RESOURCES (B4)
1
2012
PRE-SURVEY QUESTIONNAIRE
STANDARD B4: RESOURCES
"There must be sufficient resources including teaching faculty, the number and variety of
patients, physical and technical resources, as well as the supporting facilities and services
necessary to provide the opportunity for all residents in the program to achieve the educational
objectives and receive full training as defined by the Royal College specialty training
requirements."
Program
Neonatal-Perinatal Medicine
University
Date of Review (month/year)
Sites Participating in this Program:
Where the resources to provide "full training" are not available at the sponsoring university, several
different types of interuniversity affiliations may be negotiated. It should be noted that the exchange of
residents between two fully accredited programs does not require an interuniversity affiliation.
RESOURCES (B4)
2
2012
1. Teaching Faculty
List by teaching site the members of the teaching faculty who have a major role in this program, including members from other
departments. In indicating a subspecialty, use as a criterion whether he or she is considered by colleagues as a subspecialist and
functions academically and professionally as one.
Teaching Site
Name
University Rank
Specialty
Qualifications
What percentage of faculty listed above have been practising in the subspecialty:
< 15 years
%
> 25 years
%
Subspecialty
(If any)
Nature of Interaction with Resident
(e.g. clinical, teaching, research)
RESOURCES (B4)
2.
3
Names and Special Interests of All Full-Time Neonatologists
Name
3.
2012
Special Interest
Time Spent by Residents in Integrated Obstetrical/Neonatal-Perinatal Units
Give the proportion of clinical time in the two-year program which Neonatal-Perinatal residents spend
in a fully integrated obstetrical/neonatal-perinatal unit(s) % (hospital(s) with delivery service and
neonatal intensive care unit)
4.
Time Spent by Residents in Tertiary Care Neonatal Units
Give the proportion of clinical time in the two-year program which Neonatal-Perinatal Medicine
residents spend in a tertiary care neonatal intensive care unit (with or without a tertiary care delivery
service in the same hospital) %
5.
Related Programs
Is there an accredited program in Maternal-Fetal Medicine?
i)
Name of program director:
ii) Name of Chairman, Department of Obstetrics and Gynecology:
YES
NO
RESOURCES (B4)
4
2012
NAME OF INSTITUTION:
Complete separate sheets for pages 4-11 for each hospital affiliated with the residency
program.
RESOURCES FOR CLINICAL TRAINING IN NEONATAL-PERINATAL MEDICINE
6.
General Information
Total Births
Admissions Per
Year
% High Risk *
Admissions <1500
gm Per Year
% Outborn
* Indicate system used to define "high risk"
Tertiary (Level III)
NICU Beds
No. Full-Time
Equivalent
Neonatologists
Average Occupancy
(Level III)
NICU Beds
No.
Full-Time
Equivalent
Pediatricians
or Other
Physicians**
No.
NeonatalPerinatal
Residents
Each
Weekday
Intermediate
(Level II)
NICU Beds
No. NonRCPSC
Fellows
(Weekdays)
Average Occupancy
(Level II)
NICU Beds
Avg. No.
Residents
Each
Weekday
Daily Average
Number Ventilated
Patients
Avg. No. Residents
Nights and
Weekends (if "inhouse" indicate %)
"Inhouse"
"Home
call"
No. NeonatalPerinatal Residents
Nights and
Weekends (if "inhouse" indicate %)
"In"Home
house"
call"
** Does not include all pediatricians who admit patients - only include those who have assigned NICU
coverage.
7.
Antenatal Consultations
a)
How often are neonatologists consulted in antenatal high risk situations? (Check one)
Invariably (>90%)
Frequently (50-90%
Occasionally (10-50%)
Never (<10%)
b)
Average number of formal (written) antenatal consultations/month - delivery room:
Average number of verbal antenatal consultations/month - delivery room:
RESOURCES (B4)
5
Average number of consultations/month - antenatal clinic:
c)
Are neonatal-perinatal residents involved in antenatal consultations? (Check one)
Invariably (>90%)
Frequently (50-90%)
Occasionally (10-50%)
Never (<10%)
2012
RESOURCES (B4)
6
2012
NAME OF INSTITUTION:
8.
Perinatal Rounds
a)
How often are combined high risk perinatal rounds held?:
per month
Number
b)
Average number in attendance at each round:
Neonatologists
Obstetricians
Others (Who?):
9.
Births
a)
Average number of births attended by each Neonatal-Perinatal Medicine resident on clinical service
each month:
b)
List, below, the indications for attendance of Neonatal-Perinatal Medicine residents at births:
c)
List, below, the indications for attendance of neonatologists at high-risk births:
10. Neonatal Transport
a)
Is there a Neonatal Transport Program?
YES
b)
Number of transported newborns admitted per year:
NO
Percentage admitted who are transferred via neonatal transport program:
c)
Do residents participate in neonatal transports?
YES
%
NO
(Indicate nature of participation, e.g., accompany transport, telephone supervision, etc.):
d)
Average number/month:
e)
Do the following accompany the infant during transport?:
RN
YES
NO
%
Trained RN
YES
NO
%
RT
YES
NO
%
RESOURCES (B4)
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2012
EMT or Other
YES
NO
%
Neonatal-Perinatal Resident
YES
NO
%
Other Physician (Indicate who)
YES
NO
%
YES
NO
%
Name:
Neonatologist
RESOURCES (B4)
8
2012
NAME OF INSTITUTION:
11. Neonatal Surgery
Average number of major newborn surgical procedures each month:
Average number of newborns transferred to other hospitals for major newborn surgical
procedures each month:
12. Involvement of Pediatric Surgeons and Pediatric Subspecialists with the Neonatal-Perinatal
Residency Program
Consultations: Number Per
Month
NonEmergency
Emergency
1.
Pediatric Cardiologist
2.
Pediatric Endocrinologist/Biochemist
3.
Pediatric Hematologist
4.
Pediatric Immunologist
5.
Pediatric Infectious Diseases
6.
Pediatric Nephrologist
7.
Pediatric Neurologist
8.
Pediatric Pharmacologist
9.
Pediatric General Surgeon
10. Pediatric Neurosurgeon
11. Pediatric Orthopedic Surgeon
12. Pediatric Cardiac Surgeon
13. Pediatric Respirologist
14. Pediatric Clinical Geneticist
15. Pediatric Radiologist
16. Pediatric Pathologist
17. Pediatric Ophthalmologist
18. Pediatric Gastroenterologist/Nutritionist
19. Other Physician (e.g., Dermatology)
20. Other Surgeon (e.g., Plastic)
Teaching Hours Per Month
Scheduled
NonScheduled
RESOURCES (B4)
9
2012
NAME OF INSTITUTION:
a)
It is recognized that some programs will not have pediatric subspecialists in all these areas. Where
pediatric subspecialists are not available, describe alternative sources for consultations and teaching.
In doing so, state for each area whether the alternate belongs to an accredited program.
13. Other Services
a)
Nursing
i)
Is the NICU nursing service directed by a nurse prepared at the Master's level?
YES
NO
ii) Is there a program of expanded role neonatal nurses? *
YES
NO
iii) Is this program directed by a neonatal clinical nurse specialist?
YES
NO
iv) Does the nursing service meet the educational and service needs of the educational program?
YES
NO
* Briefly describe the expanded role:
v)
Give the number of expanded role neonatal nurses (FTE) in the NICU:
vi) Give the number of other staff nurses (FTE) in the NICU:
b)
Respiratory Therapy
i)
Is there a 24-hour respiratory therapy service for the NICU?
ii) Is there a full-time instructor for the respiratory therapy service?
YES
NO
YES
NO
iii) Does the respiratory therapy service meet the education and service needs of the residency
program?
YES
NO
iv) Is there a program of expanded role respiratory therapy? *
* Briefly describe the expanded role:
v)
Give the number of expanded role RRTs (FTE) in the NICU:
vi) Give the number of other RRTs (FTE) in the NICU:
YES
NO
RESOURCES (B4)
10
2012
NAME OF INSTITUTION:
c)
Social Service
Is there an organized social service for the NICU?
YES
NO
Number of social workers (FTE):
Describe the role of social service and the relationship to the obstetrical program and community
health resources.
d)
Ethics
i)
Is there a bioethicist available for consultations in the NICU?
YES
NO
YES
NO
YES
NO
YES
NO
YES
NO
Indicate the number of consultations per month:
Describe his/her role:
ii) Does this bioethicist participate in: Teaching conferences?
Case discussions?
iii) Are there other mechanisms for bioethics in relation to patient care?
Briefly describe these mechanisms:
iv) Is there an ethics review board at the hospital?
Briefly describe this role:
RESOURCES (B4)
11
2012
NAME OF INSTITUTION:
14. Does the hospital participate in accredited residency programs in:
Pediatrics?
YES
NO
Obstetrics and Gynecology?
YES
NO
15. Are nursery design and perinatal facilities in accordance with federal government
standards for perinatal intensive care services?
YES
NO
If no, indicate deficiencies.
16. Describe the physical relationship of the NICU with obstetrical and post-partum wards and
hospital laboratory and x-ray services.
17. Regional Resources
Total number of annual deliveries in region:
Total number of hospitals in the region:
18. Perinatal Outreach
Is there a formal perinatal outreach program?
YES
NO
Provide details, including site, content, and method of education. Indicate nature of involvement of
residents in neonatal-perinatal medicine.
19. Long-term Follow-up
Include name of director, details of patient selection for program entry, personnel (e.g., psychologist,
audiologist, ophthalmologist, social worker, etc.) and facilities available.
Specify provisions for residents in this area.
20. Other Ambulatory Experience
Indicate arrangements, if any, for education of residents in other ambulatory settings.
RESOURCES (B4)
12
2012
21. Perinatal Mortality Committee
a)
Is there a hospital perinatal mortality committee?
YES
NO
b)
Do residents attend meetings?
YES
NO
c)
How often are meetings held?
d)
What is the autopsy rate for:
Liveborn infants
%
Stillborn infants:
%
22. Information Resources
a) Do residents have free 24/7 access to on-line libraries, journals and other educational resources?
YES
NO
Partially
If “No” or “Partially”, please explain.
b) Do residents have adequate space to carry out their daily work? YES
NO
c) Are technical resources required for patient care duties located in the work setting? YES
NO
d) Do facilities allow resident skills to be observed and do they allow for confidential discussions?
YES
NO
23. Summary of Adequacy of Resources
Comment on the adequacy of the resources of the overall clinical program, with particular reference
to the relationship between the number of patients available for teaching and the number of residents
dependent upon them. Indicate whether there are significant areas where the work load of teachers
(clinical care, undergraduate teaching, etc.) is such as to affect adversely the continuous supervision
and instruction of residents in Neonatal-Perinatal Medicine.
Editorial revisions - February 2012