Neonatal care is a growing discipline, which evolved in the 1960s as an independent subspecialty of pediatrics.1,2 Neonatology practitioners need extensive knowledge, skills, and expertize to provide care to critically ill term and preterm newborn infants.3 Research has shown that neonatology practitioners also need experience performing key skills for effective clinical practice.4 As medical knowledge and technology advance, neonatal care must evolve alongside this progress and increasing complexity to achieve successful outcomes for every infant and address the future research needs of neonatology.5 The only way to meet this growing and evolving need is through effective neonatal education, which begins with standardized, comprehensive training programs that incorporate empirically supported best practices to ensure that healthcare providers are well-equipped to deliver safe and effective care.6,7,8,9

In recent years, neonatal care has shifted from being case driven to infant and family centered developmental care (IFCDC), which represents a more robust approach to achieving optimal long-term outcomes.10 To train neonatal professionals in this new approach, the European School of Neonatology (ESN) has developed a curriculum that aligns with the European Training Requirements (ETR) in Neonatology, providing a structured and standardized approach to neonatal training and education. The present paper will evaluate the neonatology training curriculum developed by the ESN to determine whether it can fulfill the need for a standardized neonatology training approach for physicians and eventually also for nurses.

According to curriculum theory,11 an effective curriculum provides an agreed upon set of definitions for key technical concepts within a field, classifies recent developments within an established knowledge base, and draws upon research-based knowledge to inform practice. The purpose of developing a curriculum is to reach a level of consensus within a field about what trainees should know and be able to do following training. The ESN’s European Curriculum & Evaluation Grid for Training and Assessment in Neonatology provides an in-depth step-by-step guideline of critical competencies for neonatology practitioners based on previous international frameworks and expert consultation. It integrates research-based practices that incorporate the most modern approaches within established knowledge and practices, taking a trainee-centered approach to training for infant and family-centered developmental care. In this way, the ESN curriculum synthesizes predominant theory and practices within the field into a standardized training framework rooted in the best practices of medical education.

Medical education occupies a unique place in higher education. It extends past traditional university research departments and into hospitals to teach novice practitioners how to care for real patients.12 The goal of medical education is to provide society with a consistent supply of medical professionals who put patient care first. This means that the stakes in medical education are high in two separate ways; one is the societal need for producing skilled practitioners and the second is the inherent potential for serious consequences arising from novice practitioners working directly with real patients.

In adapting to the need for practical experience rooted in the latest knowledge within the field, medical education has evolved to incorporate many educational philosophies, conceptual models, and pedagogical practices, which can vary across specialties and individual training settings. However, the predominant approach to medical education combines elements of educational theory, such as experiential learning and reflective practice, with elements of vocational training, such as competency-based evaluation.12

By the mid twentieth century, medical training programs in Europe had developed a regimented curriculum in which units were strictly time-limited.13 However, this approach faced criticism for being too rigidly structured to allow opportunities for nuance and deeper learning, and for being focused on maintaining the structure at the expense of developing learners’ competencies. As a result of this criticism, competency based medical education (CBME) was introduced which provided a set of guidelines for the skills that trainees must master to complete their training. One challenge faced by European medical educators following the CBME model is that as the body of medical knowledge and technology have grown, so too have the content and duration of medical training programs.13 As curricula have been adjusted to fit the need for ever-growing content knowledge within acceptable timelines, there is demand from professionals within the field for international training standards.14

To meet the need for a specialized pediatric curriculum in Europe, pediatric training requirements were developed by the European Academy of Paediatrics (EAP), a professional organization of pediatricians, which is the pediatric branch of the European Union of Medical Specialists. The most recent UEMS Training Requirements for the Specialty of Paediatrics were published in 2015.15 One of the key goals of this European framework for pediatrics is to create a “common house for pediatrics” in which the many subspecialities of pediatrics can come together.15 The authors note that pediatrics as a field has become increasingly specialized, and to bridge differences in resources and scope, pediatric training needs a standardized training approach.

The training framework itself is divided into sections focused on theoretical knowledge and on practical and clinical skills.15 This reflects the previously discussed need for medical training to strike a balance between knowledge and practice. The theoretical knowledge section of the framework contains a comprehensive list of pediatric subspecialties, which reflects the increasingly specialized nature of the field. The practical skills section includes a list of observable skills that practitioners must master. These skills are applicable across subspecialties and reflect the use of various medical technologies. By bridging theory and practice, the training framework is broadly applicable across training contexts while also being detailed enough to reflect the key components of theoretical knowledge.

The ETR Neonatology, released in 2021, was developed in collaboration between the pediatrics section of UEMS along with the European Board of Neonatology16 (European Society for Paediatric Research, 2021). Previous versions of the training requirements were created in 1998 and in 2007. The training requirements were updated to include the most recent developments in technology and clinical practice, as well as incorporating knowledge and best practices of national training programs that did not fit the previous training framework. The ETR Neonatology emphasizes the modern multidisciplinary team approach to neonatology in which neonatology practitioners are never acting alone, but rather are constantly communicating and collaborating with many other stakeholders, including families, nurses, midwives, other medical professionals, psychologists, and social workers.

The ETR Neonatology places particular emphasis on the end goals and skills expected from neonatology training while also providing details about time frames, accreditation, evaluation, and assessment.16 It provides comprehensive instructions for what resources and programs training centers need to provide neonatology training and how novice practitioners are tracked in terms of learning and progression of skills. The ETR provides a thorough overview of knowledge within the field of neonatology and of the skills and practices that neonatologists need. The aims in creating the ETR Neonatology are to harmonize neonatology training across European countries, establish clear standards for skills and knowledge, and facilitate the development of neonatology care centers, with the underlying goal of improving health care for neonates.16 Neonatal practitioners with certified training according to the ETR Neonatology can use their pan-European certificate of training to move freely within Europe to practice Neonatology at an accredited expert level.