Integral to the role of a neonatal consultant is antenatal consultation of parents-to-be when there are fetal concerns or anomalies. With an increasingly full curriculum and with the majority of neonatal posts being busy and time pressured, we were concerned that exposure to fetal medicine counselling and training was insufficient for many trainees to feel prepared for this as a new neonatal consultant. We aimed to gain a snapshot insight into exposure to fetal medicine and readiness for this role among neonatal subspecialty trainees in the UK.

In September 2018 an electronic survey was circulated by email to trainees on the subspecialty mailing list. The survey was anonymous and comprised 10 questions to collect quantitative and free-text qualitative information about exposure to fetal medicine and confidence with counselling.

There were 34 responses and 60% were from senior trainees (ST7/ST8) (FIGURE 1). All of the respondents had greater than four months’ tertiary neonatal experience. The main findings of the survey were:

• 64% rated their exposure to fetal medicine training so far as ‘average’ or ‘poor’ (FIGURE 2)
• often experience had been arranged
• by individuals and/or undertaken in their own time
• everyone expressed interest in attending fetal medicine clinics
• many were also keen to attend fetal medicine/neonatal multidisciplinary meetings, as well as educational sessions such as local lectures or external courses focusing on counselling
• observing senior colleagues undertaking counselling was considered the most valuable educational opportunity
• lack of structured opportunity and difficulty with release from the busy clinical environment were cited as common hurdles to learning.

FIGURE 1 The training level of respondents.

FIGURE 2 How neonatal trainees rated their exposure to fetal medicine.

Confidence with counselling

We asked how confident the neonatal trainees felt at their present stage of training to counsel families regarding a variety of fetal conditions (FIGURE 3). Predictably, trainees were far more confident counselling families with a baby with severe intrauterine growth restriction (IUGR) or threatened preterm labour – conditions more commonly seen and for which counselling is often delegated to trainees. This was compared to the less common conditions of trisomy 18 or mild ventriculomegaly, which would usually require antenatal consults with a neonatal consultant. Some comments made in the survey can be seen in FIGURE 4.

FIGURE 3 Neonatal trainee confidence in counselling parents about various fetal conditions (average score).

FIGURE 3 Comments from neonatal trainees about their fetal medicine training.

Conclusion

In summary, the results of our small survey suggest that among neonatal subspecialty trainees, the level of experience in fetal medicine and antenatal counselling is inconsistent and confidence is generally lacking. This seems to be as a result of variable opportunity to learn about fetal medicine and develop counselling skills. More emphasis on the importance of developing this knowledge and these skills during subspecialty training is required to highlight the issue among trainees as well as neonatal and fetal medicine consultants.

Greater support is needed to facilitate protected time for attendance at fetal medicine clinics, multidisciplinary team meetings and to accompany senior colleagues to observe counselling sessions. Ideally, there should be structures in place to support trainees to seek out and maximise local opportunities to learn while more formal teaching sessions are established and embedded into both local and national training.

It is in the interest of patients, current neonatologists and fetal medicine consultants that the neonatologists of the future should feel equipped to confidently support obstetric colleagues and families. This will be of growing importance in this era of earlier antenatal detection of anomaly and the ongoing evolution of neonatal intensive care.