SAUDI COMMISSION FOR HEALTH SPECIALITIES

SAUDI COMMISSION FOR HEALTH SPECIALITIES SCIENTIFIC BOARD OF PEDIATRICS PERINATAL NEONATAL MEDICINE FELLOWSHIP PROGRAM First Edition 1430 / 2009

Content Articls Page Introduction 2 Objectives 3 Admission requirements 4 Structure and content of the program 5 Fellow job description 7 Skill assessment 10 General Guidelines of Curriculum 11 Recommended references 15 Guidelines for teaching and research 18 Guidelines for rotation feto material medicine 19 Guidelines for training in intensive care area 20 Guidelines for training in intermediate continuing care area 22 Guidelines for training in resuscitation and transport 23 Recommended educational activities 24 Principles involved in scheduling of follows in the NICU 26 Evaluation 27

PERINATAL NEONATAL MEDICINE FELLOWSHIP PROGRAM SAUDI COMMISSION FOR HEALTH SPECIALITIES 1

Introduction This booklet is written for the trainees in the Perinatal - neonatal Fellowship Program to outline the Objectives addmission and training requirements. 2

Objectives A) General objectives: 1. To train and graduate interested pediatrician in the field of perinatal-neonatal medicine. 2. To provide an educational environment that will promote the standard of health services in neonatal intensive care units (NICU) 3. To promote research in the field of perinatal-neonatal medicine. B) Specific objectives: At the end of training, the candidate should have the following capabilities and skills; 1. Possess sound knowledge in the principles of Perinatalneonatal medicine. 2. Perform thorough and appropriate history and physical examination. 3. Formulate a reasonable and comprehensive differential diagnosis, recognize and manage common disorders in newborn infants as well as many of the rare ones, especially those that are amenable to treatment. 4. Select relevant investigations, and interpret their results accurately 5. Possess good skills in various diagnostic and therapeutic procedures in NICU 6. Recognize and manage emergency situations appropriately. 7. Demonstrate specifically qualities pertaining to perinatology- neonatology, e.g., knowledge on perinatal regionalization, perinatal epidemiology, quality assurance, etc. 8 Participate in provision of consultation for the high-risk fetus and of resuscitative, transport and consultative services for newborn. 9. Keep orderly and informative medical records. 10. Function as a member of the health care team. 11. Demonstrate effective communication skill. 12. Display empathy with families and neonates. 13. Relate ethical consideration of the health care of neonates. 14. Educate and update himself through appropriate continuous medical education 15. Demonstrate effective teaching of pediatric residents, and other neonatal health care providers, e.g., nurses, respiratory therapists, etc. 16. Participate in research. 17. Understand the relevant aspects of staff management and administration. 18. To Build Leadership capabilities. 3

Admission Requirements To be accepted in a training program the candidate has to fulfill the following requirements: 1. A Medical Degree (M.B.B.S) or equivalent from a recognized university. 2. Successful completion of board of Pediatrics (Saudi board or equivalent). Those who passed the Final written part of Saudi Specialty Certificate are eligible for admission 3. Passing an admission interview. 4. Provision of three recommendation letters from consultants confirming the suitability of the candidate for training in perinatal-neonatal medicine. 5. Provision of a letter from sponsoring organization approving that the candidate can join full time training for the whole period of the program (2years). 6. Signature of an obligation to abide by the rules and regulations of the training program and the Saudi Board of Pediatrics. 7. Registration as a trainee at the Saudi Council for Health Specialties. Training Requirements 1. Training is a full time commitment. Fellows shall be enrolled in continuous full time for the whole period of the program. 2. Training is to be conducted in an institution accredited for training by the Saudi board of Pediatrics. 3. Training shall be actively involved in patient care with gradual progression of responsibility under appropriate supervision. 4. Trainee shall abide by the training regulations and obligations set by the Saudi board of Pediatrics. 5. Trainee shall abide by the training regulations and obligations set hy the Saudi board of pediatrics. 4

STRUCTURE AND CONTENT OF THE PROGRAM General Guidelines of the Fellowship: 1. The duration of the fellowship is 2 years (F1 and F2) 2. During those two years the fellow will have different rotations inside and outside the neonatal intensive care unit. 3. The fellow will be under close academic and clinic supervision of neonatologist on duty. 4. The performance of the fellow will be evaluated during the two years of the fellowship. 5. Promotion from F1 to F2 depends on the end of first year overall evaluation. In addition to passing the end of the year exam 6. To be eligible to set to the final written examination, The candidate shall pass the second year overall evaluation and the end of year examination. 7. The Certification examination consists of written and clinical parts. Passing the written part is pre-requisites to enter the clinical exam. Rotation 1. Acute intensive care are** Content of the Program: Total period First year Second year 60 weeks 32 weeks 28 weeks 2. Intermediate/ continuing care** 8 weeks 4 weeks 4 weeks 3. Neonatal follow up clinic 04 weeks 04 weeks 0 weeks 4. Feto- maternal medicine* 04 weeks 0 weeks 04 weeks 5. Research Period* 12 weeks 04 weeks 08 weeks 6. Elective period* 08 weeks 04 weeks 04 weeks 7. Holiday period 08 weeks 04 weeks 04 weeks Total 104 weeks (2 yrs) 52 weeks (1 yr) 52 weeks (1 yr) 5

- Program director will arrange outside NICU rotations (*) with concerned departments. - Neonatal follow up clinic must be taken in well-established clinic supervised by a neonatologist who received special training in neonatal follow up. - Definitions(**) used are according to Guidelines Perinatal Care (AAP/ACOG) 2007. - The fellow must attend high-risk deliveries and sick newborn transport as needed. - The fellow is expected to supervise normal newborn nursery as needed. - The elective periods could be spent in any of the followings: Provided that he/she takes the night call. 1) Neonatal Ultrasonography. 2) Genetics. 3) Neonatal Anesthesia. 4) Pediatrics cardiology. 5) Pediatrics intensive care unit. 6

FELLOW JOB DESCRIPTION General Guidelines : Title : Summary : Department : Reports to : Fellow Will be involved in the provision of direct patient care to newborns, the teaching of residents and medical students, at least one research project, and participate in the neonatal perinatal medicine- training program. Department of Pediatrics, Division of Neoanatology. Neonatal Program Director. Qualifications : Academic : 1. Graduate of an approved medical school 2. Board certified in Pediatrics, Saudi Board eligible will be considered. Experience : Professional : Demonstrated clinical competency at a Fellow level in a Level III NICU. Potential medical supervisory skills. Potential teaching skills. Demonstrated ability to promote good interpersonal relationships. Current signed contract with Saudi commission for health specialties and sponsoring institution. 7

Terms o Employment: Subjected to the policies of: Saudi council of health specialties. Training commission. Neonatal intensive care unit where the training is done. Clinical functions and responsibilities: a) General 1. For supporting NICU administrative patient care policies and protocols. 2. For ensuring exemplary patient care is provided to those patients under his/her care. 3. For working cooperatively with all other staff to ensure exemplary patient care. 4. Attends Rounds promptly. 5. When on duty, attends the appropriate business handover round. 6. To stay in house during on-call duty. 7. To report directly to the Neonatologist-On-Call while providing direct patient care in the NICU. b) Specific : 1. Reviews all admissions with the Residents in detail. 2. To help in running the routine morning rounds. 3. To help (with the resident) in looking after critically ill patients. 4. Reviews and signs all discharge summaries. 5. Is responsible for the quality of medical record documentation on a day to day basis. 6. High risk deliveries: a. Is aware of and support the NICU Resuscitation Policies and Procedures, as stated in the Policy Manuals. b. Attends All high-risk deliveries when assigned. c. Notifies, prior to delivery, the neonatologist On-Call of All ultra high-risk deliveries. 7. Transports: a. Refers all consultations from physicians in other hospitals to the Neonatologist On-Call. b. Attends acute transports when assigned. 8. To attend neonatal follow-up clinics when assigned. 8

c) Evaluation: Assists in the evaluation of junior medical staff. d) Teaching: Participates in the teaching of residents and nurses. e) Research: Undertakes at least one research project under the supervision of a specific neonatologist, which should be presented in scientific meeting on published in a peer review journal. f) Professional Development: a. Assumes responsibility for development and maintenance of own professional competency. b. Participates in assigned perinatal related rotations outside the NICU. When absent for any reason: Ensures that the program director, or delegate when not on duty, is personally notified in advance Ensures personally that arrangements are made for his/ her service and teaching responsibilities to be covered by an appropriate Fellow. 9

ORIENTATION OF FELLOWS Introduction Before having full-delegated responsibilities at a Fellow level, each new Fellow must be: a. Properly oriented. b. Receive a satisfactory documented evaluation of their skills by the supervising neonatologist. Skill Assessment: Neonatologist must personally assess and officially evaluate the Fellows in the following areas: Resuscitation:* Intubation: - Oral - Nasal Insertion and securing of: - Umbilical arterial catheter - Peripheral arterial catheter - Umbilical venous catheter - Percutaneous central venous catheter - Chest tube Infection screening: - Lumbar puncture - Blood culture - Suprapubic culture All of these skills must be assessed and satisfactory evaluated before a Fellow is able to perform these skills independently. Evaluation forms are required to be completed within one (1) month of the Fellow commencing work. * A Fellow is expected to accompany Residents at a high-risk deliveries. 10

GENERAL GUIDELINES OF CURRICULUM The trainee will: 1. Discuss the growth, development and nutritional requirements of the normal fetus and newborn. 2. Describe maternal physiology, biochemical, pharmacological and pathological factors that influence the fetus and newborn 3. Describe placental physiology and pathology. 4. Describe the adaptations that occur at birth. 5. Relate how the disorders of body systems of the fetus can be prevented, diagnosed and treated. 6. Discuss the diseases of the newborn in relation to clinical decision-making and management : - basic science knowledge (e.g., genetics, physiology, biochemistry, pharmacology, pathology). - extensive, in-depth and up-to-date knowledge in the prevention, diagnosis, treatment and prognosis of common diseases involving various organs/systems of the newborn - some knowledge of unusual diseases and the ability to obtain information as needed. - recent advances in neonatology and perinatology (keep up with the literature). 7. Describe the psychology of pregnancy and parent/infant interactions. 8. Identify complications resulting from diseases and/ or their treatments in the newborn period, which may interfere/retard normal growth and development in the future. 9. Evaluate ethical issues in neonatal care. 10. Apply epidemiological and biostatistical principles in perinatal care. 11

RECOMMENDED TEACHING SESSIONS General topics in Neonatology: 1. History of Neonatology & Perinatal Medicine. 2. Neonatal Resuscitaion. 3. Transport of the Sick Neonate. 4. Physical Environment. 5. Birth Injuries. 6. Assessment of Weight and Gestaational Age SGA &LGA. 7. Hydrops Fetails. 8. Ethics in perinatal neonatal medicine. 9. Neonatal follow-up. 10. Computer Application in Perinatal-Neonatology. 11. Stress/burnout in NICU. 12. Communicating effectively with parents. 13. Normal parent infant interactions. Maternal-Fetal Medicine: 1. Assessment of Fetal Health and Gestation. 2. Diabetes in Pregnancy. 3. Hypertension in Pregnancy and their Influence on the Fetus. 4. Other High Risk Pregnancies. 5. Infertility and IVF. 6. Anaesthesia during Labour and Delivery. 7. Management of Labour and Delivery. Respiratory: 1. HMD.. 2. Wet Lung. 3. Other causes of respiratory Distress. 4. Respiratory Physiology and Ventilation. 5. Non-conventional modes of Ventilation. 6. Congenital Diaphragmaatic Hernia. 7. Apnea. 8. Upper Airway Obstruction. Cardiology: 1. Cardiac Embryology. 2. Cyanotic Congenital Heart Disease. 3. Acyanotic Congenital hear Disease. 4. Patent ductus arterousus. 5. Cardiac Surgery. 6. Arrhythmias. 12

Gastroenterology: 1. Feeding the Premature or Sick Neonate. 2. Jaundice. 3. Development of thee GI Track. 4. Malabsorption. Fluids and Electrolytes and Nutrition: 1. Fluid and Electrolyte Requirements. 2. TPN. 3. Calcium Magnesium and Phosphate. 4. Iron and Minerals. 5. Vitamins. 6. Breast Milk and Formulas. 7. Body composition in the Fetal and Neonatal Period. 8. Carbohydrate Metabolism, Hypo and Hperglycemia. Endocrine: 1. Thyroid Disease in the Mother, Fetus and Neonate (screening). 2. Ambiguous Genitalia. 3. Hypopituitarism. 4. Disorders of the adrenal glands. Haematology/Oncology: 1. Anemia and Polcythemia. 2. Thrombocytopenia and Coagulation Disorders. 3. Malignancies in the Neonate. 4. Blood products Transfusion. 5. Leukocyte Disturbances. Genetics/Inborn Errors of Metabolism: 1. Principles of Genetics. 2. Chromosomal Disorders. 3. Hyperammonemia. 4. Metabolic Acidosis. 5. Approach to Inborn Errors of metabolism. Infections Diseases and Immunology: 1. Development of the Immune System. 2. Bacterial Infection (including sepsis, meningitis, septic arthritis, UTI). 3. TORCH, Viral and Congenital Infections. 4. Ureaplasma, Mycoplasma and Chlamydia. 5. Antibiotic Use and the Local Infectious Epidemiology. 6. Immunotherapy. 7. Acquired Viral Infections. 13

Central nervous system: 1. Assessment of Neurological Function. 2. IVH and intracranial hemorrhage. 3. Hypoxic Ischemic Encephalopathy. 4. Seizures. 5. Neural Tube Defects. 6. Normal and Abnormal Development. 7. Neuromuscular Diseases of the Newborn. Surgery: 1. General Principles. 2. NEC. 3. TEF and Intestinal Atresia and Abdominal Wall/ Umbilical Defects. 4. Urological Problems. 5. Clef Lip and Palate. 6. Orthopeadics. 7. Neuro-surgical Problems. Renal: 1. Human Renal Anatomical Development. 2. Renal Physiology and Evaluation. 3. Acute Renal Failure Differential diagnosis, Assessment and Treatment. 4. Congenital Anomalies. Ophthalmology: 1. Development of the Eye and its Vasculature. 2. Congenital Disorders. 3. Retinopathy of Prematurity. 4. Conjunctivitis. Radiology: 1. Applications of ultrasound in perinatal neonatal medicine. 2. Application of other imaging techniques (MRI, CT scan, etc.,). in perinatal- neonatal medicine. Dermatology: 1. Common neonatal skin disorders. 2. Rare neonatal skin disorders. Pharmacology: 1. Principles. 2. Vaccines. 3. New Drugs. 4. Neonatal Abstence Syndrome. 5. Pharmacology of Pregnancy. 6. Drugs and Breast Feeding. 14

THE RECOMMENDED REFERENCES 1. Avery fanaroff & Richard Martin, Perinatal-neonatal disease and disease of the fetus & infant. 2. Gordon Avery, Pathophysiology of diseases of newborn. 3. Roberton, Textbook of neonatology. 4. Tricia Lacy Gomella, A lange clinical manual neonatology. 5. Neo Review 15

GUIDELINES FOR HISTORY TAKING When taking history the trainee is expected to: 1. Collect pertinent information from the antenatal, intrapartum and neonatal history (or the history at follow-up) of the well and unwell mother, fetus, and newborn. 2. Complete systematic history including: - Maternal medical history, past obstetric history, drug history, family history and social history. - Present pregnancy. - Delivery. - Resuscitation and Neonatal Course. - History of Medical Problems. - Growth and Development at Follow Up - History from mother and child relative to each System. 3. Identify and integrate appropriate historical information from clinical records. 4. Document a complete history. 5. Establish rapport with patient/parent to enable efficient collection of information. 6. Display empathy towards parent/patient. 7. Communicate constructively with patient/parent. 8. Adapt style and content to suit the individual case. 9. Display a problem-solving questioning technique. 10. Synthesize an orderly and precise summary of the case history. 16

GUIDELINES FOR PHYSICAL EXAMINATION The trainee would be able to: 1. Perform a complete physical examination including the following systems: 1. General examination (vital signs, growth parameters, signs of distress). 2. Systemic examination (different systems). 3. Assessment of gestation. 4. Examine for congenital malformations. 5. Developmental assessment. 2. Use the equipment necessary for performing physical examination as needed in various birth weight groups and clinical situations. 3. Adapt the physical examination to each individual situation by obtaining. the maximum amount of relevant information with the least amount of disturbance and risk to the patient. 4. Perform an appropriate physical examination in different settings, including: - delivery room - neonatal intensive care unit - follow-up clinic 17

GUIDELINES FOR TEACHING AND RESEARCH Teaching: 1. Prepare different presentations according to the unit schedule. 2. Demonstrate a variety of teaching methods. 3. Adopt teaching for setting and audience. 4. Help in teaching of junior staff. Research: General: A critical aspect of this training program is a commitment to both clinical and basic science research in perinatalneonatal medicine. Within the institution, the fellow will be exposed to and take part in research programs. He/ she will be encouraged to develop a questioning attitude and the ability to critically appraise neonatal-perinatal research. The fellow will be expected to assist, design, conduct, evaluate and prepare for publication of a clinical or laboratory research project in the area of perinatalneonatal medicine. Specific: 1. Develops the ability to appraise literature critically. 2. Discuss the basics of epidemiology, statistical analysis and study design. 3. Takes part in research projects (minimum of one project) under neonatologist supervision. Involvement should ideally include helping in the design, conduct and evaluation of the study. 4. Prepares an abstract and presents the findings in scientific meeting, or publication of at least one manuscript in peers reviewed journal. 5. Maintains clinical expertise during research training. 18

GUIDELINES FOR ROTATION IN FETO-MATERNAL MEDICINE 1. Becomes familiar with normal maternal and fetal physiology. 2. Becomes familiar with high-risk pregnancies, understanding the pathophysiology of common medical/ obstetrical/surgical complications of pregnancy, their effects on pregnancy and on the fetus/newborn, and also the effects of pregnancy on the disease. The common conditions include: - Diabetes mellitus - Hypertension - Antepartum hemorrhage - Preterm Labour - Premature Rupture of Membranes. - Chorioamnionitis - Cardiac Disease in Pregnancy - Autoimmune Disease SLE, ITP - Perinatal Infections - Congenital Abnormalities 3. Be able to apply the above knowledge in making decision regarding timing of delivery, mode of delivery and formulating management care plan for the newborn infant in anticipation. 4. Understands the physiology of labour and the mechanism of delivery and the effects on the fetus/newborn. 5 Recognizes high-risk labour and delivery and planning care in anticipation. 6 Becomes aware of methodology of intrapartum surveillance of mother and fetus, including, fetal heart rate monitoring, fetal blood gas sampling, fetal biophysical profile. 7 Becomes aware of the antenatal investigative techniques, their indications, risks, and benefits, as in, genetic amniocentesis, chorionic villous sampling, nonstress test, assessment of fetal growth and wellbeing (ultrasound and biophysical profile). 8. Understands principles of regionalization of perinatal care and principles ofmaternal transfers. 19

GUIDELINES FOR TRAINING IN INTENSIVE CARE AREA General: 1. Acquires special knowledge and skills in the diagnosis, assessment and management of neonates requiting intensive care. 2. Supervises and teaches residents on the Service. 3. Manages the area under the supervision of the Neonatologist. Specific: Knowledge base 1. Develops a sound understanding of the principles involved in the assessment of fetal well-being. 2. Understands the effect of maternal and perinatal factors on the health of the fetus and newborn. 3. Develops competence in the assessment, investigation and management of sick preterm and term infants requiring both medical and surgical care. This will include: Disorders of adaptation to extra uterine life Complex congenital disorders Respiratory, cardiac, renal gastrointestinal, endocrine, metabolic and neurological disorders General principles of critical care: - Respiratory support - Temperature control - Infection control - Fluid and electrolyte balance - Nutrition support - Appropriate use of monitors - Appropriate use of laboratory investigations Anticipation and prevention of iatrogenic problems associated with intensive care 20

Skills: Develops skills required to support infants requiring intensive care. This will include: Neonatal resuscitation and stabilization Oral and nasal endo-tracheal intubation Umbilical arterial and venous catheterization Peripheral arterial cathererisation Peripheral venous insertion Percutaneous central venous catheter Use of non-invasive care respiratory monitors Use of intensive care monitoring systems Insertion of chest tubes Septic work up - blood culture - suprapubic - lumbar puncture Use of ventilators including high frequency ventilation and inhaled Nitric Oxide Parenteral nutrition Exchange transfusion Parent Communication 1. Identifies the needs of parents of infants receiving intensive care, together with other members of the multidiscipline teams. 2. Counsels and support parents of infants receiving intensive care, providing realistic support. Team Responsibilities: 1. Supervises and teaches pediatric residents. 2. Manages the multidiscipline team under the supervision of the Neonatologist. 3. Works in a collaborative manner with other members of the health care team. 4. Communicates with the referring physicians. 5. Identifies patients requiring patient care conferences for management and ethical issues. Organizes the conferences 21

GUIDELINES FOR TRAINING IN INTERMEDIATE / CONTINUING CARE AREA General: 1. Develops special knowledge and skills in the diagnosis,assessment and management of infants requiring Level II care. 2. Develops competence in the assessment and management of infants who require prolonged care. 3. Manages the service and coordinates the activities off the multidiscipline team. 4. Plans and coordinates the discharge of infants home including parents education. Specific: Knowledge base: 1. Develops the knowledge and skills to manage the infant requiring continuing care. 2. Recognizes the special needs of infants requiring prolonged hospitalisation including, respiratory support, nutrition and growth, neurodevelopment. Skills: Develops the skills required to support infants requiring continuing care. This will include: Oral and nasal endo-tracheal intubation Peripheral venous insertion Use of continious respiratory monitors Septic work up including blood culture, suprapubic tap and lumbar puncture Parenteral nutrition Parent Communication: 1. Recognizes the stress placed on parents with infants requiring prolonged intensive care. 2. Counsels and support parents. Team Responsibilities 1. Coordinates the discharge of infants from NICU 2. Supervises and teaches pediatric residents. 3. Manages the multidiscipline team under the supervision of the neonatologist 4. Works in a collaborative manner with other members of the team. 5. Arrange patient care conferences as required. 22

General : GUIDELINES FOR TRAINING IN RESUSCITATION AND TRANSPORT. 1. Develops competence in the recuscitation of the high risk newborn. 2. Develops competence in the transport of sick newborns. Specific: Resuscitation: 1. Complete successfully the neonatal resuscitation programme (NRP) 2. Develops a sound understanding of the principles involved in the assessment of fetal well-being. 3. Understands the effect of maternal and perinatal factors on the health of fetus and newborn. 4. Identifies the high risk pregnancy and fetus. 5. Communicates effectively with the multidiscipline team handling the mother, and the team responsible for the infant. 6. Prepares appropriately for the effective resuscitation of the anticipated high risk neonate. 7. Works effectively with all members of the team resuscitating the infant. 8. Stabilizes the infant in a timely and effective manner. 9. Minimizes the long term risks to the infant by ensuring appropriate temperature control and respiratory management. 10. Transfers the infant safely to the NICU from the Delivery Room. Transport: 1. Demonstrate an understanding of the principles of a safe neonatal support. 2. Understands the regionalization of perinatal care and transport organization. 3. Communicates effectively at each sstage of the transport with both neonatologist on-call and parents. 4. Assesses and manages the sick newborn competently throughout the transport. 23

RECOMMENDED EDUCATIONAL ACTIVITES Weekly Fellow s Rounds 1. Neonatal Fellow s Seminars Objectives : Review of the basic sciences with a focus of one topic each week and integrating this with clinical neonatology. Topics should cover the requirements for the subspecialty training program. Review of ongoing neonatal and perinatal research projects will also be covered. Format : Options are: 1.Case presentation and topic review. 2. Formal lecture. 3. Discussion (combined with another form) 4. List of topics is included. Moderator : Neonatologist in service. 2. Paediatric Residents Seminars Objectives : Review major neonatal topics at resident s level. Format : Topic review. Moderator : Fellow covering intensive care unit in NICU. 3. Perinatal Mortality Rounds Objectives : 1. Review all delivery cases and to discuss problem cases. 2. Provide monthly cumulative data of perinatal and neonatal mortality rates. 3. Identify contributing causes of perinatal death for each case. 4. Recommended program aimed at improving the quality of future patient care. 5. To serve as an educational and research forum Format : a. Present the monthly data of admissions to NICU. b. For each use. - Maternal history presented by an obstetric representative. - Neonatal course presented by a neonatal representative. - Case discussion thereafter. Moderator : Neonatologist in service.. 24

4. Journal Club: Objectives Format Moderator : To keep abreast with recent literature and a forum for critically appraising published articles. : Two papers to be picked up by the fellow and reviewed in details. : Neonatologist in service. 5. Discharge Summaries Meeting: Objectives : To assure completion of discharge summary of all patients and to verify any questions on the management. Format : All discharge summaries the week before should be done by the resident then reviewed by the fellow prior to the meeting. Moderator : Neonatologist in service. 6. Perinatal-antenatal high risk meeting Objectives : To discuss all high risk pregnancy with perinatologist. Format : Case discussion. Moderator : Neonatologist in-service and consultant obstetrician. 7. Monthly perinatal-neonatal club meeting: Objective : To discuss a topic, case of interest. Format : Topic or case presentation. Moderator : Chairman of the club. 8. Other educational activities: - Epidemiology Course - Scientific Conferences: Fellows should attend one scientific conference (national or international) per year and are encouraged to present an abstracts at such meetings. - Teaching Opportunities : - NICU nurses, informal resident, department of Paediatrics teaching seminar. 25

PRINCIPLES INVOLVED IN THE SCHEDULING OF PERINATAL-NEONATAL FELLOWS IN THE NICU 1. Continuity of care is a high priority in the organization of all rotations during: - weekdays and nights. - week-ends. - Holidays periods. 2. Teaching commitments must be protected. 3. Rotations a) General : - Whenever possible, rotations of staff will be arrange to facilitate continuity of care. - New staff (trainees) should be paired with experienced staff until their procedures have been certified. b) Week-days Rotations - Each Fellow is assigned to specific rotation for minimum of 4 weeks or 1 month. c) Nights and Weekends - Fellows will do calls in house and are responsible to cover and coordinate NICU, delivery room and transport services during their on call time. 4. Number of calls - Five to seven calls per month. - Fellows are expected to perform regular duty till midday for continuity of care for their patients. 5. Holidays A) Fellows are entitled for four weeks vacation annually and a maximum of 10 days for both Eid holidays and emergency leave. B) Sick and maternity leave shall be compensated for during or at the end of training. 26

EVALUATION 1. End of rotation evaluation: At the end of each training rotation, supervising consultant/ team shall provide the training committee with a written evaluation of fellow performance during that rotation. 2. In-training examinations: The program shall incorporate an annual written examination,as part of the evaluation process of fellow. 3. Annual overall evaluation: This includes: A) Summation of end of rotation evaluation for the (50% of total mark). B) Results of annual in-training examination (50% of total mark). 4. Board examination: This examination will be given to candidates after successful completion of training as evidenced by an acceptable overall final-in-training evaluation (including the first and second annual overall evaluations). It is held once per year in one or more of the training centers. Candidates are allowed a maximum of three attempts to pass their examination with a period of three after completion of training. This examination consists of two parts: A) A written part: which consists of 200MCQs designed to evaluate knowledge and clinical judgment. Only successful candidates in this part allowed to set the clinical/oral part. B) Clinical/oral part: designed to test clinical skill/abilities, judgment in the field perinatal-neonatal medicine. 5. Certification: After the successful completion of the two years training and board examination, the candidate will be awarded with Saudi Sub-Board Certificate in PERINATAL-NEONATAL MEDICINE. 27