697 - Evolving Clinical Roles of Neonatal-Perinatal Medicine Fellows: Redefining Clinical Coverage and Care Team Integration in the Modern NICU

Publication Number: 2680.697

Christine Carlos, University of Chicago Division of the Biological Sciences The Pritzker School of Medicine, CHICAGO, IL, United States; Christie J. Bruno, Yale School of Medicine, Glastonbury, CT, United States; Cindy Crabtree, University of Louisville and Norton Children’s Hospital, Louisville, KY, United States; Erynn Bergner, University of Oklahoma College of Medicine, Oklahoma City, OK, United States; Elizabeth A. Hillman, McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, TX, United States; Megan M. Gray, University of Washington School of Medicine, Seattle, WA, United States; Kristen Glass, Pennsylvania State University College of Medicine, Hershey, PA, United States; Brittany Schwarz, Johns Hopkins University School of Medicine, Baltimore, MD, United States; Morgan E. Hill, Cincinnati Children's Hospital Medical Center, Loveland, OH, United States; Jennifer M. Brady, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States

Background: The clinical role of the Neonatal-Perinatal Medicine (NPM) fellows has traditionally focused on refining neonatal pathophysiology knowledge, medical decision-making and clinical leadership skills. Recent Accreditation Council of Graduate Medical Education (ACGME) pediatric residency mandates have resulted in staffing changes in Neonatal Intensive Care Units (NICU). As clinical team compositions evolve and NICU exposure in residency decreases, there may be effects on the clinical role and clinical care team leadership skills of NPM fellows.

Objective: To describe the clinical role of NPM fellows within the evolving landscape of pediatric training and modern NICU staffing models.

Design/Methods: A national program data form was electronically distributed via REDCap to all US accredited NPM programs through the Organization of Neonatal-Perinatal Training Program Directors (ONTPD) in September 2025. One survey response per training program was accepted. Survey questions assessed NPM fellows' role in clinical care and exposure to clinical care teams.

Results: 93 out of 107 NPM programs responded (87%). The wide spectrum of program characteristics was captured (Table 1). Variation exists in front-line team composition experience: 71% of programs expose fellows to resident teams, 72% to Advanced Practice Provider (APP) teams, 75% to mixed resident-APP teams, and 3% to attending only teams (Figure 1). 24% report fellow exposure to one team model during training. More commonly, fellows are exposed to multiple models, 35% to 2 models and 41% to 3 or more (Figure 1). Programs have fellows serve in front-line provider roles routinely (21%), for specific patient populations (45%), and in particular circumstances, such as early fellowship (23%). 22% of programs never have fellows serve in a front-line role (Figure 2).

Conclusion(s): The clinical role of NPM fellows continues to evolve in response to changing pediatric residency training, NICU staffing models, and workforce demands. NPM programs have fellows lead teams of varying composition, highlighting the need for collaborative interprofessional clinical leadership skill development. Many fellows serve in front-line roles which should prompt exploration into the impacts of front-line care on preparedness for independent attending clinical practice and professional identity formation. To sustain high-quality patient care and education, NPM fellowship programs and hospital administration must adapt clinical training structures, clarify clinical leadership expectations, and advocate for NICU staffing models that protect the educational mission of fellowship training.

Table 1: Characteristics of NPM Fellowship Programs
Data shown as N (%) or median (IQR).

Figure 1: Fellow Exposure to Clinical Team Compositions


Figure 2: Fellows in First-Line Provider Roles