Brigham and Women's Hospital Neonatal Medicine Rotation
Goals and Objectives
The goal of the BWH neonatal medicine rotation is to develop the ability of residents to evaluate, resuscitate and manage newborns in the delivery room, and immediately thereafter. The rotation is based in a metropolitan referral hospital that boasts nearly 10,000 deliveries per year. The neonatal intensive care unit cares for infants born prematurely, or with complex medical and surgical problems. The objectives of this rotation are designed to further the residents’ development of competency in the following six areas:
I. Patient Care
II. Medical Knowledge
III. Practice-Based Learning and Improvement
IV. Interpersonal and Communication Skills
V. Professionalism
VI. Systems-Based Practice
I. Patient Care
The primary responsibility of the resident is to respond to requests from obstetrical staff in the labor and delivery unit for pediatric coverage at deliveries. The responding resident will lead resuscitation efforts for the newly delivered infant. Backup coverage from a neonatal fellow and/or neonatology attending is available at all times.
Residents will evaluate all infants who are brought to the triage area of the nursery for evaluation. After reviewing the perinatal record, and examining the infant, the resident will plan appropriate diagnostic and therapeutic interventions. The resident will be primarily responsible for management decisions, including assessing need for admission to the NICU.
Residents will care for infants in one of the special care nurseries (NICU A) at BWH as well. They will be responsible for evaluating these patients upon admission or transfer to the nursery, formulating a differential diagnosis and planning appropriate diagnostic and therapeutic interventions, in coordination with the attending neonatologist, intensive care fellow, and primary neonatal nurse.
During antenatal consults, residents will educate and counsel women who are admitted in preterm labor about the expected course and prognosis of infants delivered prematurely.
Residents will be mindful of routine health care maintenance for infants under their care. They will order Massachusetts newborn screening, hearing screens, active and passive immunizations, car seat testing, and ophthalmologic examinations as indicated.
As medically indicated, residents will perform appropriate diagnostic and therapeutic procedures after obtaining informed consent from the patient and/or family, with supervision from the neonatology attending and fellow. Residents will document procedures in the chart and in their personal logbooks. On this rotation, these may include:
- arterial puncture
- endotracheal intubation
- intravenous catheter placement
- thoracentesis and chest tube insertion
- umbilical catheter placement
- venipuncture
II. Medical Knowledge
Residents use the large number of deliveries they attend to deepen their clinical skills and knowledge about newborn resuscitation.
During this rotation, it is expected that residents will manage infants diagnosed with, but not limited to:
- Congenital abnormalities
- Congenital pneumonia
- Hyperbilirubinemia
- Meconium aspiration
- Pneumothorax
- Prematurity
III. Practice-Based Learning and Improvement
In caring for patients, residents will utilize a broad range of published medical information available through web-based resources, as well as print textbooks and journals. It is expected that decisions about patient care will be informed by review, synthesis and application of studies available in the literature.
Residents will take part in biweekly radiology rounds, reviewing radiologic imaging of their patients with pediatric radiology attendings and the neonatology team.
IV. Interpersonal and Communication Skills
Residents will work as members of a broad team that includes neonatologists, obstetricians, obstetric and NICU nurses, respiratory therapists, and case managers.
Residents will meet regularly with parents of babies under their care in the nursery to listen to their concerns and keep them updated on their child’s condition and care plan.
Delivery room and consult notes will be completed at the time of patient contact in order to share information among team members.
Daily notes in the chart clearly documenting NICU A patients’ progress, diagnostic results and ongoing plan will be completed in order to maintain an accurate medical record and share information among team members. When patients are discharged, discharge summaries will be dictated and made part of the medical record.
Residents will communicate regularly with primary care physicians of infants they care for in the triage area and NICU A.
Residents will provide feedback to their co-residents, students and attendings on an ongoing basis throughout the rotation, completing written evaluations at the completion of the rotation. Similarly, they will receive regular verbal feedback and a final written evaluation from the attending neonatologist that will be placed in their permanent record. Residents will use constructive feedback to guide their efforts in ongoing learning and self-improvement.
V. Professionalism
Residents will interact with an extremely ethnically and socio-economically varied patient population that is treated in this referral intensive care unit. Patients will include those living in local communities, as well as those delivered at MGH because of high-risk pregnancies and those transferred for complex disease of the neonate. Residents will care for patients independent of their ability to pay for services.
Residents will provide compassionate, empathic and culturally sensitive communication with parents. They will be particularly sensitive to the unique situation of parents of premature or severely ill infants. They will demonstrate sensitivity and responsiveness at all times to parents’ culture, gender, sexual orientation and disabilities.
Maintenance of family confidentiality will be of highest priority.
Residents will at all times demonstrate ethical and professional behavior. During this rotation, in particular, residents will deal with issues of end of life care and withdrawal of support, potential for long-term disabilities and chronic illness. Residents will take part in discussions between attending physicians and patients/families about end of life care decisions.
When appropriate, residents will utilize the MGH Ethics Consultation Service to facilitate team meetings to discuss difficult issues.
Residents will ensure that families give informed consent for all aspects of care.
VI. Systems-Based Practice
Residents are expected to provide high quality, but cost-effective health care. They will collaborate with case managers and other team members to implement appropriate discharge plans.
Residents will help arrange follow up with the Massachusetts early intervention program, the NICU follow up clinic and subspecialists as indicated, in addition to the patient’s primary care provider. Residents will communicate with the patient’s primary care physician, especially near the time of discharge.
At all times, residents will act in accordance with the legal mandate in the Commonwealth of Massachusetts to report any suspicions of child abuse or neglect, being familiar with the process by which such suspicions are reported.
