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Optimizing neonatal patient care begins with education: strategies to build comprehensive and effective NPM fellowship programs

Since inception of the field in the 1970s, the typical “job description” of a neonatologist has evolved significantly. Many permutations exist based upon the type of position (academic or private practice), activities complementing clinical work, and institutional/ geographic variation. Similar evolutions have taken place in the post-graduate medical training environment. The roles and responsibilities of the Neonatal-Perinatal Medicine (NPM) fellowship program director (FPD) have changed dramatically due to expanding requirements in assessment and documentation of fellow performance and competency, navigating a wide array of potential fellow scholarly activities, incorporating best-practices and innovations in medical education into the program’s curriculum, mentoring individual fellows, and monitoring/ providing faculty development sessions on relevant educational topics. FPDs frequently “lead from the middle” as they advocate for their trainees in pursuit of an optimal balance of clinical service with education; differing perspectives on optimal allocation of fellows’ time may be encountered by division leadership needing to staff a busy NICU and allocate clinical experience and procedures across members of the interprofessional team (including students, residents, advanced practice providers, and faculty members). The 2020 global pandemic required FPDs to rapidly pivot to provide ongoing clinical training and core educational sessions in a virtual or socially distant manner; numerous partnerships were formed across the NPM community to ensure trainees in all programs were still provided with high-quality educational activities. The pandemic also sharply highlighted the important role of the FPD in prioritizing and monitoring trainee wellness/ wellbeing. In addition to juggling this myriad of tasks as well as clinical duties, FPDs continue to engage in their own scholarly activities, which are critically important for personal satisfaction and academic promotion.

The Organization of Neonatal Training Program Directors (ONTPD) was formed through the American Academy of Pediatrics’ Section of NPM in 1991 for the purpose of identifying and addressing issues relevant to NPM fellowship training, to disseminate information and advocate for Accreditation Council for Graduate Medical Education (ACGME)-accredited NPM training programs, and to liaise with other organizations. ONTPD has worked to develop a community of practice, create shared educational resources, and collaborate to enhance the training environment. Members of ONTPD have joined forces to author an exciting, future-focused series of articles addressing critical topics relevant to contemporary NPM fellowship programs, including the current training landscape [1]; clinical education and experience for fellows [2]; recent evolutions and challenges associated with fellows’ scholarly activities [3]; innovations in training [4]; best practices in competency assessment [5]; effective program administration [6]; and career paths for neonatologists [7].

At first blush, the most obvious readership for this series is the NPM FPDs themselves. However, the seven topics included in this collection which will be published in upcoming issues of this journal [1,2,3,4,5,6,7] have significant relevance to many other members of the NPM community and beyond. For example, academic neonatologists who supervise medical students, residents and fellows will benefit from a review of effective assessment strategies and how to approach determination of competency, as well as existing (and potential) educational innovations. Physician-investigators, quality improvement specialists, scholarly oversight committee members and other individuals who mentor fellows in their scholarly activities will gain an understanding of current options for scholarly pursuits, challenges associated with ensuring a rigorous and robust scholarly experience for all fellows irrespective of their individual area of focus (and balancing this with clinical training requirements), and building the pipeline of future investigators/ mentors. NPM section chiefs and pediatric department chairs may gain appreciation for the critical role of the FPD in their organization, and recognize the importance of providing necessary financial support and protected time for fellowship program leadership and faculty educators who enable fulfillment of this critical educational mission. All neonatologists and NPM fellows will appreciate the historical perspective on employment in this field, a summary of various career paths, and analysis of future challenges related to maintaining a diverse workforce able to meet clinical needs. Current day pediatric trainees, especially those with an interest in NPM or medical education, may gain insight on the training environment and existing ACGME requirements, potential ways to optimize clinical performance and develop their own skills as an educator, and consider various career options in NPM. Finally, FPDs and educators in specialties outside of NPM may be able to apply these lessons learned to build their own communities of practice, and leverage the strength of many like-minded individuals to enhance the training environment for all.

It is our sincere hope that this series will contextualize the present training environment, outline specific areas of challenge to our community, and identify priority areas to mitigate future risk. Investment in the future of NPM fellowship training programs, as well as support of program leaders and the trainees themselves, will surely pay vast dividends in the future care provided to the smallest and sickest patients.


  1. French HM, Leeman KT, Wambach JA, Malik SK, ONTPD Fellowship Directors Writing Group, Reber KM. Essentials of neonatal perinatal medicine fellowship: an overview. J Perinatol. 2021. Online ahead of print.

  2. Cicalese E, Wraight CL, Falck AJ, Izatt SD, Nair J, ONTPD Fellowship Directors Writing Group, et al. Essentials of neonatal-perinatal medicine fellowship: clinical education and experience. J Perinatol. 2021. Online ahead of print.

  3. Bauserman M, Vasquez M, Chess PR, Carbajal M, ONTPD Fellowship Directors Writing Group, Good M. Essentials of neonatal-perinatal medicine fellowship: scholarship perspective. J Perinatol. 2021 Online ahead of print.

  4. Schwarz B, Enciso J, Gray M, O’reilly D, Smith MC, Stanley K, et al. Essentials of neonatal-perinatal medicine fellowship: innovations in medical education. J Perinatol. 2021. Online ahead of print.

  5. Carbajal MM, Dadiz R, Sawyer T, Kane S, Frost M, ONTPD Fellowship Directors Writing Group, et al. Essentials of neonatal perinatal medicine fellowship: evaluation of competence and proficiency using milestones. J Perinatol. 2022. In press.

  6. Gillam-Krakauer M, Sharma J, Myers P, ONTPD Fellowship Directors Writing Group, Bonachea E. Essentials of neonatal-perinatal medicine fellowship: fellowship training program administration: roles and responsibilities of key leaders. J Perinatol. 2022. In press.

  7. Trzaski JM, Keifer AS, Myers P, ONTPD Fellowship Directors Writing Group, Johnston LC. Essentials of neonatal-perinatal medicine fellowship: careers in neonatal-perinatal medicine. J Perinatol. 2022. In press.

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L.J. conceptualized and drafted the initial manuscript. All authors critically reviewed and revised the manuscript for important intellectual content. All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.

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Correspondence to Lindsay C. Johnston.

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Johnston, L.C., Gray, M.M. & French, H. Optimizing neonatal patient care begins with education: strategies to build comprehensive and effective NPM fellowship programs. J Perinatol 42, 155–156 (2022).

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