Roehr CC, Breindahl M, van den Hoogen A, Johnston L
Click on the image to read the standard in brief.
Target group
All doctors working in neonatal care
User group
Parents, healthcare professionals, professional societies, education providers, health services, and regulators of the profession
Statement of standard
All doctors providing care to infants and their families receive training using a competency based curriculum and assessment framework.
Rationale
Neonatal outcomes have been shown to be associated with the level of training of medical and nursing staff, as well as adequate staffing levels. It has clearly been shown that healthcare professionals´ education and consistent evidence-based practice shorten the duration of hospitalisation. (1,2)
In 1988, the European Society of Paediatric Research (ESPR) Working Group on Neonatology recognised the immediate need to specify minimum training requirements for the accreditation of neonatologists throughout Europe. (3) To ensure that infants and families receive standardised, and evidence-based quality of care, the European Database of 30 member countries from the Union of European Medical Specialties (UEMS) has shown a very high degree of consensus on key skills and competencies necessary to practice neonatology. (3) Consequently, the European Board of Neonatology (EBN), developed a Curriculum and Assessment Framework (3), which was endorsed by the European Board of Paediatrics (EBP) in 2020. The curriculum supports the harmonisation of national programmes for subspecialist training in neonatology throughout Europe, aiming to establish unified training in neonatology by clearly defined standards. (4)
Benefits
Reduced mortality and morbidity (2)
Decreased rates of cerebral palsy and retinopathy of prematurity (5)
Consistency in quality of care delivery in neonatology (consensus)
Improved communication skills between medical teams and families and other members of the multi-disciplinary NICU teams (6–8)
Harmonised standards of education and training for doctors practising neonatal intensive care through a common European curriculum (consensus)
Components of the standard
Component
Grading of evidence
Indicator of meeting the standard
For parents and family
Parents contribute to the delivery of medical education programmes.
B (Low quality)
Training documentation
For healthcare professionals
Neonatologists are qualified in the sub-specialty as evidenced by the following criteria:
Registered trainees have completed a period of at least three years with a formal mentor, responsible for assessing and recording the competence level of the trainee within the sub-specialty. Completion of education links the following theory and practice elements:
Theory modules relating to the neonate and their family within neonatology at all levels of care (Level 1-3).
Management of resuscitation, cardiorespiratory intensive care, thermoregulation, neurology, haematology and blood product transfusion, genetics, metabolism and endocrine disorders, pharmacology, nutrition, feeding, gastro-intestinal and hepatic disease, immunity and infection, transport of the infant (NB: List is not exclusive and may be extended to suit national standards).
Clinical decision-making skills, ward organisation, advanced parent counselling and communication skills on congenital anomalies and genetic disorders, family-centred developmental care and care of the well newborn infant, as well as end-of-life care.
A record of tuition and teaching in form of portfolio allows provision of evidence of attended educational activities.
B (Moderate quality)
Certificates of award, professional portfolio
For neonatal unit
Infrastructure for educational programmes is provided. (see NICU design)
B (Moderate quality)
Audit report1
Leadership in every neonatal unit should strive to ensure that there is a culture of teaching and learning in the unit.
B (Low quality)
Healthcare professional feedback
For hospital
Appropriate policies and standards for the human resources departments are in place to ensure staff recruitment focusses only on appropriately educated and trained physicians.
B (Low quality)
Healthcare professional feedback
For professional societies
Standards of care, including competencies at the local level are developed and regularly updated, disseminated and promoted. (3)
B (Moderate quality)
Guideline
For education providers
A (post) graduate programme focused on neonatal medicine, including the following domains is provided: neonatal physiology and pathophysiology, family-centred care, clinical practice, leadership and teamwork, professional development and research. (3)
B (Moderate quality)
Training documentation
Core elements of training in neonatal medicine are included in educational curriculum of physicians taking care of infants. (3)
B (Moderate quality)
Training documentation
For health service and regulators of the profession
Common national training frameworks aligned with the relevant European Qualification Framework are available and regularly updated.
B (High quality)
Training documentation
1The indicator “audit report” can also be defined as a benchmarking report.
Where to go
Further development
Grading of evidence
For parents and family
Parents are given the opportunity to review and revise neonatal medical curricula.
B (Very low quality)
For healthcare professionals
Undertake continuous professional development (CPD) to remain up-to-date and sustain expertise (maintenance of competence) (see Education & training). (9)
B (High quality)
Acquire new or expanded skills and abilities so that practice can evolve over time in response to practice needs and interests (advanced expertise). (9)
B (High quality)
Provide opportunities to maintain competence in procedural, communication, and other professional skills. (9)
B (High quality)
Provide a train-the-trainer framework for team members to act as supervisors and mentors.
B (High quality)
For neonatal unit
Help build a culture of regular teaching and training throughout all professions.
B (Moderate quality)
Nurture a collaborative approach for teamwork.
B (Moderate quality)
For hospital
Support healthcare professionals to undertake continuous professional development (CPD).
B (High quality)
For professional societies
Develop, disseminate and promote care competencies at regional, national, and international level. (9)
B (High quality)
For education providers
Provide specialty national training programmes in line with agreed subspecialist neonatal training in Europe, as outlined by the ESPR/EBN assessment framework. (10)
B (High quality)
Offer access to professional development programmes which foster the development of personal skills and competencies in leadership, such as counselling and managerial, leadership, and teaching roles. (9)
B (High quality)
For health service and regulators of the profession
International mutual recognition of specialty qualifications in neonatal medicine is facilitated.
B (Moderate quality)
Getting started
Initial steps
For parents and family
Parents are involved in the delivery of medical education programmes.
For healthcare professionals
Attend broader specialty training through a university administered neonatal online training and education programme. (11)
For neonatal unit
N/A
For hospital
Support healthcare professionals to participate in broader specialty training.
For education providers
Promote and offer access to professional development programmes.
Include neonatal care content in undergraduate curricula.
For health service
Provide opportunities for neonatal placements during clinical training.
Develop and implement common training frameworks aligned with the relevant European Qualifications Framework. (10)
Lake E, Patrick T, Rogowski J, Horbar J, Staiger D, Cheung R, et al. The Three Es: How Neonatal Staff Doctors’ Education, Experience, and Environments Affect Infant Outcomes. JOGNN. 2010;(39):S97-98.
Grandi C, González A, Meritano J, Grupo colaborativo Neocosur. [Patient volume, medical and nursing staffing and its relationship with risk-adjusted outcomes of VLBW infants in 15 Neocosur neonatal network NICUs]. Arch Argent Pediatr. 2010 Dec;108(6):499–510.
Breindahl M, Blennow M, Fauchère JC, Lluch MT, De Luca D, Marlow N, et al. The European database for subspecialist training in neonatology – transparency achieved. Neonatology. 2013;103(1):74–82.
Horbar JD, Plsek PE, Leahy K, NIC/Q 2000. NIC/Q 2000: establishing habits for improvement in neonatal intensive care units. Pediatrics. 2003 Apr;111(4 Pt 2):e397-410.
Lee MC, Chen YC, Chen CH, Lu FL, Hsiao CC, Peng NH. Comparison of the Educational Needs of Neonatologists and Neonatal Nurses Regarding Palliative Care in Taiwan. Am J Hosp Palliat Care. 2016 Apr;33(3):264–71.
Hall SL, Cross J, Selix NW, Patterson C, Segre L, Chuffo-Siewert R, et al. Recommendations for enhancing psychosocial support of NICU parents through staff education and support. J Perinatol. 2015 Dec;35(Suppl 1):S29–36.
Henner N, Boss RD. Neonatologist training in communication and palliative care. Semin Perinatol. 2017;41(2):106–10.
Frank J, Snell L, Sherbino J, editors. CanMEDS 2015 Physician Competency Framework. Ottawa: Royal College of Physicians and Surgeons of Canada; 2015.
