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Am J Perinatol 2024; 41(S 01): e163-e173
DOI: 10.1055/a-1850-3929
Original Article

Changes, Challenges, and Variations in Neonatal-Perinatal Medicine Fellowship: A View from the Program Directors

Megan M. Gray   *
1   Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington
,
Christie Bruno   *
2   Department of Pediatrics, Yale University School of Medicine, New Haven, Connecticut
,
Heather French
3   Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
,
Patrick Myers
4   Department of Pediatrics, Northwestern School of Medicine, Chicago, Illinois
,
Melissa M. Carbajal
5   Department of Pediatrics, Baylor College of Medicine/Texas Children's Hospital, Houston, Texas
,
Kristina M. Reber
5   Department of Pediatrics, Baylor College of Medicine/Texas Children's Hospital, Houston, Texas
,
Helen Christou
6   Department of Pediatric Newborn Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
,
Heidi Karpen
7   Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia
,
Lindsay C. Johnston
2   Department of Pediatrics, Yale University School of Medicine, New Haven, Connecticut
,
on behalf of the Organization of Neonatal-Perinatal Medicine Training Program Directors › Author Affiliations Funding None.
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Abstract

Objectives Neonatal-perinatal medicine (NPM) fellowship programs in the United States support >800 learners annually. Understanding variations in the programmatic structure, challenges, and needs is essential to optimize the educational environment and ensure the specialty's future.

Study Design NPM fellowship program directors (PDs) and associate program directors (APDs) were invited to complete an electronic survey on their program administration, recruitment, clinical training, assessment methods, scholarly program, and career pathways. Each participant identified individual programmatic strengths, challenges, opportunities, and threats to the field.

Results Representatives from 59 NPM fellowships provided data (response rate 59/96 = 61%). In total, 30% of PDs received less than the Accreditation Council for Graduate Medical Education -recommended protected time for administrative duties, and 44% of APDs received no protected time. Fellow clinical service assignments varied widely from 13 to 18 months and 90 to 175 call nights over 3 years. Recruitment practices varied across programs; 59% of respondents raised concerns over the pipeline of applicants. Conflicts between fellows and advanced practice providers were identified by 61% of responders. Programs varied in their scholarly offerings, with 44% of NPM fellowships interested in adding broader research opportunities.

Conclusion NPM fellowship leaders identified a need for improved programmatic support, enhanced measures to assess competency, opportunities to strengthen scholarly programs, shared curricular resources, and strategies to balance education with clinical demands. PDs and APDs identified threats to the future of NPM training programs including the diminishing pipeline of applicants into neonatology, challenges with clinical exposure and competence, inadequate support for the educational mission, issues supporting high-quality scholarship, and fewer graduates pursuing physician-investigator pathways. National organizations and academic institutions should take action to address these challenges so that fellowships can optimally prepare graduates to meet their patients' needs.

Key Points

  • Numerous challenges exist for current program directors in NPM including balancing clinical work with scholarly activities, accurately assessing competency, optimizing the culture of the learning environment, and ensuring that fellows are adequately prepared for a range of postgraduate positions.

  • Significant variation exists across NPM fellowship programs in clinical service/calls assigned over 3 years of fellowship training, as well as opportunities to pursue scholarly activities across a variety of areas.

  • Challenges exist related to ensuring an adequate number of future applicants into the specialty, including those from backgrounds traditionally underrepresented in medicine, as well as those seeking to pursue careers as physician-investigators.

Keywords

neonatal-perinatal medicine - fellowship - program director - medical education

Ethical Approval

Yale University served as the reviewing IRB for this multicenter study (HSC No. 2000025426). The study was deemed exempt from full review.


Authors' Contributions

L.J. conceptualized and designed the study, and coordinated and supervised data collection. M.G., C.B., and L.J. analyzed the data, drafted the initial manuscript, and reviewed and revised the manuscript. M.G. performed statistical analyses. All authors interpreted the data, and critically reviewed and revised the manuscript for important intellectual content. All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.


* Drs. Gray and Bruno are co-first authors.




Publication History

Received: 02 December 2021

Accepted: 09 May 2022

Accepted Manuscript online:
12 May 2022

Article published online:
23 June 2022

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