P2C076: Fellowship Experience in NICU Follow-up

Background: Neonatal-Perinatal Medicine Fellowship programs require a “longitudinal outpatient experience for each fellow.” While program directors report significant variation in high-risk infant follow-up, fellow perception of the experience is unknown.

Methods: We surveyed members of the American Academy of Pediatrics (AAP) Section on Neonatal Perinatal Medicine Trainees and Early Career Neonatologist (TECaN) and Mid-Career Neonatologist (MidCaN) groups. Likert scale and multiple-choice questions addressed year and location of fellowship completion, current involvement in NICU follow-up, fellowship experience and values surrounding follow-up, and options that could improve training. Response data was summarized using descriptive statistics. Chi-Square Test of Independence was used to compare groups, (significance level alpha = 0.05).

Results: The 278 respondents were predominantly current fellows and recent graduates representing all AAP Districts (Table 1). Most respondents (88%) currently work in a facility that has a NICU follow-up clinic. Nearly all current fellows (98%) participate in a follow-up clinic, compared to less than half of those who have completed training (40%). (Table 2)

Clinics scheduled during fellowship ranged from none to more than 21 days per year. Despite this variation, most respondents believe that NICU follow-up experience is valuable to fellowship training. In contrast, only slightly more than half of respondents, including current fellows and those out of training, feel that their education in NICU follow up was adequate.

The top selections to improve training include an opportunity to follow a cohort of NICU graduates (47%) and a designated training tract for those interested in becoming a follow-up neonatologist (42%). However, less than half of respondents report providing continuity of care in follow-up clinic (43%) and only a third had specialized training available for those interested in making follow-up their niche (36%).

Other potential improvements respondents selected included: opportunities to do outcomes research (28%), more time in NICU follow-up clinic (25%), and more didactic lectures (23%). Additional suggestions to improve training included: participation in multidisciplinary clinics such as spina bifida or bronchopulmonary dysplasia clinic and learning to perform a structured neurologic exam. Most respondents felt strongly that there should be a defined curriculum for NICU follow-up, yet less than half report educational conferences focused on NICU follow-up during their fellowship (43%).

Conclusion: The majority of current and recent fellowship graduates value the NICU follow-up experience, yet only half of the respondents feel their experience was adequate. Responses may be affected by sample bias. Self-selection may over represent those that participate in follow-up clinics. However, the consistency of responses, even among those who do not currently attend clinic, suggest the findings are generalizable. The results of this survey identify opportunities to improve NICU follow-up experience for all fellows as well as fostering interest in becoming a follow-up neonatologist.