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Neonatology - Fellowship


 
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Overview

A primary focus of our training program is to provide comprehensive training in clinical neonatology to allow the graduate to independently manage all problems that would fall under the purview of a neonatologist. Fellows rotate at 2 primary teaching sites, University of Colorado Hospital (UCH) and Children’s Hospital Colorado (Children's Colorado). Both are new, state of the art facilities that opened in 2007. Under the supervision of a large and diverse faculty, trainees gain exposure to babies with a broad spectrum of clinical problems and gestational ages. Learning from direct patient care is augmented by a comprehensive series of lectures focused on neonatal medicine. Additional seminars provide training in communication, ethics, and practice administration. Fellows receive ample opportunities to provide newborn resuscitation and to learn all of the common procedures employed in neonatal medicine.


Scope of Clinical Training

Fellows in our program develop the clinical skills necessary to prepare them to competently and confidently manage the broad spectrum of conditions that fall within the practice of neonatology. The combination of two clinical sites, each with distinct patient populations, enhances the opportunities to become familiar with babies with a broad range of gestational ages and clinical problems. The patient population at University of Colorado Hospital (UCH) is dominated by preterm infants, some as young as 23 weeks gestation, with the myriad of problems that affect the preterm. In addition, the UCH NICU cares for late preterm and term babies with a host of other problems, including infection, growth restriction, respiratory failure, hypoglycemia, and surgical problems. The patient population at Children’s Colorado is dominated more by term babies with more variable clinical problems, including hypoxemic respiratory failure, hypoxic-ischemic encephalopathy, congenital heart disease, multiple congenital anomalies, congenital and postnatally-acquired infection, and surgical problems. In addition, there are typically several babies in the NICU at Children's Colorado with chronic conditions, including babies with short bowel syndrome or who are chronically ventilated. Among the services provided to babies on the neonatal service are high frequency ventilation, selective head cooling (for HIE), dialysis, and extracorporeal membrane oxygenation. The neonatology faculty and fellows maintain a very collegial relationship with the pediatric surgical services and co-manage babies with surgical problems.

Training and experience in delivery room resuscitation occurs at University Hospital. All fellows become certified NRP instructors during their first year of fellowship. Under the supervision of their attending physician, they provide antenatal counseling to families and, whenever possible, attend the deliveries of all babies < 32 weeks gestation and those with known anomalies or anticipated transitional problems.

Early in their training, fellows are encouraged to learn (and demonstrate proficiency in performing) all of the procedures that would be expected of a practicing neonatologist. This would include intubation, umbilical catheter insertion, thoracentesis and chest tube insertion, lumbar puncture, peripheral arterial catheter placement, paracentesis, and paricardiocentesis. In addition, fellows are taught to place central venous and arterial catheters by cut-down.


Expectations/Responsibilities

To prepare trainees to function as effective neonatologists upon completion of their fellowship, fellows are encouraged to assume graduated responsibility for patient care over the course of their three years. Late in the first year, and certainly during the second and third years, fellows are expected to direct clinical care during rounds, with the supervision of a faculty attending. Fellows are expected to actively seek the most up-to-date information to guide clinical care whenever possible. Likewise, fellows are expected to take an active role in teaching the pediatric housestaff, both through didactic lectures and extemporaneous bedside teaching.


Supervision

At all times, the fellow is directly supervised by a full-time member of the faculty. During the daytime, three attending physicians are assigned to Children’s Colorado and two are assigned to University Hospital (UH). During night call at Children's Colorado, a faculty member stays in-house with the fellow. At UH, the on-call fellow is paired with a separate faculty member, and both take call from home. At each stage of training, the goal is to provide a level of supervision that ensures patient safety and maximizes education while promoting the trainee’s sense of independence and autonomy.


Clinical Schedule

All clinical activity during fellowship occurs at either Children’s Colorado or University of Colorado Hospital (UH). The clinical schedule is broken into discrete 4-week blocks and over the course of the fellowship, each trainee will spend 13 blocks on service. The clinical schedule is intentionally front loaded, with fellows spending 7 blocks on service during their first year of training (5 at Children's Colorado and 2 at UH). During each of the last 2 years, a fellow spends 3 blocks on service (1 at Children's Colorado, 1 at UHl, 1 in the CICU during the 2nd year and 2 at Children's Colorado and 1 at UH during the 3rd year). There is some flexibility in the apportionment of clinical blocks, so that if an individual fellow would prefer more time at one site over another, modifications to the basic structure may be possible.

All trainees are assigned to sporadically attend the medical follow-up clinic at Children's Colorado. The clinic focuses on providing care to graduates of the NICU who were extremely premature or who have complex medical issues that require close follow-up. The clinic is scheduled for two afternoons/week and each fellow attends clinic approximately once/month. Those fellows interested in a longitudinal follow-up experience with individual patients have the flexibility to schedule those patients on their assigned clinic afternoons.


Call Responsibilities

Fellows take approximately 60 nights of call/year during each of their 3 years of training. Just over half of the call is taken at Children’s Colorado and is in-house. When on-call at Children's Colorado, the fellow supervises neonatal nurse practitioners and pediatric housestaff and is paired with an in-house faculty member. The balance of call is at University Hospital (UH), and is from home. 24-hour/day on-site care is provided at UH by neonatal nurse practitioners and pediatric housestaff. The on-call UH fellow is also supervised by a separate faculty member.

As with all aspects of clinical training, the program encourages progressive responsibility and increasing autonomy when on-call. Fellows are expected to attend deliveries of all high-risk and extremely preterm infants, when possible.


Conferences

Fellows actively participate in a number of regularly scheduled conferences devoted to clinical care:

  • Obstetric Board Rounds: This daily conference is run by the High-Risk Obstetric service at University Hospital and is attended by the faculty, fellows, and residents from the Perinatal and Neonatal services. All pre- and post-partum patients are reviewed.  
  • Chronic Ventilation Rounds: This multidisciplinary conference is held weekly and attended by neonatology faculty and fellows, pulmonary medicine faculty and fellows, neonatal nurse practitioners, respiratory therapists, bedside nurses, and developmental specialists. The comprehensive care plans of all chronically ventilated babies are reviewed.
  • Perinatal Board: This is a multidisciplinary conference that meets twice/month to review complex antenatal cases. The conference is led by the University of Colorado perinatologists and is attended by the faculty and fellows from neonatology and interested subspecialists from the pediatric faculty. The goal of the conference is to develop care plans for women and their fetuses anticipated to have complicated medical problems.
  • Perinatal Ethics Conference: This conference is a monthly multidisciplinary conference attended by Neonatology faculty and fellows, Perinatologists, biomedical ethicists, neonatal and perinatal nursing staffs, and subspecialists interested in particular cases. Individual clinical cases which include ethical conundrums are presented and discussed.
  • Morbidity and Mortality Conference: This conference takes place monthly and is attended by attending physicians, neonatology fellows, subspecialty physicians (as warranted by the topic), and neonatal nurse practitioners. Difficult cases are presented by fellows and faculty members, with particular attention given to 1) identifying system issues affecting outcome and 2) reviewing critical decision-making.
  • In addition to these conferences, fellows attend numerous other educational conferences that focus on clinical issues. These conferences are listed under the Education tab.

Overview

Research training is a major focus of the fellowship training program and fellows are provided substantial protected time throughout their fellowship to engage in rich research experiences. The research program is designed to provide comprehensive scholarly training that prepares all trainees with the background and skills to successfully compete for academic faculty positions and extramural funding at the completion of their fellowship. Historically, the training program has produced an unusual number of leaders in academic Neonatology, including several Deans, Department Chairs, and Division Heads. Each trainee is matched with one or more faculty mentors who are actively involved in an area of research that is of mutual interest. Although many neonatal fellows are mentored by a faculty member within the Division of Neonatology, the program encourages fellows to consider a broad range of potential mentors. The program will assist in identifying potential mentors, both within the Department of Pediatrics and, when appropriate, from across the School of Medicine campus.

One of the most active areas of research within the Division of Neonatology is fetal and neonatal growth and metabolism. Past and ongoing studies address glucose and protein metabolism in the normal fetus and newborn, and more recent studies have focused more on the growth-restricted fetus. These studies attempt to define perturbations that cause growth restriction and identify potential therapies that might reverse these perturbations. These studies generally take a layered approach, with whole animal physiologic studies supported by investigation at the cellular and biochemical level. In addition to basic science studies in this area, several faculty members are involved in clinical research in nutrition.

Another highly productive area of research involving Neonatology faculty and fellows has been in the area of lung growth and development, particularly pulmonary vascular growth and function. Much of this work is done in collaboration with the Pediatric Heart Lung Center, a multidisciplinary group of pulmonologists, neonatologists, cardiologists, and intensivists interested in understanding how the lung normally develops and functions and on the mechanisms that underlie disorders such as bronchopulmonary dysplasia and persistent pulmonary hypertension of the newborn. These physiologic and molecular studies have led to several ongoing clinical trials, including a number of important studies on the applications of inhaled nitric oxide in newborn medicine.

A number of other areas of scholarly activity are available to Neonatology fellows, depending on their interests and career aspirations. Areas of active research include neonatal seizures and stroke, mechanisms and consequences of normal and abnormal placentation, the effects of maternal nutrition and weight gain on neonatal outcome, and genetic control of organogenesis. Among the many campus resources are the University of Colorado Cancer Center, the Barbara Davis Center for Childhood Diabetes, the Cardiovascular Pulmonary Research Laboratory, the Program in Molecular Biology, and the Program in Developmental Biology. For those interested in clinical studies, several faculty members in the division collaborate with the division of Maternal-Fetal Medicine in a number of areas, including active studies of maternal diabetes and obesity and their consequences on fetal and neonatal health. For those interested in epidemiological research, the division participates in the Vermont Oxford Network and in the newly formed Children’s Hospital National Consortium (CHNC). In addition, the Department of Obstetrics maintains a comprehensive database for mothers and babies delivered at University of Colorado Hospital. More recently, several members of the Division and Department have developed an interest in educational research, and state-of-the-art simulation facilities are available for studies at the University of Colorado Center for Professional Excellence.


Expectations

Each fellow in the program is expected to undertake a substantive scholarly project during their training. As outlined in the following section, opportunities are available in a broad range of areas and with multiple different mentors. Many fellows choose to pursue research programs in large laboratories with several faculty members and trainees at various levels, with each trainee focusing on individual project. In general, research projects are designed to provide the trainee with broad, state-of-the-art training involving both in vivo and in vitro techniques. Fellows are expected to participate in all aspects of their individual research projects, including the development of hypotheses and study design, whole animal surgeries and in-vivo studies (when appropriate), cell and molecular biology techniques, data collection and analysis, and abstract/manuscript presentation. The division employs a number of professional research assistants who are available to help both faculty and fellows with studies and to ensure uninterrupted progress during periods of clinical commitment.


Opportunities and Resources

Research opportunities available to neonatology trainees are broad and varied. A significant strength of the division is its affiliation with and leadership of the Perinatal Research Facility. This state of the art laboratory allows interested neonatology faculty and fellows to engage in a broad spectrum of basic science research, including physiologic studies in chronically prepared fetal lambs and their mothers. In addition to in-vivo, whole animal studies, a large wet lab adjoins the large animal facility and allows researchers to conduct supporting molecular and cell biology studies. The division employs a number of professional research assistants who assist the faculty and trainees in conducting research and ensure that individual studies continue to progress during times when investigators have heavy clinical commitments.

For trainees interested in clinical studies, Children’s Colorado and the University of Colorado Hospital are both active sites of several clinical neonatal research studies. Five full-time research nurses who are dedicated to projects on maternal and neonatal health assist in coordinating patient recruitment and data collection at the two sites.


Timeline

During the first 1-2 months of assigned research time, a trainee will typically meet with a number of potential mentors to discuss possible research projects and become familiar with different research programs. In the case of a basic science program, the fellow may “shadow” in individual labs in which they are interested. With the help of the Program Director, the goal is for the fellow to choose a mentor and research project in the fall of the first year. Once a research program is chosen, a timeline for research activity is developed by the mentor and the trainee. Broadly, the goal for basic science projects is for the fellow to have made sufficient progress that they are able to consider submission of an abstract to the Pediatric Academic Society Meetings by December of their second year. For fellows pursuing prospective clinical research programs, they should be recruiting patients by the second year of fellowship. In general, research time during the third year of fellowship should be spent analyzing data, undertaking additional experimentation as necessary based in initial data analysis and feedback, preparing presentations and manuscripts, and planning follow-up projects.


Colorado Clinical Translational Sciences Institute (CCTSI)

The Colorado Clinical and Translational Sciences Institute is a collaborative enterprise between University of Colorado Denver, University of Colorado at Boulder, six affiliated Hospitals and health care organizations, and multiple community organizations with resources to promote research and training that will advance health care and improve the public health. The CCTSI was established in 2008 with funding from the Clinical and Translational Science Award (CTSA) initiative of the National Institutes of Health (NIH). Through the CCTSI, Clinical Translational Research Centers (CTRCs) have been established at several affiliated hospitals, including The Children’s Hospital, University of Colorado Hospital, and Denver Health Medical Center. The CTRCs support research with clinical inpatient and outpatient space, inpatient research beds, nursing and research staff support, and core laboratory and nutrition services. To access CTRC resources, investigators submit a clinical protocol for review by the Scientific Advisory and Review Committee (SARC). The SARC review process gives investigators experience that may improve future COMIRB (Colorado Multiple Institutional Review Board) and grant applications. The CTRC also offers biostatistical collaboration/consultation for study design, including sample size and power calculations, data analysis, and manuscript preparation. To fulfill its mission to train future researchers, the CCTSI offers ongoing comprehensive educational programs in several areas, including Informatics, Biomedical Ethics, Biostatistics, and Study Design.


Scholarship Oversight Committees

Towards the end of the first year of training, each fellow is assigned a Scholarly Oversight Committee (SOC), composed of at least 3 faculty members. The SOC meets every six months, at a minimum, to evaluate the fellow’s scholarly progress and to help provide support and direction. At the end of training, the SOC is responsible for determining whether the fellow’s work has met the American Board of Pediatric’s requirement for sub-board eligibility.

Specialty-Specific Curriculum

Fellows participate in several educational seminars focused on neonatal medicine. Below is the list of mandatory and recommended conferences:

  • NPM Fellow’s Lecture Series: This series anchors the educational program and is scheduled for 2 hours on Wednesday afternoons. Attendance is mandatory and the trainee is excused from clinical responsibilities if on-service. The primary focus of the series is to provide lectures on core clinical topics essential to the practice on neonatal medicine. Once a month, a comprehensive case review is presented by one of the fellows and a discussion is led by Dr. Kinsella and other faculty members. In addition, recent journal articles are reviewed once a month, with the focus on critical literature review and practice implications.
  • Neonatal Noon Conference: The conference runs for 10 months of the year, and is scheduled from noon to 1 pm on Wednesdays. The audience includes Neonatology faculty and fellows, NNPs, neonatal nurses, Pediatric Surgery faculty and fellows, and others (depending on the topic of the individual conference). Topics include updates on clinical management, multidisciplinary problems and management, case reviews, and review of current research initiatives.
  • Perinatal Research Facility Research Seminars: This seminar series occurs on Wednesday mornings and focuses on research presentations on topics broadly relevant to neonatology and perinatology. Neonatology faculty and fellows regularly present at and participate in this seminar series. In addition, these seminars attract researchers from a broad spectrum of basic and clinical science disciplines.
  • Pediatric Grand Rounds: These presentations occur weekly during the academic year. Speakers include CU faculty and invited guests who are nationally and internationally recognized experts in topics of broad relevance to pediatric medicine.

Department of Pediatrics Education

This educational series was recently developed to address areas of scholarly interest common to all pediatric fellows. Fellows attend 5-6 half-day seminars spread across their 3 years of fellowship. Attendance is mandatory and the trainee is excused from clinical responsibilities. In addition to providing core educational material, these sessions allow trainees in different disciplines throughout the department to meet and interact with one another in an informal and collegial environment.

Topics include:
2013-2014 Fellowship Curriculum jpeg.png


Biostatistics

Formal introductory instruction in biostatistics is give during the second year of fellowship through a 6-session, 12-hour biostatistics course that is taught by a PhD biostatistician. In addition, fellows have access (in-person or on-line) to regular biostatistics seminars which are provided by the CCTSI. Trainees who undertake advanced graduate coursework with a biostatistics component (Masters in Public Health or Masters in Clinical Science) may be exempt from the introductory course.

Biostatisticians are available for consultation on individual research projects through the Colorado Biostatistics Consortium (CBC). For more information, please see http://cbc.ucdenver.edu.

Although not required for completion of the fellowship, some trainees pursue additional graduate coursework during their fellowship. The University of Colorado School of Public Health, which is on the Anschutz Medical Campus, offers a Masters of Public Health. For more information, please see http://publichealth.ucdenver.edu. The University of Colorado Denver Graduate School offers a graduate program in clinical science, which awards a Masters of Science in Clinical Science (MSCS). This program provides training in clinical sciences through theoretical and methodological coursework and its application to an individual research project. More information can be found at http://cctsi.ucdenver.edu/training-and-education/CLSC/Pages/MSCS.aspx. Funding for additional graduate coursework is not guaranteed, but may be available on an individual basis, pending approval by Dr. Parker, the Program Director, and Dr. Wilkening, the Section Head.

Neonatology fellows are encouraged to attend regional and national scientific meetings throughout their fellowship. Among the meetings commonly attended by neonatal fellows are the annual Academic Pediatric Society (APS-SPR) meeting, the Western Society for Pediatric Research (WSPR) meeting, the annual NICHD meeting in Aspen, and a number of industry-supported national meetings targeted to Neonatology trainees. To support academic development, including travel to meetings, the section provides each fellow with sufficient money to attend at least one meeting per year. In addition, the section supports travel to any national meeting for which the trainee has an abstract accepted.

Eligibility

We particularly hope to attract applicants who are motivated and self-directed learners who want to develop academic careers based on excellence in research, scholarship, and clinical neonatology. To be considered for admission to our program, applicants must have successfully completed training in a 3-year ACGME-accredited residency program in Pediatrics. We are particularly interested in receiving applications from members of Underrepresented Minority groups.


Required Application Materials

All application material should be submitted through the Electronic Residency Application Service (ERAS). We participate in the National Residency Matching Program (NRMP) and do not offer any positions outside of the match. Required application materials include a completed ERAS common application form, a USMLE (or COMLEX/ECFMG) transcript, a personal statement addressing your interest in Neonatal-Perinatal Medicine, and at least 3 letters of recommendation. In lieu of a typical narrative letter of recommendation, we strongly encourage the use of the standardized Neonatal-Perinatal Medicine Fellowship Referee’s Evaluation Form, which is available on the Organization of Neonatal Training Program Directors (ONTPD) website.


Deadlines

The NRMP dates for applicants starting July, 2015 are as follows: ERAS opens July 15, 2014 for participants to begin applying to programs. The University of Colorado’s fellowship training program will chose approximately six dates between August and November to conduct interviews. Rank order list are due to the NRMP on December 3, 2014 with the match taking place December 17, 2014.


Interviews

Competitive applicants are offered on-site interviews on several pre-selected days from August to early November. On the interview day, candidates will be provided a broad overview of the program and will meet individually with 4 members of the faculty. They will tour the NICUs at both Children’s Hospital Colorado and The University of Colorado Hospital, as well as our state of the art research facilities. Candidates will also have lunch at an off-campus restaurant with several of the current fellows. If an individual candidate is interested in meeting with a specific faculty member, we will try to accommodate those requests. In general, the interview day concludes between 3:30 and 4 pm. The Section of Neonatology will arrange and pay for hotel accommodations on the evening before the interview to help defray costs.


Salary and Benefits

The University of Colorado offers salary and benefits packages that are competitive with other fellowship programs across the country. Current salary levels can be found at the School of Medicine - Graduate Medical Education Stipends.


Denver

The Mile High City is nestled at the eastern base of the Rocky Mountains and is the largest city in the region with a population of 2.7 million. Denver enjoys one of the best climates in the country, with 300 days/year of sunny skies. Although it snows in the winter, the snow melts quickly and temperatures are usually moderate. Hot summer days give way to cool summer evenings. The city is the home to dozens of highly rated restaurants and a vibrant nightlife. The city attracts many outdoor enthusiasts with its extensive system of hiking and bike trails and the largest city park system in the country. The Denver Center for the Performing Arts is the largest performing arts complex under one roof in the country and attracts many of the top national theater tours each year. Red Rocks Amphitheater, a natural amphitheater in the foothills west of town attracts the nation’s top touring musical talent throughout the summer. Denver is home to the Denver Broncos (NFL), the Denver Nuggets (NBA), the Colorado Rockies (MLB), the Colorado Avalanche (NHL), the Colorado Rapids (MLS) and the Colorado Outlaws (MLL). The University of Colorado, the state flagship school and a world-class educational institution, is based in nearby Boulder. In addition, Denver is the gateway to the Rocky Mountains, which offer abundant recreational and sightseeing opportunities year round. The state of Colorado is home to over 20 major ski areas, many of which are within 2 hours of the city.

Please address further questions as necessary to:

Thomas Parker, MD
Associate Professor of Pediatrics
Director, Training Program in Neonatal-Perinatal Medicine
University of Colorado Denver School of Medicine
Phone: 303-724-2861
Thomas.Parker

or

Kristine Smith
Fellowship Coordinator, Training Program in Neonatal Perinatal Medicine
Phone: 303-724-2867
Kristine.Smith


Neonatology Fellows

Front Row (Left-Right): Amy Blake (PGY5), Stephanie Skuby (PGY5), Megan Gossling (PGY4), Noorjahan Ali (PGY5), Sandra Graybeal Wai (PGY6)

Back Row (Left-Right): Josh Benjamin (PGY5), Mauricio Palau (PGY4), Robert Dietz (PGY5), Christine Culpepper (PGY7)  Not shown: Anusha Streubel (PGY7)


First Year Fellows

Megan Gossling, MD
Residency: University of Colorado Pediatric Residency Program
Medical School: University of Vermont College of Medicine
Research Interests: TBD
Megan.Gossling

Mauricio Palau, MD
Residency: Stanford University Lucile Packard Children's Hospital
Medical School: Case Western Reserve University School of Medicine
Research Interests: TBD
Mauricio.Palau


Stephanie Skuby, MD
Residency: Saint Christiopher's Hospital for Children
Medical School: Robert Wood Johnson Medical School
Research Interests: TBD
Stephanie.Skuby


Second Year Fellows

Amy Blake, MD
Residency: University of Colorado Pediatric Residency Program
Medical School: Jefferson Medical College
Research Interests: TBD
Amy.Blake

Robert Dietz, MD, PhD
Residency: University of Chicago Pediatric Residency Program
Medical School: University of New Mexico School of Medicine
Research Interests: Mechanisms of pediatric hypoxic neuronal injury
Robert.Dietz

Noorjahan Ali, MD
Residency: Children's Hospital of Pittsburgh
Medical School: New York Medical College
Research Interests: The role of intrapulmonary shunt vessels in patients with pulmonary hypertension
Noorjahan.Ali


Third Year Fellows

Joshua Benjamin, MD
Residency: Tulane University
Medical School: Boston University School of Medicine
Research Interests: The effect of chronic hypoxemia on insulin secretion in fetal sheep
Joshua.Benjamin

Christine Culpepper, MD
Residency: University of Arkansas for Medical Sciences
Medical School: Louisiana State University School of Medicine
Research Interests: The effect of chronic hypoxemia on hepatic glucose metabolism in fetal sheep.  QI project: It is establishing feeding guidelines for infants with a birth weight of <1500g at Children's Hospital
Christine.Culpepper

Sandra Graybeal Wai, MD
Residency: Children's Hospital and Research Center Oakland
Medical School: Loma Linda University School of Medicine
Research Interests: Effects of amino acid supplementation on fetal IUGR skeletal muscle
Sandra.Graybeal Wai

Anusha Streubel, MD
Residency:  The Clevend Clinic
Medical School:  Temple University School of Medicine
Research Interests:  TBD
Anusha.Streubel