The PL-1's (pediatric-2 four week rotations, obstetric-one month rotation, or family practice-one month rotation) are responsible for all NICU/IICU neonates. They attend high-risk deliveries, problem deliveries (i.e. meconium aspiration) and all cesarean sections with the resuscitation team. If the attending neonatologist is satisfied with the PL-1's skills and knowledge, the PL-1 can accompany the transport team to stabilize neonatal transports during their second month on the NICU. Usually the PL-2, neonatal fellow or neonatal nurse practitioner supervises the PL-1 on their initial transport.
The PL-1 admits all NICU/IICU admissions and initiates the diagnostic work-up and treatment (responsible for approximately 7-8 patients). The PL-1 performs most procedures after supervision by the PL-2/neonatal fellow/neonatologist. The PL-1 writes all orders, collects all data and presents cases followed by their differential diagnosis and management on daily (seven days/week) work/teaching rounds with the attending neonatologist/neonatal fellow. They work with families, coordinate consults with subspecialists and communicate with private physicians. The PL-1 presents cases at the discharge conference and works with the perinatal team (social worker, head nurse, developmentalist, VNA coordinator, neonatologist) to coordinate discharge/retrotransfer plans. The PL-1 is responsible for daily notes and dictates discharge/transfer summaries from the NICU/IICU. The PL-1 also presents cases at patient management conferences, PM&M and neuropathology conferences. The PL-1 is required to attend all regularly scheduled NICU conferences and pediatric grand rounds. The PL-1 presents an article at the journal club. The PL-1 continues to attend their regular weekly one-half day continuity clinic at UMass Memorial Health Care - UMass Campus or outside site. The PL-1 takes call every fourth night with the neonatal fellow and/or neonatologist.
The pediatric PL-2 rotates in the NICU/IICU for two four-week blocks and works in a similar role as the PL-1 as described above. In addition, the PL-2 helps to supervise the PL-1 especially with procedures and resuscitation in high-risk deliveries, problem deliveries and cesarean sections especially when the neonatal fellow is not present. The PL-2 supervises neonatal care during surgical procedures in the operating room. The PL-2 supervises the fourth year medical student subinterns. The PL-2 participates in gathering current literature on interesting cases for journal club, patient management conferences, and gives short talks as part of NICU rounds. The PL-2 goes on neonatal transports and is responsible for supervision of the neonatal team and stabilization of the neonate. The PL-2 is on call every fourth night with the neonatal fellow and/or neonatologist who stays in-house. The PL-2 selects x-ray cases for the neonatal radiology rounds bimonthly with the pediatric radiologist. The PL-2 attends their one-half day continuity clinic every week. The direct patient care is provided by the residents. The neonatal fellow provides back-up, but his/her role is primarily supervisory in the NICU. The residents are responsible for daily notes and all patients are divided between them.