Core Curriculum

Curriculum Map


PROFESSIONAL

Knowledge

• ETHICS
· Concepts of best interest of the newborn, “quality of life”, “futility”, appropriate use of technology
·  Parental authority/autonomy and vulnerability
·  Moral agency
·  Ethical theories/principles
·  Procedural framework, relevant guidelines for dealing with ethical dilemmas, medico-legal issues
·  Approach to end-of-life decision making
·  End-of-life care
·  Detection of moral distress in health care team
·  Informed consent
·  Disclosure of medical errors
·  Ethics of research
• Medico-legal issues
• Work-life balance
• Career planning/transition to staff

Skills

• ETHICS
· Identify and reflect on ethical dimensions of neonatal care
·  Explain ethical justification and reasoning re: moral dilemma
·  Solicit/explore parental views and values
·  Obtain informed consent for treatment/research
·  Deal with moral distress of team
·  Understand cultural influences in decision making
·  Document discourse with parents
·  Disclose medical error
·  Demonstrate empathy (verbal/non-verbal communication; approach to family centered care)
·  Provide end-of-life care
·  Use ethical principles in patient care

Opportunities

• Academic half day
52. Ethical frameworks
53. Concepts of decision-making in newborns
54. Approach to EOL and palliative care
55. Research ethics
56. Career planning, work-life balance
• Orientation
• Participation in antenatal consultation at limits of viability/fetus with severe congenital anomalies or life-limiting diagnoses; in end-of-life care decision-making, care and palliative care when that course pursued; participation in parent meetings when perception of best interests of newborn not being served; in discussions re: disclosure of medical error
• Lead “bad news” conferences when appropriate under staff supervision
• Lead psychosocial rounds particularly addressing ethical/psychological/social aspects of multidisciplinary care

Assessment

• OSCE
• SOE/MCQ questions
• ITER
ETHICS
• Write-up 2 ethical dilemmas encountered during training – 1000 words each
• Formal, observed “ethical encounter” (at least 2/year) with staff feedback

SCHOLAR

Knowledge

• Critical Appraisal
• Research principals and design, including statistics
• Knowledge translation
• Effective teaching
• Presentation skills

Skills

• Critically appraise medical literature
• Practice evidence-based knowledge of steps in research design and statistical analysis
• Put clinical guidelines into practice
• Teach medical students, residents, other fellows, faculty, other health professionals, parents, public
• Give a presentation
• Complete a scholarly project

Opportunities

• Academic half day
1. Teaching/presentation skills
2. Research course I
3. Research course II
4. Research course III
5. Research course IV
6. Research course V
7. Research course VI
8. Research course VII
9. Research course VIII
• Journal Club / Research rounds
• Clinical Rotations
• Research day/Conferences
• Feedback on presentations/posters

Assessment

• OSCE
• SOE/MCQ questions
• ITER
• Presentation of projects
• Observation of teaching
• Feedback forms from presentations
• Resident teaching evaluations
• Completion of scholarly project


COLLABORATOR

Knowledge

• Role of different health professionals
• Interprofessional teams
• Conflict management

Skills

• Work effectively with an interprofessional, multidisciplinary health care team in a variety of settings
• Manage conflict

Opportunities

• Academic half day scenarios
1. Conflict management
• All clinical rotations

Assessment

• OSCE
• SOE/MCQ questions
• ITER


TRANSPORT

Knowledge

• Principles of transport
• Regionalization

Skills

• Undertake safe transport of the sick infant, including communication with referring personnel, pre-transport stabilization, transport
• Stabilize infant in a non-critical care environment
• Communicate/counsel parents
• Collaborate with referring personnel, transport team members, Criticall

Opportunities

• Academic half day
2. Transport calls
3. Transport medicine
• Transport rotation

Assessment

• OSCE
• SOE/MCQ questions
• ITER
• Participation in transports


MANAGER and HEALTH ADVOCATE

Knowledge

• Quality assurance
• Patient safety
• Managing an NICU
• Health care delivery/systems/regionalization
• Community services
• Discharge planning
• Public health
• Population health

Skills

• Conduct an audit
• Manage a medical error/patient concern
• Work in a regionalized health care system
• Develop leadership skills
• Perform administrative tasks relevant to the NICU
• Prioritize tasks in the critical care setting
• Use databases and electronic health records for patient care
• Utilize appropriate community resources
• Plan the discharge of a complex patient
• Identify risk factors in individuals and populations

Opportunities

• Academic half day
4. QA and patient safety
5. Health care systems, discharge planning and community resources
6. Disclosure medical error
• NICU rotations
• Transport rotations
• Committee memberships
• Follow-up clinic

Assessment

• OSCE
• SOE/MCQ questions
• ITER
• QI project/audit
• Write guideline
• Advocacy project
• Epidemiology project


COMMUNICATOR

Knowledge

• Breaking bad news
• Communicating with families/ health professionals in challenging situations
• Antenatal counseling
• Written communications

Skills

• Breaking bad news
• Communicating with families/health professionals about patient issues in challenging situations
• Antenatal counseling
• Writing admission notes, progress notes, discharge summaries, consult letters

Opportunities

• Academic half day scenarios
7. Breaking bad news
8.  Communicating in challenging situations
9.  EOL/WLST
10. Antenatal counseling
• All clinical rotations

Assessment

• OSCE
• SOE/MCQ questions
• ITER
• Observation of consults/counseling meetings
• Feedback from families and health professionals (360)
• Chart review – notes and discharge summaries
• Review of consult letters


PHARMACOLOGY

Knowledge

• Principles of pharmacology in the preterm and term infant

Skills

• Use principles of pharmacology when prescribing medications in sick infants
• Collaborate with pharmacists

Opportunities

• Academic half day
11. Principles of pharm in newborns, specific therapies
• Clinical rotations

Assessment

• OSCE
• SOE/MCQ questions
• ITER


EAR, NOSE, and THROAT

Knowledge

• Congenital anomalies

Skills

• Manage difficult airway
• Collaborate with ENT
• Counsel/communicate

Opportunities

• Academic half day
12. Upper airway abnormalities & managing the airway
• Clinical rotations

Assessment

• OSCE
• SOE/MCQ questions
• ITER


OPTHALMOLOGY SCREENING and PREVENTION

Knowledge

• Retinopathy of prematurity
• Hearing screening
• Immunizations, RSV
• Other screening

Skills

• Ensure that ROP screening performed and communicate results
• Counsel/communicate
• Ensure hearing screening performed and communicate results
• Collaborate with ENT physicians, audiology, opthalmology
• Counsel/communicate

Opportunities

• Academic half day
13. SNUG team (ROP hearing HUS RSV)
• Clinical rotations

Assessment

• OSCE
• SOE/MCQ questions
• ITER


INFECTIOUS DISEASE

Knowledge

• Embryology, pathophysiology, epidemiology, diagnosis, management, prognosis of
· Infectious organs and organ systems (eg UTI, pneumonia, meningitis)
· Bacterial infections GBS
· Viral infections TORCH, herpes, enterovirus
· HIV
· Fungal disease
• Immunization
• Principles of infection prevention
• Principles of infection control

Skills

• Assess and manage infants with suspected or proven infectious disease
• Manage infants with overwhelming sepsis/meningitis
• Perform the components of a septic work-up (blood culture, LP, bladder tap)
• Advocate for and practice infection control
• Practice/be a role model for appropriate aseptic technique
• Manage an infectious exposure outbreak
• Counsel/communicate with parents
• Collaborate with infectious disease specialists, infection control practitioners and public health

Opportunities

• Academic half day
14. Skills day – sterile technique
15. Skills day (other technical skills)
16. Infectious disease I
17. Infectious disease II
• NICU rotations

Assessment

• OSCE
• SOE / MCQ questions
• ITER
• Observation of procedures


GENETICS

Knowledge

• Approach to the dysmorphic infant
• Embryology, pathophysiology, epidemiology, diagnosis, differential diagnosis, management, prognosis of
· Chromosomal disorders
· Deformations/malformations and disruptions
· Non-chromosomal syndromes

Skills

• Assess and manage the dysmorphic infant and the infant with antenatally diagnosed chromosomal abnormalities/syndrome
• Use results of chromosomal analysis and other genetic investigations
• Collaborate with genetics, genetic counselors
• Counsel/communicate with parents
· Explain patterns of inheritance
· Long term prognosis

Opportunities

• Academic half day
18. Approach to dysmorphic infant
• NICU rotations
• Antenatal rotations

Assessment

• OSCE
• SOE/MCQ questions
• ITER


HAEMATOLOGY

Knowledge

• Embryology, pathophysiology, epidemiology, diagnosis, differential diagnosis, management, prognosis of
· Neonatal anemia
· Platelet disorders
· White blood cell disorders
· Isoimmunization/blood group incompatibility
· Coagulation disorders

Skills

• Assess and manage infants with haematological disorders
• Practice safe and effective use of blood products, including informing parents of risks and benefits and obtaining consent
• Perform exchange transfusion
• Counsel/communicate with parents
• Collaborate with blood bank, transfusion service, hematologists

Opportunities

• Academic half day
19. Hematology of the newborn I
20. Hematology of the newborn II
• Orientation procedures session
• NICU rotation
• Antenatal rotation

Assessment

• OSCE
• SOE/MCQ questions
• ITER


RENAL SYSTEM/FLUID AND ELECTROLYTE BALANCE

Knowledge

• Development of the urinary tract
• Renal physiology and function
• Fluid and electrolyte physiology
• Embryology, pathophysiology, epidemiology, diagnosis, management, prognosis of
·  Congenital renal anomalies
·  Urinary tract anomalies
·  Acute and chronic renal failure
·  Metabolic acidosis
·  Electrolyte disorders
·  Calcium, magnesium, phosphorus disorders

Skills

• Assess and manage infants with renal/urinary tract disease
• Assess and manage fluid and electrolyte disorders
• perform urethral catheterization and suprapubic bladder aspiration
• Use results of renal and urinary tract imaging
• Prescribe fluids and electrolytes
• Counsel/communicate with parents
•Collaborate with nephrologists/urologists

Opportunities

• Academic half day
21. Fluid and electrolytes in the term, preterm, and surgical infant
22. Renal abnormalities
23. Urological abnormalities
• NICU rotation
• Antenatal rotation

Assessment

• OSCE
• SOE/MCQ questions
• ITER


METABOLIC and ENDOCRINE

Knowledge

• Glucose metabolism and disorders of glucose homeostasis
• Embryology, pathophysiology, epidemiology, diagnosis, differential diagnosis, management, prognosis of:
·  Thyroid disease
·  Adrenal disorders including adrenal insufficiency and CAH
• Ambiguous genitalia
• Inborn errors of metabolism
• Newborn screening

Skills

• Assess and manage infants with proven or suspected endocrine and metabolic disorders
• Screen for hypo and hyperglycemia
• Perform routine newborn screening, including appropriate follow-up
• Recognize and implement emergency management of inborn errors of metabolism
• Counsel/communicate with parents
• Collaborate with endocrine and metabolic specialists, newborn screening programs

Opportunities

• Academic half day
24. Ambiguous genitalia
25. Endocrine disorders
26. Inborn errors of metabolism and newborn screening
• NICU rotations

Assessment

• OSCE
• SOE/MCQ questions
• ITER


CENTRAL NERVOUS SYSTEM/DEVELOPMENT/FOLLOW-UP

Knowledge

• Development of the nervous system
• Normal and abnormal motor and cognitive development during the first 2 years
• Embryology, pathophysiology, epidemiology, diagnosis, management, prognosis of:
·  CNS congenital anomalies
·  Acquired brain injury (HIE, IVH/ICH, PVL)
·  Neonatal seizures
·  Hypotonia
·  Neonatal abstinence
• Outcome/sequelae of prematurity
• Outcomes of high risk fetal conditions
• Outcomes of congenital anomalies

Skills

• Perform a newborn neurological exam
• Perform an age-appropriate developmental assessment
• Asses and manage infants with CNS disease
• Assess and manage infants at risk of adverse neurodevelopment
• Interpret routine head ultrasound
• Interpret bedside aEEG
• Use results of neuroimaging (MRI)
• Perform lumbar puncture
• Use neuroprotective strategies (cooling)
• Counsel parents about long term neurodevelopmental outcomes of newborn disease, including prematurity
• Collaborate with other health professionals (OT, PT, speech therapist, developmental specialist, neurologist, neurosurgeon)in assessment, follow-up and management of at-risk infants and children

Opportunities

• Academic half day
27. Approach to developmental disorders (follow-up)
28. Neurological disorders of the newborn
29. Neonatal neurology in practice (NICU)
• NICU rotations
• Antenatal rotation
• Neonatal follow-up clinic

Assessment

• OSCE
• SOE/MCQ questions
• ITER
• Observation of developmental exam during follow-up rotation
• Write up a case from follow-up clinic


NUTRITION GROWTH/FEEDING/GASTROINTESTINAL SURGICAL ANOMALIES

Knowledge

• Development and function of the GI tract and hepatobiliary system
• GI absorption and malabsorption
• Bilirubin metabolism
• Fetal/postnatal growth and nutrition
• Postnatal nutrition requirements
• Breast milk and breastfeeding
• feeding difficulties/GERD
• Embryology, pathophysiology, epidemiology, diagnosis, management, prognosis of:
·  Congenital anomalies in the GI tract
·  Necrotizing enterocolitis
·  Hyperbilirubinemia
·  Osteopenia of prematurity
·  Liver failure

Skills

• Assess and management infants with disorders of GI tract, hepatobiliary system, nutrition
• Interpret xrays of the GI system
• Use results of GI/hepatic ultrasound
• Perform paracentesis
• Place abdominal drain in an emergency situation of perforated NEC
• Prescribe TPN and nutritional supplements
• Establish vascular access/insert PICC lines
• Provide lactation support and advice
• Cousel/communicate with parents
• Collaborate with dieticians, lactation consultants, GI specialists and surgeons

Opportunities

• Academic half day
30. Growth and nutrition
31. Feeding, EBM, donor milk
32. Surgical abnormalities of the newborn I
33. Surgical abnormalities of the newborn II
34. NEC and short gut
35. Bilirubin, indirect
36. Bilirubin, direct & liver disease
• Orientation procedures
• NICU rotations (nutrition rounds)
• Antenatal rotation

Assessment

• OSCE
• SOE/MCQ questions
• ITER
• Observation of procedures


CARDIOVASCULAR SYSTEM

Knowledge

• Normal and abnormal cardiovascular physiology, including cardiac failure
• Embryology, pathophysiology, epidemiology, diagnosis, differential diagnosis, management, prognosis of:
·  Congenital heart disease
·  PDA
·  PPHN
·  Shock
·  Hypertension
·  Arrhythmias
·  Myocardial disorders
·  Vascular lesions

Skills

• Assess and manage infants suspected or diagnosed cardiovascular disease
• Stabilize infants with antenatally diagnosed congenital heart disease
• Recognize infant with undiagnosed congenital heart disease
• Perform pericardiocentesis
• Perform and interpret EKGs
• Use results of echocardiograms/TnECHO
• Collaborate with cardiologists, CVS surgeons in the care of infants with CVS diseases
• Counsel/communicate with families

Opportunities

• Academic half day sessions
37. Congenital heart disease and mycocardial disorders
38. Fetal and newborn arrhythmias
39. PDA
40. Shock and pulmonary hypertension
• Orientation procedures
• Clinical Rotations
• Antenatal rotation

Assessment

• OSCE
• SOE/MCQ questions
• ITER
• Observation of procedures


RESPIRATORY

Knowledge

• Lung development and maturation
• Control of breathing and apnea
• Pulmonary function and pulmonary mechanics
• Principles and strategies of non-invasive and invasive respiratory support including indications and complications
• Embryology, pathophysiology, epidemiology, diagnosis, differential diagnosis, management, prognosis of:
·  Upper airway disease and stridor
·  RDS/Surfactant
·  TTN/delayed fluid clearance
·  Meconium aspiration
·  Pneumonia
·  Congenital lung abnormalities, including congenital diaphragmatic hernia
·  Air leak syndromes
·  Chronic lung disease/BPD

Skills

• Assess and manage infants with respiratory disease
• Manage the airway
• Provide all modalities of non-invasive respiratory support based on principles of physiology and pulmonary mechanics
• Provide nitric oxide therapy
• Provide Surfactant therapy
• Plan discharge of infant on home oxygen
• Perform pleurocentesis/chest tube insertion
• Interpret and use of non-invasive respiratory monitoring
• Interpret blood gases
• Interpret xrays of the respiratory system
• Use the results of other respiratory tract imaging modalities, including MRI
• Counsel/communicate with parents
• Collaborate with respiratory therapists, respiratory disease specialists, surgeons

Opportunities

• Academic half day
41. Lung physiology, function and mechanic
42. Principles and strategies of ventilation
43. Ventilation skills workshop
44. Acute lung disease I
45. Chronic lung disease
• Orientation – ventilation session, procedures
• Clinical rotations

Assessment

• OSCE
• SOE/MCQ questions
• ITER
• Observation of procedures


TRANSITION AND ADAPTATION AT BIRTH/THERMOREGULATION

Knowledge

• Physiology of transition, normal and abnormal
• Neonatal complications associated with birth:
·  Birth injury
·  Asphyxia
• Neonatal resuscitation and stabilization
• Principles of thermoregulation
• Consequences of hypo and hyperthermia

Skills

• Obtain and use antenatal information to develop plan of care at birth
• Assess newborn at birth to determine need for resuscitation
• Resuscitate newborn including appropriate procedural skills
• Work with and lead interprofessional resuscitation team
• Debrief, reflect on resuscitation events
• At birth, recognize and manage birth injury
• Assess gestational age
• Communicate with parents about the resuscitation plan and about their infants, including situations when resuscitation is not successful
• Provide appropriate thermal environment

Opportunities

• Academic half day
46. Developmental and nursing care
47. HIE and cooling
• NRP teaching
• Orientation – mock codes, procedure sessions, NRP
• Simulation
• Debriefing of resuscitation

Assessment

• OSCE
• SOE/MCQ questions
• ITER
• Observation of resuscitation
• 360 evaluation
• Simulation


MATERNAL FETAL MEDICINE

Knowledge

• Fetal development and physiology, including placenta
• Effect of maternal disorders on fetus and newborn
• Complications of pregnancy and effect on fetus and newborn
• Effects of medications, substance abuse, environmental agents on fetus and newborn
• Labour complications and effect on fetus and newborn
• Specific fetal conditions including hydrops, TTTS, multiple gestation
• Fetal intervention and therapy
• Prenatal screening

Skills

• Use results of prenatal screening, fetal imaging and other diagnostics, tests of fetal well-being
• Contribute expertise to the interprofessional and multidisciplinary management of antenatal patients
• Take accurate and complete antenatal history
• Counsel expectant parents in elective and urgent situations
• Convey information to expectant parents in a manner that is compassionate and readily understood
• Develop a management plan with parents, using principles of shared decision making
• Communicate management plan to other health professionals

Opportunities

• Academic half day
48. MFM I
49. MFM II
50. MFM III
51. MFM IV
• Orientation session on antenatal consultation
• Antenatal rotation

Assessment

• OSCE
• SOE/MCQ questions
• ITER
• Observation and review of antenatal consults
• Fellow portfolio of antenatal cases