neonatology elective

[m1234d]

hi,

i will be beginning a 4 wk NICU elective (as an M3 missing the IM core - blech) and i had a few questions for monday...

1. what book would you recommend for my level? (i am willing to invest)

2. besides the common path (rds, bpd, ivh, pvl, rop, nec) what is h-y for review/learning? i am guessing vents and resuscitation? fluids?

3. any common pitfalls to avoid? (like on peds when someone said "we'll put her to sleep for the procedure" to which the kid balled "like we put yappers to sleep?" - i saw this)

4. is it true (like my residents claim) that it is a good thing if you are interested in a NICU fellowship to go to a school w/o fellows b/c then as a resident you get more exposure? i'm not so convinced, and would appreciate input.

thank you~

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[oldbearprofessor]

hi,

i will be beginning a 4 wk NICU elective (as an M3 missing the IM core - blech) and i had a few questions for monday...

1. what book would you recommend for my level? (i am willing to invest)

2. besides the common path (rds, bpd, ivh, pvl, rop, nec) what is h-y for review/learning? i am guessing vents and resuscitation? fluids?

3. any common pitfalls to avoid? (like on peds when someone said "we'll put her to sleep for the procedure" to which the kid balled "like we put yappers to sleep?" - i saw this)

4. is it true (like my residents claim) that it is a good thing if you are interested in a NICU fellowship to go to a school w/o fellows b/c then as a resident you get more exposure? i'm not so convinced, and would appreciate input.

thank you~

Welcome to neonatology.

The book by "Gomella" (Seach it out on SDN or Amazon) is traditionally the best for med students and interns although, in an era of Up-to-Date, I'm unconvinced that any text is needed if you have good on-line access to UTD. There are some newer ones too. I'd wait and see what's used where you are by the interns and buy that if you must.

There have been lots of threads you can search on SDN over the years about what you need to know. The main thing is to remember that a huge amount of your teaching can come from the non-physicians in the NICU - NNP, RT, Dietitians. Respect them and they'll help you a lot. Disrespect them (or appear to) and it'll be a very long 4 weeks. You don't need to go into the rotation knowing anything about vent management - they'll teach it to you if you are in a Level 3 setting and need to know it and no one will allow you to make vent changes without guidance.

As far as doing residency where there are fellows, I don't think it makes a whole lot of difference. Do the residency where you are happiest and feel the most comfortable. I've seen it both ways many times and you can get good training and lousy training in either setting. Pay more attention to what opportunities the residents have to attend high risk deliveries and spend time in the NICU with sick babies than whether there are fellows around.

Good luck and as I've noted before, 100% of students who do a sub-I or elective in neo end up as neonatologists (n=1, me).

OBP

 

[emeddo]

Are there any specific residencies or things to look for in a residency that you would recommend to someone interested in neonatology or is the playing field pretty level?

 

[siempre595]

I'd argue against the comment about a fellow-run program. I did the NICU rotation at my school where fellows more or less run the NICU,especially at night, and I found it to be a really good learning experience for the residents and students. Not to mention that the interns were totally just not qualified to be left in there without a fellow (no offense, it's not like I had a clue what was going on either).

 

[m1234d]

Are there any specific residencies or things to look for in a residency that you would recommend to someone interested in neonatology or is the playing field pretty level?

i was told by my dean that one big thing to ask is how many people they have go to a fellowships each year. he also mentioned that its more important to be really good where you are than average at a "top" program. so, its a bit of a balancing act.

the two hospitals i have been at for peds, it seems only a couple of the 40 residents actually liked the NICU, and my understanding is that it is not the most competitive. but it's still scary to enter a residency for which i need a fellowship to be happy (PICU or NICU). of course, since i truly enjoy kids and cc and would be miserable in just about anything else, i don't really have much of a choice, now do i?

 

[oldbearprofessor]

i was told by my dean that one big thing to ask is how many people they have go to a fellowships each year. he also mentioned that its more important to be really good where you are than average at a "top" program. so, its a bit of a balancing act.

the two hospitals i have been at for peds, it seems only a couple of the 40 residents actually liked the NICU, and my understanding is that it is not the most competitive. but it's still scary to enter a residency for which i need a fellowship to be happy (PICU or NICU). of course, since i truly enjoy kids and cc and would be miserable in just about anything else, i don't really have much of a choice, now do i?

It's fine to ask about things like that, but truthfully it doesn't make much difference whether a program sends 10% or 50% of its grads to a fellowship. What really matters is that you can get to know a neonatologist well enough during residency to get a good letter or rec. What matters even more is that you are happy in your residency with the city and program. The rest will work itself out.

In any case, welcome to neonatology. Nope, you don't have any choice. Ask TexasRose.

Feel free to PM me if you have Q about specific residency programs.

Regards

OBP

 

[TexasRose]

he also mentioned that its more important to be really good where you are than average at a "top" program. so, its a bit of a balancing act.

Now this is advice that worries me. The program I would like to go to is top notch, but with so many residents, I fear I'll be a smaller fish in a big pond. Thoughts, anyone?

What really matters is that you can get to know a neonatologist well enough during residency to get a good letter or rec. What matters even more is that you are happy in your residency with the city and program. The rest will work itself out.

In any case, welcome to neonatology. Nope, you don't have any choice. Ask TexasRose.

OBP

The decision is made then?

So, does the good letter or rec sort of cancel out being in the middle of the pack in terms of your peers at a big program?

 

[oldbearprofessor]

Now this is advice that worries me. The program I would like to go to is top notch, but with so many residents, I fear I'll be a smaller fish in a big pond. Thoughts, anyone?



The decision is made then?

So, does the good letter or rec sort of cancel out being in the middle of the pack in terms of your peers at a big program?

Residency to fellowship is not like earlier transitions. You won't be evaluated relative to your peers very much if at all. All that matters is that you do reasonably well on your in-service exams, are liked by your program in general, and that you find a good mentor in your chosen field who will support your application. So, pick the program you like and don't worry about the other residents and how you would rank amongst them. A program that is too small so that you don't have enough neo experience might be a problem, but that wouldn't describe most programs these days.

I find that chocolates are an excellent way to encourage mentors.

 

[emeddo]

Residency to fellowship is not like earlier transitions. You won't be evaluated relative to your peers very much if at all. All that matters is that you do reasonably well on your in-service exams, are liked by your program in general, and that you find a good mentor in your chosen field who will support your application. So, pick the program you like and don't worry about the other residents and how you would rank amongst them. A program that is too small so that you don't have enough neo experience might be a problem, but that wouldn't describe most programs these days.

I find that chocolates are an excellent way to encourage mentors.

You don't know how much more the non competitiveness among my peers makes neonatology look really really tempting to me.