NATIONAL MEDICAL COMMISSION

Postgraduate Medical Education Board

D 11011/1/22/AC/Guidelines/10 Date: 04-08-2022

GUIDELINES FOR COMPETENCY

BASED
POSTGRADUATE TRAINING
PROGRAMME FOR DM IN
NEONATOLOGY

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 GUIDELINES FOR COMPETENCY BASED
POSTGRADUATE SUPER-SPECIALTY TRAINING
PROGRAMME FOR DM IN NEONATOLOGY

1. Preamble
The aim of the DM Programme is to impart advanced training in neonatology to produce
competent super-specialists who can provide clinical care of the highest order to newborn
infants and serve as future teachers, trainers, researchers, and leaders in the field of
neonatology. After successfully completing the course, they would work as productive
members of interdisciplinary teams consisting of obstetricians, neonatologists, pediatric
surgeons, other specialists, nurses, and other healthcare functionaries providing care to the
pregnant mother, fetus, and the newborn in any setting of the health care system. This document
has been prepared by subject-content specialists of the National Medical Commission. The
Expert Group of the National Medical Commission had attempted to render uniformity without
compromise to the purpose and content of the document. Compromise in purity of syntax has
been made in order to preserve the purpose and content. This has necessitated retention of
“domains of learning” under the heading “competencies.

2. SUBJECT SPECIFIC OBJECTIVES

The training program is designed to facilitate the ‘acquisition of learning’ by the postgraduate
student in the following three domains of learning:
• Cognitive (knowledge),
• Affective (communication),
• Psychomotor (practice).

2.1 Predominant in Cognitive domain (Knowledge)

The student should:
 Understand the basic sciences (embryology, anatomy, physiology, biochemistry,
pharmaco-therapeutics, etc.) related to the field of neonatology.
 Be conversant with the etiology, pathophysiology, diagnosis, and management of
common neonatal problems.
 Should understand the importance of providing acute care with the goal of ‘intact
survival.’

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 Know the common problems in pregnancy, including antepartum and intapartum
assessment, and their impact on fetuse and newborn.
 Know the chronic problems in neonates, including respiratory, neurological, metabolic
problems, and understand the importance of neurodevelopmental follow-up until
childhood.
 Be able to analyze neonatal health problems and develop preventive strategies to
decrease neonatal morbidity and mortlity at hospital and community level including
National programs.
 Know neonatal end of life care and bereavement follow up.

Group/team approach:
At the end of the course, the postgraduate student should be able to:
• Recognize the role of multi-disciplinary and interdisciplinary approaches in
managing various neonatal disorders and recognize the importance of family,
society, and socio-cultural environment in treating the sick neonate.
• Function as a part of a team, co-operate with colleagues, and interact with the
neonate’s family to provide optimal medical care.

Evidence-based approach:
At the end of the course, the postgraduate student should be able to critically appraise
medical literature in order to provide evidence-based care.

Research Methodology:
The postgraduate student should acquire:
(a) basic knowledge of research methodology and biostatistics,
(b) familiarity and participation in clinical and experimental research studies, and
(c) knowledge in scientific presentation and publication.

Skills:
At the end of the course, the postgraduate student should acquire (a) skills necessary
for neonatal patient care. He/She should be able to undertake preparation of oral
presentation, medical documents, professional opinion in interaction with patients,
caretakers, peers, and paramedical staff - both for clinical care and medical teaching.
Effective communication with the patient/caretakers regarding the nature and extent of
disease, treatment options, realistic outcomes, and optimal management is essential.

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2.2 Predominant in Affective domain (Communication )

The PG student should:

 Acquire adequate communication skills to counsel and support the parents and families
of the newborns. Regular clinical rounds and academic presentations during the
teaching program should help the trainees to develop patient-centric and family-centric
attitudes, knowledge, and communication skills.
 Establish effective communication with the patient's caregivers, including appropriate
counseling for sickness, terminal illness, and bereavement care.
 Interact professionally and obtain relevant specialist/ancillary 'services' consultation
where appropriate.
 Ensure effective communication and teamwork while teaching others, including
undergraduates in a clinical care unit.
 Be able to communicate and work effectively with a multi-disciplinary team and
understand the role of other team members, including nurses, physiotherapists,
dieticians, psychologists, and others.
 Inculcate ethical principles in all aspects of neonatal, pediatric surgical care/research
(professional honesty and integrity, humility, moderation, informed consent,
counseling, awareness of 'patients' rights and privileges) and be a role model for other
health care team members and respect patient confidentiality.
 Maintain proper etiquette in dealings with patients, caretakers, and other health
personnel, including due attention to the 'patient's right to information, consent, and
second opinion. Maintain professional integrity while dealing with patients, colleagues,
seniors, pharmaceutical companies, and equipment manufacturers.
 Take rational decisions in the face of ethical dilemmas in neonatal - perinatal practice.
 Develop a communication style - both verbal and written, to ensure that the content is
accurately understood by the audience.

2.3 Predominant in Psychomotor domain (Practice)

The PG student should:

 Evaluate a patient thoroughly (history, clinical examination), order relevant
investigations, and interpret them to reach a diagnosis and plan of management.

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  Plan and carry out simple investigations/procedures (bedside, laboratory, imaging)
independently.
 Provide Basic and Advanced Life Support services in emergencies, e.g., NALS.
 Acquire familiarity with and provide critical care of surgical neonates, including airway
support, ventilation, central vascular access.
 Prepare a patient for an elective/emergency surgery and provide specific post-operative
care.
 Provide counseling to the patient and primary caretakers for the smooth dispensation of
medical care.
 Acquire skills in neonatal procedures (including but not limited to invasive and non-
invasive respiratory support, peripheral and central venous access, resuscitation, bladder
catheterization, planning and preparation of parenteral nutrition, insertion of chest tubes,
sepsis workup, suprapubic urine sampling for culture, lumbar puncture, use of medical
equipment such as ventilators, including high-frequency ventilation, exchange
transfusion, therapeutic hypothermia, etc.).
 Monitor the post-operative patient in the standard post-op ward / high dependency unit
/ and in the intensive care setting.
 Provide specific and relevant advice to the patient and family at discharge time for
proper domiciliary care, hospital reporting in an emergency, and routine follow-up.

3. SUBJECT-SPECIFIC COMPETENCIES

3.1 Predominant in Cognitive (knowledge) domain

After completing the DM (Neonatology) course, the student be able to :
1. Know and analyze neonatal health problems scientifically, considering the
biological basis and socio-behavioral epidemiology of the perinatal-neonatal
disease, and be able to advise and implement strategies to prevent neonatal
morbidity and mortality.
2. Acquire knowledge on providing evidence-based primary, secondary, and tertiary
care of highest quality, including intensive care of the highest standard to the
critically sick neonates and very low birth weight infants using advanced
therapeutic and supportive modalities and skills.

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 3. Acquire knowledge on developmental assessment of sensory and motor function of
infants and coordinate post discharge comprehensive follow up.
4. Acquire knowledge to be be able to take rational decisions in the face of ethical
dilemma in neonatal - perinatal practice.
5. Plan and carry out research in neonatal health in the clinical, community, and
laboratory settings.
6. Teach newborn care to the medical and the nursing students and other paramedical
/ community health functionaries, and develop learning resource materials.
7. Plan, establish, and manage level II and level III neonatal units independently.
8. Contribute toward the development and adaptation of neonatal care technologies.
9. Organize newborn care in the community and at the secondary health system level
and play the assigned role in the national programs aimed at the health of mothers
and their infants.
10. Work as a focal point for a multi-disciplinary endeavor for clinical care, education,
research, and community action with other stakeholders and partners.
11. Seek and analyze new literature and information on neonatology, update concepts,
and practice evidence-based neonatology.
12. Lead development of quality improvement projects & develop standard care
practices/ protocols for the unit.
13. Develop skills to train nurses in key components of essential & sick newborn care.

3.2 Predominant in Affective domain (communication and values)

During the course of three years, the postgraduate student is expected to attend
instructive courses that facilitate proficiency relevant to this domain (eg.,
communication skills, biomedical ethics, patient counseling).
After completing the DM (Neonatology) course, the student should be able to do the
following:

 Have empathy for patients and their family and should address them as worthy
human beings.

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 Discuss options, including the advantages and disadvantages of each investigation
and treatment. She/he should be able to discuss medical issues with them in
‘layperson's language’.
 Become confident communicator and well-accomplished professional.
 Acquire communication skills to be able to debate & deliver a scientific lecture and
participate in panel discussions, hold group discussions and be able to deliver the
knowledge received by him/her during the course.
 Be able to function as a part of a team, develop an attitude of cooperation with
colleagues, and interact with the patient and the clinician or other colleagues to
provide the best possible diagnosis or opinion.
 Always adopt ethical principles and maintain proper etiquette in dealing with
patients, relatives, and other health personnel and respect the patient's rights,
including the right to information and second opinion.
 Acquire communication skills of a high order to write reports, interact with peers,
and paramedical staff, and with students for effective teaching.
 Demonstrate humane and compassionate attributes befitting a caring neonatologist.

 Acquire communication skills to give a professional opinion and interact with

patients and relatives in a caring manner.

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 3.3 Predominant in Psychomotor domain (skills)
A. At the end of the course, the student should acquire the following skills (table 1):
Table 1:Must know, desirable to know and observed skills
Must know skills Desirable skills Observed skills
These are mandatory skills. The student These are good to know skills. These are mandatory
should be able to perform the following The student should be able to skills but need to be
procedures independently: perform the following ONLY observed
procedures independently or
as a part of a team and/or
interpret the results of:
Common neonatal procedures to be 1. Nasotracheal intubations 1. Assist the
performed: 2. Bone marrow ophthalmologist,
1. Endotracheal intubation: 30 3. Liver Biopsy visualize the retina
2. Surfactant administration: 30 4. Peritoneal dialysis for retinopathy of
3. Application of CPAP: 20 5. Ventricular tap prematurity and be
4. Intravenous cannulation: 30 6. Ultrasonography of able to provide post-
5. Lactation support and management of ROP care in at least
kidneys, urinary bladder,
feeding problems: 30 20 eyes
and chest to detect gross
6. Peripheral arterial cannulation: 20 2. Observe neonatal
abnormalities
7. Arterial stab sampling: 10 surgery
7. Postural care and oromotor
8. Oro/nasogastric tube insertion: 30 3. Observe neonatal
therapy
9. Lumbar puncture: 30 cardiac surgery
10. Partial exchange transfusion: 5 8. Amplitude integrated EEG
9. Developmental assessment 4. Observe perinatal
11. Double volume exchange transfusion: 5
using common tools e.g. autopsy
12. PICC line: 10
DASII (Disability scale), 5. Observe house-
13. Umbilical venous line (excluding for
BSID (Bayley Scales of keeping protocols and
Exchange Transfusion): 10
Infant Development), etc. asepsis routines of
14. Umbilical arterial line: 10
10. Early intervention. individual units.
15. Peripheral arterial line: 10
16. Suprapubic puncture: 5
17. Intercostal chest drains: 5
18. Orotracheal intubations of <750 g infants:
10
19. Total parenteral nutrition: 10
20. Cranial ultrasonography: 25
21. Functional Echocardiography: 25
22. Therapeutic hypothermia: 5
23. Independent & safe neonatal transport of
sick neonates, intra and inter hospital: 15
24. Neurodevelopmental follow up and
organizing developmental supportive
care: 30
(Figures in parenthesis indicate no. of
procedures)
Laboratory investigations
25. Perform the following basic tests in the
side lab: microscopy of body fluids and
peripheral smear, point of care screening
tests, hematocrit, bilirubin by
spectrophotometry, and blood gas
analysis.

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 Skills Training and Simulation (All medical colleges are mandated to have simulation
labs by NMC )
The postgraduate students are encouraged to utilize low and hi-fidelity mannequins;
individual task trainers are to be made available in the department for skill practice.
Sessions in workshop mode are specially organized for new trainees to teach neonatal
resuscitation, cranial ultrasonography, functional echocardiography, PICC line
insertion, CPAP (Continuous Positive Airway Pressure) & neonatal ventilation.
Simulation sessions on team training and communication also must be organized.

B. Should be able to interpret the results of the following procedures and take necessary
action:
Biophysical profile, CTG and FHR patterns, antenatal doppler, interpretation of genetic
tests, interpret metabolic screen/diagnosis.
Ultrasonography to detect position of tubes and lines; interpret plain x-ray images
related to all parts of the body and contrast studies of GIT, MCU; interpretation of
cranial CT scan (both NCCT and CECT), MRI (T1 weighted, T2-weighted, DWI and
flair); basic interpretation of nuclear scans (HIDA, DRCG, EC, bone scan); basic
interpretation of FDG-L-dopa PET-CT scan for hyperinsulinemia; interpretation of
electrophysiological tests (BERA, VEP, aEEG); use of wide-angle cameras to image
retina for ROP.
Risk prediction for probable fetal neonatal outcome, counseling, and decision making.
Participate in morbidity and mortality review (death audits).

C. The student should be able to observe or perform under supervision the following
procedures –desirable skills:
 Community-based death surveillance and audit
 Partnership with IT for newer and simpler LMIC specific technology innovation
 Systematic reviews

SYLLABUS
Course contents
I. Cognitive domain
A) Basic sciences as applied to neonatology

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  Basic genetics
 Fetal and neonatal immunology
 Mechanism of diseases
 Applied anatomy and embryology
 Feto-placental physiology
 Neonatal adaptation
 Thermo-regulation
 Development and maturation of lungs, respiratory control, lung functions, ventilation,
gas exchange, ventilation-perfusion.
 Physiology and development of the cardiovascular system, developmental defects,
physiology and hemodynamics of congenital heart disease.
 Fetal and intrauterine growth.
 Development and maturation of nervous system, cerebral blood flow, blood-brain
barrier, special senses.
 Fetal and neonatal endocrine physiology
 Developmental pharmacology
 Developmental hematology,
 Development of liver functions and bilirubin metabolism
 Renal physiology
 Physiology of gastrointestinal tract, sucking, swallowing, digestion, absorption.
 Fluid and Electrolyte balance
 Metabolic pathways including pathways of glucose, calcium, and magnesium
 Biochemical basis of inborn errors of metabolism
B) General topics
 Research methodology
 Biostatistics
 Ethics in perinatology/neonatology
 Principles of education (objectives, curriculum, assessment, and use of media)
 Computer, information technology, internet, telemedicine, neonatal networking
 Biotechnololgy, and basis of working of common equipment
 Counseling – antenatal, discharge counseling, breaking bad news, lactation counseling,
grieve counseling.
C) Perinatology
 Perinatal and neonatal mortality, morbidity, epidemiology

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  Perinatal pathology, autopsy, microbiology
 High-risk pregnancy: detection, monitoring, and management
 Fetal monitoring, clinical, electronic; invasive, and non-invasive
 Intrapartum monitoring and procedures
 Assessment of fetal risk and decision for termination of pregnancy
 Diagnosis and management of fetal diseases
 Medical diseases affecting pregnancy and fetus, psychological and ethical
considerations
 Optimal timing of delivery in various medical and obstetric conditions
 Fetal interventions
 Fetal origin of adult disease.
D) Neonatal resuscitation
Successful completion of the neonatal resuscitation program (NRP).
E) Essential newborn care
 Breastfeeding, lactation support
 Kangaroo Mother Care
 Prevention of infections
 Counseling
 Danger signs
 Newborn screening
F) Neonatal ventilation
 Mechanical ventilation
 Continuous positive airway pressure, high flow nasal canula
 High-frequency ventilation
 Clinical uses of surfactant and administration
 Inhaled nitric oxide therapy

G) Blood gas and acid-base disorders

H) Neonatal assessment and follow up
 Assessment of gestation, neonatal behavior, neonatal reflexes
 Assessment of vision & hearing, detection of neuromotor delay, stimulation techniques
 Growth monitoring
 Immunization

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  Early intervention and goal directed therapies.
I) Care of low birth weight babies
J) Specific body systems
i) Respiratory system
 Neonatal airways: physiology, pathology, management
 Pulmonary diseases: Hyaline membrane disease, transient tachypnea, aspiration
pneumonia, pulmonary air leak syndromes, pulmonary hemorrhage, developmental
defects
 Oxygen therapy and its monitoring
 Pulmonary infections
 Miscellaneous pulmonary disorders.
ii) Cardiovascular system
 Fetal circulation, the transition from fetal to neonatal physiology
 Examination and interpretation of cardiovascular signs and symptoms
 Special tests and procedures (Echocardiography, angiography)
 Diagnosis and management of congenital heart diseases
 Rhythm disturbances
 Hypertension in neonates
 Shock: pathophysiology, monitoring, management.
iii) Gastrointestinal system
 Disorders of liver and biliary system.
 Bilirubin metabolism
 Neonatal jaundice: diagnosis, monitoring, management, phototherapy, exchange
transfusion.
 Kernicterus
 Prolonged hyperbilirubinemia
 Congenital malformations
 Necrotising enterocolitis
iv) Nutrition
 Fetal nutrition
 Physiology of lactation
 Breastfeeding
 Lactation management, breast milk banking, maternal medications and nursing

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  Feeding of Low Birth Weight neonate
 Parenteral nutrition
 Vitamins and micronutrients in newborn health
v) Renal system
 Developmental disorders
 Renal functions
 Fluid and electrolyte management
 Acute renal failure (diagnosis, monitoring, management).
vi) Endocrine and metabolism
 Glucose metabolism, hypoglycemia, hyperglycemia
 Calcium disorders
 Magnesium disorders
 Thyroid disorders
 Adrenal disorders
 Ambiguous genitalia
 Inborn errors of metabolism
vii) Hematology
 Physiology
 Anemia
 Polycythemia
 Bleeding and coagulation disorders
 Rh hemolytic disease
viii) Neurology
 Clinical neurological assessment
 Neonatal seizures
 Intracranial hemorrhage
 Neurophysiology, EEG, BERA etc.
 Brain imaging
 Neonatal encephalopathy :Hypoxemic ischemic , metabolic etc
 Neuro-muscular disorders
 Degenerative diseases
 CNS malformation

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 ix) Surgery and orthopedics
 Diagnosis of neonatal surgical conditions
 Pre and post operative care
 Neonatal anesthesia
 Metabolic changes during anesthesia and surgery
 Orthopedic problems
x) Neonatal infections
 Intrauterine infections
 Superficial infections
 Diarrhea
 Septicemia
 Meningitis
 Osteomyelitis and arthritis
 Pneumonia
 Perinatal HIV
 Miscellaneous infective disorders including HBV and Candidemia
 Outbreak and its managment
 Establishing an infection control program, audits, establishing HIC committee
xi) Neonatal Imaging
 X-rays, ultrasound, MRI, CT Scan etc.
xii) Neonatal ophthalmology
 Developmental aspects
 Retinopathy of prematurity
 Sequelae of perinatal infections
xiii) Neonatal ENT disorders
xiv) Neonatal dermatology
K) Transport of neonates
Understanding of safe neonatal support/transport
L) Neonatal procedures
M) Organization of neonatal care
N) Follow up care of the high risk NICU graduate
 Establishing a high risk follow up program

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  Identification of early signs of growth and development disorders (Neuromotor /
Neurodevelopmental Assessment techniques)
o Amiel Tison, Hammersmith, General movements, DDST, TDST, DASII, BSID
 Early intervention therapy
 Counseling
O) Community neonatology
 Vital statistics, health system;
 Causes of neonatal, perinatal death
 Neonatal care priorities and National programs
 Neonatal care at primary and secondary levels
 Role of low cost interventions
 Role of different health functionaries
 Traditional practices
 IMNCI training,
 Regionalization and neonatal health system organization
P) Other topics of contemporary importance: Neonatal metabolic screening, neonatal
palliative care, stress in NICU & management, leadership skills and capacity building.
II. Psychomotor and affective domain
A: The Postgraduate student should be able to perform the following skills
independently:
1. Core skills listed above (see page no: 7)
2. Developmental assessment and follow up
 Should be competent to perform structured neurological examination of infants and
young children in follow-up as well as their developmental assessment using
common standard screening tools used in the high-risk follow-up clinic.
 It is desirable for trainees to learn definitive developmental assessment tool. Should
be able to organize and coordinate multi-disciplinary care of these infants during
follow-up.
3. Infection control, antimicrobial resistance, and antibiotic stewardship
 Should be familiar with and implement evidence-based infection control and
biomedical waste management measures.
 Should have an understanding of mechanisms of development of antimicrobial
resistance.

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  Should have an understanding, practice and implement various components of
antibiotic stewardship.
4. Organization of neonatal care and egionalization of neonatal care
5. Adoption procedures and laws
6. Lactation management, kangaroo mother care, and enteral feeding support
7. Education / Training
a. Teaching skills
b. Learning skills
c. Participatory and small group learning skills
d. Preparing learning resource material
8. Effective and safe use of teleconsultations/telemedicine
9. Research methods and activities
Should have knowledge and understanding of and perform the following:
a. Identifying researchable issues and framing research questions
b. Choosing appropriate study design and conducting a study
c. Analyzing and interpreting data
d. Publication and writing a paper
e. Review and presentation of research findings
f. Critically appraising published literature of various study designs
g. Systematic reviews, meta-analysis, and GRADING of evidence
10. Research Activities
The postgraduate student should be able to perform the following under supervision:
 Thesis: The postgraduate students in superspecialty courses are not required
mandatorily to submit thesis, but, they may be encouraged to conduct chosen
research programs for which research protocol may be submitted within the first
six months of the course. Progress on the conduct of the research project will
give the student valuable training for the future. This may be reviewed every
semester, and feedback given to the student by the guide. The PG student will
make at least 3 formal presentations (i) Protocol, (ii) mid-course progress and
(iii) final report. It is desirable that at least one research paper based on the
above project is published or submitted for publication during the three year PG
training period.

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  Quality Improvement Project: A minimum of one quality improvement
project must be carried out by the postgraduate student.
 Data analysis: Using the existing database of patient records, the postgraduate
student will be expected to perform one complete data analysis based on a pre-
defined approved research question.
 Follow-up of high-risk infants : A minimum of 15 high risk infants must be
followed up for one year, and a record of all assessments and their interpretation
maintained.
 Publications
The following minimum number of publications will be expected from a DM
neonatology postgraduate student by the end of the course:
 Letters to the editor : 1
 Case reports/series: 1
 Original articles: 1
 Presentations: a minimum of 02 research presentations in conferences/
workshops.
11. Data handling skills
The postgraduate student would be expected to have learned the basics of data entry
into Excel, transferring data to a statistical software program, and performing basic
analysis.
12. Bio-medical equipment
 The postgraduate student should become thoroughly familiar with parts,
accessories, setting-up, maintenance, preventing infection, and basic
troubleshooting of all the equipment used in neonatology.
 The should have participated in the entire purchase process from planning to the
installation of at least one equipment costing above Rs. 100,000.
 The postgraduate student should know about equipment inventory and maintenance
details of the equipment.
13. Communication skills
The postgraduate student should be able to demonstrate interpersonal and
communication skills that result in effective information exchange and teaming with
'infants' families and professional colleagues. He/She should be able to effectively

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 communicate: with parents, families, and community, with colleagues and other
healthcare providers and with health authorities.
14. The postgraduate student should be able to conduct Perinatal Death audits and
community-based death surveillance and response.
15. Quality and safety in healthcare
a. The candidate should be well versed with concepts and determinants of quality and
safety.
b. Should be able to work in inter-professional teams to optimize patient safety and
quality.
c. Should be able to communicate effectively for patient safety.
d. Should be able to anticipate, recognize & manage situations leading to errors &
poor quality.
e. Should be well versed with the methods and tools of quality improvement.
f. Should be able to identify medical errors and adverse events, should be able to
respond effectively to mitigate harm, ensure disclosure and should be familiar with
the methods of analysis and preventing recurrences.
16. Medical Ethics, Laws and Professionalism
The postgraduate student must demonstrate a commitment to carrying out professional
responsibilities and adherence to ethical principles. They should be familiar with
principles of ethics, evolution of laws over time at national and international levels and
current ethical standards of treatment and research at national and international level.
They should be familiar with various laws governing medical practice in the country.
The postgraduate student will be expected to inculcate and demonstrate :
 Compassion, integrity, and respect for others
 Responsiveness to patient needs that supersedes self-interest
 Respect for patient privacy and autonomy
 Accountability to patients, society and the profession
 Sensitivity and responsiveness to a diverse patient population
17. Essential and desirable workshops during the duration of the course: The student
should enroll in the listsed workshop as and when they are organized in the unit or
outside the unit depending on the clinical responsibility and availability of leave of
absence. The idea is to facilitate learning and expand horizon in critical thinking.

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 Table 2: Essential and desirable courses and workshops

Essential:
1. Online certification in Research Methodology
Course on SWYAM platform*
o 2.Neonatal Resuscitation Program (NRP)
o 3.Lactation Management
o 4.Neurodevelopmental supportive care
o 5.Neonatal Ventilation (Basic)
o 6.POCQI
o 7.Kangaroo mother care
o 8.Death certificate ICD 10 **
o 9.Neonatal Ventilation (Advanced)
o 10.Functional Echocardiography
o 11.Cranial ultrasonography

Desirable
1. 1.Neonatal EEG
2. 2.Therapeutic Hypothermia
3.3.Developmental assessment
(DASII/BSID/Griffiths etc)

*Must undertake online certification in Research Methodology Course on SWYAM platform

**Must undertake online certificate course on death certificate filling by ICMR DHR

TEACHING AND LEARNING METHODS

Postgraduate teaching program
General principles
Acquisition of practical competencies being the keystone of postgraduate medical education,
PG training should be skills-oriented. Learning in PG program should be essentially self-
directed and primarily emanating from clinical and academic work. The formal sessions are
merely meant to supplement this core effort.
Teaching Methodology
The postgraduate student should be given the responsibility of managing and caring for patients
gradually under supervision.
Formal teaching sessions and learning opportunities
A. Intramural activities
Teaching and learning during bedside rounds of various areas, case discussions in NICU, wards
by self-reflection, and follow up clinics are mainstays. Several organized learning experiences

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should be provided to the students to facilitate the refinement of knowledge and skills. Students
are expected to actively participate in the teaching program of the department and allied
specialties within the department and other departments of the institute. They get regular
opportunities to prepare and make presentations in these teaching programs.
Following formal sessions are recommended in order to facilitate learning* :
 Journal club (once 15 days )
 Perinatal round (once 15 days)
 Seminar (once 15 days)
 Clinical case discussion (once 15 days )
 Perinatal audit/CPC (once a month)
 Research review (once a month)
 Neonatal surgery (once 3 month)
*In addition, depending on the strength of the institutions, sessions on imaging, pathology,
microbiology, biostatistics/epidemiology, and interdepartmental seminars may be undertaken.
B. Extramural opportunities
The postgraduate students are encouraged to attend continuing education symposia,
workshops, and academic conferences, including meetings of national and international
societies, workshops on neonatal resuscitation, CPAP, ventilation, point of care neonatal
ultrasound, neonatal functional echocardiography, Developmental assessment, quality
improvement, and simulation.
C. Learning by Teaching
The students will participate in teaching junior residents, nurses, nursing students, and trainees
from other hospitals coming for observership. They will also be given the exposure of teaching
and training during workshops and CMEs organized by the faculty within the institution and
outreach activities.
 In addition, the student should attend accredited scientific meetings (CME, symposia, and
conferences) once or twice a year.
 Additional sessions on Research methodology, use of computers in Medicine, Biostatistics,
ethical and legal issues in the care of the newborn, teaching methodology, hospital waste
management, health economics are suggested.
 The postgraduate students shall be required to participate in the teaching and training
program of undergraduate and postgraduate students and interns (if available).

19
  A postgraduate student of a postgraduate degree course in super specialties would be
required to present one poster presentation or read one paper at a national/state conference;
should write a research paper from his/her work which should be published/accepted for
publication/sent for publication during the period of his postgraduate studies
D. Log Book: During the training period, the postgraduate student should maintain a Log
Book indicating the duration of the postings/work done in Wards, OPDs, and Casualty.
This should indicate the procedures assisted and performed and the teaching sessions
attended. The purpose of the Log Book is to:
a) Help maintain a record of the work done during training,
b) Enable Consultants to have direct information about the work; intervene if
necessary,
c) Use it to assess the experience gained periodically.

The Log Book should be used to aid the internal evaluation of the student. The Logbook
shall be checked and assessed periodically by the faculty members imparting the training.
Candidates will be required to produce the logbook original or copy at the time of practical
examination. It should be signed by the Head of the Department. A proficiency certificate
from the Head of Department regarding the clinical competence and skillful performance
of procedures by the student will be necessary before he/she would be allowed to appear in
the examination. The teaching faculty are referred to the MCI Logbook Guidelines
uploaded on the Website.

E. POSTINGS
Overview
The total period of the DM course is 36 months. Of this, at least 27 months will be spent
in the newborn service, 6 months will be meant for essential rotations in related specialties,
and the rest 3 months will be apportioned for either elective rotations or the newborn
service.
Newborn services
The candidates will have at least 27 to 30 months of posting in the newborn services at
concerned institutions. The candidates must get adequate exposure to neonatal follow-up,
neonatal emergencies, delivery room care of neonates, and acquisition of practical skills
(specified under skills).

20
 Essential Rotations/postings
These rotations may be in the parent institution or at other institution(s), public or private,
approved by the Department / Institution. The duration of elective postings may vary based
on PG student numbers and clinical load. The postgraduate student can undertake up to 1-
2 'months' elective rotation at the parent or any other institution(s), public or private,
approved by the Department/institution. The areas to be covered could be genetics,
perinatal pathology, anesthesiology, CTVS, epidemiology/ biostatistics, basic sciences,
informatics, and education technology etc. Table 1 depicts the overview of the postings.
Table 1: Overview of the duration of postings in different areas*
Newborn unit Essential Rotation 6 Discreationary 3
& LDR ( Decided in
consultation with HOD)
Duration of 27-30 months 6 months 3 months
posting
Rotations/ -- 
Obstetrics: 2  Research
Postings 
Pediatric/ Neonatal  Exam leaves
Surgery /PICU /  Miscellaneous
Cardiology: 1 Leaves
 Community/ SCNU:
(urban slums/ home
visits/ PHC etc
through community
medicine): 2
 Elective 1
*Every unit has to write learning objectives for their essential rotations

The postgraduate students are expected to plan at least 6-9 months in advance for all
optional electives and have concrete learning objectives. Depending on clinical exigencies
and the number of trainees available, the duration of optional electives may be curtailed.

Community neonatology
As part of mandatory rotations, community neonatology posting shall form an important
part of the curriculum to give exposure and experience of organization and delivery of
neonatal care at various levels in the community. The trainees will be facilitated to work in
district level special care newborn units (SCNUs), Newborn Stabilization Units (NBSUs)
under National health Missions of neighboring states, and get exposure to neonatal care in
urban slums rural areas in collaboration with the Department of Community Medicine.

F. Research & Quality Health Care

Covered earlier

21
G. Patient safety

During the training programme, patient safety is of paramount importance; therefore,

skills are to be learnt initially on the models, later to be performed under supervision
followed by performing independently. For this purpose, provision of skills laboratories
in medical colleges is mandatory.

4. ASSESSMENT
FORMATIVE ASSESSMENT, during the training program: Formative assessment should
be continual and should assess medical knowledge, patient care, procedural & academic skills,
interpersonal skills, professionalism, self-directed learning, and ability to practice in the
system.
Periodic Evaluation:
Candidates will be evaluated continuously for their performance in all areas such as clinical
and investigative work, case presentations, seminars, journal clubs, procedures
undertaken/participated in etc. Additional periodic assessment will include theory and practical
assessment mimicking the final examination and should be conducted every 6 months. Such
an evaluation will help assessing the progress of the trainees and the quality of the training
programme. Evaluation will be communicated to trainees and their feedback would be taken
into consideration for modifications in the training programme.

Internal Assessment should be frequent, cover all domains of learning and used to provide
feedback to improve learning; it should also cover professionalism and communication skills.

Quarterly assessment during the DM training should be based on:

1. Journal based / recent advances learning
2. Patient based /Laboratory or Skill based learning
3. Self-directed learning and teaching
4. Departmental and interdepartmental learning activity
5. External and Outreach Activities / CMEs/Workshops/Conferences
6. Participation/conduct of research project - desirable

The student to be assessed periodically as per categories listed in Postgraduate Student

Appraisal form (Annexure I).

22
In Medical disciplines, the student should be assessed in all aspects of case management
including history taking, physical examination, differential diagnosis, cost effective and
appropriate investigations, treatment plan, monitoring and evaluation, patient and family
counselling and interaction with all the health workers involved in the care of patients and
academic presentations.

Clinical skills and performance, academic performance and personal attributes shall be graded
on a scale of 1 to 5 (5 being the highest). The academic presentations shall be graded at the
time of presentation, by the faculty in-charge. Evaluation on clinical skills shall be done by the
unit/department in-charge at the end of every semester.
The student to be assessed periodically as per categories listed in post graduate student
appraisal form (Annexure I).

SUMMATIVE ASSESSMENT
The summative examination would be carried out as per the Rules given in the relevant
POSTGRADUATE MEDICAL EDUCATION REGULATIONS.

Essential pre-requisites for appearing for examination include:

1. Log book of work done during the training period including rotation postings, departmental
presentations, and internal assessment reports should be submitted.
2. At least two presentations at national level conference. At least one research paper should
be published/ accepted in an indexed journal. (It is suggested that the local or University
Review committee assess the work sent for publication).
3. Submission of thesis/ research work (desirable: As per PG Regulations)

1. Theory
There will be four theory papers, as below:
 Paper I: Basic sciences relevant to the discipline of Neonatology, Perinatology
 Paper II: Core Neonatology
 Paper III: Neonatology and allied specialties
 Paper lV: Recent Advances in Neonatology & community neonatology
2. Theory and Practical/Oral Examinations: Theory and Practical/Oral examinations will
be conducted as per University guidelines. The theory examination shall be held in advance

23
 before the clinical and practical examination, so that the answer books can be assessed and
evaluated before the commencement of the clinical/practical/oral examination.

The practical examination should consist of the following and should be spread over two
days, if the number of candidates appearing is more than five. Oral examination shall be
comprehensive enough to test the student's overall knowledge of the subject.
1. There should be one long or semi-long case which must be on acute care of a sick
neonate. The long case should include: History taking, physical examination,
interpretation of clinical findings, differential diagnosis, investigations, prognosis
and management.
2. Three short cases from various sections of the specialty.
3. The log book of procedures and interventions shall also be assessed in the practical
examination.
Proposed plan for clinical examination (Clincal cases should assess affective domain
also) should include:
o Intensive care (a neonate receiving intensive care)
o Level II care or ward rounds
o Follow up high-risk newborn
o Ten Objective Structured Clinical Examination (OSCE) including affective
OSCE. One session can be inside ICU with focus on ICU care.
3. Viva-voce Examination: The viva voce examination should focus on psychomotor
and affective domain, for a minimum period of 20 minutes per candidate. It should
include:
o General viva on drugs, equipment, including radio-imaging, investigations
i.e. ultrasound/CT/MRI, records, interpretation of 'ABGs', neurophysiologic
records such as BERA, EEG; national programs, policy.

Recommended Reading:
1. Fanaroff and Martin's Neonatal-Perinatal Medicine, 2-Volume Set, ISBN:
9780323567114. Richard J. Martin; Avroy A. Fanaroff; Michele C. Walsh.
2. Assisted Ventilation of the Neonate ISBN: 9780323390064. Jay P. Goldsmith;
Edward Karotkin; Gautham Suresh; Martin Keszler.
3. Avery's Diseases of the Newborn ISBN: 9780323401395. Christine A. Gleason;
Sandra E. Juul.

24
4. Beyond the NICU: Comprehensive Care of the High-Risk Infant, ISBN:
9780071748582. William Malcolm.
5. Breastfeeding ISBN: 9780323680134. Ruth A. Lawrence; Robert M. Lawrence.
6. Care of the Jaundiced Neonate ISBN: 9780071762892. David Stevenson; M.
Jeffrey Maisels; Jon F. Watchko.
7. Cloherty and Stark's Manual of Neonatal Care ISBN: 9781496343611. Eric C.
Eichenwald; Anne R. Hansen; Camilia R. Martin; Ann R. Stark (Editors).
8. Neonatology Principles and practice. Dipak Guha.
9. Fetal and Neonatal Physiology, 2-Volume Set. ISBN: 9780323825559. Richard A.
Polin; Steven H. Abman; David Rowitch; William E. Benitz.
10. Fetal and Neonatal Secrets ISBN: 9780323172868. Richard A. Polin.
11. Klaus and Fanaroff's Care of the High-Risk Neonate ISBN: 9780323608541.
Avroy A. Fanaroff; Jonathan M. Fanaroff.
12. Manual of Neonatal Respiratory Care ISBN: 9781461421559. Steven M. Donn;
Sunil K. Sinha (Editors).
13. Neonatal Cardiology ISBN: 9780071834506. Michael Artman; Lynn Mahony;
David F. Teitel.
14. Gomella's Neonatology, latest edition. ISBN: 9781259644818. Tricia Lacy
Gomella; Fabien Eyal; Fayez Bany-Mohammed.
15. Remington and Klein's Infectious Diseases of the Fetus and Newborn Infant, ISBN:
9780323241472. Christopher B. Wilson; Victor Nizet; Yvonne Maldonado; Jack S.
Remington; Jerome O. Klein.
16. Rennie and Roberton's Textbook of Neonatology ISBN: 9780702034794. Janet M.
Rennie.
17. Smith's Recognizable Patterns of Human Malformation ISBN: 9780323186681.
Kenneth Lyons Jones.
18. Volpe's Neurology of the Newborn ISBN: 9780323428767. Joseph J. Volpe
(Editor-in-Chief); Terrie E. Inder; Basil T. Darras; Linda S. de Vries.
19. The Harriet Lane Handbook ISBN: 9780323674089. Johns Hopkins Hospital;
Helen Hughes; Lauren Kahl (Editors).
20. Red Book 2018 ISBN: 1581109261. David W. Kimberlin; Michael T. Brady;
Mary Anne Jackson; Sarah S. Long.
21. Nelson Textbook of Pediatrics ISBN: 9780323529501. Robert M. Kliegman;
Joseph St. Geme.

25
22. Park's Pediatric Cardiology for Practitioners ISBN: 9780323681070. Myung K. Park;
Mehrdad Salamat.
23. Atlas of procedures in neonatology. Philadelphia: Wolters Kluwer/Lippincott Williams &
Wilkins; 5th ed. Mhairi G MacDonald. Jayashree Ramasethu.

Website:
1. www.cochrane.mcmaster.ca/neonatal
2. www.nichd.nih.gov/cochrane
3. www.neonatology.org
4. www.emedicine.com/ped/neonatology.htm
5. www.pocqi.org
6. www.preterm-eliminatingrop.com
7. www.ihi.org

Journals
3-5 international and two national journals (all indexed).

26
 ANNEXURE I

Student appraisal form for DM in Neonatology

Less than More than
Element Satisfactory Comments
Satisfactory satisfactory
1 2 3 4 5 6 7 8 9
Scholastic Aptitude
1 and Learning
Knowledge appropriate
1.1 for level of training
Participation and
contribution to learning
activity e.g., Journal
Club, Seminars, CME
1.2 etc)
Conduct of research
and other scholarly
activity assigned (e.g
Posters, publications
1.3 etc)
Documentation of
acquisition of
competence
1.4 (eg Log book)
Performance in work
1.5 based assessments
1.6 Self Directed Learning

2 Care of the patient

Ability to provide patient
care appropriate to
2.1 level of training
Ability to work with
other members of the
2.2 health care team
Ability to communicate
appropriately and
empathetically with
patients families and
2.3 care givers
Ability to do procedures
appropriate for the level
of training and assigned
2.4 role
Ability to record and
document work
accurately and
appropriate for level of
2.5 training
Participation and
contribution to health
care quality
2.6 improvement

27
 Professional
3 attributes
Responsibility and
3.1 accountability
Contribution to growth
3.2 of learning of the team
Conduct that is ethical
appropriate and
3.3 respectful at all times
4 Scholarship
Teaching and
mentoring skills
appropriate to level of
4.1 training
Ability to formulate
research questions,
initiate conduct and
complete research
4.2 projects
Ability to review and
use the published
literature appropriately
in care of the patient
4.3 lab or workspace
Ability to provide
consultations to other
specialties as may be
4.4 required

Space for additional

5 comments

6 Disposition
Has this assessment
been discussed with
the trainee? Yes No
If not explain

Name and Signature of

the assesse

Name and Signature of

the assessor
Date

28
Subject Expert Group members for preparation of Guidelines for
competency based postgraduate training programme for DM in Neonatology

1. Dr. Ashok Deorari Convener

Professor & Head,
Department of Paediatrics,
AIIMS, Ansari Nagar, New Delhi – 110029

2. Dr Praveen Kumar Member

Professor, Neonatal Unit,
Department of Pediatrics
Post Graduate Institute of Medical Education and Research
Chandigarh-160012.

3. Dr. Suman Rao PN Member

Professor and Head of Neonatology
St John’s Medical College & Hospital,
Koramangala, Bangalore -560034

4. Dr. Ruchi Nimish Nanavati Member

Professor and Head of Neonatology
KEM Hospital & Seth GS Medical College
Acharya Donde Marg, Parel,
Mumbai 400 012

5. Dr Suchandra Mukherjee Member

Professor and Head of Neonatology
Department of Neonatology,
IPGMER and SSKM hospital
Kolkata 700020

6. Dr. Mangala Bharathi S Member

Professor and Head of Neonatology
Institute of Child Health, Madras Medical College,
Egmore, Chennai -600008

29