DEPARTMENT OF PEDIATRICS
WALTER REED ARMY AND NATIONAL NAVAL MEDICAL CENTERS
NATIONAL CAPITAL CONSORTIUM PEDIATRIC RESIDENCY PROGRAM
Pediatric Nephrology Rotation
Overall goal: The Pediatric Nephrology service aims for residents to be
competent in the following competency based goal and
objectives by the end of the rotation.
Participants: PL-2, PL-3 residents. All goals and objectives are equal for
the PL-2 and PL-3 training levels.
Duration: Four weeks, 1 block
Facilities utilized: WRAMC and NNMC Pediatric clinic, Inpatient General
Pediatrics Ward, NNMC NICU
Teaching faculty: LTC Brent Lechner, MD, USA, MC
CDR Greg Gorman, MD, USN, MC
Resources available: Text library in the resident conference room;
access to faculty texts and education files; nccpeds Renal
Methods of evaluation: Case discussion; chart review; direct observation;
nurse and ancillary staff feedback; end-of-rotation
Resident will receive an oral mid-rotation evaluation and a
written and oral evaluation at the completion of the
COMPETENCY BASED GOALS AND OBJECTIVES
History and Physical Examination Skills
Elicit the clinical features that help distinguish between glomerular
and urologic causes of hematuria.
Elicit symptoms of hypertension.
Demonstrate the technique to identify the correct blood pressure
cuff size for a pediatric patient.
Place the stethoscope in the appropriate place to listen for a renal
Perform a fundoscopic exam on a child.
Inspect the sacral area for stigmata of neural tube defects in an
Dip a urine specimen with a dipstick and report the results
Prepare a urine specimen for microscopic analysis.
Correctly identify a red blood cell, a white blood cell and an
epithelial cell on a urine microscopic analysis or photomicrograph.
Correctly identify a red cell cast, a granular cast and a hyaline cast
on urine microscopic analysis or on clinical photomicrographs.
Diagnostic and Therapeutic Decision Making
Use the Schwartz formula to determine if a creatinine is normal in
Use history, physical and labs to determine if proteinuria is
transient, fixed or orthostatic.
Identify 2 factors which influence the interpretation of the urine
dipstick test for protein.
Define a hypertensive urgency and emergency.
Order the appropriate tests for a patient with persistent microscopic
Order the appropriate workup for a hypertensive pediatric patient.
Evaluate the results of a 24 hour urine collection for stone risk
Knowledge of Disease Processes, Pathophysiology, Diagnosis & Treatment
Know the most common cause of an abdominal mass in a
Name advantages and disadvantages of contrast and radionuclide
Draw a pie-chart of the etiologies of end-stage renal disease in
Know the triad of post-infectious glomerulonephritis.
Name 5 complications of chronic kidney disease and when they
Name the top 3 causes of hypertension in neonates, school-age
children and adolescents.
Know the significance of the following numbers in nephrology:
1.73, 1440, and 0.2.
Know the short-cut to convert a urine protein to creatinine ratio to
“grams of protein per day.”
Recite 5 stimuli for vasopressin release.
Interpersonal and Communication Skills
Education and Counseling Skills
Observe a VCUG in the radiology suite.
Wear an ambulatory blood pressure monitor for 24 hours.
Maintains complete, timely, accurate and legible medical records.
Communicates appropriately in written and/or oral forms.
Explains and discusses physical exam and diagnostic findings with
the patient and their family in a clear manner while avoiding
Effectively counsels the patient and their family on various
anticipatory guidance topics.
Recognizes any language, cultural, educational, socioecomonic or
religious barrier to communication or medical treatment and seeks
to overcome this barrier.
Works well with nurses and support staff, in a manner which is
respectful and enhances timely and effective patient care.
Use diagnostic studies, medications, and subspecialty referrals in a
cost-effective manner that doesn’t compromise patient care.
Help a patients and their families navigate the military medical
system when referring a patient to another provider, to a civilian
provider, or to a community resource.
Know how to access and work with pediatric social workers and
case managers to optimize medical care delivery to a patient and
Demonstrates appropriate military bearing; well-groomed in the
uniform of the day; behaves in a manner appropriate for a
military medical officer.
Demonstrates respect for ethnic, cultural, and religious diversity,
and attempts to modify treatments when necessary to suit a
patient’s or families’ diverse needs.
Knows the importance of continuity of care; takes ownership of
patients by offering and providing follow-up of complicated and/
or seriously ill children, or by arranging follow up with the
Respects patient privacy by demonstrating proper custody of
patient medical records and by not discussing patient care in
public; knows HIPAA regulations and follows HIPAA instruction
with respect to transfer of medical information by fax, e-mail, etc.
Practice-Based Learning and Improvement
Identifies their own strengths and weaknesses at the beginning of
the rotation and strives to improve on them during the course of the
Demonstrates awareness of their own limitations with respect to
experience and knowledge base and appropriately seeks
consultation with faculty.
(Where appropriate) Demonstrates progression from prior rotations
with respect to the general pediatric competencies.
Adept at searching the medical literature and using internet
Actively educates self, patients, parents, faculty, and peers; able to
tailor education to fit the level of the audience; uses written
information to reinforce education.
Participates in chart review with preceptor, striving to identify
accuracy of documentation, appropriateness of medical treatment,
and medical errors.
Brent Lechner, LTC, USA, MC
Chief, Pediatric Nephrology
Thomas Burklow, MD Clifton E. Yu, MD
Chief, Department of Pediatrics Pediatric Program Director