225 - Development and Implementation of a Novel Fellowship Training Program for Level II Special Care Nursery Providers

Poster Number: 225
Publication Number: 225.332

Ajay B. Ponkshe, Cincinnati Children's Hospital Medical Center, Mason, OH, United States; Beth Ann A. Johnson, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States; Scott Wexelblatt, Cincinnati Children's Hospital Medical Center, Mason, OH, United States; Amy T. Nathan, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States; Nicole L. Boswell, Cincinnati Children's Hospital Medical Center, Waynesville, OH, United States; Jennifer M. Brady, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States

Background: With changes to residency duty hours and decreased ICU time requirements, pediatric residents graduate with minimal NICU experience. Most pediatric residency graduates are not adequately prepared to independently care for level II Special Care Nursery (SCN) infants without additional training or experience. With an aging workforce, a need exists for competent physicians to provide Level II SCN care.

Objective: We hypothesize that completion of a novel yearlong level II fellowship curriculum will adequately prepare pediatricians to provide care in level II SCNs.

Design/Methods: Local practicing Level II SCN providers were asked to complete a needs assessment survey to define key curriculum content. Using this data, a structured curriculum was developed to support immersive clinical experiences based on a social cognitive theory framework. Fellow trainees completed quarterly comfort surveys and documented procedures, cases, and experience exposure. Preceptors completed weekly evaluations of trainees’ core competencies. Competencies were based on Neonatology ACGME core competencies, adapted for Level II SCN care. A clinical competency committee met quarterly to review all data and assign core competency scores.

Results: Eight of 9 Level II SCN physicians (89%) participated in the needs assessment which identified key knowledge content areas, procedures, and cases (Table 1). Curriculum included one week per month of 1) Normal Newborn care, 2) Level II SCN care, 3) Level III NICU care, and 4) Adjunct didactic/learning activities. Adjunct curriculum structure and content was based on areas identified by the needs assessment and adult learning theory principles (Table 2).

Two recent Pediatric Residency graduates enrolled and completed the fellowship program between 7/2020-10/2021. During the 12-month curriculum trainees attended a mean ± SD of 89 ± 11 deliveries and had 14 ± 4 intubation attempts. Competency scores (based on a 5-point Likert scale) improved from a mean ± SD of 2.36 ± 0.01 at program initiation to 3.82 ± 0.12 at completion. Both trainees met goal competency scores by 12-months and graduated to providing independent Level II SCN care.Conclusion(s): We report the creation of a novel 12-month Level II Fellowship. After completion of the training program, recently graduated pediatricians met core competency goals to graduate to independent practice and reported increased comfort in the Level II setting. Our study provides a framework for implementation of Level II Fellowship programs to aid in closing the workforce gap of Level II SCN providers.
Table 1: Level II Fellowship Curriculum Content based on Needs Assessment
Table 2: Level II Fellowship Training Curriculum Structure