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Neonatology - Clinical Fellowship

I About The Programme
II Assessment and Evaluation
III Target Audience and Eligibility Requirements
IV Other Information


I About The Programme

Name of Programme

Clinical Fellowship in Neonatology

Overview

Our Neonatal Intensive Care Unit (NICU) is the largest facility in Singapore that treats premature babies and infants, including those referred from other hospitals.

KKH has one of the lowest mortality rates in the world, at 1.99 per 1,000 live births. This outcome has been made possible by close coordination between our perinatal and neonatal teams to manage high-risk pregnancies and deliveries and extend timely and advanced neonatal care to the newborn.

For more information on the Neonatal Intensive Care Unit (NICU) and the services they offered, click here.

Aim of Programme

This programme provides Fellows with clinical training in neonatal intensive care. On completion of the training programme, Fellows would have acquired sufficient theoretical knowledge and clinical skills that will enable them to independently manage babies requiring Level 3 Neonatal care. The Fellow will eventually practice neonatal intensive care that is evidence-based and tempered with the art of medicine.

Duration of Programme

12 months

Number of Training Places

3 positions available at any point of time

Learning Outcomes

After completing the programme, Fellows will be able to:

  • acquire clinical examination and assessment skills and apply these in a neonatal intensive care setting;
  • acquire all basic technical and advanced life support skills for a sick neonate;
  • acquire skill in planning care management for sick neonates requiring intensive care;
  • understand the principles of critical appraisal and research methodology in neonatology.

Content Areas

The programme covers the following areas:

  1. Resuscitation of babies in the delivery room
  2. Neonatal Intensive care
  3. Neonatal Special care
  4. Level 1 Nursery Care & Newborn Screening Programme
  5. Long-term follow-up of high risk infants

Training Methods

The training will only take place in Department of Neonatology, KKH. There is no rotation to other departments/institutions.

The fellows will be full-time residents in the Department working under the supervision of Consultants/Associate Consultants. They will be assisted by Registrars. The trainees will be supervised at all times. Each fellow will have periods of mentoring by the Consultants and Associate Consultants. The Fellow will be rostered on a monthly basis to the NICU, Special Care Nursery, and Level 1 Nurseries, and will be functioning at a junior doctor (medical officer) level under close supervision.

Training is obtained through each of the following:

  1. Active participation under supervision in all aspects of patient care. This involves being the first doctor to evaluate the child and initiate immediate care both in the wards and in the delivery room. This is followed by participation in the twice daily ward rounds in the intensive and special care nurseries. Fellows are required to evaluate patients and offer management decisions. The emphasis is on objective evaluation of patient data, and management is to be evidence-based. The Fellow will also be rostered to attend the birth defect clinic, high risk perinatal consultation rounds and long-term growth and development clinics. Training will also be given in the field of newborn screening programmes, e.g. G6PD, congenital hypothyroidism, universal newborn hearing, and IEM.
  2. Opportunities to become proficient in the performance of the following procedures:
    • Obtaining vascular access through arterial puncture
    •  Percutaneous venous
    •  Peripheral arterial
    •  Umbilical arterial and umbilical venous catheterisation and percutaneous longline insertion
    •  Ventilation with a mask
    •  Endotracheal intubation
    •  Percutaneous longline insertion
    •  Setting up and operation of a ventilator
  3. Training also includes ordering of parenteral and enteral nutrition, mechanical ventilation in different modes including HFOV, exogenous surfactant treatment, nasal-prong CPAP, non-invasive ventilation and INO therapy. Trainees will maintain and submit a logbook three-monthly for certification. Opportunities are abound for learning under close supervision, higher order practical skills like decision making in the management of extremely low birth weight babies, micropremies and those with multisystem disease, the use of cerebral ultrasonography and therapeutic hypothermia for full-term and late-preterm infants with hypoxic ischaemic encephalopathy. Duties and responsibilities that are assigned will enable them to develop an understanding of the ethical and psychosocial aspects, organisation and administration, and the audit of neonatal care.
  4. Formal tutorials that take place for a period of 2-3 weeks during the orientation programme held at the beginning of each posting. Through these lectures, the common neonatal diseases and their practical management will be introduced. Theoretical and practical training on resuscitation of the newborn infant will also be given. The Fellow will undergo a theory and practical test, and will be formally certified to do neonatal resuscitation. The department’s teaching activities include CME lectures, core lectures, journal clubs; X-ray round and mortality/morbidity meetings, clinical teaching sessions and combined neonatal meetings.
  5. Outpatient provision of well-baby care and the long-term follow-up of babies who were unwell in the neonatal period and who are at risk for growth and developmental abnormalities. Senior staff members provide broad directions in the management supervise the care that is being extended and are available for immediate consultations.
  6. Research exposure through assisting senior staff in their research projects. This involves participation in any of the following stages: defining objectives, designing the study, obtaining data, and analysis and presentation of results. They will also be involved in prospective and retrospective audits.

The training activities and methodologies are summarised in the following table:

​Training Activities & Methodology:
​Name of Activity
Frequency/No. of Sessions/ Length of Session
Teaching Methodology
Clinics
One session per week during the Level 1 nursery postingObservation & case-based discussion on patient care
Grand Ward Rounds
Once per week on Monday morningsComments from Consultants & Senior Consultants
Handover Rounds
DailyComments from Consultants & Senior Consultants
Journal Clubs
Weekly (3 sessions per month)Critique & Appraisal; Evidence-based Medicine
Morbidity (QA)
FortnightlyProblem-based learning
Clinics
FortnightlyProblem-based learning
Case Presentation
Daily during the NICU & SCN postingsBedside teaching & case-based discussion
Clinicopathological
Conference/Perinatal Mortality meeting
Once in 4 monthsDiscussion
Consultant led teaching/masterclass/
Grey cases
Once in two weeks
Face-to-face discussion

Team of Experts

​Name
​Designation
​Qualification
Adj. Prof. V.S. Rajadurai
Programme Director; Senior Consultant, Dept of NeonatologyMBBS, MD (Paeds), MRCP, DCH, FAMS

II Assessment and Evaluation

Aims of Assessment

Fellows are required to continually demonstrate the following six competencies throughout the programme:

(A) Patient Care

(B) Medical Knowledge

(C) Practice-Based Learning and Improvement

(D) Interpersonal and Communication Skills

(E) Professionalism

(F) Systems-Based Practice

Assessment Approaches

Formative Assessment:

  • Monthly evaluation between Fellow and supervisor
  • Reflective journal and paper critique once in 4 months
  • Logbook recordings of training activities and signed by the supervisor once in 2 months
  • Case-based discussion: 2 cases per 6 months
  • 360 degree feedback from peers, nurses and respiratory therapists

Summative Assessment:

  • Viva at the end of Fellowship training

Feedback:

  • Supervisor to provide monthly feedback to the trainee on his performance
  • End-of-training feedback session (by the Supervisor & HOD)

The trainee will be encouraged to provide feedback about the learning needs, neonatal practical procedures and difficulties encountered during the posting during the monthly supervisor-supervisee meetings. The candidate will also have the opportunity to meet up with the consultant in-charge of the ward and give feedback with reference to a particular posting.

Evaluation Process

The general overall grading system evaluates the Fellow’s performance upon completion of the fellowship programme. All Fellows will be given a general overall grading status at the end of the fellowship programme based on the grading criteria requirements incorporating the six competencies based knowledge, skills and performance that Fellows must demonstrate throughout the programme. There will also be a clinical scenario-based assessment of the candidate during the last month of the Fellowship.

Grading Status ​Description ​Grading Criteria Requirements
​CMP
​Completes the programme
  • Overall score of 60% in the Competency based assessment by the Supervisor and pass the clinical scenario examination.
USP*
Unsatisfactory performance
  • Overall score of less than 60% in the Competency based assessment by the Supervisor and failure to pass the clinical scenario examination.
​DCP
​Did not complete the programme

​WDN
​Withdrawn from the programme


*Fellows who have attained a USP grade may be given options to extend their fellowship programme for another 6 months.

Early Termination

The attachment programme will be terminated early on the grounds of the Fellow’s poor performance, misdemeanour, misconduct or negligence. The Fellow may also request to terminate the attachment programme for reasons such as serious illness or other personal obligations.

III Target Audience and Eligibility Requirements

Target Audience

The Department of Neonatology invites those candidates who have a passion for neonatology to join us in rendering excellent care to the sick newborn and with its long experience in providing postgraduate training looks forward to assisting the prospective fellow in his/her career development.

Pre-requisite/Eligibility Requirement(s)

Candidates must have:

  • A basic medical degree, i.e. MBBS or equivalent
  • A postgraduate medical degree or diploma in Paediatrics from the home country
  • Prior experience in an NICU for ≥ 1 year

IV Other Information

Course Fees

A fee of SGD5000 will be charged for a 1-year course.

Funding

Clinical Fellows must be sponsored by either the government, regional health authority or an appropriate institution in their home country to undergo the fellowship training in Singapore.

Certification

A formal certificate signed by the Head of Department, Division Chairman and Chairman Medical Board of KKH will be awarded upon successful completion of training.