Aligned Neonatal Framework for Level 3 GRID Training in Neonatology
This document is based on an amalgamation of components of the syllabus of the European Society for Neonatology, the curriculum of the Royal College of
Paediatrics and Child Health and a variety of assessment documents from the Organisation for Neonatal Training Program Directors in the United States and
other perinatal-neonatal training programs in Canada. It draws together training goals and objectives into an assessment framework for trainees and
supervisors.
Key objective
After completion of higher specialist training in neonatology, trainees should have the necessary knowledge skills and attitudes to practise high quality
neonatal medicine in a neonatal intensive care unit in the United Kingdom.
User guide
This framework should be used to help identify areas of practice which need to be developed through higher specialist training. It would also be appropriate
to apply the framework in personal development planning and educational supervision meetings. This document should be maintained by the trainee and
reviewed by the trainee and his/her educational supervisor throughout higher specialist training. It should be presented to the speciality training adviser
during application for a CCT in neonatal medicine. The relevant assessments or evidence supporting each competency should be maintained on the eportfolio. There are a number of level 1 and 2 neonatal competencies that should have been obtained before commencing higher specialist training – these
are not duplicated within this framework document.
Learning approach
This relates to how the trainee will learn and develop each competence and be assessed. Examples include work based assessments (DOPS, mini-CEX or
CBD), involvement with specific clinical cases, teaching delivered to others and attendance on certified courses. Depending on local services, occasionally,
attendance at other departments might be appropriate (suggestions when this might be appropriate are in light font). As part of the learning approach,
developing the ability to teach many of these competences is also expected.
Assessment/Evidence provided
This section should refer to the relevant evidence for learning that the trainee has documented in the e-portfolio. Examples include outcomes of work
based assessments (DOPS, mini-CEX or CBD), feedback from teaching delivered to others if possible, reflective notes from clinical cases, skills logs, multisource feedback and results of assessments from certified courses.
For some competences there may be overlap – it would be appropriate either to repeat an entry or to refer to where the original evidence has been
reviewed. For other competences it may be appropriate to include several types of evidence (for example results of CBD and reflective notes of a difficult
resuscitation). For some competences, the learning approach has been specifically identified in bold. This, together with the associated assessment and
evidence should be regarded as a MINIMUM that the trainee should perform and obtain in these areas.
Trainer’s signature and date
The relevant higher specialist neonatal trainer in the Deanery should sign in these spaces to indicate that he/she feels that learning in each competence has
occurred and that the evidence presented is of an appropriate standard
Section 1 Resuscitation and stabilisation of the newborn
General competence
It is important to demonstrate understanding and competence in resuscitating neonates with a variety of problems. . In addition to being able to teach and
assess these skills in the workplace, it would also be helpful (but not mandatory) to teach core skills on resuscitation courses both for neonates and
children.
Specific competence
Know and understand the important physiological
changes and adaptations after birth
Understand the physiology of advanced resuscitation
and the response to it
Be able to lead a resuscitation team in difficult
resuscitation situations (Including extreme
prematurity, severe congenital abnormality, severe
fetal depression and failed resuscitation)
Be able to teach resuscitation skills
Be familiar with basic and advanced simulation
training
Demonstrate competence of resuscitating the
neonate with a difficult airway (using appropriate
adjuncts including LMA where available)
Learning
Approach
Assessment/Evidence provided
Trainers
signature and
date
Section 2 Procedures and technical skills
General competence
Trainees should be able to provide evidence that the following advanced procedures can be performed independently and that they can safely teach and
supervise others in these. For all techniques, demonstrating understanding of the appropriate aseptic precautions is mandatory.
Specific competence
Learning
approach
Lumbar puncture of neonate (although a core skill
evidence of competence with this procedure should
be maintained)
DOP
Ventricular tap (or observe if performed by
neurosurgeons in some centres) and/or access from a
ventricular reservoir
DOP
Tracheal intubation and airway management
techniques for neonates with anticipated difficult
airways (for example congenital airway abnormality
or acquired airway obstruction)
DOP
Intubation of extremely small and preterm infants
DOP
Be able to diagnose and manage a pneumothorax
Be able to perform a partial volume exchange
transfusion
Be competent in the use of cranial ultrasound in the
new born
Peripherally inserted central catheter (longline)
DOP
Assessment/Evidence provided
Trainers
signature and
date
Section 3 Epidemiology and Outcome statistics
General competence
A good understanding of the incidence and prevalence of conditions affecting the neonate is important to be able to provide effective counselling. National
initiatives in information governance and benchmarking also mean that it is important to understand and contribute to data collection programs and the
development of local and regional service developments (such as service commissioning).
Specific competence
Learning
approach
Understand process on local and national neonatal
data collection
Be involved in
local regional
and national
neonatal data
collection
projects
Be familiar with local and regional outcome statistics
and reasons for variation ( and understand local and
regional data in the context of counselling parents)
Understand major factors influencing perinatal
mortality and morbidity
Understand local and national death notification and
congenital anomaly monitoring
Understand local, regional and national quality
assurance projects (including neonatal care quality
indicators)
Assessment/Evidence provided
Trainers
signature and
date
Section 4 Fetal and Maternal medicine
General competence
It is important to have a good understanding of maternal and fetal pathophysiology to appreciate the significance of specific conditions but also to be able
to provide appropriate counselling for high risk pregnancies.
Specific competence
Learning approach
Know and understand how fetal growth and
development are assessed
Attend at least four
fetal centre sessions
Know and understand the impact of major
complications, including prescribed and illegal
drug use in pregnancy on the fetus
Attend at least four
fetal centre sessions
Know and understand how fetal anomaly is
detected
Attend at least four
fetal centre sessions
Counselling congenital anomalies
Attend at least two
antenatal counselling
sessions
Counselling high risk pregnancies
Accompany senior
ante-natally at least
once and carry out
own counselling
Counselling for extremely preterm birth
Accompany senior
ante-natally at least
once and carry out
own counselling
Know and understand the impact of organ
system development and on fetal abnormality
Assessment/Evidence provided
Trainers
signature and
date
Section 5 Diagnostic skills
Specific competence
Learning approach
Be able to identify and manage the correct
location for invasive catheters and devices using
appropriate radiological investigations
Might include
radiology reporting
sessions
Understand the place of MRI and CT investigation
in neonatal care
Be able to identify the correct use and
interpretation of cerebral function monitoring
(including management of HIE and other seizure
disorders)
Be able to diagnose and interpret common
neonatal arrhythmias on ECG
Understand the process of investigation of inborn
errors of metabolism
Understand how to investigate infants with
significant gastrointestinal pathology (such as
reflux and bowel obstruction)
Understand how to investigate and when to refer
infants with hepatobiliary disease
Assessment/Evidence provided
Trainers
signature and
date
Section 6 Neonatal Follow-up
Specific competence
Learning approach
Be able to perform a structured neurological
assessment at term
Be able to perform a developmental assessment
aged 2 years
Be able to diagnose and make appropriate
referrals for infants with neurodevelopmental
problems detected during follow up (including
cerebral palsy or sensory impairment)
Attachment to
child development
centre may be
appropriate
Support and manage families and infants with
feeding difficulties
Understand the long term follow up and
management of infants with significant chronic
lung disease, including those discharged with
home oxygen
Attend at least one
discharge planning
meeting and attend
‘BPD’ clinic if
available
Assessment/Evidence provided
Trainers
signature and
date
Section 7 Transport
Specific competence
Learning approach
Be able to transfer a sick neonate including
awareness of potential emergencies during
transport
Be trained in
neonatal transport
– either at
induction or on
separate course.
Might also involve
attachment to
neonatal transport
service
Be able to liaise by telephone with referral
hospitals regarding the transfer of sick babies
Be involved in decision making for neonate with
complex and severe problems
Assessment/Evidence provided
Trainers
signature and
date
Section 8 Safeguarding and Family Care
Specific competence
Learning approach
Assessment/Evidence provided
Be familiar with local and national safeguarding
priorities including legal procedures
Understand the place of a pre-birth conference for
at risk families
Contribute to a
pre-birth
conference for at
risk families
Understand the role of a case conference for at
risk neonates
Contribute to a
case conference for
at risk neonates
Understand the diagnosis and post natal
management of neonates affected by maternal
substance misuse(remove included in above)
Be familiar with local procedures for looked after
children
A number of competences under standard 13
Understand and be able to counsel parents in the
benefits of breast milk for babies and support
them in their choice of feeding
Shadow breast
feeding team at
least once
Understand multidisciplinary discharge planning
for neonates with complex needs
Be involved in a
multidisciplinary
discharge planning
for neonates with
complex needs
Understand the benefits of developmental care
Trainers
signature and
date
Section 9 End of Life Care
General competence
The management of families and other team members at the end of life is particularly challenging. Empathy and good communication are very important
and you should assess and develop these skills in appropriate situations.
Specific competence
Learning approach
Be able to manage and support families with a
dying infant
To understand the principles of palliative care
including the appropriate use of pharmacologic
agents within end of life care
Understand the role of bereavement follow up and
support of families who have lost a child
Be involved in
bereavement
follow up and
support of a family
who have lost a
child
Be able to counsel and obtain consent for neonatal
post mortem examination
Be familiar with major ethical issues having an
ethical framework for complex cases
Be familiar with referrals to the
coroner/procurator fiscal
Understand the importance of appropriate records
following neonatal death and be familiar with the
child death review process locally and confidential
enquiry reports
If possible, attend
coroner’s inquest
and /or coroners
post-mortem
Assessment/Evidence provided
Trainers
signature and
date
Section 10 Neonatal surgery
General competence
Good communication and team working with other professionals involved in the care of neonates with surgical conditions is particularly important,
especially when care is shared between teams.
Specific competence
Learning approach
Be familiar with common neonatal surgical
conditions and their management
Attachment to
neonatal surgical
unit or attending
surgical ward
rounds might be
appropriate
Be able to counsel parents with antenatally
diagnosed congenital conditions
Be able to resuscitate and manage a neonate with
lung hypoplasia including congenital
diaphragmatic hernia
Be familiar with the management and referral of
neonates for vascular access surgery
Be familiar with pain assessment tools and be able
to manage pain adequately
Assessment/Evidence provided
Trainers
signature and
date
Section 11 Respiratory Disorders
Specific competence
Learning approach
Understand the use and complications of
surfactant
Be able to use appropriate modes of ventilation
Understand the place of sedation and muscle
relaxants in infants with severe lung disease
Understand the pathophysiology and management
of pulmonary haemorrhage
Understand and initiate the appropriate use of
pulmonary vasodilators
Understand the classification and pathophysiology
of CLD
Understand indications and adverse effects of
postnatal steroids
Understand the long term respiratory prognosis of
CLD
Understand the planning and post discharge
management of home oxygen
Understand the indications for RSV prophylaxis
Understand the indications for ECMO therapy and
referral
Communicate this
to parents (or
observe)
Assessment/Evidence provided
Trainers
signature and
date
Section 12 Cardiac Disorders
Specific competence
Learning approach
Be able to recognise the symptoms and signs of
PDA
Understand the role of echocardiography in PDA
Understand the treatment options and
complications of PDA including prophylaxis
Understand the diagnosis and management of
hypotension in different gestational ages
Be able to diagnose and manage heart failure
Be able to investigate and manage neonatal
hypertension
Be able to diagnose and manage fetal and
neonatal cardiac rhythm disorders
Be able to distinguish between cyanotic heart
disease and primary pulmonary hypertension
Have an awareness of the echocardiographic
assessment of congenital heart disease
Be able to diagnose and manage critical duct
dependent cardiac conditions
Consider cardiac
catheter and
imaging meetings,
follow up clinics
and post operative
cardiac follow-up
experience
Assessment/Evidence provided
Trainers
signature and
date
Section 13 Gastrointestinal disorders
Specific competence
Learning approach
Be familiar with the indications and complications
of long term parentereral nutrition
Be able to diagnose and manage neonates with
necrotising enterocolitis
Be able to manage pre and post operative care for
infants with gastrointestinal and hepatobiliary
disease
Be familiar with benefits of breast milk, the
indications for donor EBM when maternal EBM not
available, and the composition and indications of
specialist milk formulae
Understand the importance of surveillance and
interventions for post natal growth failure for the
high risk infant in the outpatient setting
Be able to distinguish between non-significant and
significant gastro-oesophageal reflux and initiate
appropriate investigations and treatments
Attend 12 neonatal
out-patient clinics
a year when
attached to NICU
Assessment/Evidence provided
Trainers
signature and
date
Section 14 Neurological disorders
Specific competence
Know and understand the aetiology of periventricular
haemorrhage
Understand the severity scoring system and the short
and long term implications of periventricular
haemorrhage
Understand implications and management of post
haemorrhagic ventricular dilatation
Understand the long term outcomes and morbidity for
high risk neonates and be able to effectively
communicate with parents
Understand the pathophysiology of PVL
Understand the long term implications of PVL and be
able to explain the implications to parents
Know the possible causes and effects of neonatal
neuromuscular conditions
Be able to initiate management and investigations of
neuromuscular conditions
Be able to investigate and manage neonatal seizures
Understand the long term implications of hypoxicischaemic damage
Be able to initiate management to minimise and prevent
secondary brain injury
Understand referral for screening tests for infants at risk
of hearing loss
Learning
approach
Assessment/Evidence provided
Trainers
signature and
date
Be able to refer and counsel parents infants with
significant retinopathy of prematurity
Section 15 Fluid balance and renal disorders
Specific competence
Be able to manage severe hyponatraemia
Be able to manage severe hypernatraemia
Be able to manage hyperkalaemia
Be able to anticipate and manage acute renal failure in
the neonate (including considering and referring for
dialysis)
Know how to counsel and manage antenatally diagnosed
renal tract disorders
Understand indications for appropriate nephro-urology
referrals for complicated or urgent renal tract disorders
Learning
approach
Assessment/Evidence provided
Trainers
signature and
date
Section 16 Genetic Disorders
Specific competence
Be able to diagnose and manage common chromosomal
disorders
Be able to counsel parents when a genetic disorder is
suspected and obtain consent for genetic testing
Be able to diagnose and manage an infant with multiple
congenital abnormalities making appropriate multidisciplinary referrals
Learning
approach
Assessment/Evidence provided
Trainers
signature and
date
Section 17 Haematological Disorders
Specific competence
Be familiar with screening for congenital haematological
disorders (eg haemophilia) and their perinatal
management
Be able to identify and manage polycythaemia and
hyperviscosity disorders
Be able to counsel and manage severe haemolytic
disease of the newborn (Including Rhesus and other
major blood group incompatibility disorders)
Be able to arrange and supervise an exchange
transfusion for haemolytic disease
Be able to manage and investigate severe and persisting
neonatal thrombocytopenia
Be able to diagnose and manage major coagulation
disorders (Including the appropriate use of blood
products and coagulation factors)
Learning
approach
Assessment/Evidence provided
Trainers
signature and
date
Section 18 Metabolic and Endocrine Disorders
Specific competence
Learning
approach
Assessment/Evidence provided
Trainers
signature & date
Learning
approach
Assessment/Evidence provided
Trainers
signature & date
Understand the diagnosis and management of inborn
errors of metabolism
Be able to investigate and treat disorders of
carbohydrate metabolism (including transient and
refractory hypoglycaemia and hyperinsulinism and
hyperglycaemia)
Be able to identify, counsel and make appropriate
referrals for infants with disorders of sexual
differentiation (ambiguous genitalia)
Section 19 Infection and Immunity
Specific competence
Be able to diagnose and manage the neonate with
congenital viral infection
Be able to diagnose and manage the neonate with
fulminant early onset infection
Be able to manage and counsel neonates at risk of
perinatal HIV infection
Have a sound knowledge of infection control measures
Be able to manage the neonate with multi-resistant
infection (incluing MRSA infection)
Be able to diagnose and manage infants with hospital
acquired and catheter related infection (including central
lines)
Sudden
Section 20 Musculoskeletal disorders
Specific competence
Be familiar with the screening and follow up of infants
with congenital hip dislocation
Be able to counsel and manage infants with suspected
severe skeletal dysplasia
Be able to prescribe treatment to prevent metabolic
bone disease and manage and diagnose infants with
metabolic bone disease
Learning
approach
Assessment/Evidence provided
Trainers
signature & date
Section 21 Management and Leadership skills
General competence
Throughout higher specialist training it is important to develop leadership and general management skills by working with teams in acute care and other
centres including primary care providers. You should be confident in making appropriate decisions within a team and be aware of the impact on other team
members.
Specific competence
Learning approach
Understand the role of mortality meetings
Review and present relevant
cases at local or regional
mortality meetings
Understand risk management processes
Regularly attend local or
regional risk management
meetings
Understand the local and national
mechanisms behind patient complaints
and the legal process behind clinical
negligence claims
Write a draft response to each
of at least one complaint and
one medico-legal case and
discuss with supervisor
Understand root cause analysis and
processes for dealing with adverse
incidents
Be involved in the process for
dealing with a significant
clinical governance issue
(including root cause analysis)
Understand guideline development
Lead a local or regional
guideline development
Understand the process of producing an
annual report
Prepare a report (such as an
annual report) or sub section
of a report
Understand how formal meetings take
place
Attend, for example medical
staff committee meeting, and
chair at least two local
meetings
Assessment/Evidence provided
Trainers signature
& date
Understand the processes for supporting a
poorly performing doctor
Be involved with the
supporting of a trainee in
difficulty
Be aware of the business planning process
Attend business planning
meetings
Be aware of the need to manage resources
Attend at least one
directorate/business meeting
with senior management
Standards 23/24
Be aware of the job planning process
Be aware of the logistics of organising
meetings
Organise at least one meeting
Be aware of transition to consultant role in
the clinical area
Lead a series of ward rounds
(with supervisor present and
then absent but contactable)
and run intensive care for
several days (with supervisor
available close by)
Possibly overnight cover with
supervisor back-up
*new or modified competence
Be able to recognise the need for referral for neonatal skin conditions
Have a basic understanding of mechanical and electrical function of radiant heaters. Incubators, ventilators and monitoring equipment