John Hartline, MD, FAAP

Regardless of practice type, most neonatologists have at least some teaching responsibilities. Of the non-clinical work output, about 1/3 is allocated to teaching. Clinical teaching overlaps its time with clinical responsibility. In addition to the teaching and student evaluation required, clinical teachers often have responsibility (and bill) for patient care, requiring their personal documentation of patient assessment and participation in procedures. Teaching is work, as the popular phrase "Show me a medical student who doesn't triple my work and I'll kiss his feet" exemplifies. Educational duties also include scheduled didactic lectures, grand rounds presentations, case discussions, and outcomes analysis (mortality/morbidity review, collaborative reports, etc). Academic practices recognize an obvious commitment to teaching, but in private or hospital-based sites, commitment to teaching may vary among practice associates, especially when the educational role is as "volunteer faculty." That said, participating in education may not be optional for the practice as a whole if the hospital has a university affiliation, sponsors residency programs, or has other educational affiliations requiring students to have exposure to the NICU. Time spent fulfilling the practice's educational roles should be appropriately recognized. If teaching proficiency and interest varies among colleagues, the educational work should be distributed accordingly and balanced with other practice duties.

 

​Educational Roles

Bedside teaching or "rounding" or being "on-service." Teaching in this setting is co-mingled with clinical care, and topics discussed mostly are predicated by the clinical material. Although much of this can be done in a rounding format, teachers have responsibilities in individual student development and evaluation. Practices should have stated approaches toward these duties.

Fellows in Neonatal-Perinatal Medicine. Faculty responsibility for fellows will be overseen by the training program director, who will be coordinating the other faculty members' roles as research mentors, "on-service" teachers, conference leaders, journal club leaders, and evaluators of fellows' progress as clinicians, teachers, and investigators. Teaching time comprises a large fraction of academic neonatologists' on-duty hours and has considerable overlap with clinical duties. Fellowship programs also may have a structured set of periodic lectures, conferences, case reviews, and journal clubs requiring faculty oversight.

Pediatric residents, Family Practice residents, & medical students. There are over 200 pediatric residency programs in the US, only about one-half of which are co-located with one of the 98 (or so) active NPM fellowship programs, making neonatologists in the other half more directly involved in and responsible for pediatric resident teaching. In addition, many NICUs have commitments towards training of residents from other disciplines (Family Practice or Obstetrics & Gynecology) or medical students. Some of these nurseries are university based; others are community hospitals with local programs which may or may not have university affiliation. The expectations and responsibilities for teaching in these venues are often not explicitly defined, but definitely comprise a part of the neonatologists' workdays.

 

Lectures and Presentations

Students from various programs may cycle through the NICU on a regular basis, and the educational expectations for each new group are somewhat similar. These expectations should be presented to neonatologists serving as faculty and an educational program developed. Some topics (eg, resuscitation, newborn assessment for gestational age, jaundice, screening for common problems, etc) need to be offered to each set of trainees. Some topics are given to the residency group as a whole; others are repeatedly offered to house officers as they come on service. How are these recurrent, and to the faculty redundant, educational needs met? Some have a lecture and topic cycle presented by the faculty. Others use media presentations. Some use online resources, as found in the Resident Center on PediaLink. In any case, considerable time is committed to education by faculty and how the practice recognizes, schedules, and compensates for this commitment should be discussed.

 

Outreach Education

Regional NICUs often have programs for education of professionals practicing at referring hospitals. Time for preparation and presentation of these programs can be extensive on a yearly basis. Inquire as to the practice's involvement in NRP, STABLE, and other educational programs directed toward primary care. Other students. Many hospitals have programs for nursing continuing education, in-service training, or training of allied health professionals to which neonatologists may be asked to contribute. Teaching these individuals is another time-consuming activity important to the time analysis and workload of a neonatology practice. Clinical teaching involves the important pedagogical duties of role modeling, demonstration of procedures, oversight, delegation of responsibility, and evaluation of the student, while simultaneously assuring patients and families of competent intensive care.

 

Education as Real Work

If a practice has defined commitments to education, teaching time should factor into the analysis of the total workload and individuals' participation appropriately recognized. Those associates not as deeply involved may lack appreciation for the time and work education requires.

In academic practices, teaching is an assumed and integral part of the basis for physicians' compensation. If the practice functions as "volunteer faculty," educational activities often are functionally subsidized by the practice. If this is the situation, it is key to ascertain the degree to which the practice values and distributes the time commitment to education, especially if the educational activities are not evenly distributed among practice members, which they probably should not be!

This outline reviews areas for discussion regarding educational roles in neonatal practice.

  • Professionals being educated
    • Neonatal Fellows
    • Residents: pediatric; other
    • Medical students
    • Advance practice nurses
    • Nursing students
    • Ancillalry health personnel: PA, RT, PharmD, etc
  • Responsibility for educational duties
    • Academic: Clinical-Educator track available
    • Practice overall educational roles
    • Individual teaching responsibility
      • Time commitment
      • Educational directorships
  • Integration of teaching and practice responsibilities
    • Teaching rounds
    • Conferences
  • Regional outreach educational programs
  • Educational subsidy
    • Integral part of faculty salary
    • Assumed as part of non-reimbursed care
    • Stipend provided to practice
    • Individual reimbursement for education
  • ​Attitude: acceptance of educational responsibility within the practice.

 

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Last Updated

04/14/2022

Source

American Academy of Pediatrics