A career in neonatology
Authors: Nicola Holme, Kathryn Williamson, Cath Harrison
Publication date: 10 May 2012
Nicola Holme and colleagues look at what is involved in a career in neonatology
A neonatologist is responsible for the care of all newborn babies who need extra support shortly after birth. Babies require admission to the neonatal unit for a variety of reasons, making the job challenging and stimulating. You never know what emergency you will be faced with next. Acute situations vary, from a baby born at full term with a complex cardiac abnormality to a baby born extremely prematurely at 24 weeks. A neonatologist is responsible for liaising with obstetricians, providing antenatal and bereavement counselling to families, caring for babies on the neonatal unit during their acute stay, and following up babies in clinic after they have been discharged from the neonatal unit. Neonatologists also do research and teaching. Simulation training is becoming an integral part of neonatal teaching programmes.
A neonatologist needs a holistic approach to caring for a baby to manage all elements of the baby’s care. However, involvement of paediatricians from other specialties may be necessary if the baby’s condition is complex. Babies are often admitted to the neonatal unit for several weeks, especially if they are extremely preterm. This enables neonatologists to build a rapport with the families of these babies and provide continuity of care.
Neonatology is an emotionally challenging specialty full of complex ethical dilemmas. It requires team work among all health professionals involved in the care of babies on the neonatal unit. Even the most senior and experienced consultants will want to and should seek advice from their colleagues. As the specialty is relatively small, great camaraderie develops among neonatologists across the United Kingdom.
Neonatology is part evidence based and part consensus, and the management of patients is always changing with new research findings. This means that you need to keep up to date. Many research opportunities exist within the specialty. Some trainees will choose to gain out of programme experience in research and obtain an MD or PhD. Trainees may choose to do out of programme experience in cardiology or other specialist areas to increase their skills (fig 1).
Steps to becoming a neonatal consultant
All paediatric trainees need to obtain key competencies in neonatology. This means that there are plenty of opportunities to gain experience within this specialty. The key is to make the most of your training and seek opportunities, such as by writing trust guidelines and doing audits with a neonatal focus. There are many stages before you can become a neonatal consultant (fig 2). Paediatric trainees must complete eight years of training regardless of the specialty chosen. The assessment process is generic and applies to all specialties within paediatrics, not just neonatology.
When you apply for specialist training in neonatology at specialty training year 4-5 (ST 4-5) you will need to demonstrate the key skills of a neonatologist:
Enthusiasm, empathy, and endurance
Ability to work effectively in a pressurised environment
Excellent communication skills
Breadth of knowledge across all specialties
Skills in research.
Neonatology is a competitive specialty. Many ST1-3 trainees dislike neonatology because of all the baby checks and blood gases. However, once you get to the stage where you are more involved in patient care and making decisions, neonatology becomes more attractive. This means that you need to think about your application in advance to give yourself the best chance (see box).
Tips on getting ahead in neonatology
Student selected component projects
Liaise with neonatal consultants and trainees
Elective—paediatric and neonatal projects
Foundation years 1-2
Academic foundation year 1-2 jobs
Paediatric and neonatal rotations
Out of programme experience at any level
Specialty training years 1-5
Academic paediatric posts
Case reports, audits, teaching, posters
Bereavement and antenatal counselling
Gain management or governance experience—rota coordination, writing guidelines, and so on
British Association of Perinatal Medicine member and trainee meetings
Neonatal life support course
At every stage of your training there will be many opportunities to get more neonatal experience to help you stand out from your colleagues. Most trainees do not consider neonatology as a career until they are at ST2-3; however, if you are in the earlier stages of your training there is no harm in optimising your experiences now.
Step 1—undergraduate/foundation years
If you are an undergraduate student and are considering a career in neonatology or paediatrics then it is worth making the most of your fourth year paediatric placement. Try to attend neonatal ward rounds, clinics, and deliveries (with permission). Also ask trainees to teach you on the unit, as there are plenty of generic learning opportunities, such as blood gas and chest radiograph interpretation. Most medical students undertake student selected component projects, which are an ideal opportunity to do a project or audit in neonatology. Many universities offer essay prizes in paediatrics, and the spring meeting of the Royal College of Paediatrics and Child Health (RCPCH) offers a prize to undergraduates. It is worth doing an intercalated degree as this is a great opportunity to develop some generic skills in research. If possible, make your degree paediatric or neonatal based. Your medical elective is also an opportunity to do something unique, and many placements offer small projects that can have a neonatal or paediatric theme.
If you wish to pursue a career in neonatology or paediatrics you should try to work within the specialty for one of your rotations as a foundation year 1 or year 2 doctor. However, this is not essential, and many deaneries offer taster days or weeks within specialties, which provide some useful experience.
During your foundation training most deaneries offer academic jobs. These provide further opportunities to do research and teach. Some posts fund further degrees such as postgraduate certificates in medical research. It may not be possible to get an academic post in paediatrics, but the skills and experience will be generic and still applicable. If you are unable to do an academic job it is worth considering a postgraduate certificate in medical research or medical education.
Step 2—level 1 training (ST1-3)
After you have entered a paediatric training programme you will have the opportunity during your ST1-3 years to do up to 12 months of neonatology training.
These attachments give you a clear perspective on the variety of work and many challenges you will face within the specialty. During this time trainees aim to build up a portfolio showing an interest in neonatology, making use of many opportunities to undertake audit, attend and present at scientific meetings, participate in small research projects, and develop a competencies based skills log in the many technical skills required to deliver intensive care support.
Many deaneries offer academic paediatric posts. These may be academic clinical fellow or more informal positions and may be laboratory based or medical education oriented. Academic posts will open up an array of opportunities in research, management, and teaching. Funding is normally available for relevant courses and scientific meetings.
It is worth while sitting in on bereavement and antenatal counselling sessions and shadowing outreach nurses. This will provide a more holistic approach to the care of the newborn and enhance your communication skills. It is important to gain experience in management and clinical governance. Trainees tend to find this aspect the hardest to develop—becoming involved with rota coordination and writing guidelines is a great start. Several opportunities exist within the RCPCH, such as writing exam questions.
Step 3—level 2 training (ST4-5)
During your level 2 paediatric training you will spend a further six months working on a tertiary neonatal unit at a middle grade level. This provides more time to gain experience and competencies highlighted in step 2. At ST5 you can apply to the national subspecialty training (NTN Grid) scheme. Most specialties within paediatrics offer these schemes, including neonatology.
What is the grid scheme?
The RCPCH runs yearly schemes in paediatric subspecialties enabling paediatric trainees to apply for approved training programmes. Deaneries supply the scheme with local training programmes that reflect the specialist training available within their tertiary neonatal units. As a result the training programmes offer a variety of opportunities, depending on allied services linked with these units. The number of places offered each year varies—in 2012 it was 33.5.
How do I apply?
Neonatology is recognised as a two to three year grid training scheme. Providing you fulfil the eligibility criteria set out by the RCPCH you can apply during your ST5 or ST6 year. The grid scheme opens in September, and after an online application process successful candidates are shortlisted for interview in November. Full details are at www.rcpch.ac.uk/NTNgrid.
Candidates rank programmes according to preference, and depending on interview performance successful candidates are offered programmes accordingly.
Step 4—Neonatal grid trainee: what next?
You have a place on the programme . . . so now what?
This is where you can explore the specialty and build on the foundation stones laid down in the previous years, developing important training opportunities. Think about what you would like to achieve.
Developing a personal development plan within the training scheme allows you to focus on particular areas of interest.
Each training scheme provides a unique experience with opportunities such as managing complex cardiac cases and antenatally detected surgical cases, transport of the sick neonate, along with the challenges of caring for vulnerable preterm infants. Opportunities to do a six month attachment to allied recognised specialties such as transport or neurodisability are offered.
Access to fetal medicine clinics and developing counselling skills are encouraged. Some programmes offer training in skills such as echocardiography.
Teaching and supervision
Training juniors and teaching with resources such as simulation packages help to develop advanced teaching skills.
Supervision of skills development and encouraging juniors in their own development and achievement of competencies are expected and enable you to acquire a number of different teaching skills.
Participate in research and clinical governance
Within the neonatal specialty many clinical questions remain unanswered. Opportunities to use and develop research skills are abundant, linking with national studies. These skills can be used locally, such as in reviewing management strategies or new treatments and technologies, or can lead to higher degrees.
Active participation in clinical governance includes involvement with guideline development and implementation, along with risk management and audit.
Develop consultant skills
As you progress through the training schemes in your final year you are encouraged to act up as a consultant with the support of your seniors.
This helps you learn and develop vital skills related to managing a neonatal service: delivering intensive care and working within wider neonatal networks.
Opportunities to develop leadership skills are everywhere. Working within a unique team of experienced neonatal nurses, advanced neonatal nurse practitioners, neonatal pharmacists, dietitians, physiotherapists, and occupational therapists encourage these skills to develop.
Neonatology is an exciting and satisfying specialty offering many different challenges and interests. The mix of intensive care medicine, technical skills, advanced counselling skills, along with managing long term chronic conditions presents a varied and challenging working life. Perhaps the most rewarding aspect is building relationships with families who are under tremendous pressure. Working within a unique team environment that focuses on delivering a family centred approach to care can be extremely satisfying.
Competing interests. None declared.
Article written on behalf of the BAPM trainees group.
Nicola Holme ST5, neonatal grid trainee
Kathryn Williamson ST8, neonatal grid trainee Leeds, UK
Cath Harrison consultant neonatologist and lead neonatologist for Embrace, Yorkshire and Humber Infants and Children’s Transport Service Leeds Teaching Hospitals Trust, Leeds