Educational Experiences

Overview

MUSC is the only Level IV center in the state of South Carolina and the only provider of tertiary neonatal services to southeastern South Carolina. We offer multiple ventilatory options, including volume-targeted patient-synchronized ventilation and high frequency jet and oscillatory ventilation. Dedicated pediatric surgeons in all surgical subspecialties bring complex patients to MUSC through a statewide referral system.

Neonatal Intensive Care Units

During their rotations in the NICUs, fellows participate in and direct the multidisciplinary management of neonates with medical and surgical disorders across varying levels of intensive care, from antenatal consultation through discharge.

General goals of these rotations include the development of competency in the following areas:

• Stabilization of neonates of various gestational ages;
• Anticipation and recognition of maternal disease processes and conditions, and their effect on the neonatal state;
• Assessment/diagnosis of ill neonates;
• Management of neonates with medical or surgical conditions that require intensive care;
• Assessment and management of the nutritional needs of the critically ill and convalescing neonate;
• Pre- and post-operative management of neonates undergoing surgical procedures;
• Pre-discharge management of infants from intensive care and intermediate care environments;
• Support of families of infants requiring intensive care;
• Palliative care and end of life management, including family support;
• Anticipation, recognition and prevention of complications of prematurity and of intensive care;
• Effective team management and communication; and
• The continuous assessment of team and self-performance in critical patient care situations.

Neonatology Admission / Resuscitation / Consult Team (ARC)

Obstetrical services and delivery rooms are located one floor below the NICU. During these rotations, the fellow develops skills in the prenatal consultation process, delivery room management of neonates of varying risks, and the remote management of patients requiring transfer from a referral hospital to our tertiary facility.

Fellows will assume increasing responsibility, under the supervision of neonatology staff, over the course of these rotations. The objectives of this elective will be met through the fellow’s participation in the Neonatology Consult Service, through the fellow’s participation in the delivery room management of newborns, and through the management of neonates with disease processes that require transfer to a tertiary center.

Pediatric Cardiac Intensive Care Unit (PCICU) Rotation

During the PCICU elective, fellows will gain exposure to the presentation, evaluation and management (pre- and post-operative) of congenital cardiac disorders that require cardiothoracic surgery. Included in such disorders are the common congenital cardiac malformations that occur in neonates. The fellow will also gain exposure to diagnostic testing available both to assist in the diagnosis of such disorders and to assess effectiveness of interventions. Responsibilities vary based on the individual fellow’s goals and can include direct patient care (with appropriate supervision by Pediatric Cardiology attendings/fellows), participation in echocardiographic exams and their interpretation, observation of invasive cardiac procedures, and participation in conferences and meetings.

Outpatient High Risk Follow-Up Clinic

Fellows will attend developmental follow-up clinic regularly during their subspecialty training. The goal of this experience is to understand the long-term outcomes related to NICU care and diseases of newborns. During this experience, fellows will interact with a team of developmental specialists skilled in the assessment of graduates of neonatal intensive care and intervention available to improve the health and well-being of such children. 

Perinatal Medicine Rotation

During the Perinatal Medicine selective, fellows will gain exposure to the presentation, evaluation, and management of disorders of pregnancy that impact the outcome of pregnancy and the neonate, through participation in MFM rounds, conferences, and in outpatient settings (perinatology, twins, diabetes, and preterm labor clinics). Fellows will also gain exposure to the range of antenatal and intrapartum testing offered to patients with uncomplicated through high risk pregnancies.

The development of individual electives to meet fellow’s individual educational needs is a corner stone of our program.

The David and Laura Stone Neonatal Intensive Care Unit (NICU) is a state-designated regional perinatal center, providing comprehensive care to healthy and critically ill newborns throughout the state. We believe that parents are active partners in the care of their babies and in the understanding and development of the science of newborn care. The compassionate treatment we provide is a model of effective integration of evidence-based, interdisciplinary and family-centered approaches. As a result of this approach, MUSC Children's Hospital is recognized as the premier provider of care for high-risk newborns.

Each year approximately 2,700 newborns are delivered at the Medical University of South Carolina, and an additional 12,000 babies are born within our referral area. These deliveries generate approximately 1,000 admissions to our intensive care nurseries. Neonatal transports account for 40 percent of the total admissions to our NICU.

Multiple opportunities for development of skills in adult education exist within our program, including:

• Certificate program in medical education – the clinician as an educator program
• Brown Bag Lunch series presented by educators in the University Appletree Society of the Center for Academic Excellence
• Structured formal feedback after conference presentations

Teaching opportunities exist throughout our program, including:

• Bedside and team-based education
• Didactics within the division
• Didactic presentations to the Department of Pediatrics
• Individual small group opportunities within the College of Medicine
• The opportunity to present at a national conference hosted by MUSC on evidence-based approaches to neonatal pharmacology
• The state-of-the-art simulation center at MUSC offers fellows the opportunity to develop the skills to effectively use this exciting and very useful educational tool. Fellows are currently participating as trainees and instructors in simulations of neonatal care during the first two hours of postnatal life.

Case-Based Neonatal Physiology

The Physiology Conference meets twice per month in didactic session. A faculty facilitator works with individual fellows to prepare presentations which emphasize medical knowledge competencies as described by the ABP. Presentations are didactic in nature but with ample opportunity for interaction.

Foundations in Neonatology

This board review and more conference occurs weekly and is comprised of interactive discussions among fellows and a facilitator. The process begins by the identification of reading material before sessions which emphasize medical knowledge competencies as described by the ABP.

Quality and Safety Case Conference (Q’n’S)

The Q’n’S Case Conference serves as a multidisciplinary forum at which presentations and discussions will occur that support an atmosphere of practice assessment and improvement. The goals of this conference are to review care offered to patients in the nursery system and identify opportunities for improvement. A summary of points pertinent to the Institute of Medicine (IOM)’s goals for patient care and the AAMC competencies addressed during the meeting are maintained during each conference. Systems issues identified may be referred to nursery interdisciplinary teams, such as the practice guideline committee and the newborn medicine QA committee, for consideration. Practitioners who identify opportunities for personal improvement or advancement will be encouraged to pursue these through independent study.

Fetal Board

Fetal Board is a monthly multidisciplinary conference whose goals are to provide coordination of antenatal and postnatal care of patients with fetal anomalies between multiple pediatric and adult specialties.

Neonatology Evidence-Based Journal Club

Neonatology Journal Club consists of monthly multidisciplinary meetings that serve as a forum to discuss emerging practices in neonatology. The forum supports a professional atmosphere in which medical literature is evaluated. The framework for this evaluative process follows the principles of evidence-based medicine.

Pediatric Fellows’ Core Retreat

The Department of Pediatrics Fellows’ Core Retreat is designed to both facilitate interactions among fellows of all pediatric programs and address those elements of fellow education common to all training programs.

Evidence & Value Conference

The Evidence and Value Conference is a multidisciplinary quality and safety conference used to design and implement practice protocols in neonatal medicine. The goal of this conference is to improve clinical care through the application of evidence or best practices. Participants learn the basic principles of practice improvement: scientific analysis of practice patterns and improvement cycles, the application of principles of evidence-based medicine to clinical practice, and the application of best practices (potentially better practices) to clinical care.

Research and Scholarly Activities Meeting

The Research and Scholarly Activities Meeting serves as a forum at which presentations and discussions occur that support an atmosphere of inquiry and scholarship. Participants in this conference include fellows, faculty, and invited guests as appropriate.

Clinical and Scholarly Activities Boot Camps

During Boot Camp, fellows gain an overview of neonatology through a series of didactics, discussions, simulation labs, and readings. We cover the basics of practice as a fellow—from how we round, the layout of our clinical days, census and transport management, and our management of our perinatal region to the basic pathophysiology and our approach to common disorders encountered in a Level IV NICU. 

Through participation in the research portion of boot camp, fellows develop the skills to independently develop, design, carry out, interpret, and disseminate research and other forms of scholarly activities.

Attending Lecture Series

The series occurs twice monthly. Fellows identify topics that require more in-depth review to supplement material covered elsewhere in the curriculum. Fellows invite faculty they see as experts in the topic to be discussed. The meeting is small-group based and interactive. 

Our fellows actively participate in a research program that is nationally and internationally recognized for its accomplishments. We collaborate closely with two bench Ph.D. researchers and a third Ph.D. in Public Health. Biostatistical support is available through divisional and institutional resources. Our bench and translational research programs in neonatal nutrition and maternal/neonatal vitamin D biochemistry have been impacting national standards of care for over two decades. In addition, bench and translational research in neuroprotection (both in the setting of neonatal hypoxic-ischemic injury and that of maternal chorioamnionitis) has also flourished and impacted the well-being of infants. We also support ongoing investigations in the areas of protein biochemistry and surfactant physiology. Initiation of and collaboration in multicenter clinical trials continues to be an important component of the neonatology program at MUSC. The success of these academic programs is reflected in our fellows’ achievements, including numerous presentations and publications, and several awards and grants.

Research Infrastructure at MUSC

There is a rich research infrastructure at MUSC that allows each fellow the opportunity to pursue an area or areas of research that match his or her interests. Whether a fellow wishes to pursue a career in academic neonatology or private practice, there is much to be learned through the design and implementation of both basic and clinical studies. Through the process, each fellow will become versed at turning a clinical question into a research study, how to conduct research given the regulatory issues that exist today, and how to analyze the data that is generated from such a study. Research infrastructure at MUSC includes the Clinical and Translational Research Center and its associated SUCCESS Center, the Darby Children’s Research Institute, and a variety of quality and research networks, all of which are at the disposal of our fellows.

South Carolina Clinical and Translational Research (SCTR) Institute

Included in SCTR’s programs and services are the SUCCESS Center (designed to assist with both the design and implementation of research studies, including biostatistical support) and the Research Nexus (offering a 10,000 sf outpatient unit). The outpatient research clinic includes five exam rooms, a procedure room, a computer laboratory, as well as specialized research equipment. SCTR also offers an informatics core that features Web Access, Database Storage, File Services, and automated information gathering from hospital systems.

Information Systems

Fellows have access to a wide array of local and external databases for research and quality improvement projects.

• Perinatal Information Network System (PINS) is a research quality computerized database that includes information from the mother’s record as well as that of the newborn. PINS is a rich database containing over 40 years of information.
• The Vermont Oxford Network (VON) encompasses over 90% of the VLBWs born in the USA. WE have been a member since 1996.
• Congenital Diaphragmatic Hernia Study Group (CDHSG) - “MUSC is a contributing member of the CDHSG, which is a consortium of ~70 centers from around the world dedicated to improving the care of patients with CDH through collaboration and clinical research. The study group has been functioning for over 20 years and has over 10,000 patients. As contributing investigators, we obtain an annual benchmarking report compared to the registry as a whole. We also have access to the registry data to run clinical queries or perform research investigations. More information can be found at the CDHSG website.
• Kidney Intervention during Extracorporeal Membrane Oxygenation Study Group (KIDMO) - MUSC is a proud to be a part of the international, multidisciplinary KIDMO study group with representation from both neonatology and pediatric nephrology. The KIDMO study group seeks to systematically answer questions regarding the use of renal support therapies during ECMO in neonatal and pediatric patients.”
• Extracorporeal Life Support Organization (ELSO) provides information on all patients who undergo ECMO therapy in member institutions. 

The Darby Children's Research Institute (DCRI)

MUSC’s 122,000 sf, 7-story research center opened in February 2005 as the largest and most comprehensive pediatric research facility in the Carolinas. Its mission is to improve the lives of children, their families, and communities by conducting high quality children’s research; training superior physicians and scientists; and fostering innovation through the sciences of discovery and application.