Neonatal – Perinatal Medicine Program
MESSAGE FROM THE FELLOWSHIP PROGRAM DIRECTOR
Marta Valcarcel, MD FAAP
Program Director and Chair
University of Puerto Rico
PO BOX 365067
San Juan, Puerto Rico 00936
I welcome you to the Departments of Pediatrics, Neonatology Section website at the University of Puerto Rico. Our mission is to train physicians in the discipline of Neonatology who will become competent in understanding basic medical principles relevant to neonatal care.
The Neonatology Section of the Department of Pediatric, UPR Medical Sciences Campus has a group of neonatologists that provide excellent care to sick neonates in the Neonatal Intensive Care unit of the University Pediatric Hospital, and has been involved on teaching medical students and residents (pediatrics, obstetrics, anesthesiology and surgery) in the care of the high risk newborns. They also participate actively in research.
Welcome to our web page!
The Neonatal –Perinatal Medicine Program of the University of Puerto Rico, Medical Sciences Campus was begun by Dr. Marta Valcárcel in 1992. This is a three-year training program with a maximum of five trainees. The program facilities are located at the Puerto Rico Medical Center, San Juan, Puerto Rico. The base institutional program is located at the sixth floor of the University Pediatric Hospital in a state of the art 50 beds Neonatal Intensive Care Unit. This unit and service also provides subspecialty services such as: pediatric surgery, pediatric subspecialty services such as neurosurgery, ophthalmology, urology, otorrhinolaryngology, cardiology, pulmonologist, endocrinology, geneticist, Infectious Diseases, neurology, orthopedics and cardiovascular surgery. Also, the University Pediatric Hospital has facilities for the High Risk Clinics for longitudinal neurodevelopment care in outpatient basis of the infants and families. The Fetal-Maternal Unit, Pre-partum Care and Delivery room are located in the University District Hospital which is a participating institution of the program.
The Neonatal –Perinatal Medicine Fellowship Program has five full-time faculty members who are Board Certified in Neonatal-Perinatal Medicine:
Marta Valcárcel, MD, FAAP – Program Director
Inés García, MD, FAAP- Program Coordinator
Gloria Reyes, MD, FAAP
Lourdes García, MD, FAAP
Juan Rivera, MD, FAAP
The program also has board certified faculty members in pediatric sub-specialties who are direct contributors, including research mentorship and or advisors.
Waldemar Carlo, MD, FAAP
Pedro J. Santiago-Borrero, MD, FAAP
Marta Suárez, MD, FAAP
Enrique Carrión, MD, FAAP
HOW TO APPLY
Applicants must submit the University of Puerto Rico, Medical Sciences Campus application form, a recent photograph, three letters of recommendation, evidence of medical certifications and diplomas to the Neonatal-Perinatal Medicine Program:
Marta Valcárcel, MD
Neonatal-Perinatal Medicine Program
University of Puerto Rico
PO BOX 365067
San Juan, Puerto Rico 00936
The applicants must have completed an ACGME accredited pediatric residency program and must be eligible to take the American Board of Pediatrics. Approval of the AMBP must be completed prior to fellowship graduation.
One to two fellows are accepted to the program on a yearly basis.
Residents have access to counseling services through confidential referral or self-referral to the Graduate Medical Education- Counseling Services Director Office directed by a Social Worker who has a Masters Degree.
Please see the UPR School of Medicine Graduate Medical Education Site for information on support services.
Please see the UPR School of Medicine Graduate Medical Education Site
for information on basic benefits and other benefits.
Fellowship Academic Curriculum
The design and conduct of the Neonatal – Perinatal Medicine sub-specialty program is guided by an understanding of the general competencies that the resident physician is required to achieve based in the requirements of the Accreditation Council for Graduate Medical Education (ACGME). The curriculum content includes the recommendations of the American Board of Pediatrics and the American Academy of Pediatrics. The sub-specialty program of the University of Puerto Rico, Medical Sciences Campus emphasizes that sub-specialty resident physicians must acquire certain knowledge, skills, and attitudes that will allow them to be fully competent practitioners at the completion of their sub-specialty residency. The purpose of this program is to provide residents with the background to understand the physiology and altered structure and function of the fetus and the neonate and to diagnose and manage problems seen in the continuum of development from the prenatal through the intra partum and neonatal periods, including longitudinal follow-up.
This program includes the core curriculum topics including: ethics, socio-economics, medical/legal issues, cost-containment issues, introduction to communication skills, research design, biostatistics, and skills required for critical review of literature.
The comprehensive curriculum of this program includes specific aims and goals during the three year training program. The program integrates an adequate learning design in order to provide the competencies required by a neonatal-perinatal medical specialist; including the eligibility to the Neonatal-Perinatal Board Certification and the educational perspective of lifelong learning and self assessment.
In the Neonatal-Perinatal Medicine Program the medical students, residents from anesthesiology and obstetrics, pediatric residents, neonatal-perinatal medicine residents, board-certified in-house pediatricians (non-resident providers) and board certified staff in neonatal-perinatal medicine function as a team. The core attending neonatal-perinatal faculty supervises the entire team and is available 24 hours a day and make attending rounds 7 days per week during the fellows and pediatric resident’s intensive care unit rotations. The roles of the sub-specialty residents vary based on experience level, including direct patient care and supervision. The teaching environment includes the neonatal intensive care unit, fetal evaluation clinics, labor and delivery room, pediatric operating room, cardiovascular clinics, and High Risk Clinics. Board certified physicians supervise the sub-specialty residents in the rotations outside the neonatal intensive care unit.
The evaluations of essential components of clinical, research and educational competencies provide the neonatal-perinatal medicine trainee with an excellent tool which defines the educational material, resources and clinical experiences required to assess their knowledge and professional skills. The medical faculty of the Neonatology Section participates actively in providing the supervision, guidance and timely evaluations of the neonatal-perinatal resident’s performance.
By the time the sub-specialty residents complete their training programs the resident physician must achieve competency in the six domains of clinical practice: patient care, knowledge, practice based learning and improvement, interpersonal skills and communication, professionalism, and system based practice.
At the end of the Postgraduate year 3 the Neonatal-Perinatal Medicine residents are expected to have fully incorporated the competencies into their routine practice and understand the appropriate roles of the general pediatrician and the neonatologist in the intervention with the neonate. The resident are able to provide care to neonates and their families at an independent level and are able to obtain a certification of the American Board of Pediatrics, Sub-specialty in Neonatal-Perinatal Medicine representing the dedication to the highest level of professionalism in patient care. Three residents graduate from the program every two years.
Description of Teaching & Didactic activities:
The neonatal resident coordinates with the Obstetrical Department the Ob-Pediatric Conference. In this activity an Ob resident, the neonatal resident and the perinatologist prepare a presentation of the medical case of a mother-newborn patients evaluated and treated by both services. The neonatal resident reviews the physiology and pathophysiology of illness, scientific literature and current diagnostic modalities and strategies of intervention.
In this activity the neonatal residents use life-long learning skills and practice improvement, including the use of information technology to access scientific evidence, interpret the evidence they uncover, and then apply it to the care of their patients.
In this learning activity the neonatal resident participates in the education of students, residents and faculty members.
The Neonatology Section provides skilled teachers as role models. This activity assures full integration of this and other competencies with learning and clinical care. A written evaluation is done by each faculty member in the activity (neonatologists and perinatologists), including the evaluation of the neonatal resident’s teaching abilities. The evaluation form is signed by the faculty and the trainee.
Neonatal Morbidity & Mortality
Mortality-Morbidity Neonatal Conference is planned and conducted by the neonatal fellow. The case load presented is the total number of NICU deaths per month. This conference is discussed formally in the Neonatal Quality of Care Committee.
Neonatal Quality Assurances
The neonatal residents conduct a quality improvement activity that fulfills the requirement for experiential learning in identifying system errors. Clinical outcomes that are outside the expected range are discussed in the Neonatal Quality Activity with the neonatologist, neonatal residents, nurses, respiratory therapist, epidemiology nurse and social workers. This meeting is held every two months. This learning activity provides the opportunity to the neonatal residents to understand the hospital based institutional programs, to learn the policy statements from the American Academy of Pediatrics and the requirements from the Joint Commission on the Accreditation of Healthcare Organizations.
In this meeting, a quality improvement activity is assigned to the neonatal resident. The neonatal resident addresses the medical issue. The neonatal resident identifies a system error, reviews the medical literature, develops and implements system solutions to rectify it which are at a system level. The neonatal resident demonstrates competence in systematically accessing, analyzing and applying evidence.
Neonatal Journal Club
The Journal Club activity promotes research studies analysis on experimental design, data collection and interpretation of results and conclusions. The research papers assigned to this activity are evaluated using the Critical Evaluation of Published Research Articles-Scoring Rubric Form. There are 1 to 2 activities monthly and Pediatric Subspecialists participate in Journal Club activities in which their area of expertise is reinforced. The neonatal resident participates in Journal Club activities related to professionalism/ethics as coordinated by the Pediatric Department and the Faculty Developmental Program.
The Section of Neonatology has a research program with active participation of the faculty. The faculty serves as a mentor for the research program of the fellows of neonatology. There is involvement with research on Growth and Development of the High Risk Infant and Preventive Care of High Risk Newborns and its Family. The Neonatology Section participates in the Vermont Oxford Network and obtains significant epidemiological data about sick neonates using prospective data collection of all neonatal admissions to the Neonatal Service; this provides ample opportunities for research in a large sample of subjects. This data is available for the development of research by the faculty and the residents. The results of research studies are presented in different local, national and international forums.
All the neonatologists have actively supported research work with focus in the neonatal residents research work. In the first year the resident participates in a three month, three hours per week course "Introduction to the Principles and Practice of Clinical Research”, sponsored by the National Institutes of Health Clinical Center. The course is offered yearly at the University of Puerto Rico, Medical Sciences Campus.
The resident completes the online courses on Human Subjects Protection and Health Information and Security from the Collaborative Institutional Training Initiative available at www.citiprogram.org.
The neonatal resident prepares two posters/oral presentations in local, national or international conferences. All prospective presentations are presented to the neonatology staff prior official presentation, in order to give feedback to the neonatal resident.
The Section of Neonatology members participate in two outpatient activities: High Risk Clinics.
The Residents Follow up Clinic which include the participation of Dr. Luis Marti Developmental Behavioral Pediatrics Specialist.
The High Risk Clinic directed by Dr. Gloria Reyes is conducted once per week with the participation of a speech pathologist, speech therapist, nurse, psychologist and audiologist. Also pediatrics residents participate in this clinic there is a multidisciplinary meeting at the end of the activity. There are 553 NICU follow up visits in this clinic per year.
The neonatal resident conducts the Family Conferences. In this activity the family education is interdisciplinary, collaborative, and interactive. In this meeting, there is participation of the family of the newborn admitted to the Neonatal Intensive Care Unit, the social worker, the psychologist, the nurse supervisors, the neonatologist and other pediatric subspecialist participating in the newborn care. This learning activity provides the means of teaching, giving feedback and assessing competence in conducting family meetings.
Professionalism is promoted through a foundation of clinical competence, communication skill, and ethical and legal understanding, upon which is built the aspiration to apply the principles of professionalism: excellence, humanism, accountability, and altruism. The Faculty Development Program has prepared lectures and workshops for the faculty and neonatal resident on professional behavior, ethical principles and cultural competence.
Faculty members and residents have the opportunity to participate in community service, professional organizations and institutional committee activities.
The training program fosters a commitment to professional ethics in residents that is demonstrated by a spirit of collegiality and a high standard of moral and ethical behavior within the clinical setting in the care of patients, in the education of residents, in conducting research and in interactions with pharmaceutical companies and funding organizations.