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| NICU Fellowship Program |
| Neonatal Fellowship Program |
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Neonatal Intensive Care Unit is accredited by National Neonatology Forum of India. IAP-Neonatology Chapter recognized our institution in November 2008 for IAP-Neonatology Fellowship Program for two candidates every year commencing from January 2009.
The Neonatology Chapter of the Indian Academy of Pediatrics is a subspecialty chapter of the Academy, which deals with academic, scientific and community activities conducted by the Academy for the care of newborn babies in the country. Beginning 2008, the Chapter started one-year Fellowship in Neonatology with the purpose of providing specialized training in Neonatology to students who have completed their post graduation in Pediatrics. The program will be conducted for candidates who are employed fulltime, as resident doctors, for a period of one year, in the institution, and the institution will conduct the training to be followed by Central examination.
Nirmal Hospital Pvt. Ltd. has a modern, well-equipped and sophisticated neonatal intensive care unit (NICU), which can provide all three levels of neonatal care and has dedicated and experienced transport team to transfer newborn and children from other health facilities. The intensive care nursery has a capacity of 20 beds for level 2 and 3 care. There is a Paediatric Department WHICH has 30,000 OPD attendance and 3,500 indoor admissions per year. NICU has the capacity to ventilate 9 babies at one time with invasive ventilation including 2 high frequency ventilators and monitoring with support of experienced medical and nursing staff. In addition, there is facility to provide non-invasive respiratory support with continuous positive airway pressure (CPAP) and bi-level positive airway pressure (BiPAP) devices. Bio Medical Engineer is available round the clock for the trouble free and smooth functioning of the life support equipment. NICU provides IV fluid administration with infusion pumps, hence accurate volume delivery is ensured. There are multiple multi channel vital sign monitors, which are capable of measuring blood pressure both invasively and non-invasively. Every baby requiring continuous pulse oximetry has its own dedicated pulse oximeter. NICU has abilities to support Paediatric Surgeons and Cardiologists pre and post operatively. Cardiac Echo and EEG services are available from visiting sub specialists. There is availability of portable x-ray and ultrasonography round the clock and hospital has 24-hour laboratory support for urgent investigations including blood gas analysis. CT and MRI Scan are available in close by facilities and the baby is transported to and fro for these investigations accompanied by trained Paediatrician.
Neonatal Transport Services-The unit also provides 24 hrs neonatal transport services from Surat and South Gujarat by a paediatrician to retrieve a newborn and is able to provide artificial ventilation & IV fluid administration as and when required. Hospital plans to use transport ventilator to support transfer from outside Surat. | |
| NICU Staff |
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The unit is staffed with four fulltime Consultant Neonatologists Dr. Nirmal Choraria, Dr. Rajiv Agrawal, Dr. Rajesh Maheshwari and Dr. Bharat Bhargava. Parents have a chance to interact with one of them on a regular basis Dr Rajiv Agrawal and Dr Rajesh Maheshwari have extensive working experience in Neonatal Intensive Care in Australia. | |
| We are very pleased to present our statistics for the period of last 6 months (April 2008- September 2008): |
| Gestation |
No |
Survival (Percentage) |
| <29 weeks |
20 |
12 (60%) |
| 29-32 weeks |
31 |
31 (100%) |
| ≥37 weeks |
147 |
136 (92.5%) |
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All Preterm (≤ 32 weeks) |
51 |
43 (84.3%) |
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All preterms (<37 weeks) |
143 |
130 (90.9%) |
| Term |
147 |
136 (92.5%) |
| Total |
290 |
266 (91.7%) | |
| Birth-weight |
No |
Survival (Percentage) |
| <1000 gm |
11 |
7 (63.6%) |
| 1000-1249 gm |
25 |
21 (84%) |
| 1250- 1499 gm |
20 |
20 (100%) |
| All Babies 1000g -1500 gm |
45 |
41 (91.2%) |
| 1500- 2499 gm |
113 |
106 (93.8%) |
| >2499 gm |
121 |
112 (92.6%) | |
| Diagnoses |
No |
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| RDS |
55 |
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| Meconium aspiration syndrome |
19 |
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| Perinatal asphyxia |
34 |
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| Sepsis |
37 |
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| Jaundice |
29 |
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| Hypoglycemia |
24 |
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| Surgical |
11 |
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| Cardiac |
12 |
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| Respiratory distress (other than RDS and MAS) |
39 |
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| Congenital anomalies |
21 |
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| Seizures |
12 |
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| Necrotizing enterocolitis |
1 |
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| Intervention |
No |
Survival (Percentage) |
| Ventilation |
100 |
77 (77%) |
| CPAP |
38 |
38 (100%) |
| Surfactant |
26 |
22 (84.6%) |
| Exchange transfusion |
12 |
12 (100%) | | |
| Eligibility: |
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Any student of Indian nationality who has completed the M.D. or D.N.B course in Pediatrics from a recognized University in India is eligible for this one-year fellowship program. At the time of application the trainee would have to produce a bonafide certificate from the Head of Department of Pediatrics of his / her institution where he / she has completed the post graduate training in Pediatrics, along with photocopies of the post graduate degree from the University concerned with the original degree for checking
All the trainees joining the Neonatology fellowship program shall work as Full Time Residents during the period of training for one year.
The goal of Neonatology Fellowship program is to provide specialized training in Neonatology to produce competency in all the various fields of medical management of neonatal infants (infants below the age of one month), by obtaining specialized training in Institutions that have specialized Neonatology departments with a Tertiary Level Care Neonatal Intensive Care Unit, over a stipulated period of one year, i.e. twelve months. These specialists will be capable of providing subsequent such care of neonates in the community as well as clinical tertiary care centers. They shall recognize the health needs of the community and carry out professional obligations ethically and in keeping with the objectives of the National Health Policy. | |
| Detailed List of Topics for Training in the Fellowship Program |
| D. Neonatology |
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Neonatal resuscitation |
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Management of normal newborn |
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Management of LBW, VLBW, |
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ELBW infants |
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Management of sick neonate |
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Emergency neonatal care |
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Thermoregulation |
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Neonatal transport |
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Fluid & electrolyte management |
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Neonatal ventilation |
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Blood gas and acid base disorders |
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Neonatal assessment |
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Assessment of gestation, neonatal behavior, neonatal reflexes |
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Developmental assessment, detection of neuromotor delay, stimulation techniques | |
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Respiratory system |
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Neonatal airways: physiology, pathology; management |
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Pulmonary diseases: hyaline membrane disease, transient tachypnea, aspiration | |
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pneumonia, pulmonary air leak syndromes, pulmonary hemorrhage, developmental defects |
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Oxygen therapy and its monitoring |
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Pulmonary infections |
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Miscellaneous pulmonary disorders | |
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Cardiovascular system |
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Fetal circulation, transition from fetal to neonatal physiology |
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Examination and interpretation of cardiovascular signs and symptoms |
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Special tests and procedure (Echocardiography, angiography) |
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Diagnosis and management of congenital heart diseases |
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Rhythm disturbances |
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Hypertension in neonates |
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Shock: pathophysiology, monitoring, management | |
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Gastrointestinal system |
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Disorders of liver and biliary system |
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Bilirubin metabolism |
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Neonatal jaundice, Prolonged hyperbilirubinemia, Kernicterus |
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Congenital malformations |
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Necrotising enterocolitis | |
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Neurology |
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Clinical neurological assessment |
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EEG, Ultrasonography, CT scan |
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Neonatal seizures |
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Intracranial hemorrhage |
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Brain imaging |
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Hypoxic ischemic encephalopathy |
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Neuro-muscular disorders |
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Degenerative diseases |
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CNS malformations | |
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Renal system |
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Development disorders |
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Renal functions |
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Fluid and electrolyte management |
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Acute renal failure (diagnosis, monitoring, management). | |
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Hematology |
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Physiology |
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Anemia |
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Polycythemia |
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Bleeding and coagulation disorders |
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Rh hemolytic disease |
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Blood Component therapy | |
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Nutrition |
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Fetal nutrition |
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Physiology of lactation |
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Lactation management |
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Parenteral nutrition |
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Vitamins and micronutrients in newborn health |
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Human milk banking | |
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Surgery and orthopedics |
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Diagnosis of neonatal surgical conditions |
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Pre and post operative care |
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Neonatal anesthesia |
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Metabolic changes during anesthesia and surgery |
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Orthopedic problems | |
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Neonatal infections |
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Intrauterine infections |
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Superficial infections |
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Diarrhea |
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Septicemia |
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Meningitis |
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Osteomyelitis and arthritis |
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Pneumonias |
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Perinatal HIV |
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Miscellaneous infective disorders & fungal infections | |
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Metabolic & Endocrine |
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Glucose metabolism, hypoglycemia, hyperglycemia |
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Calcium disorders |
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Magnesium disorders |
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Thyroid disorders |
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Adrenal disorders |
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Ambiguous genitalia |
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Inborn errors of metabolism | |
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Neonatal ophthalmology |
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Development aspects |
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Retinopathy of prematurity |
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Sequelae of perinatal infections | |
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Neonatal Hearing assessment |
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Community neonatology |
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Vital statistics |
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Health system |
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Neonatal care priorities |
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Care at primary, secondary & tertiary level |
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Role of different health functionaries |
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National programs |
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National Neonatology Forum | |
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Neonatal dermatology |
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Neonatal Imaging |
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Developmental assessment & follow up |
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Organization of neonatal care |
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Adoption |
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Recent Advances |
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Neonatal procedures |
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Therapeutic agents |
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Biomedical equipments, use & maintenance | | | |
| E. List of Skills |
| Clinical |
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Neonatal examination & anthropometry |
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Developmental assessment |
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Neonatal resuscitation |
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Neonatal ventilation: CPAP, Mechanical ventilation |
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Blood sampling: Capillary, venous, arterial |
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Insertion of peripheral venous, umbilical venous and umbilical arterial catheters |
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Monitoring: invasive, non-invasive |
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Enteral feeding (katori-spoon, gavage, breastfeeding) |
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Lactation management |
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Parenteral nutrition |
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Endotracheal Intubation |
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Lumbar puncture and ventricular tap |
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Placing of chest tube |
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Exchange transfusion |
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Bed side tests: Hemoglucometer glucose estimation, Apt test etc. |
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Neonatal drug therapy |
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Nursery house keeping routines |
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Infection control & Universal precautions |
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Handling, effective utilization and trouble shooting of neonatal equipment. |
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Decision making, clinical diagnosis, planning & interpretation of investigations |
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Management of Neonatal problems | | | |
| Communication |
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Communication with parents, families and communities |
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Interdepartmental communication | | |
| Education / Training |
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Teaching skills |
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Learning skills |
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Participatory and small group learning skills |
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Preparing learning resource material | | |
| Self-Directed Learning |
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Learning needs assessment, literature search, evaluating evidence | | |
| Research Method |
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Framing of research question |
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Designing and conducting study |
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Analyzing and interpreting data |
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Publication & writing a paper |
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Review & presentation of research findings | | |
| Fellowship Program commences in January every year. |
For inquiries and application for the IAP Fellowship Program Contact: |
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Dr Nirmal Choraria, Chief Paediatrician & Intensivist, Nirmal Hospital Pvt. Ltd., Ring Road, Surat. 395002. |
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email: nirmalhospital@gmail.com | |
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