PAEDIATRICS DEPARTMENT OF - Sinai Health System
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DEPARTMENT OF
PAEDIATRICS
10-YEAR REPORT
2009-2018
© 2019 Department of Paediatrics, Mount Sinai Hospital
This report was compiled by Dr. Sarah Hutchinson, Ms. Cynthia Yeh, Ms Amuna Yacob, Ms. Nerizza Matignas, and
Ms. Angela Lim with material provided by Dr. Shoo Lee, Dr. Edmond Kelly, Dr. Sharon Unger, Dr. Amish Jain, Dr. Emer
Finan, Dr. Jennifer Young, Dr. Amish Jain, Dr. Adel Mohamed, Ms. Kasia Pytlik, Ms. Janet Narciso, Ms. Nely Amaral,
Mr. Sonny Yeh, Mr. Philip Ye and Dr. Sarah Hutchinson. Layout and design were provided by Laurie Barnett.
2 DEPARTMENT OF PAEDIATRICS
FOREWORD
I would like to offer my gratitude and congratulations
to everyone in the Department of Paediatrics for their
hard work and dedication to improving patient care
over the last 10 years. During Dr. Shoo Lee’s tenure,
the Department has gone from being primarily a clinical
department to hosting the most productive research
NICU in Canada. Innovations including Family Integrated
Care, the Rogers Hixon Ontario Human Milk Bank,
continuous quality improvement using the Evidence-based
Practice for Improving Quality (EPIQ) method, and the
integration of point-of-care services like targeted neonatal
echocardiography have not only improved neonatal
outcomes, but are reshaping infant care across Canada.
This 10-year report highlights the extraordinary impact the
Department of Paediatrics has had under the leadership
of Dr. Lee. Through patient-centered care, interdisciplinary
teamwork, integrated research, and a commitment to
continuous quality improvement, the Department of
Paediatrics has become a model of high-quality, cutting-
edge care for others to follow.
Thank you for the commitment of our clinical and
research teams in the Department of Paediatrics and
our government and philanthropic funding partners. Your
devotion has improved the lives of the thousands of fragile
newborns and their families who stay at Mount Sinai
Hospital each year. We are grateful for all you do and are
proud of your continuous efforts to make care better.
Dr. Gary Newton, President and CEO
10-Year Report 3
Foreword......................................................3
Message from the Paediatrician-in-Chief......5
TABLE OF Executive Summary......................................6
CONTENTS Clinical........................................................12
Research....................................................28
Education....................................................34
Donors........................................................41
People........................................................43
Awards and Honours..................................50
Funding.......................................................54
Publications................................................60
4 DEPARTMENT OF PAEDIATRICS
MESSAGE FROM THE
PAEDIATRICIAN-IN-CHIEF
It has been a pleasure for me to serve as Paediatrician-in-Chief of the Department of
Paediatrics at Mount Sinai Hospital, part of Sinai Health System, from 2009 to 2018. During this
time, the Department has transformed from a primarily clinical department into an international
leader in innovative, quality neonatal care; high-caliber research; and training excellence for
the leaders of the future. This remarkable transformation was made possible only through the
dedication and selfless contributions of staff members in the Department. Congratulations must
go to them for their hard work and success.
I am especially proud of how the individuals representing many professional disciplines in the
NICU, from physicians to nurses, respiratory therapists, dieticians, pharmacists, social workers
and others, have transformed themselves into a true inter-professional team and elevated care to
the next level. The culture change that resulted from their teamwork focuses on patient-centered
care and continuous, evidence-based quality improvement to ensure that our fragile patients
have the best start in life. For example, the pioneering and adoption of the Family Integrated Care
(FICare) philosophy made parents an integral part of their infants’ NICU-care team and improved
infant outcomes. FICare is truly revolutionary and has the potential to fundamentally transform the
delivery of health care globally.
Over the last 10 years, we were fortunate to move into new clinical and administration space,
which coincided with the expansion of our service offerings. The David and Stacey Cynamon
Mother & Baby Unit and Department of Paediatrics administration space opened in 2012 and a
new state-of-the-art NICU was completed in 2014. The new NICU has a single-room design and
is equipped with a fully electronic health information system that integrates antenatal, obstetric,
neonatal and follow-up care. The opening of the Roger Hixon Ontario Human Milk Bank marked a
major milestone not only for Mount Sinai Hospital, but also for our partners at the Hospital for Sick
Children and Sunnybrook Hospital, and the province of Ontario. The use of point-of-care services
in the NICU, including targeted neonatal echocardiography and lung ultrasound, has reduced the
need to transport fragile infants and improved diagnoses and patient care.
Our achievements would not have been possible without the unwavering support and visionary
leadership of the Sinai Health System Executive Team, the Board of Directors and the Sinai
Health System Foundation. Acknowledgements must go to the Lunenfeld-Tanenbaum Research
Institute, the University of Toronto, the Hospital for Sick Children and the Ontario Ministry of
Health and Long-Term Care for their generous support and partnership. Thanks must also go
to the Parent Advisory Board and many parent volunteers who spent countless hours helping
families in the NICU and the NICU staff who care for them. Finally, we would like to extend a very
warm expression of thanks to everyone who has contributed to our work, either as a member of
our team or by providing financial assistance to the Department.
Dr. Shoo Lee, Paediatrician-in-Chief
10-Year Report 5
EXECUTIVE
Dr. Shoo Lee has led the
Department of Paediatrics
at Mount Sinai Hospital, part
SUMMARY of Sinai Health System, as
Paediatrician-in-Chief for the
last 10 years. The time has been
filled with growth, changes, and
improvements in the Department,
which are summarized in this
report. The report is divided
into three sections reflecting
the three areas of excellence
in the Department — Clinical,
Research, and Education.
6 DEPARTMENT OF PAEDIATRICS
Department of Pediatrics
in a Nutshell
=
The Department of Paediatrics Our 7 clinical services include the following:
is one of the largest academic
neonatal programs in Canada with • Antenatal consults for women with high-risk pregnancies
112 beds and over 10,000 patient in our Labor and Delivery Unit, Antenatal Ward, and
encounters each year. In addition, Special Pregnancy Clinic
we are the only hospital in • Resuscitation and stabilization of infants in the Labour
Canada that performs advanced and Delivery Unit
procedures like laser and in-utero
• Healthy newborn care in the 55-bed David and Stacey
fetal surgery for pregnancies.
Cynamon Mother and Baby Unit
Medical care is provided
by 13.7 full-time equivalent • Both level 2 and level 3 neonatal intensive care in our
neonatologists, working with a mixed-acuity, 62-bed NICU
dedicated inter-professional team • Outpatient post-natal and postpartum care in our
of nurses, respiratory therapists, Postnatal Ambulatory Clinic (PNAC)
physiotherapists, occupational
• 7-day-a-week breastfeeding support in the NICU
therapists, lactation consultants,
social workers, dieticians, • Developmental follow-up for high-risk infants in our
pharmacists, administrative, and Follow-up Clinic
other support staff.
Research is conducted by all neonatologists in the Department and is supported by research
staff from the Maternal-Infant Care Research Centre (MiCARE), which Dr. Lee established as an
in-house facility to support Departmental research. Our Department also prioritizes high-quality,
cutting-edge education and clinical training for medical students, specialty residents, sub-specialty
fellows, nurses, and respiratory therapists, as well as post-graduate research training for both basic
and clinical sciences.
10-Year Report 7
Highlights of the Between 2009 and 2018 under Dr. Shoo Lee’s
leadership, the Department of Paediatrics
significantly improved the provision of care,
Last 10 Years expanded our research outputs, and continued to
deliver world-class education and training.
8 DEPARTMENT OF PAEDIATRICS
CLINICAL CARE
Providing the best clinical care is at the heart of everything we do in the Department of
Paediatrics. Over the last 10 years, improvements in the facilities, staffing, processes of care,
and services were all geared towards improving the outcomes and quality of life of our most
vulnerable patients. We were fortunate to have several facility upgrades that enhanced both
the care environment for patients and tools available to medical professionals. Between 2012
and 2014, we moved into new spaces for the Mother and Baby Unit, Neonatal Intensive Care
Unit (NICU), and Department of Paediatrics’ administration. In addition, a fully electronic NICU
information system was implemented. The new NICU is a single-room design that provides
space for families to stay with their infants and enabled the re-organization of the NICU into a
mixed-acuity model to minimize patient movement.
During Dr. Lee’s tenure, he made changes to the Department staffing that helped increase
efficiency, lower costs, and improve the quality of care. For example, he reorganized the
Department and clarified job descriptions for neonatologists, recruited an additional 3.7 full-time
equivalent neonatologists, and hired a nursing Clinical Coordinator, a Nurse Educator, and a
dedicated Quality-Safety Nurse.
Two key changes were made to the care culture in the NICU over the past 10 years. First, the
NICU implemented a continuous quality improvement process that uses the Evidence-based
Practice for Improving Quality (EPIQ) method designed by Dr. Lee. Now, continuous quality
improvement is ingrained in the culture of the Mount Sinai NICU and has led to multiple leading
practice awards. Second, Dr. Lee and Dr. Karel O’Brien developed the Family Integrated Care
model, which was implemented in the Mount Sinai NICU in 2011 as a pilot program and is now
the philosophy of care for the whole NICU.
Many changes were made to the clinical services offered by the Department of Paediatrics.
For example, services like Level 1 neonatal care and developmental follow-up were brought
in-house for greater consistency of care. The Rogers Hixon Ontario Human Milk Bank and
point-of-care technologies, including functional echocardiography and lung ultrasound, were
integrated into the NICU services. Last, the Post-Natal Ambulatory Clinic (PNAC) and Life With
A Preterm Baby Program were established to fill care gaps after discharge home. Together,
these service changes made the Mount Sinai NICU a leader in quality NICU care.
10-Year Report 9
RESEARCH
Over the last 10 years, research has been a key area
of focus for the Department of Paediatrics. As a result,
the Department now hosts one of the most productive
research NICUs in Canada. Our faculty members
continually strive to be at the leading edge of perinatal-
neonatal medical research. Between 2009 and 2018,
Dr. Lee made many organizational changes that have
significantly enhanced our research capabilities. For
example, the Department started providing training and
mentorship to faculty and enabling research through
protected research time. In addition, the Department
recruited research expertise and increased the number of
clinician-scientists in the Department from 0 to 6. Finally,
Dr. Lee established the Maternal-Infant Care Research
Centre (MiCARE) to support Departmental research.
The research program is complemented by the major
national and international networks and multi-centre
trials that are coordinated and managed at Mount Sinai
Hospital through MiCare. MiCare is the coordinating
centre for the Canadian Neonatal Network™ (CNN),
Canadian Preterm Birth Network (CPTBN), Canadian
Neonatal Follow-Up Network (CNFUN), Canadian
Pediatric Surgery Network (CAPSNet), Canadian
Neonatal Transport Network (CNTN), International
Network for Evaluating Outcomes in neonates (iNeo),
and WHO Perinatal Surveillance System. Together, the
networks provide benchmarking and outcomes data that
contribute to both the continuous quality improvement
efforts and the research productivity of the Department
of Paediatrics.
The Department of Paediatrics has consistently
produced a large quantity of high-quality research
over the past 10 years. The Department published 731
manuscripts in peer-reviewed journals. In addition,
we were awarded 160 new research operating grants
valued at $103,968,934, including 41 CIHR grants; and
the annual grant funding for the Department increased
from $4.7M in 2009 to $16.2 M in 2018. The number of
peer-review grant-funded principal investigators among
Department members increased from 5 in 2009 to 10
in 2018, with 5 investigators receiving CIHR awards.
Between 2009 and 2018, the Department made over
1000 national and international presentations and
received 104 awards and honours for our work.
10 DEPARTMENT OF PAEDIATRICSEDUCATION
The level of quality care and research in the Department could not be achieved without
cutting-edge training programs. Our training programs reach a wide spectrum of healthcare
professionals, both nationally and internationally.
The Department of Paediatrics is a leader in medical training. Over the past 10 years we have
provided training for 528 specialty residents and 205 subspecialty fellows as well as elective
training for 138 medical students, midwives, physician assistants, and others. In addition,
Department members were instrumental in developing and implementing national curricula and
exams for perinatal-neonatal fellows.
Research is a key area of focus for the Department of Paediatrics and requires extra training
on top of a typical medial education. In addition to research training and mentorship of specialty
and sub-specialty residents in pediatrics and neonatology, the Department has provided post-
graduate research training for 8 researchers at the masters, doctoral or post-doctoral level, and
Dr. Lee established a unique clinician-scientist training program that has successfully trained 5
clinician-scientists, with 1 more in training.
In the last 10 years, Dr. Lee has established the Department of Paediatrics at Mount Sinai
Hospital as a major coordinating centre for international training programs in neonatal medicine
and nursing. Researchers and clinicians come from around the world to observe and learn from
us. In addition, we run two international programs in neonatal medicine and nursing.
10-Year Report 11The Department of Paediatrics plays a vital role in
the care of all infants born at Mount Sinai Hospital,
but particularly those born following high-risk
pregnancies or in need of intensive care. Close
to 7,000 infants a year are delivered in
the hospital and over 1,100 per year are
CLINICAL admitted to our neonatal intensive care
unit (NICU). To ensure infants born at
Mount Sinai Hospital have the best start
in life, the Department of Paediatrics provides a
breadth of services that range from perinatal care
through to early childhood.
The Department of Paediatrics continually strives to
improve patient care. To this end, the Department
has made significant changes since 2009 to
improve the quality and continuity of care provided
to our patients, with a significant focus on delivering
patient and Family Integrated Care. Throughout
this report we provide details and examples of the
changes in the Department, but key changes and
services are highlighted here:
12 DEPARTMENT OF PAEDIATRICSCLINICAL SERVICES
Antenatal Consults
Antenatal consults are an important part of the services provided by physicians in the
Department of Paediatrics. They provide consults to both in-patient high-risk mothers in the
Antenatal Ward and Labour and Delivery Unit and out-patient high-risk mothers in the High-
Risk Pregnancy Program.
Number of Antenatal Consults
2009 2010 2011 2012 2013 2014 2015 2016 2017 2018
650 667 740 806 748 683 722 681 675 726
Delivery Room Care
Physicians, nurses, and respiratory therapists are all intimately involved in providing delivery
room care for all infants who are born at Mount Sinai Hospital. Whether it is a planned high-risk
delivery with an infant who needs immediate respiratory care and stabilization, an emergency
situation, or the birth of a healthy baby, the Paediatrics Team is always ready to provide
newborn care.
Healthy Baby Care in Mother and Baby Unit
Pediatricians, nurses, and respiratory therapists ensure that all infants born at Mount Sinai and
staying in the 55-bed David & Stacy Cynamon Mother and Baby Unit are healthy and ready to
go home before discharge.
Number of Mother and Baby Unit Discharges
2009 2010 2011 2012 2013 2014 2015 2016 2017 2018
5773 5779 5802 5571 5846 5473 6205 5621 5711 6014
10-Year Report 13Neonatal Intensive Care Unit
The Mount Sinai NICU is a 62-bed, mixed-acuity unit that provides Level 2/3 neonatal care.
We admit more than 1,100 infants per year on average, and since we moved to our new NICU
space in 2014, all infants have their own rooms. The NICU is focused on interdisciplinary
care; neonatologists, nurses, respiratory therapists, social workers, nutritionists, lactation
consultants, psychiatrists, phycologists, and other specialists all work together to provide both
the infants and their families high-quality care.
Number of NICU Discharges
2009 2010 2011 2012 2013 2014 2015 2016 2017 2018
1083 1214 1212 1220 1118 1111 1161 1164 1219 1197
Postnatal Ambulatory Clinic
Established in 2011, the Postnatal Ambulatory Clinic (PNAC) provides consistent outpatient
care during the early postpartum and neonatal period to infants delivered at Mount Sinai and
their mothers. The clinic is open 7 days a week and paediatricians provide screening and
neonatal assessments for near-term infants less than 3 months old and preterm infants of less
than 1 month corrected age. An ophthalmologist provides follow-up eye exams for retinopathy
of prematurity and maternal services include breastfeeding support, maternal staple/clip
removal, maternal postpartum assessment, and maternal blood work.
Number of Paediatric PNAC Visits
2009 2010 2011 2012 2013 2014 2015 2016 2017 2018
0 0 302 584 660 755 793 699 737 765
Breastfeeding Support
The Department of Paediatrics NICU has integrated lactation consultants who provide 7-day-a-
week lactation support for all mothers with infants in the NICU.
Neonatal Developmental Follow-Up Clinic
Since 2010, the Neonatal Developmental Follow-Up Clinic provides screening and diagnostic
services for high-risk infants. The interdisciplinary staff works together to diagnosis infants with
any adverse outcomes as early as possible.
Number of Follow-Up Visits
2009 2010 2011 2012 2013 2014 2015 2016 2017 2018
0 591 1327 1298 1334 1462 1500 1496 1397 1329
14 DEPARTMENT OF PAEDIATRICSFACILITY IMPROVEMENT
In the past 10 years, the Mother and Baby Unit, Department of Paediatrics office space, and
NICU moved into new, state-of-the-art spaces. In 2012, the David and Stacey Cynamon Mother
and Baby Unit opened. It has more than 40 beds, decentralized care stations to enable efficient
computer charting and allow clinicians to be closer to the point of care, and a clean and safe
environment for patients including more sinks close to patient rooms and enhanced security.
The new Department of Paediatrics administration space opened in 2013 with an efficient
design that placed offices around a central administrative area and allowed more staff to work
together in the same space.
In 2014, Mount Sinai Hospital opened a new 62-bed NICU with a mixed-acuity model and single-
room design. In the mixed-acuity model, either Level 2 or Level 3 NICU care can be provided
in any bed, which improves access to tertiary care and limits infant movement. The single-room
design allows each infant to have a private room with improved noise, light, and infection control
in addition to space and privacy for families. It also makes it easier for parents to participate
in daily medical rounds. In addition to single rooms, the new NICU has 6 resuscitation bays, 8
negative pressure airborne isolation rooms, a new fleet of VN500 ventilators, and a procedure
room. For families, there is a comfort care room, family lounge space, and improved pumping
space for mothers, making it easier for families to spend time with their infants in the NICU.
The big windows let light in and make the space welcoming, and several rooms even have an
amazing view of the CN tower.
10-Year Report 15CHANGES IN STAFF NUMBERS
AND ORGANIZATION
The job descriptions of staff physicians were clarified, with each neonatologist assigned to
distinct career tracks as academic clinicians, scientists, educators or administrators, and with
clear responsibilities, expectations and performance-based reimbursement. We increased the
number of staff neonatologists in the Department by 3.7 full-time equivalent, and 1.0 full-time
equivalent staff pediatricians now provide coverage within the Mother and Baby Unit, which
minimizes the need for external paediatricians. Also, the coverage model was changed to
a weekly format from a daily format to improve continuity of care for patients in the Level I
nursery. Reorganization of the Department and improvement in our revenue stream enabled
us to reduce the annual departmental operating deficit while increasing and introducing new
services at the same time. In addition, Mount Sinai Hospital now has the most cost-efficient
NICU among the hospitals in Toronto, delivering care at the lowest cost per patient day.
Since 2009, there have been many staffing changes in the Department of Paediatrics. To the
nursing team we added a Nurse Educator position, a nursing Clinical Coordinator position
and a dedicated Quality-Safety Nurse. These positions were added to improve the quality
and continuity of care provided in the Department. In particular, the Nurse Educator provides
training for nurses and the Quality-Safety Nurse coordinates and tracks the activities of the
Improving Quality Team. The respiratory therapists also made staffing changes to improve
the quality of care. Now there is one NICU respiratory therapist dedicated to resuscitation and
another dedicated to transport. These changes ensure fragile infants receive the consistency of
care they need, even when they are transported for diagnostic procedures or surgery.
CHANGES IN SERVICES
AND CARE DELIVERY
An area of focus for the Department of Paediatrics Clinical Care team over the last 10 years
has been to bring more services in-house and increase access to point-of-care technology.
With these goals in mind, the Neonatal Developmental Follow-Up Clinic moved in-house in
2010, the PNAC clinic was established in 2011, and the Rogers Hixon Ontario Milk Bank was
established at Mount Sinai Hospital in 2013. Furthermore, the clinicians in the Department of
Paediatrics have become national leaders in the development and implementation of point-of-
care technology like targeted neonatal echocardiography and lung ultrasound.
16 DEPARTMENT OF PAEDIATRICSNeonatal
Intensive Care
KEY METRICS
1164
average 33.9
14.8
discharges weeks’
per year average
gestation
days average
stay
64% infants
< 37 weeks’
gestation
2246
grams average
birth weight
75%
singletons
21% twins
4% triplets
or more
10-Year Report 17FAMILY INTEGRATED CARE (FICARE)
The Mount Sinai Hospital NICU is a world leader in a new care philosophy called Family
Integrated Care (FICare) that was developed by Dr. Shoo Lee and Dr. Karel O’Brien. FICare is
a philosophy of care that empowers parents to become a part of their infant’s care team in the
NICU. When infants are admitted to the NICU they are physically separated from their parents
for extended periods of time, which can affect the physical, psychological, and emotional health
of both infants and their parents. The goal of FICare is to facilitate collaboration between NICU
staff, Veteran Parents, and current parents to integrate families as partners in their infant’s
NICU care team, which will promote parent-infant interactions and build parents’ confidence to
care and advocate for their infant, both in the NICU and when discharged.
Dr. Lee and Dr. O’Brien piloted FICare at Mount Sinai Hospital in consultation with an inter-
professional program steering committee from 2011 to 2012, enrolling a total of 42 infants and
their mothers. The pilot study showed that infants experiencing FICare had higher weight gain
and breastfeeding rates at discharge and FICare parents had lower stress and anxiety than
controls.1 They followed up the pilot study with a cluster randomized controlled trial that took
place between 2013 and 2015 and included infants born at 25 NICUs in Canada, Australia, and
New Zealand. In 2018, the results were published showing that FICare improves infant weight
gain, reduces parental stress and anxiety, and improves high-frequency breastfeeding rates.2
Recently, they also published an abstract and are working on a manuscript showing that FICare
also improves infant neurodevelopmental outcomes.
The success of FICare has piqued the interest of NICUs around the world, many of whom have
come to visit and learn from the Mount Sinai NICU. A national FICare Steering Committee was
established to help standardize and disseminate information about FICare and enable the
program to scale while still maintaining its integrity. In 2017, the FICare website and toolkit were
1
O’Brien, K. et al “A pilot cohort analytic study of Family Integrated Care in a Canadian neonatal intensive care unit” BMC
Pregnancy Childbirth 2013;13Suppl1:S12
2
O’Brien, K. et al “Effectiveness of Family Integrated Care in neonatal intensive care units on infant and parent outcomes:
a multicentre, multinational, cluster-randomised controlled trial” Lancet Child Adolesc Health 2018;2(4):245-254.
18 DEPARTMENT OF PAEDIATRICSdeveloped to enable the expansion of FICare in both Level 2 and Level 3 NICUs across Canada.
Going forward, the team is working to both implement FICare for infants who need critical care
and extend psychosocial and peer support for parents for a full year after infant discharge.
As FICare continues to grow, the Mount Sinai NICU is adding programs to help parents who
are not able to be in the NICU as much as they wish. For example, in the past year a cuddler
program has begun for infants whose parents cannot be present to hold them, and a reading
program has been established where high school students read to infants in their family’s
absence. Both holding infants and reading to infants in the NICU were reported to improve their
neurodevelopmental outcomes.
PARENT EDUCATION AND
PSYCHOSOCIAL SUPPORT
Even before the implementation of FICare, the Department of Paediatrics was fully committed
to patient and family-centered care. Our family programs are coordinated by a dedicated Parent
Resource Nurse and Social Worker in partnership with a team of social workers, lactation
consultants, nurses, physicians, respiratory therapists, and veteran parent volunteers. In the
last three years, following the implementation of FICare, the family education and psychosocial
support services have been re-vamped and grown to meet the changing needs of families.
Parent Education
The Mount Sinai NICU has a vibrant parent
education program. Parent classes happen
daily and are scheduled by month. Classes are
developed and led by a diverse group of NICU
team members and cover a variety of topics
relevant to preterm birth. Typically 10 to 12 parents
attend each session and both current NICU parents
and parents of recently discharged infants are
welcome to attend.
Parent Buddy Program
More and more research shows that parental
mental health is essential for the best infant
and family outcomes. For this reason, parent
psychosocial support is a key part of care in the
Mount Sinai NICU. We have 3.0 full-time equivalent
Social Workers and a dedicated Parent Resource
Nurse in the NICU to help parents navigate the
complex NICU environment and manage difficult
care decisions for their infant. In addition, we
have regular peer support groups for parents
(both mothers and fathers) and the Parent Buddy
Program.
10-Year Report 19The Parent Buddy Program was established in 1991 as a way to help parents manage the
emotional complexity of having an infant in the NICU. Parent Buddies are parent volunteers
who had an infant in the NICU, and they are matched with interested current NICU parents on
the basis of their infant’s gestational age, weight, and situational criteria. There are currently
about 50 Parent Buddy Volunteers and about 30% of NICU parents are matched at any given
time. New Parent Buddies are trained twice a year using a Parent Buddy Training Program that
was recently re-vamped by the social workers, Parent Resource Nurse, and Veteran Parent
volunteers. Going forward the team is working to recruit more diversity in the volunteer pool for
the Parent Buddy Program.
PARENT ADVISORY BOARD
The Mount Sinai NICU is proud of the active role Veteran Parents play in all aspects of the NICU
operations. Veteran Parents were an integral part of the development and implementation of
the FICare philosophy in the NICU, and they continue to play an important part the growth and
development of our NICU community. The Parent Advisory Board, which has been in existence
for over 20 years, is the primary mechanism for Veteran Parents to stay involved with the Mount
Sinai NICU. In 2017, the Board reorganized and now has two co-chairs who manage the Board
leadership. The Board has 50 members, but 10 to 12 primary members who meet once a month
for two hours in the evening, and is supported by the social work lead and Parent Resource
Nurse. The Board is responsible for reviewing parent documents and policies for the NICU,
updating content on the display boards in the NICU, participating in research, holiday events
in the NICU (e.g. Christmas, Mother’s Day, and Father’s Day), World Prematurity Day Events,
Journey Beads and NICU Holiday Baskets with Handfull Hearts, Veteran Parent Picnic, and the
quarterly newsletter for the Perinatal Parent Association (1200 former NICU parents).
20 DEPARTMENT OF PAEDIATRICSCONTINUOUS QUALITY
IMPROVEMENT
The NICU team at Mount Sinai is dedicated to working as an interdisciplinary team to
continuously improve quality of care and is a national leader in quality improvement initiatives.
In 2011, we established an Improving Quality Team to improve the safety and quality of care of
NICU patients, families, and staff through communication, feedback, and ongoing education.
A key addition to the Improving Quality Team was a Quality-Safety Nurse in the Evidence-
based Practice for Improving Quality (EPIQ) program, a position Mount Sinai was the first to
implement. The Quality-Safety Nurse works closely with the Quality Improvement lead, the site
coordinator for the national EPIQ program, and the Mount Sinai Hospital Quality and Safety
Council that is made up of 15 people (12 nurses, 1 medical lead, 1 respiratory therapist, and 1
lactation consultant).
Quality improvement at Mount Sinai focuses on 4 priorities:
PATIENT HEALTH
PATIENT STAFF
SAFETY AND SYSTEMS
EXPERIENCE SATISFACTION
OUTCOMES IMPROVEMENT
There are weekly Quality Rounds for the whole NICU as well as biweekly Quality and Morbidity
Rounds where the team reviews past actual and potential safety events, monitors trends, does
root-cause analysis, and identifies potential solutions. In addition, in the past 5 years there have
been many quality improvement initiatives that involve the whole unit, including promoting brain
health, infection prevention, line bundle and new line configuration, delayed cord clamping
to improve outcomes, preventing unplanned extubation, pressure injury prevention, device
integration into the electronic medical records, and process improvements related to moving into
a new unit.
Several of the quality initiatives in the Mount Sinai NICU were the first of their kind and highly
successful. For example, the team earned an Accreditation Leading Practice award for their
work establishing electronic surveillance of medical devices to prevent infection. Another project
that earned an Accreditation Leading Practice award was an initiative that identified lack of
visibility and awareness factors that contribute to unplanned extubations. The project led to new
guidelines and reference materials outlining the best care practices for intubated infants that led
to a more than 50% decrease in unplanned extubations. Last, the Mount Sinai NICU recently
initiated and implemented a program that trains and certifies bedside nurses to insert central
venous lines (PICC) in collaboration with the medical team. By enabling nurses to perform this
essential task, infants no longer need to wait as long to have a PICC inserted. The consistency in
the availability of PICC insertion expertise substantially reduced the number of infants referred to
image guided therapy and reduced the number of PICC related infections.
10-Year Report 21POINT-OF-CARE TECHNOLOGY
Targeted Neonatal Echocardiography
Targeted neonatal echocardiography (TNE) is a point-of-care technology that uses cardiac
ultrasound to assess cardiac function and blood flow in infants. When integrated with clinical
signs, TNE helps guide therapeutic decisions in real time, which has the potential to refine
care and improve outcomes. In 2011, we acquired state-of-the-art ultrasound equipment and
recruited Dr. Amish Jain to start an in-house TNE service. Before TNE service was available at
Mount Sinai Hospital, the echocardiography service had to be organized through the Hospital
for Sick Children, including transfer of infants in some cases, which delayed infant diagnosis and
increased the risk of complications. Since the in-house TNE service began in 2012, consults can
be done at the infant’s bedside with reports available on the same day. Further, the clinicians are
able to access clinical neonatal hemodynamic expertise on a day-to-day basis.
In addition to bringing the TNE service to Mount Sinai, Dr. Jain developed an imaging protocol
that is now in use at Mount Sinai, Sunnybrook, and SickKids and is in the process of being
adopted as a national guideline. He is working to expand the clinical and academic use of TNE
across Canada and beyond by formalizing TNE training into a subspecialty fellowship program
called the Neonatal Hemodynamic Fellowship.
Number of TNE Consults
2012 2013 2014 2015 2016 2017 2018
111 126 214 301 365 516 489
Lung Ultrasound
Lung ultrasound is an emerging point-of-care technology that has the potential to reduce
the use of x-rays in infants by 50% while improving diagnostic sensitivity and specificity.
Dr. Adel Mohammed and Dr. Yenge Diambomba spearhead lung ultrasound research and
training in Sinai Health System. They analyze lung ultrasound images then make treatment
recommendations based on the results. In addition, they are working to analyze the impact of
the lung ultrasound program and define Canadian-specific guidelines for the lung ultrasound
technology. To this end, Dr. Mohammed established the national Lung Ultrasound Committee to
set guidelines and policy for implementing and using lung ultrasound.
22 DEPARTMENT OF PAEDIATRICSROGERS HIXON ONTARIO
HUMAN MILK BANK
The Rogers Hixon Ontario Human Milk Bank at Mount Sinai Hospital has
~70%
grown rapidly since it opened in 2013 under the leadership of Medical Director
Dr. Sharon Unger and in partnership with the Hospital for Sick Children and
Sunnybrook Health Sciences Centre. The Milk Bank opened with the goal of
of preterm infants in Ontario
providing human milk to infants in the NICU born at less than 1250 grams.
require some donor milk
These infants are particularly fragile, and it has been shown that mother’s
> 5000
own milk improves both short and long-term infant health; however, only 30%
of mothers with infants in the NICU have enough breast milk to exclusively
feed their infant mother’s own milk. The Rogers Hixon Ontario Milk Bank has Litres of donor milk
received a huge amount of support and enthusiasm from families, health are dispensed each year
care providers, and donor mothers alike, which has allowed the Milk Bank to
100-125
grow much faster than expected. It now provides donor milk for infants born
at less than 1800 grams and born at less than 34 weeks of gestation at 8
Level 3 NICUs and 29 Level 2 NICUs in Ontario. In addition, in 2016, Mount Litres of donor milk
Sinai Hospital became the first hospital in Canada to make informed consent are dispensed each week
mandatory for infant artificial formula feeding rather than donor milk feeding.
> 2000
approved donors to date
29
Ontario Level 2 NICUs
receive donor milk
8
Ontario Level 3 NICUs
receive donor milk
10-Year Report 23The Milk Bank has enabled large-scale research projects analyzing the effectiveness of feeding
preterm infants human milk. In 2016, Dr. Unger and her colleagues in the DoMINO study group
published the results of a pragmatic randomized controlled trial showing that donor milk as a
supplement to mother’s own milk provided significant protection against necrotizing enterocolitis
with similar long-term neurodevelopmental outcomes.3 In a second publication in 2018,4 it was
reported that the families of infants supplemented with donor milk lost significantly less time
from paid work than those supplemented with formula when followed to 18 months’ corrected
age. Also in 2018, the OptiMOM group published the results from a randomized controlled trial
showing that, when infants are fed a diet of mother’s milk supplemented with donor milk as
required, there is no advantage to using a fortifier that is human milk based compared to bovine
based, a significant cost saving.5 Going forward, the Milk Bank team has funding to continue
analyzing the benefits of human milk, including the long-term effects of receiving human milk
(at 5 years of age), effect of human milk on the infant microbiome,6 ethics of donor milk,7 and
an in-depth analysis of human milk biology.
NEONATAL DEVELOPMENTAL
FOLLOW-UP CLINIC
The Mount Sinai Neonatal Developmental Follow-Up Clinic was established in 2010 under the
leadership of Dr. Edmond Kelly as Clinical Director. The clinic provides screening and diagnostic
services for infants born at less than 30 weeks’ gestation or less than 1250 grams birth weight. In
addition, infants who had laser therapy, chest shunts in utero, fetal therapies, congenital hernias,
spina bifida or other complications are referred to the Follow-Up Clinic. The clinic staff includes
two occupational therapists, a physical therapist, nurse, nurse practitioner, speech/language
therapist, psychologist, psychiatrist, and clinic coordinator. Together, the staff works to diagnose
high-risk infants with any adverse outcomes such as cerebral palsy, speech delays, autism, motor
deficits, behavioral disorders, or learning disorders, as early as possible.
The Follow-Up Clinic enrolls over 300 infants a year, has an 87% average follow-up rate, and
enters all infants into the Canadian Neonatal Follow-Up Network (CNFUN) database. Each infant
visits the clinic at 4, 8, 12, 18, and 36 weeks’ corrected gestational age for screening. If a problem
is identified the Follow-Up team connects patients with dieticians, community care access
centres, speech and language specialists, or other specialist care, depending on the child’s
needs. Since 2010, more than 2000 infants from the Follow-Up Clinic were included in CNFUN.
Data collected by the Follow-Up Clinic, both as part of CNFUN and for individual studies,
are an important part of many research projects that assess neonatal care and its impact on
neurodevelopmental outcomes. Some examples of characteristics or care processes that
were analyzed for association with neurodevelopmental outcomes are surgical ligation for
3
O’Connor, D.L. “Effect of Supplemental Donor Human Milk Compared With Preterm Formula on Neurodevelopment of
Very Low-Birth-Weight Infants at 18 Months: A Randomized Clinical Trial” JAMA 2016;316(18):1897-1905.
4
Trang, S. “Cost-Effectiveness of Supplemental Donor Milk Versus Formula for Very Low Birth Weight Infants” Pediatrics
2018;141(3): pii: e20170737
5
O’Connor, D.L. “Nutrient enrichment of human milk with human and bovine milk-based fortifiers for infants born weighingpatent ductus arteriosus, acute severe pulmonary hypertension following rescue treatment with
inhaled nitric oxide, donor milk versus formula for very low birth weight infants, bevacizumab
injections for retinopathy of prematurity, inhaled and systemic steroid exposure, Family
Integrated Care, midazolam dose, maternal anti-Ro antibodies, slow fetal heart rate, prolonged
dexamethasone therapy, and nutrient intake in the first two weeks of life.
In January 2018, the Follow-Up Clinic moved to new facilities where they have more space
and easier access to transit. Moving forward the Follow-Up Clinic is working to incorporate new
screening methods to detect autism earlier, and online screening for older children to eliminate
barriers to follow up like long drives and parking costs. Last, given the impact parental mental
health has on neonatal outcomes, the Follow-Up Clinic would like to incorporate screening for
parental post-natal depression to actively promote whole family health as a way to improve
infant outcomes.
Discharge from the NICU is both an exciting and challenging time for families with infants born
preterm. The transition home can be stressful and isolating for families and can contribute
to parental mental health issues. Healthy, supportive parents are key to positive infant
outcomes; therefore, in 2015, Dr. Jennifer Young, under the guidance of Dr. Shoo Lee and Dr.
Karel O’Brien, and in collaboration with Healthy Start, Healthy Future, and Life With A Baby,
established Life With A Preterm Baby. The mission of Life with A Preterm Baby is “to strengthen
and build parent confidence by providing ongoing support to families of preterm babies.”
Through a combination of online resources, annual symposiums, webinars, Facebook chats,
and meet up events, Life With A Preterm Baby provides parents of preterm infants professional
and peer support targeted to the challenges of parenting a child born preterm. Dr. Young is
working to expand Life With A Preterm Baby to include regular peer support groups for parents
throughout the city of Toronto.
6 12
18 annual World
4 annual
symposiums webinars meet ups 9 Facebook
chats
online
hangouts
Prematurity
Day events
10-Year Report 25The Department of Paediatrics has experienced many changes in
the last ten years, including the implementation of FICare, opening
of the Rogers Hixon Ontario Human Milk Bank, moving into a new
NICU with a mixed-acuity model, establishment of a NICU culture
focused on continuous quality improvement, and the integration of
Outcomes new point-of-care technology. At the same time, the number of beds
in the NICU increased, over 30 new nurses were hired, and more
infants needing critical care (i.e. born with high SNAP-II [Score for
Neonatal Acute Physiology-II] scores, at extremely low gestational
ages, and with a low birth weight) were admitted to the NICU.
Number of infants ≤ 32 weeks’ gestation
500
31 to 32 weeks’
gestation
400
29 to 30 weeks’
gestation
300
27 to 28 weeks’
200 gestation
25 to 26 weeks’
100 gestation
22 to 24 weeks’
0 gestation
2009 2010 2011 2012 2013 2014 2015 2016 2017 2018
26 DEPARTMENT OF PAEDIATRICSMount Sinai Hospital
Infants with a SNAP II score > 20 Canadian Neonatal Network
35%
30%
25%
20%
15%
10%
5%
0%
2009 2010 2011 2012 2013 2014 2015 2016 2017
Mount Sinai Hospital
Survival without morbidity rate Canadian Neonatal Network
80%
70%
60%
50%
40%
30%
20%
10%
0%
2009 2010 2011 2012 2013 2014 2015 2016 2017
Mount Sinai Hospital
Mortality rate Canadian Neonatal Network
9%
8%
7%
6%
5%
4%
3%
2%
1%
0%
2009 2010 2011 2012 2013 2014 2015 2016 2017
Mount Sinai Hospital
Breastmilk only at discharge rate Canadian Neonatal Network
80%
70%
60%
50%
40%
30%
20%
10%
0%
2010 2011 2012 2013 2014 2015 2016 2017
10-Year Report 27Since 2009, the Department of Paediatrics has rapidly
developed its research capacity and is now the most
productive research NICU in Canada. In addition to
physician researchers, our
RESEARCH
Department also engages
Veteran Parents and non-
physician clinical staff in
research including nurses,
dieticians, pharmacists, social workers, and respiratory
therapists. Department members are leading or involved
in many studies including national and international large,
multicentre studies.
One key component of the research success of the
Department of Paediatrics is the support from the
Maternal-Infant Care Research Center (MiCARE), which
was established in 2009 by Dr. Shoo Lee. Funded
through research grants from CIHR and the Ontario
Ministry of Health and Long-Term Care, MiCare includes
4 PhD scientists and 13 other research staff to support
researchers in the Department. MiCARE is affiliated with
the Lunenfeld-Tanenbaum Research Institute, which
expanded to include clinical research in late 2014.
28 DEPARTMENT OF PAEDIATRICSResearch Areas
NEWBORN PHYSIOLOGY
Hemodynamics and Cardiac Physiology
Dr. Amish Jain is studying cardiac physiology of the newborn infant and refining the use of
functional echocardiography in diagnosis and management of cardiovascular problems,
particularly for those born preterm. Specifically, he is interested in understanding the
pathophysiology and identifying the best practices for treatment of acute and chronic pulmonary
hypertension, shock, and patent ductus arteriosus.
Hemodynamics and Brain Function
Dr. Poorva Deshpande is interested in monitoring the brain function and blood flow of preterm
infants at the bedside. Her research integrates heart function assessment by echocardiography
with continuous brain monitoring techniques such as near-infrared spectroscopy (IRS) and
amplitude integrated electroencephalography (aEEG) to identify preterm infants at risk of
brain injury.
Hemodynamics in Sepsis
Dr. Ashraf Kharrat is using functional echocardiography to study neonatal hemodynamics in
sepsis and septic shock. In addition she is working to integrate cardiopulmonary physiology
findings into quality improvement initiatives that identify best care practices.
10-Year Report 29PATIENT-ORIENTED RESEARCH
Outcomes Research
and Evidence-Based Medicine
Dr. Prakesh Shah is a leader in evidence-based medicine, quality improvement, and systematic
reviews. He is Director of the Canadian Neonatal Network™ (CNN) and both founder
and Director the Canadian Preterm Birth Network (CPTBN), established in 2017, and the
International Network for Evaluating Outcomes (iNEO) of neonates, established in 2012. All
three neonatal networks collect population-based data on infants admitted to Level 3 NICUs
and use the information for outcomes research, benchmarking, and comparative effectiveness
research. Dr. Shah holds a Canadian Institutes of Health Research (CIHR) Applied Chair in
Reproductive and Child Health Research.
Quality Improvement
and Health Services Research
Dr. Shoo Lee is the Scientific Director of the Institute of Human Development, Child and Youth
Health at the CIHR. Dr. Lee founded the Canadian Neonatal Network™ (CNN) in 1995 and
developed and implemented the Evidence-based Practice for Improving Quality (EPIQ) method of
quality improvement as an effective way to improve infant outcomes using data from CNN. EPIQ
has transformed care in tertiary NICUs across Canada as well as in countries across the world.
Human Milk
and Nutrition
Dr. Sharon Unger is Medical
Director of the Rogers Hixon
Ontario Human Milk, founded in
2013, and is a leading member
of a University of Toronto
research team that is funded
by CIHR to conduct studies on
human milk and infant nutrition.
In particular, Dr. Unger’s
research focuses on analyzing
the benefits of mother’s own milk
versus formula, the microbiome
in different kinds of human milk,
the association of human milk
with infant outcomes, and the
biology of human milk.
30 DEPARTMENT OF PAEDIATRICSFamily Integrated Care
Dr. Shoo Lee and Dr. Karel O’Brien developed and implemented a new
care philosophy called Family Integrated Care (FICare) that integrates
parents into their infants’ care teams. They recently completed
an international cluster randomized controlled trial that showed
improved infant weight gain, decreased parental stress and anxiety,
and increased high-frequency breastfeeding in infants experiencing
FICare. Building on their success, FICare is expanding into Level 3
and Level 2 NICUs across Canada and internationally. Dr. O’Brien is
also working to assess whether infants who are critically ill can safely
benefit from FICare.
Family Integrated Care Home
Dr. Jennifer Young and Dr. Karel O’Brien are working to expand
FICare support to families post-NICU discharge in a program called
FICare Home. They are studying how timely referral to a home-visiting
program for high-risk families and regular peer support targeted
to families experiencing preterm birth can improve family function,
parental stress, and infant health.
Pain Reduction
Dr. Vibhuti Shah uses her expertise in clinical trials and systematic
reviews to investigate interventions that minimize infant pain. In addition,
she is actively involved in the implementation of new evidence-based
pain management practices.
10-Year Report 31Point-of-Care Technologies
Dr. Adel Mohammed and Dr. Yenge Diambomba are working to use lung ultrasound severity
scoring as a diagnostic tool for the early prediction of bronchopulmonary dysplasia. In addition,
they developed a lung ultrasound workshop to train clinicians across Canada how to use lung
ultrasound. They are also studying the lung ultrasound implementation process and evaluating
lung ultrasound training methods.
Neonatal Follow-Up
Dr. Edmond Kelly is the site leader for the Canadian Neonatal Follow-Up Network (CNFUN), which
maintains a national database and is funded by CIHR to study neurodevelopmental outcomes of
high-risk infants. He is actively involved in many studies associating care practices with adverse
neurodevelopmental outcomes, including a recent study showing systemic steroid use before 4
weeks of age was associated with significantly worse neurodevelopmental outcomes.
EDUCATION RESEARCH
Neonatal Resuscitation
and Simulation Training
Dr. Emer Finan has been a member of the Canadian Paediatric Society (CPS) Neonatal
Resuscitation Program (NRP) Steering Committee since 2010 and Chair since 2018. She has
also been the CPS Liaison to the American Academy of Paediatrics NRP Steering Committee
since 2018. As a member and, more recently, Chair of the CPS NRP Education Subcommittee,
Dr. Finan actively contributed to the development of educational materials for the launch
of the 6th and 7th editions of NRP in Canada. In addition, Dr. Kin Fan Young Tai is a NRP
regional trainer who has facilitated and taught NRP instructor and provider courses to residents
throughout University of Toronto health centres. Dr. Finan and Dr. Young Tai, along with Carol
Chang, RN, conduct research on NRP procedures and ways to improve teaching of NRP
including use of simulation techniques.
Curriculum Development and Trainee
Evaluation
As Director of the Integrated Neonatal-Perinatal Training Program at the University of Toronto,
Dr. Emer Finan is involved in the development of new training and assessment tools. In her
role, she is working to implement competency-based medical education within the Division
of Neonatology. Competency-based medical education focuses on training outcomes, which
enables teachers to provide more effective and timely feedback to trainees while taking a
learner-centered approach through the training stages.
The MiCare Research Centre was established at Mount Sinai Hospital in 2009 by Dr. Shoo
Lee. The goal of MiCare, then and now, is to strengthen Mount Sinai’s, Ontario’s, and Canada’s
health care system by improving the quality of care for newborn and paediatric patients.
32 DEPARTMENT OF PAEDIATRICSMATERNAL-INFANT CARE RESEARCH CENTRE (MICARE) MiCare is a central data repository and analysis centre for all Canadian networks and hospitals that provide care for high-risk mothers and infants and one international neonatal network. Dr. Shoo Lee founded the Canadian Neonatal Network™ (CNN) in 1995 to collect data on characteristics, treatments, and outcomes for all infants admitted to Level 3 NICUs in Canada, and the database was then expanded to include the Canadian Neonatal Follow-Up Network (CNFUN), Canadian Neonatal Transport Network (CNTN) and Canadian Pediatric Surgery Network (CAPSNet). In 2012, Dr. Prakesh Shah established the International Network for Evaluating Outcomes of neonates (iNEO) to collect population-based outcomes data for infants
MiCare staff deliver essential research support services that enable high-caliber clinical
research at Mount Sinai Hospital, throughout Canada and globally. MiCare researchers and
biostatisticians provide expertise about study design and statistical analysis for perinatal-
neonatal research projects as well as assist in the preparation of comparative reports for
Ontario NICUs. MiCare database managers maintain the current network databases and
facilitate data access, as well as provide advice on the design, development and management
of research databases to other interested groups. Finally, writing and editing services help
researchers prepare manuscripts for publications and apply for grants.
A key service provided by MiCare is benchmarking for the Mount Sinai NICU plus 30 Level
3 NICUs in Canada. Benchmarking is provided biannually and gives NICUs feedback on
processes or outcomes they are targeting in their quality improvement initiatives. NICUs then
use the benchmarking reports to adjust their initiatives in response to real-world data about
the effect of the implemented changes. Benchmarking by MiCare is also used to evaluate
new technologies and models of care like the targeted neonatal echocardiography service
implemented in the NICU.
34 DEPARTMENT OF PAEDIATRICSRESEARCH PRODUCTIVITY
AND AWARDS
The services described above along with high-caliber MiCare researchers have made MiCare
Research Centre at Mount Sinai highly productive and effective.
2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 TOTAL
Abstracts 43 68 79 61 54 68 83 58 90 62 663
National
43 59 67 80 64 42 33 31 15 26 439
Presentations
International
29 32 66 70 96 47 79 51 39 57 531
Presentations
Awards
6 15 12 16 10 7 5 12 15 6 104
and Honours
Publications 55 54 73 103 79 66 80 69 77 82 736
ANNUAL AMOUNT OF GRANT FUNDING
2009 $4,711,898
2010 $6,251,396
2011 $7,231,331
2012 $9,608,427
2013 $9,513,117
2014 $6,416,354
2015 $9,726,196
2016 $14,964,759
2017 $19,332,055
2018 $16,213,400
Total $103,968,934.48
10-Year Report 35Medical education stands on an equal footing with
clinical excellence and world-class research in the
Department of Paediatrics. The large volume of complex
clinical cases seen in the in-patient
EDUCATION
and out-patient maternal, foetal,
and neonatal populations allows
the Department of Paediatrics to
provide state-of-the-art training to
multiple levels of learners in the NICU, Mother and Baby
Unit, Neonatal Developmental Follow-Up Clinic, and
Special Pregnancy Program Antenatal Clinic.
36 DEPARTMENT OF PAEDIATRICSDr. Emer Finan, who holds a graduate degree in health professional education, is the Director
of the Integrated Neonatal-Perinatal Fellowship Program at the University of Toronto. All
faculty are involved in teaching during their clinical service months and also participate in
undergraduate and postgraduate didactic teaching for medical trainees, graduate student
teaching, and continuing medical education. In accordance with the high value the Department
places on inter-professional education, nurses, respiratory therapists, pharmacists, dietitians,
therapists and social workers are actively involved in didactic and clinical education of medical
postgraduate trainees. The University of Toronto Neonatal-Perinatal Training Program has full
accreditation status with the Royal College of Physicians and Surgeons of Canada.
Dr. Finan’s expertise, along with that of Dr. Ann Jefferies who retired in 2016, has allowed
Mount Sinai Hospital to play a leadership role in postgraduate medical education and faculty
development at the specialty and subspecialty levels at the University of Toronto, as well as
nationally. Dr. Jefferies developed the current two-year curriculum for the perinatal-neonatal
training program using Delphi methodology and Dr. Finan helped implement it in 2012. In
addition, Dr. Jefferies co-led the development of both the Neonatal Structured Oral Exam and
objective structured clinical examinations (OSCE) that were disseminated nationally and are
used by virtually all training programs in Canada. Dr. Finan is currently involved in examination
development for both the Neonatal Structured Oral and OSCEs. As a corresponding member
of the Royal College Subspecialty Committee, Dr. Finan has contributed to the development
of subspecialty specific standards of training and documents to guide both competency-based
subspecialty training and assessment following the implementation of “Competence by Design”
for neonatal-perinatal medicine in 2020.
Neonatal- Other
Academic Perinatal U of T
Year Paediatric Residents Fellows Residents External Electives TOTAL
PGY1 PGY3 Residents Fellows
2009-2010 22 24 21 9 3 2 60
2010-2011 24 23 22 7 1 0 55
2011-2012 25 20 22 8 6 0 59
2012-2013 22 21 22 12 3 1 59
2013-2014 23 12 24 4 3 1 67
2014-2015 27 22 19 4 10 2 84
2015-2016 30 20 24 5 8 0 87
2016-2017 27 24 23 4 8 2 88
2017-2018 30 25 20 5 7 0 87
TOTAL 207 179 173 54 46 7 579
Physician
Academic Year Medical Midwifery TOTAL
Observers
2009-2010 6 3 5 14
2010-2011 9 3 1 13
2011-2012 5 5 13 23
2012-2013 2 3 2 7
2013-2014 8 3 2 13
2014-2015 1 6 12 19
2015-2016 0 4 10 14
2016-2017 1 3 10 14
2017-2018 0 5 16 21
TOTAL 24 32 69 125
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