Jennifer B. Helderman, MD, MS,
Michael O'Shea, MD, MPH,
A committed faculty, rich curriculum of multidisciplinary conferences, seminars and workshops, a large and diverse clinical service and strong research mentorship assure that our trainees complete the fellowship competent clinicians, teachers and researchers.
Fellowship training begins with a one-month orientation. The purpose of this orientation will be to become familiar with each unit and the hospital systems, to learn the daily routines and responsibilities of team members and most importantly to begin to develop relationships with members of the health care team including nurse practitioners, respiratory therapists, nutritionists, pharmacists and others involved in the care of our neonates. After the orientation, the fellow will then begin either clinical or research months according to their schedule and begin to take overnight call. Research months will be spent reading and developing an idea for a fellowship project. By March of the first academic year, with guidance from the Program Director and other faculty members, first year fellows identify an area of interest for research, a mentor, and form their Scholarship Oversight Committee.
Clinical training takes place at Brenner Children’s Hospital, a facility of Wake Forest Baptist Medical Center, and at Forsyth Medical Center. Our intensive care nurseries have among the largest number of admissions of any program in the nation. Upon completion of the fellowship, graduates have had substantial exposure to the full range of diagnostic and treatment issues facing practicing neonatologists.
All deliveries in Forsyth County, and most high risk deliveries in Perinatal Region II of North Carolina, occur at Forsyth Medical Center (FMC). Slightly less than 7,000 deliveries occur each year, and more than 1,000 of these infants are admitted to the NICU. The 54-bed NICU at FMC is staffed exclusively by faculty neonatologists from the Neonatology Section of Wake Forest School of Medicine. All infants born at FMC who require surgery in the neonatal period are transferred to the 38-bed Intensive Care Nursery (ICN) at Brenner Children’s Hospital, where all pediatric surgical subspecialties, as well as extracorporal membrane oxygenation are available. Brenner Children’s Hospital is a part of the Wake Forest Baptist Medical Center. The ICN at Brenner Children’s Hospital admits approximately 500 infants each year. Both the ICN at Brenner Children’s Hospital and the NICU at FMC are served by the Ronald McDonald House, located one block from Brenner Children’s Hospital and less than 3 miles from FMC.
Brenner Children's Hospital Clinical Rotations
1st and 2nd Year: The experience for the first and second year neonatology fellows at Brenner Children’s Hospital focuses on increasing skill in medical decision making, gaining proficiency in procedures frequently performed on neonates, gaining leadership skills by supervising residents, and increasing skills as a communicator by interacting with parents, consultant physicians, and other members of the health care team. As the fellow gains confidence and knowledge, she/he is given more responsibility and autonomy.
3rd Year: The major focus of third year rotations in the BCH NICU will be on developing skills as an independent neonatologist. The third year fellow conducts daily rounds on the resident service without the attending neonatologist. After rounds, she/he discusses all patients with the attending. In addition, the third year fellow will manage consult calls and arrange transfer via the transport team.
Forsyth Medical Center (FMC) Clinical Rotations
1st Year: The experience for first year neonatology fellows at Forsyth Medical Center (FMC) focuses on attendance at deliveries, resuscitation, admission of neonates to the Neonatal Intensive Care Unit (NICU), performance of procedures associated with admission, participation in morning Maternal-Fetal Medicine rounds, and the performance of obstetric consultations.
2nd Year: The experience for the second year fellow focuses on gaining clinical experience by participation in rounds on one of two clinical services. Responsibilities of the second year fellow includes attendance at deliveries less than 28 weeks gestation or in deliveries at which there is a high likelihood of the need for significant resuscitation, participation in morning Maternal-Fetal Medicine rounds, and the performance of obstetric consultations.
3rd Year: The major focus of third year rotations in the FMC NICU will be on developing skills as an independent neonatologist. The third year fellow conducts daily rounds without the attending neonatologist. After rounds, she/he discusses all patients with the attending. Responsibilities of the third year fellow includes attendance at deliveries less than 28 weeks gestation or in deliveries at which there is a high likelihood of the need for significant resuscitation, participation in morning Maternal-Fetal Medicine rounds, and the performance of obstetric consultations after the rounding process has been completed.
Developing skills in the administrative aspects of neonatology is a focus during third year rotations. Fellows learn medical and procedural coding as well as the process of billing for services. They participate in regularly scheduled administrative meetings such as monthly NICU Joint Practice, weekly NICU Administrative Meetings, and the meetings of the Best Practices Committee.
Our 3-year curriculum, reinforced by our large clinical service, stresses normal development and pathology during the prenatal, intrapartum and neonatal periods. The educational curriculum and clinical training is supported by a full complement of pediatric medical and surgical subspecialists. Our high volume clinical service provides our trainees with experience in the management of clinical problems, from routine newborn care to the most intensive of critical care, including ECMO and cardiothoracic surgery. The number and variety of high-risk obstetrical patients ensure that our fellows become knowledgeable in identifying high-risk pregnancies and evaluating fetal well being and maturation. Our training program is closely aligned with the Maternal-Fetal Medicine and Obstetrical Residency Programs at Wake Forest School of Medicine. An active neonatal follow-up program is an essential part of our division. It provides both diagnostic and referral services to infants after discharge, and research opportunities for those interested in this avenue of investigation.
We are proud to offer varied opportunities for our fellows to participate in clinical, epidemiological and laboratory research projects with established and respected investigators. Fellows are expected to complete projects under the guidance of a faculty mentor and prepare the results for presentation at national meetings and for publication. We recognize that graduates of pediatric residencies entering fellowships rarely have substantial experience in research.
Consequently, a curriculum and mentorship program is devoted to research training, including regular research conferences and didactic sessions in study design, data analysis, manuscript preparation and grant writing. A lecture series on biostatistics and epidemiology for the neonatologist is taught each year by Drs. O'Shea, Welch, Helderman, Downey and Rojas. A formal course in biostatistics, offered through the Department of Public Health Sciences at the Medical Center can be taken for credit or audit.
Laboratory Research Opportunities
Several NIH-funded laboratories offer training opportunities for fellows in basic science research. Active areas of laboratory investigation include the pulmonary microcirculation and control of pulmonary vascular resistance, the cerebral circulation and regulation of cerebral blood flow, molecular genetics and the inherited predisposition to disease sequelae of prematurity, such as chronic lung disease, and the neuroendocrine development in the fetus and newborn.
Clinical Research Opportunities
Fellows in our program have constant exposure and ample opportunity to participate in clinical research. We have a long track record of participation in multi-center and single site clinical trials on broad and diverse topic relevant to neonatology.
These include ventilator management, nutritional management, pain management, management of chronic lung disease and epidemiological studies of preterm sequelae including cerebral palsy and chronic lung disease. From 2001 to 2006, we participated as a member of the National Institute of Health NICHD Neonatal Network, expanding our opportunities for collaborative clinical trials. Both nurseries are members of the Vermont-Oxford Neonatal Database.
Global Health Experience
Dr. Mario Rojas directs a multi-center research network in Columbia, South America. Drs. Akinola and Washburn participate in efforts to decrease infant mortality in Ghana working with Kybele, a non-profit humanitarian organization dedicated to improving childbirth conditions worldwide through medical education partnerships.
Master's in Science Program
The Medical School’s Department of Public Health Sciences is nationally regarded for its leadership in clinical, epidemiological, and health outcomes research. Fellows in our program are eligible to apply to the Department of Public Health Sciences for admission to the Master’s Program in Science – Clinical Epidemiology and & Health Services Research. The fellowship and the course work for the master’s degree can take place simultaneously, permitting completion of both programs in 4 years.
Preparing the neonatologist for an ever-changing practice environment is an important aim of the program. A curriculum addressing such topics as NICU design, organization, and management allows the fellow to deal with such issues effectively after completing our program. A structured approach to exploring career choices, evaluating practice positions, learning interviewing and negotiating techniques helps our fellows obtain positions which best meet their goals.
Finally, an introduction to practice management permits the fellow to understand an increasingly complex world of managed care, integrated health care systems, capitated systems and the variety of other issues facing the neonatologist entering into academic or private practice.