The Next Generation: Fellowship programs train tomorrow's pediatric specialists

In the 10 hours since Dr. Blair Germain’s last shift ended, one baby had emergency surgery, two new sets of twins were born prematurely, and another preemie is being weaned off oxygen in preparation for the trip home.

She’s sitting in a meeting room in the GCH NICU, coffee in one hand, pen in the other, while three doctors fill her in on those cases, and everything else that’s happened while she’s been gone. It’s 5:30 p.m. and her workday is just beginning.

Just as the team wraps up their briefing, a call comes from the overhead speakers: “Obstetrics team, call 3-1600.” Germain darts out of the room and sprints to the labor and delivery unit, expecting to find a newborn baby in distress.

This time, it’s a false alarm. But it’s only 15 minutes into her shift. “That could happen several times a night,” she says, catching her breath as she makes her way back to the NICU and gets ready to see the babies she was just briefed on. “That’s what I love about the NICU. It keeps you on your toes.” 

Germain knew the NICU was the place for her early on in her training. She has already graduated from medical school and completed her three-year pediatrics residency program, but to work as a physician in the NICU, she needs three more years of specialized education.

That’s where the University of Rochester Medical Center’s Neonatal-Perinatal Medicine Fellowship steps in — taking trained pediatricians like Germain and giving them intensive training in the care of high-risk newborns.

“We gain more responsibility as we go, so that by the end of the three years, we are able to practice confidently as neonatologists on our own,” said Germain. “For example, when we do a procedure on a patient for the first time, the general philosophy is that you see one, do one, and then, you’re able to teach one. As a fellow, I have autonomy, but I always have support when I need it.”

Fueling the Pipeline

URMC’s Department of Pediatrics has been training fellows for more than 50 years, equipping pediatricians with the skills and knowledge they need to provide specialized care in their chosen field. Pediatricians can now choose from 18 different pediatric fellowship programs at URMC — from cardiology to emergency medicine to psychiatry.

“Full-service hospitals, like Golisano Children’s Hospital, need subspecialists — doctors who have additional years of advanced training within a specific area, like childhood cancer, or childhood kidney disease,” said Michelle Bonville, pediatric administrator. “Fellowships are how those subspecialists become trained.” 

The programs are selective and attract talented pediatricians from across the country. Akua Asante, M.D., who is in her final year of the fellowship program focused on pediatric cancer and blood disorders, came to Rochester after her residency in Illinois and was one of 30 applicants to vie for just one fellowship spot.

“I was looking for a program that wasn’t too big, because I wanted to work closely with the attending physicians and learn from them as much as possible,” said Asante. “Because this is such an academic center and there are so many specialists, we almost never have to send our patients to other places, which allows me to learn about the most complex cases. This program is a hidden gem.”

Asante didn’t have any ties to Upstate New York before moving here for fellowship, but now, she hopes to stay in Rochester after she graduates — and she’s not alone. Forty-five percent of fellows stay on as attending physicians at Golisano Children’s Hospital following their training. 

“We trust who we train,” said Susan Yussman, M.D., the program director for the Adolescent Medicine Fellowship. “Hiring our fellows after they graduate helps ensure we’re recruiting top-notch physicians and filling necessary spots.” 

New Perspectives

Choosing to go through three more years of training after four years of medical school and three years of residency isn’t always an easy decision. But for Germain and Asante, the opportunity to make a difference in the lives of some of the hospital’s most vulnerable patients is what drew them to their fields.

In addition to providing valuable clinical experience, fellowships also serve to train the medical researchers of tomorrow. All fellowship programs also have a research component, whereby fellows — supported by faculty mentors — select a research focus and move projects forward when they aren’t seeing patients.

For some, the time in the lab becomes just as engaging as the clinical work.

“Each fellowship class brings new perspectives and opportunities. We teach our fellows, but they teach us, too,” said Yussman. “The research projects that these doctors start as fellows often develop into new discoveries over the course of their careers. They’re creating the building blocks for the future.” 

Germain and Asante’s line of work is a constant reminder of the need to develop new treatments and improve care. It’s the children they’ve met — the 9-year-old battling leukemia, or the newborn baby born 16 weeks early — that push them forward through the days in the laboratory and the long nights in the hospital.  

 “Every time I see a baby that I cared for go home, or get to visit with a happy, chubby baby that I remember weighing a pound or two when he was born…it just reminds me why I’m doing what I’m doing, and that I’m on the right path,” said Germain. “There’s no doubt in my mind that these three extra years will be worth it.”