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Simulation-Based Training Program for Fellow Education

The Division of Neonatology at the Children’s Hospital at Montefiore runs a multidisciplinary perinatal simulation program that provides comprehensive and innovative training to improve perinatal care and educate staff and trainees. The education of Neonatal Perinatal Medicine fellows and their development as educators is essential to this effort. The program integrates the elements of Team STEPPS, state of the art and custom made simulators, and highly trained facilitators. Since the program’s inception, the program has expanded to include residents, fellows, nurses, respiratory therapists, and paramedics from the community. We have coordinated our efforts with other disciplines to run simulation-based scenarios in conjunction with Obstetrics and Gynecology, and Pediatric Subspecialties including Cardiology, Anesthesia, Surgery, and Otolaryngology. Techniques and models that have been developed at our institution have been presented at both national and international meetings, as well as published in peer-reviewed academic resources.

The elements of the simulation based training program for Neonatal Perinatal fellows include:

  1. Neonatal Resuscitation Program initial course completion: Fellows contribute to the education of new residents by assisting with the initial course completion. This program has been adapted to incorporate simulation-based training for all new pediatric interns. These training sessions are carried out annually over two days in late June.
  2. Neonatal Resuscitation Program course renewal of 2nd year, Chief Pediatric residents, and Fellows: Fellows maintain their knowledge and skill by attending and teaching Neonatal Resuscitation course renewals. This program is designed to emphasize simulation-based training and teach advanced procedural, teamwork and communication-based skills.
  3. NICU Rotation Neonatal Resuscitation training: Fellows take a lead role in running monthly training sessions for all residents and students rotating through the NICU. Trainees are taught with a simulation-based curriculum given on the first Friday of their rotation. Each resident participates in a mock delivery room code and then is debriefed in a group session with their colleagues. Learning to run simulated codes, developing skills as a facilitator and learning to be a debrief leader are emphasized as the fellows move towards functioning independently in this capacity.
  4. Fellow Neonatal Resuscitation Instructor Training: Each fellow is offered the opportunity to become a Hospital Based Instructor by completing the online course and working with a faculty mentor in teaching Neonatal Resuscitation courses. Fellows are offered the additional opportunity to become Regional Trainers for Neonatal Resuscitation programs if they so desire.
  5. Fellow Boot Camp: A three and one half day boot camp is conducted at the beginning of each academic year in July for both new and returning fellows. These sessions include simulation-based hands on training in essential topics such as emergency procedures (examples include chest tubes, endotracheal intubation and pericardiocentesis), managing patients with possible hypoxic ischemic encephalopathy (including the decision to initiate therapeutic hypothermia, analysis of aEEG, and the initiation and management of hypothermia protocols), central line insertion and safety, and simulation based sessions in Extracorporeal Membrane Oxygenation (ECMO).
  6. Fellow Simulation-Based Training: Throughout the year, simulation sessions are conducted to give fellows experience in techniques and procedures that are essential to their training. The focus of these sessions includes developing technical skills, improving teamwork and communication during emergencies, and improving family interaction. Topics covered include special deliveries (gastroschisis, meningomyelocele), breaking bad news (medication error, dying patient), and quality improvement or safety initiatives (central line safety procedures). These simulation exercises augment actual clinical experiences in supporting attainment of the ACGME milestones and entrustable professional activities for neonatal fellows.
  7. Multidisciplinary Simulation: The Division of Neonatology collaborates with the Department of Obstetrics and Gynecology to conduct interdisciplinary simulation-based training sessions. These occur monthly and fellows are trained in the sessions and also become facilitators. Each year has a different theme that incorporates elements of both specialties. Past sessions have taught Team STEPPS elements (SBAR, CUS words), breaking bad news, and interdisciplinary communication with families.
  8. Preparation for complex procedures: Fellows are incorporated in the interdisciplinary planning and practice sessions that precede special circumstance deliveries. The steps include one or more interdisciplinary team meetings, in-situ or off-site simulation based sessions with all involved specialties and debriefing sessions. Subsequent cycles of meetings, simulation, and debriefing are repeated as necessary. Examples of conditions and treatments that have warranted this level of preparation include: Exit procedures for critical airways, cesarean section delivery with immediate transfer to the cardiac catheterization lab for emergent atrial septostomy, delivery and surgical management of giant sacrococcygeal teratoma, and delivery and management of a pregnancy with antenatally diagnosed placenta percreta.