The three-year program comprises clinical and research training. That training is supplemented by many weekly conferences and meetings.
BTGH Q4 Calls
|Total number of 4 week blocks|
Off Service time is for research and vacation.
Fellowship training begins with a four-week orientation. During July of their first year, fellows attend a lecture series entitled Introduction to clinical neonatology, designed to provide an evidence basis for common clinical problems. Other training and experiences during the first block include:
- Neonatal Resuscitation Program and Pediatric Advanced Life Support Training Course
- Clinical procedure labs (e.g., chest tube insertion, intubation, percutaneous central venous catheter insertion, umbilical line placement, pericardiocentesis, exchange transfusion, oscillator ventilation)
- Orientation to the NICUs and Labor & Delivery services
- Orientation to the Kangaroo Crew® air transportation service
- ECMO Training and Simulation
- Respiratory Physiology Review accompanied by Ventilator Wet Lab
- Meet and Greet with Ancillary Services Team
- Introduction to Research and Writing IRBs
During the first few months of the academic year, with guidance from the program director and other faculty members, fellows identify an area of interest for research and interview prospective mentors. Most fellows identify a mentor by the end of October of the first year.
The emphasis during the remainder of the first year is clinical training. Seven blocks are assigned to NICU rotations at Texas Children’s Hospital. The remaining five blocks are devoted to research.
First Year Fellowship Schedule
|Rotations||Number of 4 week blocks|
|TCH West Tower Level 4 (Q5 Call)||2|
|PFW NICU (Teams 1 and 2) (Q5 Call)||3|
|PFW L&D (TLC) (Q5 Call||2|
|Holiday Coverage (Q5 Call)||0.5|
|Call Free Blocks (Summer school, Board Prep, Research)||5.5|
An emphasis on clinical training in the first year allows uninterrupted protected time for research training during the second and third years. During the second year of training, three blocks are spent on NICU rotations: one in the Texas Children’s Hospital level three Pavilion for Women NICU, one in the Texas Children’s Hospital West Tower level four NICU and one at the Ben Taub Hospital. One block of the second year is also devoted to an experience in the Cardiovascular Intensive Care Unit, caring for critically ill perioperative neonates.
The remaining eight blocks during this year are devoted to research. Clinical duties assigned during these periods are limited to night calls. This blocked time affords fellows an opportunity to make significant progress on their project often allowing them to present at regional and national meetings prior to starting the third year.
Second Year Fellowship Schedule
|Rotations||Number of 4 Week Blocks|
|TCH West Tower Level 4/PFW NICU (Q5 Call)||2|
|Ben Taub (Q4 Call)||1|
|Holiday Coverage (Call)||0.5|
|CVICU/Complex Care Clinic (Call Free)||1|
|Research Block with BTGH Call (Q4 Call)||3|
|Call Free Blocks (Research/Vacation)||5.5|
During the third year of training two blocks are spent on clinical service, one at Texas Children's Hospital and one at Ben Taub Hospital. Third-year fellows serve a supervisory role on the team closely simulating being an independent attending to prepare them for practice after fellowship. They lead rounds, provide teaching to residents and NNPs and manage the patients with advisory mentorship from the service attending. In addition to clinical service, third-year fellows gain experience with the High-Risk Obstetrical Team at the Texas Children’s Hospital Pavilion for Women.
Third Year Fellowship Schedule
|Rotations||Number of 4 week blocks|
|TCH West Tower Level 4/PFW NICU (Q5 Call)||1|
|Ben Taub Service (Q4 Call)||1|
|Holiday Coverage (Call)||0.5|
|High Risk OB (Call Free)||0.5|
|Research Block with BTGH Call (Q4 Call)||3|
|Call Free Blocks (Research/Vacation)||7|
Block 7 is our “Holiday Block” and is split into two two-week sections. Fellows are scheduled on service with call for one half of the block, with the remaining two weeks service and call free for vacation or travel to visit family. Fellows submit requests for which half of this block they would prefer to have vacation to be accommodated as best as possible by the scheduling committee.
Creating the Schedule
The schedule is created by a scheduling committee composed of one fellow from each class, led by the third-year fellow with oversight and approval from Dr. Melissa Carbajal. Fellows submit their block schedule requests to the scheduling committee in the spring. After the block schedule is published, fellows have the opportunity to submit specific requests for specific nights or weekends without calls.
One of the benefits of being a fellow in a large program such as ours is easily being able to find swaps or coverage in the event of illness, childcare emergencies, conference acceptance, weddings, etc. The culture of our program is friendly and supportive, thus fellows easily find swaps.
7 – 8 a.m.
Arrive at unit, pre-round, check in with NNPs/Residents
8 – 9 a.m.
9 a.m. – Noon
Noon – 1 p.m.
1 – 4:30 p.m.
Update families, follow up with consultants, admissions, L&D
4:30 – 5:30 p.m.
Morning Report is led by the post-call fellow every morning. Overnight admissions are presented and review of relevant pathophysiology, mechanisms of disease, evidence–based decision making and teaching points are reviewed. The presence of numerous on-service attendings, fellows, residents and neonatal nurse practitioners makes for a rich discussion group with interactive learning from each other. A teaching radiologist accompanies rounds to review images on any patients the group requests.
Desmond Neonatal Follow-Up Clinic
Our fellows attend the Desmond Neonatal Follow-Up Clinic throughout their three years of fellowship. Fellows have access to the clinic patient schedule and are able to choose which dates and patients they would like to attend visits with. This allows fellows to attend visits for the patients that were on their primary team, improve their educational experience and promotes patient continuity.
During their time in the Desmond Clinic, fellows gain exposure to the following:
- General Follow-up for the High-risk Neonate
- Post-hospital Discharge Coordination
- ECMO, Hypothermia Therapy, Congenital Diaphragmatic Hernia
- Developmental Assessments
Fellows College is an innovative and collaborative approach to address the ACGME nonclinical skills required for subspecialty training. It was implemented at Baylor College of Medicine in 2011. The program has expanded from approximately 11 sessions in the first year to now about two sessions per month.
Expanded curricular opportunities provided by Fellows' College, help to prepare subspecialty fellows for their future careers. Furthermore, fellows have a wider range of opportunities to network and interact with an extended community of learners and leaders participating in Fellows' College.
Fellows College also dedicates a series of sessions to developing quality improvement skills through the implementation of longitudinal projects within each fellowship subspecialty. Within the Neonatology division, the second and third-year classes participate in newborn center quality improvement projects of their choosing. Faculty mentors with formal quality improvement training foster collaboration within the newborn center and advise fellows through each PDSA cycle.
In total, the Baylor College of Medicine Department of Pediatrics has 190 subspecialty fellows that all meet together during the Fellows College sessions. This offers an opportunity for networking and comradery with fellows of other subspecialties.
The Simulation Center at Texas Children's Hospital is a multidisciplinary, hospital-based center, providing hands-on pediatric and obstetric simulation training in a realistic environment to improve patient safety and patient care. The medical director of the center, Dr. Mona Khattab, is an assistant professor within the Division of Neonatology and leads the simulation training of our fellows.
Fellows begin training in the simulation center within their first week of fellowship. Training during the July orientation month includes:
- Neonatal Resuscitation Program
- Pediatric Advanced Life Support
- Potential Level 4 NICU code scenarios (delivery resuscitations, respiratory distress/arrest, arrhythmias, septic shock, surgical emergencies, intracranial hypertension, electrolyte disturbances, etc.)
- Intubations, umbilical artery/vein catheterizations, chest tube placement
- Exchange transfusions (partial and complete)
- Patient/parent communications skills: delivering bad news, medical error disclosure, explaining complex medical diagnoses
Throughout the year additional simulation trainings occur for a multitude of other medical professionals (nurses, respiratory therapists, EMT/paramedics, nurse practitioners, residents, medical students, etc). Fellows have the opportunity to become NRP instructors and assist with these educational sessions if they desire. Additionally, some fellows have chosen to do simulation research for their scholarly work.
Division of Neonatology Educational Conferences
Our division has a robust educational conference curriculum with a faculty champion(s) and fellow representative(s) for each lecture series. View more information on the conference schedule. Fellow representatives work with the faculty champions to review conference content, structure, educational objectives and possible future directions. Fellows have a significant role in advising the curriculum committee to ensure conferences are meeting the educational needs of the fellows and reviewing the neonatology board content specifications.
Opportunities to Teach
Fellows have opportunities to teach students across a variety of training levels and specialties. In the Texas Children’s Hospital, West Tower rounding teams often include neonatal nurse practitioner students, pharmacy interns, nursing students, respiratory therapist students, and residents who have declared an interested in neonatology.
In the Texas Children’s Hospital Pavilion for Women NICU teams are composed of second-year pediatric residents or combined medicine-pediatrics residents. Second and third-year medical students also join these teams as part of their core pediatrics rotation. A unique group of learners in this unit are the Texas Children’s Hospital Nutrition Fellows, who join daily rounds and help design individualized nutrition plans for each patient.
At Ben Taub Hospital teams are composed of the attending neonatologist, one fellow and two-three pediatric residency interns and medical students. In addition to teaching during rounds and noon conference lectures, fellows lead the labor and delivery resuscitation teams consisting of a nurse, respiratory therapist and resident.
Fellows in our program have also built a core curriculum of case-based teaching modules to serve as a foundation for teaching the residents and medical students during their rotations. The eight cases with included questions for discussion and handouts are a great base for fellows to build off of and embellish with their own personal touch.