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Fellowship Overview
This three-year program, which is administered by the Division of Neonatology, is designed to prepare pediatricians for careers in clinical and academic neonatal medicine and research.
The fellowship training program consists of clinical experiences and formalized instruction, including weekly research conferences, perinatal physiology conferences, clinical case conferences, monthly M&M conferences and perinatology conferences with faculty from the Division Maternal-Fetal Medicine.
Our Fellows are expected to participate actively, very early in their training, in research programs and are encouraged to develop individual research projects of their own design. For individuals interested in continuing their research beyond three years, there will be an opportunity to remain at Children's Hospital of New York one or two additional years as junior faculty.
Currently the Organization of Neonatal Training Program Directors (ONTPD) is requiring all training programs to utilize an electronic application submitted to programs through ERAS. All fellowship training programs currently participate in the match administered by the National Residency Matching Program (NRMP). Information for prospective fellow applicants may be obtained utilizing the link to the ONTPD website referenced below.
ONTPD homepage
Clinical
Activities
The clinical experience during the three-year fellowship training program at the Morgan Stanley Childrens Hospital of Presbyterian Hospital, Columbia Campus is intense and extensive. The first year of training is comprised of seven months of clinical experiences, four months of research and one month of vacation. Clinical service is divided equally between three rotations. Two rotations include management of the entire sixty-two bed neonatal intensive care unit and the third includes management of the delivery service, transitional nursery, transport service, and neonatal consultation service. One of the two NICU rotations includes managing and coordinating pre and post-operative care for neonates with congenital heart disease. During the first year of training, fellows acquire the bulk of their clinical skills. By directing daily work rounds and the didactic lecture series for residents, the fellows acquire both leadership experiences and teaching skills.
The second and third years are similar to the first but with three and two months of clinical service respectively with progressively increasing responsibility for independence in patient management decisions. Throughout the three years the fellows participate in in-house night call on an every sixth-every eighth night rotation. The fellow, in conjunction with the attending physician is the primary director of clinical care for all neonates within the unit. Although many therapeutic decisions are discussed with the attending physician, fellows operate with substantial independence. Fellows also are responsible for informal and impromptu teaching sessions during rounds. They acquire an enormous amount of clinical experience because of the high volume of admissions (>1,000 per year), in-house call and the extremely high risk population cared for at Morgan Stanley Childrens Hospital of New York Presbyterian. Because we are an ECMO center, have a high volume of maternal-fetal medicine patients referred to our prenatal pediatric center, have a very high volume of cardiothoracic patients for whom we offer primary care, and are using nitric oxide and other cutting edge therapies, there is a continuous flow of gravely ill neonates. The fellows are fully competent to manage infants using the newest forms of mechanical ventilation, surfactant replacement therapy and continuous positive airway pressure. They are adept and competent at performing procedures such as the placement of umbilical catheters as well as percutaneous placement of central venous catheters. Our cardiac, neurology, genetic and surgical services (both general and subspecialty) are extremely active and provide a full range of clinical challenges. Housing both the Departments of Pediatrics and Pediatric Surgery of Columbia University School of Medicine, our hospital ensures a full complement of pediatric medical and surgical generalists and subspecialists to assist our faculty and our fellows with patient care and both teaching and learning opportunities. We are confident that the three years of clinical experience at our institution prepares our fellows for all possible clinical contingencies.
Our fellows are also competent in communication with families and other healthcare professionals and use information technology to gather information and to develop rational therapeutic plans. The full services of the clinical and basic science faculty of the Medical School and the full electronic and hardbound journals held by the Columbia Medical Library are available to and widely utilized by all fellows.
Philosophy
of Research Training
There is a long history of excellence in Neonatal and Perinatal research. Since the founding of the division in May of 1959, many of its clinician-scientists have contributed substantively to the field. These include Drs. L. Stanley James and Virginia Apgar who were among the first investigators to measure the acid-base and oxygen status in the neonatal intensive care unit. In the same setting, Drs. William Silverman and Jack Sinclair undertook the first controlled clinical trials in neonatal patients. These studies are the original models for evidence-based practice in neonatal intensive care. In addition, Drs. Mervin Susser, Zina Stein, and Nigel Paneth helped establish the Gertrude H. Sergievski Institute at Columbia University, one of the first centers to foster Perinatal and Pediatric Epidemiology. The Division also has a long-standing interest in neurodevelopment and has well-established collaborations with the New York State Psychiatric Institute. Under the leadership of Dr. Richard Polin, the division has focused on these strengths and has successfully trained fellows in developmental neurobiology and behavior and perinatal epidemiology. Currently, all Neonatology fellows are allotted the same amount of time for research during three years of fellowship (3 months during year 1, 8 months during year 2, and 10 months during year 3). During the first year, Drs. Diacovo and Lorenz introduce trainees to the principles of basic and clinical research, respectively, as well as assisting the fellows in finding prospective research mentors within the Department of Pediatrics, the Medical School, or the undergraduate campus.
When fellows come to Columbia with specific research questions or interests, every effort is made to assist the fellow in reaching his/her goals. This situation is, in fact, rather unusual. More commonly, trainees are uncommitted and prefer to examine the options at the institution before making their choice of a research objective. We believe there is a sufficiently wide range of choices at Columbia to insure first-rate research experience for all serious candidates.
Fellows frequently choose to do research with faculty members outside of our division. The most frequently chosen areas include obstetrics, pharmacology, development psychobiology, neurology, computer science, hematology and pulmonology. We encourage fellows to follow their interests and we have generally been able to find faculty advisors and other resources to assist the fellow in whatever area is appealing to them. Advice regarding experimental design and statistical analysis is available from many sources within the institution.
Research Activities
The American Board of Pediatrics has issued criteria for certification in neonatal/perinatal medicine. Of major concern to the Board is that potential diplomates demonstrate competence in clinical or basic science research. For a listing of ongoing research projects within the division please see the research section.
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