Educational Goals and Objectives

Mission:

The mission of the Stanford Pediatric Nephrology Fellowship Training Program is: 1) to develop physicians who are clinically competent in the diagnosis and management of newborns, infants, children, adolescents and young adults who have disorders of the kidneys and related conditions; hypertension; urologic abnormalities; and disorders of body fluid homeostasis;  2) to develop physicians who have acquired the operational skills, professionalism and knowledge necessary to direct a pediatric nephrology service, including dialysis and kidney transplantation;  3) to develop physicians who possess the habits of life-long learning and a commitment to advancing the science and art of renal medicine through research and scholarship; and 4) to develop physicians who have the knowledge and skills required to  succeed in an academic health care setting. 

I.  PEDIATRIC NEPHROLOGY: FIRST YEAR

A.  PATIENT CARE

  • Learn the indications for and the ability to perform percutaneous native kidney and kidney transplant biopsies under ultrasonic guidance. The fellow is expected to learn the basics of pathologic interpretation of the biopsy, including all the components: light, immunofluorescence, electron microscopy and immunohistochemical staining.
  • Learn the analysis, interpretation and limitations of the urinary sediment, and its correlation with pathological entities.
  • Learn the interpretation, correlation and limitations of imaging tests used in the diagnosis and treatment of pediatric nephrology disorders. These include: renal ultrasound, magnetic resonance imaging, computerized tomography, renal arteriogram and nuclear medicine renal scans.
  • Learn the indications, principles and complications and develop the ability to supervise acute and chronic peritoneal dialysis, acute and chronic hemodialysis, continuous renal replacement therapies. Learn the indications, principles and complications of plasmapheresis, including concurrent plasmapheresis and continuous renal replacement therapy.
  • Learn the indications for and risks of kidney transplantation, including pre-emptive, living donor and deceased donor transplantation. Learn the elements of transplantation work-up from histocompatibility principles to donor requirements for both live-related and deceased donor transplantation. Know the management of transplant recipients, including fluid and electrolyte management strategies, especially in the immediate pre- and post-transplant period.  Know the risks and indications for the various immunosuppressive agents and protocols, and the diagnosis and management of acute cellular and humoral kidney transplant rejection. Longitudinal assessment of pediatric renal transplant recipients will allow the resident to learn to optimize immunosuppressive therapy to reduce the risks of rejection of the graft while minimizing the toxicities of the immunosuppressive drugs.  This includes prevention or early detection of infections, promotion of adequate nutrition and optimization of growth and development of cognitive and psychosocial potential.
  • Ability to obtain a full history of pediatric and renal characteristics including relevant perinatal information, previous medical history and family history. Learning to obtain information from both patients (when appropriate) and other family members.
  • Ability to perform a full physical examination including genitourinary system.
  • Ability to present effectively orally and in writing the results of the pediatric and renal history and physical examination.
  • Ability to formulate orally and in writing a complete differential diagnosis, select the most likely diagnosis and plan of investigation and treatment.
  • Ability to write timely and legible pediatric renal progress notes in a readable and effective style.
  • Ability to provide concise and complete consultation reports and discharge summaries for inpatients or monthly review summaries for patients with end-stage renal disease.
  • Ability to perform a percutaneous renal biopsy (native kidney and renal transplant).

 

B. MEDICAL KNOWLEDGE

  • Learn the characteristics, presentation, investigation, diagnosis and treatment of pediatric patients who have a wide variety of renal conditions.
  • Learn the changes in normal renal development in order to correctly assess disease processes. These include the assessment of changing renal function, blood pressure patterns and fluid and electrolyte physiology from the neonatal period to adolescence.
  • Learn the indications, side-effects, contraindications, and typical length of therapy of major drugs used commonly in pediatric nephrology. These include corticosteroids, anti-hypertensives, antibiotics and immunosuppressive agents, among others.
  • Recognize the patterns of presentation of acute versus chronic renal failure.
  • Learn the principles, therapy and psychosocial implications of end-stage renal disease in children. Longitudinal follow-up of patients will provide acquisition of skills in the areas of nutrition and growth and replacement therapies (dialysis, control of secondary hyperparathyroidism, prevention of anemia of chronic renal failure, optimization of growth).
  • Evaluate and treat general nephrology conditions: acute and chronic glomerulonephritis, nephrotic syndrome, renal tubular acidosis, renal artery stenosis, hypertension, urinary tract infections, interstitial nephritis, metabolic diseases, etc.

 

C. INTERPERSONAL AND COMMUNICATION SKILLS

  • Ability to interact with non-physician colleagues including clinical nurse specialists, dialysis nurses, ward and clinic clerks and secretaries, nurses, occupational therapists, child life specialists, dieticians, pharmacists, social workers, psychologists and school personnel (teachers, child guidance specialists).

 

D. PROFESSIONALISM

  • Ability to establish a professional relationship with pediatric nephrology patients, their families, care givers and support personnel.
  • Ability to relate to pediatric nephrology patients and their families and caregivers with compassion, respect and integrity.
  • Ability to relate well to other members of the health care team.
  • Ability to accept and integrate constructive criticisms pertaining to clinical skills, fund of pediatric nephrology knowledge and interpersonal skills.

 

E. PRACTICE BASED LEARNING

  • Ability to recognize one’s own limitation in knowledge or clinical skills and seek assistance from a more senior fellow or from a pediatric nephrology faculty member.
  • Ability to teach pediatric nephrology and pediatric care to medical students, junior residents and nurses.
  • Participation in patient care conferences with medical and non-medical personnel, including counseling and psychological issues involved with pediatric renal patients.
  • Participation in regular pediatric renal patient review conferences, including assessment of patient care and formulation of a plan in concert with other members of the pediatric nephrology team.
  • Participation in the review with the renal pathologist following each renal biopsy and in the weekly renal pathology conference including native kidney and kidney transplant biopsies.
  • Participation in renal courses, lectures and workshops including regional, national and international conferences on nephrology, dialysis, continuous renal replacement therapies, and transplantation.
  • Participation in research seminars from both pediatric and adult nephrology services to learn the scope of the research available and conducted at Stanford.
  • Identification of pediatric renal diseases unique in their presentation or response to therapy in order to prepare a manuscript to be submitted to medical journals. Learn the methodology and rigors of preparing and submitting a manuscript.
  • Identification of researchers with projects of similar interests and research pursuits for potential collaboration.
  • Identification of courses and workshops for subsequent training in which to enroll for second and third year research needs.

 

F.  SYSTEM BASED PRACTICE

  • Ability to identify and recognize ethical issues in the care of pediatric nephrology patients and to respond to them appropriately.
  • Participation in quality improvement meetings and morbidity/mortality conferences to assess quality of care delivered to pediatric renal patients, problems and solutions to improve care delivery.

II.  PEDIATRIC NEPHROLOGY: SECOND YEAR

The fellow should maintain and improve the skills and knowledge acquired in the first year. In addition the fellow is expected to master the following in the second year of training in pediatric nephrology:

A. PATIENT CARE

  • Learn the various protocols in the treatment of common and uncommon pediatric nephrology disorders, the underlying rationale, and rigorous application and follow-up of these protocols.
  • Ability to provide competent independent pediatric nephrology consultation in inpatient or outpatient settings.
  • Ability to obtain pediatric renal history, perform a full physical examination and formulate diagnosis, differential diagnosis and plan for evaluation and treatment in a timely and efficient manner.
  • Ability to discern the important from the unimportant in clinical pediatric nephrology.

 

B. MEDICAL KNOWLEDGE

  • Learn the characteristics, presentations, methods of diagnosis, treatments of the uncommon pediatric renal diseases.
  • Learn the indications, contraindications, efficacy, side-effects, monitoring and follow-up of the medications commonly used in the treatment of pediatric patients with renal disease including acute and chronic renal failure, end-stage renal disease and transplantation.
  • Learn basic epidemiology and investigational skills to understand clinical studies of pediatric renal diseases or to further pursue an area of research in this field.
  • Ability to identify the controversies in treatment of pediatric nephrology disorders, formulate the pros and cons, support an opinion based upon current literature and standards of care and discuss the options with the pediatric nephrology team.

 

C.  INTERPERSONAL AND COMMUNICATION SKILLS

  • Further develop the skills to interact with professional colleagues for the care of the renal patient: eg., pediatric urologist for the child with obstructive uropathy, radiologist/intervention radiologists for diagnosis or intervention, pediatric subspecialists for renal patients with other systems affected besides the genitourinary tract.
  • Ability to lead a team including a more junior resident and medical students to effectively evaluate and treat inpatients with pediatric renal disorders.
  • Ability to present clinical patient care or pediatric nephrology lectures to members of the pediatric department (resident lectures) or to members of the adult nephrology or transplantation services (clinical conferences).

 

D.  PROFESSIONALISM

  • Ability to form appropriate and constructive professional relationships with colleagues.

 

E. PRACTICE BASED LEARNING

  • Develop a clinical or basic research project with hypothesis, objectives and research design.
    Acquire methods for appropriate statistical design and analysis of research data.
  • The fellow will identify a mentor, learn to review extensively the literature, develop a plan of investigation and apply the research in a timely and closely supervised fashion. The fellow will learn to interact with the research and resource personnel, participate in research conferences and formulate a periodic update of the progress accomplished. During that period of time, the fellow’s clinical duties will be substantially reduced. During the first year, the fellow should have clearly selected a research project, delineated the goals and objectives and have acquired the basic skills to fully accomplish the project in the second and third year.
  • Attend journal clubs, research symposia, laboratory meetings pertinent to interest.

 

F.  SYSTEM BASED PRACTICE

  • Ability to recognize the cost effectiveness of tests and treatments.
  • Ability to deliver quality pediatric nephrology care without obtaining unnecessary tests or using expensive treatments unnecessarily.

III.   PEDIATRIC NEPHROLOGY: THIRD YEAR

The fellow should maintain and improve the skills and knowledge acquired in the first and second years. In addition the fellow is expected to master the following in the third year of training in pediatric nephrology:

A. PATIENT CARE

  • Refine the clinical skills developed in the previous years.
  • Develop the ability to lead the multidisciplinary renal team under the supervision of the attending physician.

 

B.  MEDICAL KNOWLEDGE

  • Learn medical ethics as it applies to pediatric nephrology.
  • Learn the unusual presentations, pathophysiology, and epidemiology of the common pediatric nephrology disorders.

 

C.  INTERPERSONAL AND COMMUNICATION SKILLS

  • Ability to interact effectively with administrative personnel and to deal effectively with administrative issues.

 

D. PROFESSIONALISM

  • Develop a collegial attitude with fellow investigators, technicians and support personnel.
  • Ability to lead the pediatric nephrology team with compassion, enthusiasm and humility.

 

E.  PRACTICE BASED LEARNING

  • Recognize good and poor research methodology and be able to appraise the literature in pediatric nephrology critically.
  • Develop self-education skills to be able to continue professional development following completion of residency training.
  • Maintain a current, up-to-date knowledge of major national and international protocols in the treatment of pediatric nephrology diseases and provide a critical analysis of the methodologies of these projects.
  • Knowledge of the current research needs and upcoming therapies in pediatric nephrology, dialysis and transplantation.
  • Further participate in the lectures and conferences outlined in the second year but participate as a consultant providing expert knowledge in the discussion of patients with pediatric nephrology disorders.
  • Ability to independently prepare and present lectures on common pediatric nephrology topics to residents or pediatricians or family physicians in the community.
  • Ability to conduct thoroughly and actively a research project developed during the first and second years.

 

F.  SYSTEM BASED PRACTICE

  • Learn the requirements and complete the applications relevant to the project: Institutional Review Boards (Humans or Animals) and become familiar with the federal or state requirements for the ethical treatment of Human or Animal Subjects.
  • Participate and lead quality assurance meetings to assess quality of care delivered to pediatric renal recipients, problems and solutions to improve care delivery

 

For applicants
We are using the ERAS system for applications (http://www.aamc.org/students/eras/start.html).  Please upload your documents and identify our fellowship in the application.

Our ACGME Core Program ID# is 3200521041    
Our ACGME Pediatric Nephrology ID# is 3280521029