91社区

Innovations

Extensive experience with multidisciplinary partners (rehabilitation, specialized developmental disabilities programs) is provided. Clinical experience from implication in the NICU to the outpatient clinic setting up to school year age. General movement assessment is part of clinical care. Provincial Neonatal Follow-up teams meet on a regular basis throughout the year to compare and improve our program.

Curriculum

Neonatal Intensive Care Unit聽rotations:

• One month of rehabilitation services
• Six聽months of Neonatal Follow-Up (one聽month聽at CHU Sainte-Justine)
• One聽month of short clinical research project or systematic review research
• Four-month electives such as: complex care, Neurology, Respirology, Autism clinic, Pediatric wards, Nursery, etc.,聽according to the fellows future needs.

Training Sites

Affiliated rehabilitation centres

Program Description

The purpose of the聽Neonatal Hemodynamics Clinical Research fellowship program is to provide the trainee with additional knowledge, skills and experience in neonatal hemodynamics needed to begin a potential career as an independent investigator using neonatal echocardiography and other tools for hemodynamic assessment. Indeed, the Neonatal Hemodynamics Clinical Research fellowship program aims to teach the skills of cardiac ultrasound, provide an in depth understanding of cardiac physiology and to integrate both in the application of a neonatal research project. The training neonatologist will understand the scope of neonatal hemodynamics practice and its limitations. Specific training objectives are described in the curriculum.

Training Objectives

A summary list is below of Neonatal Hemodynamics Clinical Research core knowledge areas.聽Proficient practice in Neonatal Hemodynamics Clinical Research requires skills that include the ability to:

• Develop a complete understanding of neonatal cardiovascular physiology, anatomy and hemodynamics in the context of various neonatal pathological conditions and during their development.
• Understand the physics of ultrasound, the limitation of the technique, the standardization of measures, the functioning of the echocardiography machine and of the software for analysis.
• Understand the modalities for saving echocardiography images and ECG signals.
• Apply all the necessary echocardiography views in the context of a research question in the neonatal period.
• Understand the principles of two鈥恉imensional, Doppler (blood and tissue), M鈥恗ode and 3D imaging.
• Understand the meaning of echocardiography measurements.
• Appropriately calculate indices of function, pulmonary pressures and structural dimensions.
• Interpret echocardiographic hemodynamic indices in the context of an infant's presentation.
• Standardize the approach to cardiac imaging, data extraction and data interpretation.
• Develop a research question centered on a neonatal hemodynamics topic and using echocardiography as a tool for analysis.
• Train in the methods of clinical research, including learning basic epidemiologic and biostatistical methods for a neonatal hemodynamics research project.
• Implement one or more clinical neonatal hemodynamics research projects, leading to the analysis, interpretation, and presentation of research data.
• Clinical training will represent 25%, and academic /research training 75% of the fellowship.

Curriculum

The Neonatal Hemodynamics Clinical Research Fellowship Program consists of 1 or 2 years of additional training in hemodynamics / echocardiography research targeted to the neonatal population with research methods, under the supervision of a primary faculty supervisor. The duration of the fellowship will depend on the predicted time frame of the research project and funding. The supervisor and the duration of the fellowship will be identified and agreed by all concerned, including the fellowship director, before the fellowship begins. A 1-year fellowship may be extended to a 2^nd year if all parties agree (including 91社区 postgraduate office and the sponsor, where applicable). Patient care responsibilities are designed to maintain clinical competence in Neonatology and to enhance knowledge and experience in neonatal diseases targeted by the fellow鈥檚 research.

Only PhD or MD researchers with faculty appointments at 91社区 will be permitted to supervise research fellows. The fellowship director and fellowship committee members must approve research proposals.

Training:

1. Longitudinal Research Experience: Supervised echocardiography laboratory and clinical/epidemiologic research for 11 (for a 13 blocks program) but up to 22 blocks for a 26 blocks program. In year 1, phase A to C. If second year, extension of Phase B and Phase C.
   1. Phase A) Expectations: orientation to the program, orientation to echocardiography machine, Endnote course at the MUHC library, 鈥淩esearch of literature course鈥� (OVID and Pubmed) at the MUHC library, introduction to research, preparation of the literature review, training for the research ethics board (REB) submission and requirements, concept for the development of the research protocol, REB submission if necessary (Nagano, research modules for MUHC-RI, RedCAP training), mandatory readings and learning provided in Appendix B, log book creation, Neonatal Resuscitation Program training if not accomplished, certification on the defibrillator and its use in the NICU and meeting with the librarian regarding research project, orientation to the units (JGH, MUHC).
      1. In phase A: Learning the views of echocardiography (mandatory readings, 1 on 1 training) and learning the standardized measures and their meanings, learning how to use a software for data extraction. Orientation of ongoing research projects in the Research lab. Scanning of participants (which my happen on both sites: JGH/MUHC).
      2. In phase A: Please refer to 鈥淎cquisition of Skills鈥�
   2. Phase B) Data collection, scanning of participants
   3. Phase C) Data extraction, data consolidation, data analysis, conclusions and presentation. Preparation of poster, abstract, manuscript. Ongoing scanning for the participants of research projects.
2. Clinical: 1 to 2 blocks of NICU service per year (2-4 weeks x 2聽at MUHC, based on funding source and length of fellowship).
3. Elective: Highly recommended Hemodynamics rotation at the CHU Sainte-Justine, otherwise: cardiac anesthesia, cardiology, cardiac critical care, neonatal follow-up (emphasis on cardiac patients).
4. Teaching:
   1. Mandatory: Four聽Friday afternoon teaching sessions given to NPM residents related to cardiovascular anomalies of the newborn (arrhythmias, pulmonary hypertension, patent ductus arteriosus, congenital heart defect).
   2. Mandatory: One聽presentation per year at Neonatal Rounds.
   3. Mandatory: Two聽presentations at Journal Club with article related to neonatal hemodynamics.
   4. Mandatory: Three聽case presentations per year at Quebec-TnECHO meetings.
   5. Mandatory: Two聽mock codes in the NICU related to a Neonatal Hemodynamics Cas
   6. Optional: Two聽Tuesday afternoon teaching sessions given to pediatric residents.
   7. Optional: Help teach one聽class in CCHCSP.

Acquisition of technical skills (Part of Phase A)

1. Echocardiography Laboratory rotation: During their first year, the fellow will spend two months in the Echocardiography Laboratory. During that time, they will work with both sonographers and echocardiography attendings to learn to acquire, as well as interpret standard echocardiographic views.
2. Simulation Cases (optional but highly recommended): the trainee will be exposed to the simulator owned by Dr Anie Lapointe and Dr Andr茅anne Villeneuve (CHU Sainte-Justine), shared for the training of fellows at 91社区.
3. Ongoing scanning: The trainee will be involved in the scanning of participants in research projects throughout the training period. This will continue in Phase B and Phase C.

Lectures, Readings and Conferences

The trainee will be exposed to lectures, case presentations and mandatory readings throughout the curriculum. Lectures will occur every other weeks (Thursday afternoon) on material that may be presented by the trainee, by the program director or by an invited speaker. During block 1, there will be a mandatory presence for an introductory echocardiography course (by Dr. G. Altit). The minimum content that will be covered by the lectures and mandatory readings include:

Basic echocardiography (5, 6):

• Echocardiography: principles, safety, aliasing, Doppler, M-mode
• Echocardiography: Obtaining the standard views and assessment of gradients, Bernouilli equation and its limitations
• Assessment of shunts: VSD, PDA, ASD and what to understand from them?
• Heart function (part 1): the left side (7, 8)
• Heart function (part 2): the right side (9-11)

Heart, Physiology and Pharmacology (5, 6, 12, 13):

• Transitional physiology, fetal and immediate neonatal hemodynamics / adaptation
• Cardiovascular embryology
• Basic cardiac anatomy, nomenclature and clinical application
• Pharmacology of cardiovascular drugs: inotropes
• Pharmacology of cardiovascular drugs: anti-pulmonary hypertension medications
• The case of inhaled Nitric Oxide

Neonatal diseases and their hemodynamics (5, 6)

• The extreme preterm: when the focus is perfusion and not blood pressure
• Persistent pulmonary hypertension of the newborn: clinical vignettes, diagnosis and management
• Controversies about the patent ductus arteriosus: to treat or not to treat? (14-16)
• Current understanding about hemodynamic impact of a large persistent ductus (17-19)
• Septic shock and NEC in the newborn: pathophysiology, diagnosis, hemodynamic impact
• Septic shock and NEC in the newborn: management and outcome
• HIE: hemodynamic management for brain safety
• Congenital Diaphragmatic hernia: the hemodynamic golden hour
• Management and controversies about congenital diaphragmatic hernia: management of pulmonary pressures, heart function, fluid status and timing of surgery
• BPD and pulmonary hypertension: epidemiology, pathophysiology, screening and diagnosis
• BPD and pulmonary hypertension: controversy about management and invasive testing
• The extremes: severe IUGR and infant of mother with preeclampsia
• The extremes: the LGA and infant of diabetic mother

Cardiac anomalies (5, 6)

• Coarcatation of the aorta and hypoplastic arch
• Tricuspid atresia, Ebstein鈥檚 anomaly, pulmonary atresia intact septum
• L-TGA and D-TGA
• Anomalies of the mitral valve, Hypoplastic Left Heart Syndrome and variants, Shone鈥檚 complex
• Pulmonary veins, left sided obstruction and post-capillary hypertension (MS, MR)
• TOF and DORV
• Coronary anomalies 鈥� fistula, sinusoids, ALCAPA and abnormal insertion
• Genetic syndromes and their cardiac involvement
• Endocarditis and inflammatory disease of the myocardium (infants of lupique mothers)
• Pericardial effusion and how to recognize tamponade in the newborn

Other advanced diagnostic and therapeutic measures(5, 6)

• Advanced echocardiography: how to understand a report and a journal article about TDI, 3D imaging, strain and speckle tracking echocardiography
• NIRS and its applications: current knowledge of literature
• Biomarkers: the right ventricle, the left ventricle and the pulmonary vasculature
• MRI, VQ scan and CT: how they complement your assessment
• Basic understanding of ECMO: cannulation, circuit, VV, VA
• Basic understanding of cardiac transplant and ventricular assist device
• Basic understanding of cardiac catheterization and how to interpret a diagnostic study

Research and Epidemiology:

• Preparation of a research questions
• Critically appraise the literature: observational studies, cohort studies, randomized control trials, meta-analysis
• Understand basic statistical tests and epidemiological strategies to analyze data
• Study designs
• How to prepare a poster, manuscript and abstract
• CV preparation

Mandatory readings will be provided to the trainee at the beginning of the year and complemented throughout the training. Please refer to Appendix B.

Trainee should attend at least one conference among these during the year(s) of training: NeoHeart, Pediatric Academic Societies, UCSF Neonatal Pulmonary Vascular Disease Conference, NeoPOCUS workshop, American Academy of Pediatrics, Canadian Pediatric Society, American Society of Echocardiography, American Thoracic Society meeting.

Mandatory Local Conference attendance:

1. Neonatal Rounds every Friday afternoon
2. Journal club every other Tuesday morning
3. Neonatal Cross-Canada Rounds (4 times a year)
4. Canadian Child Health Clinician Scientist Program (CCHCSP) training at the MUHC

Duties, Responsibilities, Resources聽and Evaluation

Fellows Duties, Responsibilities and Resources:

1. Call: 7 in-house shifts (night class and/or week end shifts) per block (alternating between JGH and MUHC sites), as decided by the program director based on source of funding.
2. Resident Supervision: The fellow will supervise residents and students during clinical duties and will provide mid-rotation and end of rotation feedback.
3. Academic Activities: Fellow should present his/her work at a national or international conference. The fellow is expected to present his/her work at the Neonatal Rounds - MUHC.
4. Support staff: Administrative tasks will be managed by the program coordinator.
5. Will need to keep track of echocardiography done on participants / patients and on simulator. Logbook will be available for the trainee. Data from the log-book will be reviewed 3 times per year with the trainee, but will not be accounted for in an evaluation.

Protocols

Professional:

1. Model and mentor principles of medical professionalism
2. Model and mentor principles of commitment to patients, profession, and society through ethical practice
3. Model and mentor principles of commitment to patients, the profession, and society through participation in profession-led regulation

Evaluation:

1. Senior Research ITER to be completed after every research block by the primary supervisor.
2. Junior Attending ITER to be completed after every NICU rotation (2 per year) by the supervising Neonatologist.
3. Echocardiography rotation ITER to be completed by cardiologist supervising the rotation (Dr Tiscar Cavalle is responsible for the rotation). Supervising attendings may complete O-scores The competence committee will review and complete summative evaluations every 6 months.

Training Sites

CHU-Sainte Justine

Curriculum

The fellowship in neonatology research consists of 1 or 2 years of additional training in laboratory or clinical research methods, under the supervision of a primary faculty supervisor. The duration of the fellowship will depend on the predicted time frame of the research project and funding. The supervisor and the duration of the fellowship will be identified and agreed by all concerned, including the fellowship director, before the fellowship begins. A 1-year fellowship may be extended to a second year if all parties agree (including 91社区 Postgraduate Medical Education聽office and the sponsor, where applicable). Patient care responsibilities are designed to maintain clinical competence in Neonatology and to enhance knowledge and experience in neonatal diseases targeted by the fellow鈥檚 research.

Only PhD or MD researchers with faculty appointments at 91社区 will be permitted to supervise research fellows. The fellowship director and fellowship committee members must approve research proposals.

Training:

1. Research: Supervised laboratory or clinical/epidemiologic research for 11- 22 blocks
2. Clinical: 1-2 blocks of NICU service per year (1 at JGH, 1 at MUHC) and 3 to 5 night calls per block. Clinical part of training will account for 15-25% of total fellowship time.
3. Optional course work as appropriate
4. Teaching: 4聽Friday afternoon teaching sessions given to NPM residents, 2 Tuesday afternoon teaching sessions given to pediatric residents, Help teach 2 classes in CCHCSP, 1-2 presentations at Neonatal Rounds, 2 presentations at Journal Club

Evaluation:

1. Senior Research ITER to be completed after every research block by the primary supervisor
2. Junior Attending ITER to be completed after every NICU rotation (2 per year) by the supervising Neonatologist
3. Supervising attendings may complete O-scores
4. The competence committee will review and complete summative evaluations every 6 months.

Reading materials:

Will depend on the research subject and techniques

Conference attendance:

1. Neonatal Rounds every Friday afternoon
2. Journal club every other Tuesday morning
3. Pediatric Academic Society meeting once per year
4. Other conferences appropriate for research purposes

Fellow Duties, responsibilities and resources:

1. Call: 3-5 in-house calls per block
2. Resident Supervision: The fellow will supervise residents and students during clinical duties and will provide mid-rotation and end of rotation feedback.
3. Academic Activities: Fellow will be expected to present their聽work at a national or international conference
4. Support staff: Administrative tasks will be managed by the program coordinator.

Teaching Faculty and Research Interests are available at: www.mcgillneonatology.ca

Program Administration

Fellowship Director: Dr. Marc Beltempo
Fellowship Coordinator: Tamara Slovick, Glen Site鈥�

Fellowship Training Committee Members:

1. Marc Beltempo, Neonatologist at MUHC, NPM Scholar Fellowship Director
2. Julie Bartholomew, Neonatologist, JGH, NPM residency Program Director
3. Nina Nouraeyan, Neonatologist at JGH, Curriculum Coordinator
4. Elisabeth Hailu, Neonatologist at MUHC, MUHC NICU rotation coordinator
5. Michelle Ryan, Neonatologist at MUHC, Simulation coordinator
6. Victoria Bizgu, Neonatologist at JGH, JGH NICU rotation coordinator
7. Gabriel Altit, Neonatologist at MUHC, mentorship program coordinator
8. External member: To be determined

Training Sites

How to Apply

As well as submitting聽the Postgraduate Medical Education online application, please provide the following documents to tamara.slovick [at] muhc.mcgill.ca (subject: Neonatal%20Perinatal%20Medicine%20Scholar%20Fellowship%20Program) (Tamara Slovick):

1. Recent CV
2. Letter from the current Program Director confirming that the resident will complete a 2-year core NPM residency in a recognized Canadian NPM residency program
3. Letter of intent
4. Academic goals for the year (in additional to those described in the Neonatal Perinatal Medicine Scholar Fellowship)
5. Description of how this training will be an asset in your future career
6. A brief description of the research done to date
7. Brief research proposal which should include research protocol
8. A description and timeline of how the third year will be spent