Clinical Experience

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.