Rotation Objectives

Rotation Specific Goals and Objectives


Pre-Entry Assessment Program (PEAP)

The PEAP assessment is required by the College of Physicians and Surgeons of Ontario (CPSO) for international medical graduates going into residency training programs. This assessment requires registration with the CPSO before commencement of the assessment period. A fellow’s general knowledge and competency appropriate for practice in his/her specialty will be assessed during the PEAP. Individuals who are deemed not to have general knowledge and competency appropriate for practice in their specialty cannot enter fellowship training.

Definition: 

The Pre-entry Assessment Program (PEAP) is an assessment process that evaluates IMGs to determine whether they can function at their reported level of a Canadian trainee, in order to qualify to enter an Ontario residency/fellowship program. The majority of PEAP candidates are on a Visa and are expected to return to their country of origin following completion of postgraduate training. PEAP is for a duration of 4 – 12 weeks, PEAP time does count towards fellowship training.

PEAP must:

  • Provide assessment of the candidate’s clinical skills, knowledge and judgment in the discipline in which the candidate is seeking postgraduate education, as well as the candidate’s basic skills in appropriate for practice in the chosen discipline.
  • Provide assessment in respect to whether the candidate is: mentally competent to practice medicine; has the ability to practice with decency, integrity and honesty and in accordance with the law; has sufficient knowledge, skill and judgment to engage in the kind of medical practice authorized by the certificate; and can communicate effectively and displays an appropriately professional attitude.

Level of Practice:

  • Is supervised and is able to function at their reported level
  • Are able to sign their own orders, however, the supervisor may wish that orders initially be cosigned

Possible Outcomes: 

Successful: After successful completion of a PEAP or AVP, the CPSO must be notified (with sign-off from the Postgraduate Dean) and the license will be converted to a Postgraduate Education Certificate of Registration.

Unsuccessful: Unsuccessful PEAP may be appealed based on due process only.*

No repeat PEAPs are allowed in the same discipline. If the candidate is unsuccessful in PEAP, s/he will not be permitted to continue on at the designated level of training.

Final Assessment form is completed and returned to the Postgraduate Medical Education Office for submission to the CPSO.

* Please refer to Procedures on Appeals at PGME website

http://fhs.mcmaster.ca/postgrad/documents/TERMSOFREFERENCEAPPEALREVIEWBOARDFINAL.doc

Role of a trainee undergoing PEAP

The trainee undergoing PEAP will initially be expected to work at a junior grade before they can be signed off to work at a more supervisory grade as a fellow. The PEAP trainee will be assessed in six main areas:

(I) Clinical Expectations: 1. Attendance at deliveries 2. Admission of inborn/outborn infants 3. Ongoing management of NICU patients: usually 4-6 patients are assigned to each trainee each day. 4. On weekends, usually one pod is assigned to each resident, CNSNP, fellow and/or clinical assistant. 5. All care is under the direct supervision of attending. 6. Participation at management and teaching rounds 7. Daily handover to the overnight staff. This should communicate a brief history, the needs of the patient and the general plan.

(II) Communication: Prior to acceptance into the PEAP, the Program Director will review a candidate’s communication capabilities during an interview and using the CPSO’s current requirements for English/French fluency. The Program Director may require a candidate to write English language assessment test (TOEFL / IELTS), which is mandated by neonatal perinatal medicine program. The PEAP is the official mechanism for determining ability to communicate effectively.

During the PEAP period trainees are expected to conduct antenatal consultations under direct supervision. Satisfactory completion of 3 consults is mandatory before a candidate can be signed off to conduct them independently.

(III) Transport: The NICU at McMaster being a tertiary centre provides referral hospitals in the region with both advice and transport services. Trainees will provide the necessary support and or advice under supervision. Satisfactory completion of 3 transport consults is mandatory before a candidate can be signed off to conduct them independently.

(IV) Clinical Skills: Each fellow will receive a “Clinical Technical Skills Record”. When you are performing a procedure, the PEAP trainee should ask the attending staff to observe and then “sign off” that the procedure if it has been completed successfully. You must be observed performing the procedure – word of mouth the next morning is not adequate

(V) Leadership Skills: The role of a fellow is more supervisory and trainees are expected to be leaders in several situations. All PEAP trainees will be expected to lead at least one “Code Pink” (either ‘mock code’ or ‘the real one’), satisfactorily under supervision during PEAP period. Candidates need to meet expectations in all of the five areas mentioned to be eligible for further assessment.

(VI) Case Discussion: Once a candidate is deemed to be PEAP competent, she/he will undertake a long case discussion and a structured oral examination (SOE) with two attendings lasting for 1.5 hours. Trainees will be signed off as having successfully completed their PEAP and can function as fellows in the program.

Timelines:

An initial assessment could be completed at the end of the 2nd week and a candidate could be signed off as having successfully completed PEAP as early as the 4th week. If deficiencies are identified, the trainee will be assessed once again by the end of the PEAP period. The maximal evaluation period for PEAP can extend up 12 weeks. If by 12 weeks, the candidate in unsuccessful in the PEAP, she/he is ineligible for postgraduate training in that particular specialty.

NICU Service - Acute1 and 2, IMC, Consults, and Float

Objectives of Neonatal Intensive Care Unit rotation

Medical Expert:

  • Acquire skills in neonatal resuscitation and stabilization in a perinatal setting including extremely high-risk situations, unanticipated emergencies and low-risk deliveries with relatively minor problems
  • Understand and interpret antepartum and intrapartum fetal assessment. Learn the outcome of pregnancies of varying gestational age
  • Gain experience in antenatal consultations especially prematurity
  • Gain experience in the diagnosis and management of the major clinical disorders of the newborn
  • Gain experience in the management of infants with chronic medical and surgical problems requiring prolonged hospitalization and the counseling and support of the families
  • To understand the provision of neonatal intensive care in a family centered, community based environment
  • Gain proficiency in neonatal consultation for infants from postnatal wards
  • Gain experience in the management of preterm infants who require prolonged hospitalization and in the support of their families
  • Gain awareness of infants at risk of neurodevelopmental disabilities and the need for regionalized follow-up within the community setting
  • Become familiar with the tools for assessing high risk infants for motor and cognitive assessments, vision and hearing impairment, and for cognitive behavior and academic functioning
  • Gain proficiency in neonatal consultation for infants in the level I nursery and the advanced level II nursery

Manager:

  • Understand the concept of regionalized perinatal healthcare
  • Gain experience in the operation of a regional level III NICU
  • Develop the judgment and expertise to organize the transfer of a sick newborn from a referral hospital and to manage the transport of sick infants by telephone discussion with the transport team
  • Understand the resource issues related to provision of perinatal care
  • Awareness of the scope of practice of a healthcare team in a community hospital
  • Understand the development of clinical guidelines and how they are implemented in the day-to-day delivery of healthcare

Scholar:

  • Supervise and teach others in neonatal resuscitation
  • Learn how to research a clinical problem
  • Develop initiative and curiosity in dealing with clinical problems and utilizing them in teaching key concepts
  • Critically appraise and synthesize medical literature in order to implement evidence based medical practice
  • Supervise and teach junior members of the healthcare team

Communicator and Collaborator:

  • Provide telephone consultation and advise to referring physicians on the management of newborns who do not require transfer to a Level III centre
  • Gain experience and judgment in the use of subspecialty consultation and collaboration in the care of the newborn with multisystem disorders
  • Develop skills in counseling and supporting families of newborn infants in the NICU
  • Communicate and work effectively in the multidisciplinary team approach to neonatal care
  • Understand the roles of other members of the team, including nurses, respiratory therapists, dieticians, and physiotherapists

Health Advocate:

  • Develop the skills to plan the discharge of a child with complex ongoing needs
  • Gain knowledge of available community resources to facilitate discharge of the sick infant

Professional:

  • Develop an awareness of ethical issues in the care of the critically sick newborn infants with multiple medical and surgical problems
  • Provide culturally sensitive counseling and be respectful of racial, cultural, gender and societal differences in family and staff interactions.
  • Demonstrate professional respect for legal and ethical issues with regard to confidentiality
  • Demonstrate professional attitudes and behaviors as a role model for others.

NICU Service - Junior Staff

Objectives of Neonatal Intensive Care Unit – Junior Staff rotation

Objective:

The main objective of this rotation is for fellows to experience the roles and responsibilities of a neonatologist.

Learning opportunity:

Fellows need to focus on the following clinical opportunities during this rotation.

  • Ward rounds
  • Weekly Neonatologist meetings
  • Parent Meetings
  • Psycho-Social Rounds
  • Bed management rounds with pediatricians
  • Complex deliveries and transport calls
  • Supervisory role in day to day affairs

On calls:

  • During this rotation on calls are from home and supernumerary.
  • The fellow is expected to offer advice and manage situations from a remote site based on information received via the telephone
  • In situations when a fellow does not have transport and or cannot drive, on calls could be in-house
  • The senior fellow will be the main liaison individual between the neonatal team and the attending.

Communicator:

A) Develop rapport, trust, and ethical therapeutic relationships with families

  • Recognize that being a good communicator is a core clinical skill for physicians, and that effective physician-patient and physician-family communication can foster patient and family satisfaction, physician satisfaction, adherence and improved clinical outcomes
  • Establish positive therapeutic relationships with families that are characterized by understanding, trust, respect, honesty and empathy
  • Demonstrate an understanding of the family’s perspective and concern for the health of the fetus, neonate and infant and the impact of their illness on the family
  • Support and counsel families who are experiencing the stress of a high-risk pregnancy, critically ill or dying infant
  • Show respect and understanding of factors such as parental age, religion, ethno-cultural background, socioeconomic status which may affect the family’s experience and decision making
  • Respect patient and family confidentiality, privacy and autonomy
  • Listen effectively and be responsive to nonverbal cues
  • Effectively facilitate a structured clinical encounter that includes other health care professionals involved in the care of the fetus and newborn as well as family member

B) Accurately elicit and synthesize relevant information and perspectives of families, colleagues, and other professionals

  • Gather information about a disease, but also about a family’s beliefs, concerns, expectations and illness experience
  • Seek out and synthesize relevant information from other sources, such as a patient’s family, caregivers and other professionals
  • Seek out and utilize information from other health care professionals including physicians, nurses, social workers and midwives who are involved in care of the mother, infant and / or family
  • Seek out and utilize information about the pregnancy including maternal perinatal screening, serology and fetal ultrasound when providing care for the infant

C) Accurately convey relevant information and explanations to patients and families, colleagues and other professionals

  • Deliver information to families, colleagues and other professionals in a humane manner and in such a way that it is understandable, encourages discussion and participation in decision-making within their comfort level

D) Develop a common understanding on issues, problems and plans with patients, families, and other professionals to develop a shared plan of care

  • Effectively identify and explore problems to be addressed from a family encounter, including the family’s context, responses, concerns, and preferences.
  • Respect diversity and difference, including but not limited to the impact of age, gender, religion and cultural beliefs on decision-making
  • Gather information not only about the disease of the fetus, newborn and young infant but also about the family’s beliefs, concerns and expectations about the illness, while considering the influence of factors such as cultural and socio-economic background and spiritual values.
  • Encourage discussion, questions, and interaction in a family encounter
  • Engage families and relevant health professionals in shared decision-making to develop a plan of care
  • Understand and demonstrate the importance of cooperation and communication amongst members of the inter-professional team so that consistent messages are delivered to families
  • Effectively address challenging communication issues such as obtaining informed consent, delivering bad news, and addressing anger, confusion and misunderstanding

E) Convey effective oral and written information about a medical encounter

  • Maintain clear, accurate, and appropriate records (e.g., written or electronic) of clinical encounters and plans
  • Effectively present verbal reports of clinical encounters and plans
  • When appropriate, effectively present medical information to the public or media about a medical issue

Collaborator:

As Collaborators, physicians effectively work within a healthcare team to achieve optimal patient care.

  • Recognize differences, misunderstanding and limitations that may contribute to inter-professional tension
  • Reflect on inter-professional team function

A) Participate effectively and appropriately in an interprofessional healthcare team

  • Understand the roles and responsibilities of other professionals within the Neonatal-Perinatal health care team such as nurses, nurse-practitioners, respiratory therapists, social workers, pharmacists, dieticians, therapists
  • Recognize and respect the diversity of roles, responsibilities and competences of other professionals in relation to their own
  • Work with others to assess, plan, provide and integrate care for individual patients (or groups of patients)
  • Develop a care plan for the fetus, neonate and infant, including investigation, treatment and continuing care, in collaboration with the members of the inter-professional team.
  • Participate effectively in inter professional team meetings
  • Enter into interdependent relationships with other professions for the provision of quality care
  • Respect team ethics, including confidentiality, resource allocation and professionalism
  • Where appropriate, demonstrate leadership in a healthcare team

B) Effectively work with other health professionals to prevent, negotiate, and resolve inter professional conflict

  • Demonstrate a respectful attitude towards other colleagues and members of an Inter-professional team
  • Work with other professionals and employ collaborative negotiation to prevent conflicts
  • Respect differences, misunderstandings and limitations in other professionals

Manager:

As Managers, physicians are integral participants in healthcare organizations, organizing sustainable practices, making decisions about allocating resources, and contributing to the effectiveness of the healthcare system.

  • Employ information technology appropriately for patient care
  • Demonstrate ability to utilize electronic databases as a source of patient information
  • Demonstrate understanding of perinatal and neonatal databases in provision of patient care and as sources of population data

A) Participate in activities that contribute to the effectiveness of their healthcare organizations and systems

  • Participate in systemic quality process evaluation and improvement, such as patient safety initiatives
  • Demonstrate a particular understanding of patient safety issues in the NICU, that arise because of the vulnerability of the high risk infant and the use of medical technology
  • Understand the principles of quality assurance and administration, as well as the importance of principles of cost effectiveness and continuous quality assurance/improvement relevant to perinatal care
  • Describe the structure and function of the healthcare system as it relates to Neonatal-Perinatal Medicine, including the roles of physicians
  • Understand basic concepts of physical design and function of the NICU
  • Describe systems of regionalized perinatal and neonatal care, including the levels of maternal and neonatal care and their capabilities
  • Understand appropriate placement of mothers and infants within a regionalized perinatal and neonatal health care system to ensure optimal care and effective use of health care resources
  • Understand population-based approaches to neonatal-perinatal health care services and their implication for medical practice
  • Describe principles of healthcare financing, including physician remuneration, budgeting and organizational funding

B) Manage their practice and career effectively

  • Set priorities and manage time to balance patient care, practice requirements, outside activities and personal life
  • Participate in planning, budgeting, evaluation and outcome of a Neonatal- Perinatal patient care program
  • Implement processes to ensure personal practice improvement

C) Allocate finite healthcare resources appropriately

  • Recognize the importance of just allocation of healthcare resources, balancing effectiveness, efficiency and access with optimal patient care
  • Apply evidence and management processes for cost-appropriate care

D) Serve in administration and leadership roles, as appropriate

  • Chair or participate effectively in committees and meetings
  • Lead or implement a change in health care
  • Plan relevant elements of health care delivery (e.g., work schedules)

Health Advocate:

As Health advocates, physicians responsibly use their expertise and influence to advance the health and well being of individual patients, communities, and populations.

  • Assume an advocacy role when monitoring and allocating needed resources, primarily for the individual but also in the context of societal needs.

 A) Respond to individual patient health needs and issues as part of patient care

  • Identify the health needs of an individual patient and family considering factors such as maternal age, education, occupation, socio-economic and nutritional status
  • Assess each patient’s/family’s ability to access services in the health and social system.
  • Identify opportunities for advocacy, health promotion and disease prevention with patients and families to whom they provide care
  • Promote and support policies which improve health outcomes for the fetus and infant such as breastfeeding, cessation of smoking, and immunization
  • Provide anticipatory guidance to families with regard to care and safety of their child particularly in preparation for discharge from hospital including optimal follow-up
  • Identify opportunities for advocacy, health promotion and disease prevention with individuals to whom they provide care

B) Respond to the health needs of the communities that they serve

  • Describe the practice communities that they serve
  • Identify groups within practice community who are at risk of adverse pregnancy and neonatal outcomes such as adolescents, recent immigrants and First Nations
  • Describe the use of population data to identify health problems within communities and populations (e.g. rates of adolescent pregnancy, low birth weight, perinatal mortality and morbidity)
  • Identify and respond appropriately to opportunities for advocacy, health promotion and disease prevention in the communities that they serve
  • Appreciate the possibility of competing interests between the communities served and other populations

 C) Identify the determinants of health for the populations that they serve

  • Identify the determinants of health of the populations, including barriers to access to care and resources, including:
  • Issues of maternal health that affect fetal, neonatal or infant health (i.e.,
  • poverty, unemployment, education, social support systems)
  • Health care issues in the general population such as substance abuse which are relevant to Neonatal-Perinatal Medicine
  • Identify vulnerable or marginalized populations, in particular those who are at risk of adverse pregnancy and neonatal outcomes such as adolescents, recent immigrants, First Nations, and apply available knowledge about prevention to the “at risk” groups

 D) Promote the health of individual patients, communities, and populations

  • Describe an approach to implementing a change in a determinant of health of the populations they serve
  • Be familiar with examples of policy implementation or change effected as a result of actions by physicians and the impact on maternal, fetal and neonatal health (such as folic acid supplementation and incidence of neural tube defects)
  • Describe how public policy impacts on the health of the mother, fetus, infant or neonate, either positively or negatively (e.g., communicable diseases, tobacco, substance abuse)
  • Identify points of influence in the healthcare system and its structure including the role of governmental and non-governmental organizations such as the Canadian Paediatric Society and community advocacy groups in developing health policies and advocating for infants and families
  • Describe the ethical and professional issues inherent in health advocacy, including altruism, social justice, autonomy, integrity and idealism
  • Appreciate the possibility of conflict inherent in their role as a health advocate for a patient or community with that of manager or gatekeeper
  • Describe the role of the medical profession in advocating collectively for health and patient safety

Professional:

As Professionals, physicians are committed to the health and well-being of individuals and society through ethical practice, profession-led regulation, and high personal standards of behavior.

  • Recognize the principles and limits of patient and family confidentiality as defined by professional practice standards and the law
  • Maintain appropriate relations with patients and families.

A) Demonstrate a commitment to their patients, profession, and society through ethical practice

  • Exhibit appropriate professional behaviors in practice
  • Demonstrate a commitment to delivering the highest quality care and maintenance of competence
  • Use appropriate strategies to maintain and advance professional competence. This will include continually evaluating one’s abilities, knowledge and skills and knowing one’s limitations
  • Recognize and appropriately respond to ethical issues relating to Neonatal-Perinatal Medicine and use this understanding in providing care.
  • Understand and appropriately manage conflicts of interest

B) Demonstrate a commitment to their patients, profession and society through participation in profession-led regulation

Appreciate the professional, legal and ethical codes of practice, including:

  • Withholding and withdrawal of treatment, Truth-telling, Informed consent, Advanced directives, Confidentiality, End-of-life care, Conflict of interest, Resource allocation, Research ethics
  • Demonstrate accountability to professional regulatory bodies
  • Recognize and respond to others’ unprofessional behaviors in practice
  • Participate in peer review

C) Demonstrate a commitment to physician health and sustainable practice

  • Balance personal and professional priorities to ensure personal health and a sustainable practice
  • Strive to heighten personal and professional awareness and insight
  • Recognize other professionals in need and respond appropriately

NICU Transport Rotation

Overall Aim:  To become familiar with and actively participate in the processes & procedures involved in the safe transportation of sick neonates from first referral call to arrival at destination hospital

Orientation in Transport 

  • Orientation to transport in the Province of Ontario
  • Triaging processes and resources
  • Transport & Admission processes for PICU & NICU
  • Orientation to transport telephone and digital recorder
  • Use of Criticall
  • Equipment training (Transport incubator, ventilator, NO delivery system, IV pumps, etc.)

Expectations 

  • Attend extramural and intramural transports with orientation to the process
  • Take all advice & transport calls while present in the unit to promote expertise in dealing with
    telephone advice, consultation and triaging
  • Mandatory attendance on minimum of 6 neonatal transports
  • Maintain case log of all extramural runs attended
  • Mandatory participation in transport team meeting, with presentation of a neonatal transport
    case with a focused discussion (The first transport team meeting after the rotation)

* Supervision and mentoring for this month is provided by the transport medical director   

Objectives of Transport Rotation 

Medical Expert: 

  • Enhance the awareness and understanding of a fully Regionalizied System of Maternal Newborn and Paediatric Health Care within the Province and across GTA Child Health Network
  • Refinement of skills in history taking, critical thinking and problem solving, to promote excellence in telephone consultation and advice
  • Develop awareness of Pre-hospital Care Systems in the MOHLTC Emergency Medical Services and how to access the appropriate resource
  • Develop working knowledge of transport equipment & technology for Neonatal Transports
  • Enhance knowledge base of modes of transport and aeromedical physiology
  • Develop a comprehensive understanding of effective triage of referrals, processes fundamental to transport and strategies involved in the stabilization & subsequent management of critically ill neonates/infants
  • Develop strategies and become competent with skills necessary to manage critically ill patients in the transport environment

Communicator: 

  • Enhance communication skills with families through the participation in feedback and counselling of families in crisis
  • Provide telephone consultation and advice to referring physicians on the management of new-borns who do not require transfer to a Level III centre
  • Communicate and work effectively in the multidisciplinary team approach to neonatal care

Collaborator: 

  • Understand the role of transport team members in a collaborative practice model operating under strict medical directives for RNs and RRTs
  • Knowledge of roles and responsibilities of dedicated transport fellowship trainees
  • Develop qualities to be an effective team member, problem solve complex scenarios and guide colleagues to ensure safe and effective patient stabilization and transport

Manager:

  • Development of triaging skills

Health Advocate:

  • Promotes and facilitates a family centered care approach to the management of sick new-borns in transport
  • Develop strategies for promotion of safety in transport

Professional:

  • Develop a compassionate interest and overall understanding of the critically ill new-born infant as a person
  • Provide empathy and support for all members of the family  

Follow-up Clinic, Growth and Development Clinic

The following information will be helpful in planning the Growth & Development rotation.  The fellows should discuss their plans with Dr. El Helou before starting their rotation in order to ‘tailor’ the rotation to their specific interests.  It is mandatory for neonatal fellow to attend eight Follow up clinics in 4 weeks block, two Bayley Development Scale Assessments, two CP Clinics, one Complex care clinic and one Cleft lip-palate clinic during this rotation. It is also expected that the fellow present a scholarly presentation at monthly high-risk follow-up meeting.

Important Contact Information

Neonatal Follow up Clinic:

Clinic Location:  McMaster Children’s Hospital, 2G Clinic. Receptionist (ext. 75773 / 78520)

Clinic Hours:

Wednesday afternoon 1:00 PM to 4:30 PM and

Thursday full day 8:30 AM to 4:30 PM

Clinic Coordinator: Barb Flaherty (72781)

Clinic Secretary: Diane Brophy (73459)

 Physicians:      

Dr. Saroj Saigal – email: saigal@mcmaster.ca

Dr. Salhab elhelou – email: elhelos@mcmaster.ca

Dr. Peter Rosenbaum – email: rosenbau@mcmaster.ca

Bayley Development Scale Assessments:

Tara Mitchell – email: mitchtar@hhsc.ca

Cerebral Palsy Clinic:

Clinic Location:  Chedoke Hospital, 555 Sanatorium Rd, Hamilton, ON L9C 1C4

Clinic Hours:  All days 8:30 AM-4:30 PM

Clinic Secretary:  Jennifer Middleton (74275) email: jmiddl@mcmaster.ca

Physicians:      

Dr. Ronit Mesterman – email: mesterma@mcmaster.ca

Complex Care Clinic:

Clinic Location:  Juravinski M2 (40 wing)

Clinic Hours:

Monday 8.30 Am – 4.30 PM

Tuesday afternoon 12.30 PM – 4.30 PM

Clinic Secretary: Kim Fitzhenry (76340) email:  fitzhen@mcmaster.ca

Physicians:

Dr. Audrey Lim – email: limau@mcmaster.ca

Cleft lip-palate Clinic:

Clinic Location:  Chedoke – Evel Building, Level 4

Clinic Hours:   Monday – Friday 8:30 – 4:30 (One-six Clinic daily)

Clinic Coordinator:  Dorothy Rim (77210)

Learning Opportunities at the follow-up clinic (MUMC):

  1. Clinical – experience in Growth & Development and other clinics
  2. Academic – reading relevant literature
  3. Scholar – Internal audit on developmental outcome in high risk babies

Clinical:

  • To gain experience in assessing high-risk infants in terms of neurological and developmental status
  • To be able to pick up variations in normality, subtle neurological findings and delayed development for corrected age
  • To be comfortable in discussing outcome with parents – reassuring parents regarding normality and/or findings of neurological impairments
  • To provide parents with the available community resources as indicated
  • To plan to assess some 2 or 3 high-risk infants (selected from NICU rotation) prospectively from “due date” to at least one-year corrected age, to gain insight into developmental and neurological changes over time. Please contact Barb Flaherty to “flag” the patients.  The fellows will be paged when the infants arrive in the clinic.  Also the patient list for each week in the Growth & Development Clinic will be provided to the fellows.
  • To review neonatal ultrasounds with subsequent outcome (for infants with identified PVL or other abnormalities)
  • Observe formal psychometric assessments at age 18 and 36 months.

Academic:  Suggested reading list: (Borrow binder of references from Dr. S. Saigal)

  • Methodological Issues in Follow-up
  • Survival and Early Neonatal Morbidity
  • School Age Difficulties
  • Behavioral Problems
  • Early Identification if Impairments
  • Cerebral Palsy, diagnosis and Prevalence
  • Outcomes: BPD, SGA, ELBW, VLBW, IVH, HIE
  • Association of Perinatal Variables and Outcome
  • Role of Psychometric Assessments
  • Other mechanisms of assessing outcomes: Self completed and/or Interviewer Administered Questionnaires
  • Quality of Life Perspectives: Parents, Children & Health Professionals
  • Role of Intervention in NICU and follow-up

Scholarly Activities:

  • Participate in ongoing research activities/ meetings
  • Pick one high-risk category and conduct audit on the developmental outcome.

Additional opportunities at Chedoke Hospital and Juravinski Hospital:

There is an opportunity to work with other health professionals and learn about their various roles during the rotation.  Seeing children in other settings also adds to one’s appreciation of their function and needs.  You may be able to obtain these experiences by attending some of the multidisciplinary clinics (e.g. Cleft Lip and Palate Clinic includes audiology and speech, Cerbral Palsy Clinic, Complex care clinic (Juravinski).  Plan to include at least two of these into your schedule (priorities – psychological assessment, speech, audiology), and make the contacts as early as possible before the rotation to ensure some flexibility in scheduling.

  • Observe Psychological assessment (contact: Bertha Parish, x 77214, Evel 3)
  • Observe Audiological assessment (contact: Audiology Dept., x 77810, Evel 1)
  • Cleft Lip & Palate speech pathologists: Christina, x 77207 or Brenda 77237
  • Half day at CDRP – see team assessment in action on Tuesdays at 10:00 am (except 2nd Tuesday) and 1:00 pm (except 4th Tuesday) (contact Robin Halls x 74469, Holbrook Building)
  • Half-day with early intervention Infant-Parent Program (Joan Urquhart 77911, Holbrook Building 24, Room H281)
  • Community visits with PDD Team (contact: Sue Robertson, x 77758, Holbrook Building)
  • SDBS (Specialized Development and Behaviour Services) for Preschool Clinics, Tuesday mornings – please contact
  • Amber, x 74259, speech & language, Linda, x 74692 resource teacher or Nancy, x 77885 intake coordinator Evel 311

CanMEDS OBJECTIVES

Medical Expert/Clinical Decision Maker:

  • Understand the normal movement patterns of the developing preterm infant
  • Acquire the skills required to perform neurodevelopmental assessments of high risk infants in follow up with appropriate referrals if necessary
  • Develop an understanding of the principles of motor and cognitive assessments performed at each visit
  • Become familiar with the range of psychological testing done in the neonatal follow-up clinics as a means of assessing cognitive behavior and academic functioning. Observe psychometric testing on children at 18 months of corrected age.
  • Learn how a follow up clinic contributes to patient care both in the NICU and at the time of discharge
  • Gain awareness of infants at risk of neurodevelopmental handicap and the need for regionalized follow-up within the community setting
  • Gain awareness of and learn to diagnose the complex physical and neurodevelopmental outcomes in high risk infants
  • Become familiar with the recommended testing of high-risk infants for physical problems such as abnormalities of vision and hearing, nutrition, and motor development.
  • Review ultrasound of infants with the radiologists of infants with impairments.
  • Gain appreciation of how follow up guides us in our antenatal counseling of parents with a diagnosis of a fetal abnormality

Communicator:

  • Learn to counsel families being seen in clinic -reassuring them of normality and/or conveying a diagnosis of impairment/developmental lag in an empathetic manner.
  • Share information about infants in the follow-up clinic with other healthcare providers in verbal and written format
  • Gain insight into the psychosocial effects on the family of an infant with problems and provide empathetic support to these families, working in liaison with nursing staff and social work

Collaborator:

  • Understand the roles of different health care professionals in a neonatal Follow-up program
  • Learn to work as part of a inter-professional team caring for these infants.(physicians, physiotherapists, occupational therapists, nurse practitioners, rehab practitioners, speech pathologists, and psychologists)
  • Gain appreciation of the expertise and value of an inter-professional, multidisciplinary team in the care of these infants

Manager:

  • Learn about the organization of follow-up care for high risk infants both in a tertiary care facility and in the community, i.e. regional follow up
  • Gain awareness of the preparation required when planning to discharge a baby home from the NICU (community supports, early intervention etc.)

Health Advocate: 

  • Become familiar with community resources and treatment options available to these families, both at the time of discharge and after follow-up clinic visit and to make appropriate referrals of patients requiring these services

Scholar: 

  • Become familiar with the literature about neonatal follow-up.
  • Give a presentation that focuses on a developmental topic – one related article in a journal club format and one presentation in the perinatal rounds.

Professional:

  • Understanding the difficulties that parents experience when they take their preterm or previously ill baby home
  • Gain awareness and openness to understanding the difficulties that families of ‘children with special needs’ experience

Level II Community Rotation - Brampton

Level II Community Rotation goals and objectives coming soon.


Maternal Fetal Medicine

Goals and Objectives of the Rotation in Maternal-Fetal Medicine

During the two-­‐year Neonatal Fellowship training program the resident will fulfill the Goals and Objectives in Maternal-­‐Fetal Medicine listed below.

The learning in the subject will be fulfilled in:

  1. The rotation block in MFM
  2. Formal tutorial series during the residents half day teaching
  3. Ongoing learning during the Neonatal Unit r

Medical Expert:

On completion of the Neonatal Residents training they should:

  • Have knowledge of the Feto-­‐maternal unit, including placentation and the transfer of gasses, nutrients and medications across the placent They should also have an understanding as to how pathology in any of the above will affect the fetus and how this if detected, is managed in the antenatal period.
  • They should have an understanding of the maternal physiological adaptations to pregnancy and how these influence fetal development.
  • Have an understanding of the first and second trimester prenatal screening and diagnostic options offered to pregnant This includes an understanding of how the tests and procedures are performed as well as the advantages and disadvantages of the various tests and how the results are interpreted. This includes
    • Amniocentesis, CVS
    • First trimester ultrasound screening tools (Nasal bones, Nuchal Translucency etc)
    • IPS/NIPT and other screening tools
    • 18-­‐20 week Anatomical
  • An understanding of the antenatal and labor management in both normal pregnancies aswell as in those complicated by fetal growth problems and fetal anomalies.
  • Understand the use of and interpretation of antenatal fetal monitoring tests including, growth scans, BPP, NST, Fetal Doppler and Fetal Movement Counting.
  • Understanding of the management of the mother and fetus in Maternal Medical diseases that affect pregnancy as well as the effects of maternal medications, recreational drugs and environmental exposures.
  • Understanding of the decision making, utilization and risks and benefits of treatments used in pregnancy complications and maternal disease that impact on the Fetus and Specifically the utilization of:
  • Antenatal corticosteroids
  • Tocolysis
  • Maternal antibiotics in situations of PPROM, Prem labor and GBS +v
  • MgSo4
  • Aspirin and heparin in prothrombotic states

Communicator:

At the end of the training the resident is expected to have:

  • Written and verbal communication skills that allow for effective professional relationships with patients, their families, and other members of the health care team.
  • Be able to effectively elicit a clinical history from a mother and or parents as is relevant to appropriate counseling of fetal, neonatal and long-­‐term childhood complications.
  • Be able to communicate clearly, logically and in a compassionate, professional and ethical manner, the relevant information required in consultations.
  • Respond appropriately to parental quest
  • Provide appropriate and clear documentation of clinical encounter

Collaborator:

  • The resident should be able to effectively work as a member of the interdisciplinary team to develop appropriate diagnostic and therapeutic strategies for patient care.
  • They should know when to appropriately consult other caregivers and be able to manage patients with an integrated team approach.

Manager:

  • Make cost effective use of health care resources based on sound judgment and evidence-­based medicine.
  • Understand and make effective use of information technology such as patient related databases and other medical informatics.
  • Be able to effectively prioritize and time-­‐manage to ensure timely and effective completion of tasks.

Health Advocate:

  • Work to develop effective health promotion strategies for patients and their fam
  • Intercede on behalf of their patients in the complexities of the health care institutions, services and multiple physicians.
  • Recognize and respond to those issues where advocacy is important and necessary

Scholar:

  • Develop skills in critically appraising medical information and be able to effectively integrate information from a variety of sources in order to practice ethical, evidence-­‐ based
  • Practice an effective self-­‐directed learning strategy.

Professional:

  • Follow appropriate  professional  behavior  in  relationships  with  patients,  their families, colleagues, and allied health professionals.
  • Deliver the highest quality patient care with integrity, honesty, compassion and respect for diversity.
  • Appreciate the professional, legal and ethical codes of practice including:
    • Termination of pregnancy.
    • Palliative care
    • Truth telling
    • Informed consent o Confidentiality o Conflict of interest
    • Resource allocation

Printable Maternal-Fetal Medicine rotation Log and Encounter Card.

The Royal College of Physicians and Surgeons of Canada has information on Neonatal Perinatal Medicine subspecialty training.  You can find information about examination dates, FITERs, Standards of Accreditation, Specialty Training Requirements, Objectives of Training, and examination formats on their website.