonatal transports and prenatal consults under the supervision of the attending faculty. The patient load on team B is managed by NNPs and PAs in collaboration with the attending and the fellow. This allows the fellows to learn the skills of leading skilled neonatal providers, prioritization, multitasking and being in a leadership/supervisory role for the team as they also manage high-risk deliveries, transports and prenatal consults.
Starting academic Year 2022-2023, fellows will be rotating for 1 block/year for a total of 3 blocks during the entire fellowship at the BCH Level IV NICU. This block has been designed to provide clinical experience to complex medical and surgical cases and enhance the clinical experience currently existing at the Level IIIb NICU at Tufts Medical Center. Fellows will be responsible for direct patient care during this experience with a structured rotation schedule and will be a part of the Core Clinical team at BCH. These blocks will provide the fellows an opportunity to interact and be mentored by the attending team at BCH.
All in-house night and weekend calls for the fellows will be at the Tufts Medical Center NICU. As PGY-5 and PGY-6 our fellows have the is opportunity to take extra-clinical duty hour calls at a level 2 special care nursery with delivery room experience.
Fellows also rotate through the BCH CICU for a 4-week period. This program has evolved over the last couple of years as a much enriched regional program for all NPM fellowships in New England under the leadership of a dedicated core group of BCH CICU and regional NICU attendings. In addition to clinical experience, a bi-annual case conference series addresses complex case management issues.
Senior fellows have the option of pursuing a more intense clinical elective in maternal-fetal medicine, palliative care or pediatric cardiology.
The call frequency lightens with advancing fellowship years to allow for elective and research endeavors. Fellows have an average of 5 calls per month during fellowship.

Educational curriculum

The Division of Newborn Medicine at Tufts is dedicated to the training and education of our neonatal-perinatal fellows. We strive to incorporate variable teaching methods by mixing traditional lectures with hands-on simulation, 'flipped classroom" and group discussions. Fellows are also encouraged to join faculty development seminars provided by the Department of Pediatrics, as well as other department-wide seminars. Below is a description of the structured educational activities provided during the neonatal-perinatal medicine fellowship at Tufts Medical Center.

A. Daily

Morning board rounds: fellow leads multidisciplinary, evidence-based discussion of management plans for high-risk impending deliveries, patient flow and new patient/challenging case discussion from the day before. While on the delivery service, fellows also participate in daily rounds with the obstetric service.

B. Bi-weekly

Neonatal-Perinatal Medicine Physiology Curriculum Series based on the American Board of Pediatrics content specifications, and additional topics related to the practice and science of neonatology. Weekly sessions completed over a two-year cycle during fellowship. There will be collaboration of the NPM Physiology Curriculum with Boston Children's NPM Fellowship and all didactic sessions will be available to Tufts Fellows and incorporated into the Curriculum Series.

C. Weekly

The weekly Neonatal/Perinatal Divisional conference provides a medium for faculty as well as national experts to present on their area of authority. It provides fellows an opportunity to present mentored educational conferences.
Evidence-based topic reviews
Case discussions
Journal club: critical appraisal of a peer reviewed publication
Neonatal Topic debate
Surgical case discussion with our pediatric surgical colleagues and pertinent review of literature.
Other weekly conferences:
Pediatric Grand Rounds (departmental)
Tufts Biostatistics, Epidemiology, and Research Design (BERD) center seminars

D. Monthly

Multidisciplinary Neonatal Simulation Curriculum addresses key neonatal, high acuity low occurrence (HALO) scenarios and difficult/ethically challenging conversations.
The Woman, Mother and Baby Research Institute seminars present cutting edge, multi-disciplinary research focusing on fetal, maternal and newborn health.
Fetal boards: discussion of complex pathologic states of mother and or fetus with MFM and subspecialty service.
Mortality, and Morbidity conferences are fellow led and peer reviewed. These address adverse events and quality issues using root cause analysis under faculty mentorship. The report of QI/QA issues is presented at monthly NICU QI/QA meetings and fellows participate in developing divisional QI practices.
18-month Combined Pediatric Subspecialty Fellow's Research/Core Scholarly Curriculum

E. Quarterly

Medical economics curriculum occurs quarterly
Research seminars (fellow and faculty project updates) including quality improvement project updates.
Combined MFM/Neonatology Conference: discussing evidence-based topics affecting the mother and fetus.

F. Yearly

Simulation Boot camps: First year fellow participate in the Yale Simulation Boot Camp in July of entering year. Senior Fellows participate in the Regional Simulation Boot Camp hosted by Tufts Division of Newborn Medicine. New Fellow Orientation: First year fellows receive a structured orientation including systems orientation, basics practical high-yield neonatal didactics, introductions to neonatal faculty and multidisciplinary NICU staff, shadowing in NICU for first 2 weeks and then rounding with a mentoring senior fellow for the second half of July.

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