PEDIATRIC RENAL RESIDENT JOB DESCRIPTION
Graduated Levels of Responsibility
Graduate medical education is based on the principle of progressively increasing levels of
responsibility, in caring for patients, under the supervision of the faculty. The faculty is
responsible for evaluating the progress of each resident in acquiring the skills necessary
for the resident to progress to the next level of training. Factors considered in this
evaluation include the resident's clinical experience, judgement, professionalism,
cognitive knowledge and technical skills. These levels are defined as postgraduate years
(PGY) and refer to the clinical years of training that the resident is pursuing. The
requirements for training in the primary care specialties such as pediatrics, internal
medicine and family practice call for three years of training. Subspecialty training,
traditionally called fellowship, includes considerable autonomy especially in the tasks
already mastered in the core program. At each level of training, there is a set of
competencies that each resident is expected to master. As these are learned greater
independence is granted the resident in the routine care of the patient at the discretion of
the faculty who, at all times, remain responsible for all aspects of the care of the patient.
Pediatric Nephrology Subspecialty Training
The goal of our fellowship program is to develop during a three year period academic
nephrologists who are capable and committed to the care of children with all types of
renal disease, including those with acute and chronic renal failure, as well as, those
requiring dialysis and transplantation. And to foster an environment that will allow one to
acquire the clinical and /or basic research skills necessary to make a significant
contribution to the understanding of the pathophysiology and treatment of diseases that
affect the kidney. Finally, we expect the fellow to gain the necessary skills to become an
excellent teacher. This will be accomplished utilizing all components of the following
PGY 4 (first year renal resident): In-patient Responsibilities
The first year pediatric renal resident will have four months of inpatient care experience
along with training in the pediatric dialysis unit and peritoneal dialysis outpatient clinic.
There are approximately 300 admissions to the renal service per year along with 100
renal biopsies, 200 requests for renal consultations, daily hemodialysis with 1500 to 1800
dialysis sessions per year and 100 peritoneal dialysis outpatient clinic visits per year.
The renal resident independently assesses and writes a note on each patient every
morning, as well as, writes orders for the patients on hemodialysis. The renal resident
discusses the patient with the pediatric resident, medical student, nurse and all others
involved in the care of the patient. Following this, the renal resident assesses and writes a
note for all consults. Later in the morning, he/she presents the patients to the renal faculty
attending who may edit and always countersigns his note and writes his own note.
Following this discussion the renal resident is expected to discuss the patient once again
with the pediatric resident and other consulting staff as might be necessary to modify the
diagnosis and treatment.
The renal resident is the first to receive a page regarding the care of patients. When
appropriate he will discuss the call with the attending. The nursing staff and residents are
informed to call the attending should the renal resident not answer the call after a
reasonable time has elapsed.
The renal resident prepares patients for kidney biopsy, including doing an initial history
and physical exam, working with the pediatric resident in ordering the appropriate pre
and post biopsy orders and working with the nurse specialist to see that ultrasound
guidance has been arranged.
The renal resident will do the biopsy and write the post biopsy orders with the direct
supervision of the renal attending. He/she will arrange with the pediatric pathologist for
review of the renal biopsy with the he/she and the renal attending.
The renal resident does a monthly physical examination on all hemodialysis patients,
reviews the laboratory data, discusses her/his findings with the renal attending, writes
appropriate orders to change management and then dictates a note for review and
signature of the renal attending.
The renal resident will do the initial assessment of patients who come to the pediatric
dialysis unit for outpatient peritoneal dialysis clinic visits. He/she will perform a history
and physical, write a note, propose lab work and other diagnostic procedures and
treatment to be discussed with the renal attending. Following the discussion, the renal
resident will dictate a note.
The renal resident will call and dictate a brief same day note to the referring physician on
all discharged patients. The note will need to be reviewed and signed by the renal
At times there will be a pediatric resident on elective. The renal resident is expected to
participate in the teaching and evaluation of the resident.
The renal resident will be on call every third weekend throughout the year along with the
renal attending of the month. She/he will be first call for any from physicians, dialysis
nurses or patients.
The renal resident will be ask to give a conference to the pediatric residents once each
month throughout the year. This one-half an hour conference is on Tuesday mornings at
7:30 a.m. followed by morning report at 8:00 a.m.
The renal resident will be required to give two pediatric presentations each month during
the weekly renal seminars which are held twice each week. He/she will also be
responsible for arranging the monthly radiology and pathology conference, i.e., the date
and case material.
The pediatric renal resident is expected to read about each patient in a major pediatric
renal textbook and whenever appropriate make a journal search. All of the major
pediatric and nephrology journals are in the pediatric renal library for the renal resident's
Pediatric Resident Outpatient Job Description
The pediatric renal resident will have five months of outpatient experience. Clinics are
held each morning from 7:30 a. m. to 12:30 p.m. The resident is to arrive at the clinic on
time. She/he is expected to independently assess and develop a plan for diagnosis and
treatment of at least seven patients for subsequent individual review by the renal
attending. Following which she/he will dictate a patient care note for the renal attending
review and signature.
At the end of each clinic, the renal attending and renal resident will review all no-show
patients for disposition, including letters to those who are being discharged or being sent
a final appointment prior to discharge should the no-shows continue
We will also plan to have the renal resident work with Pediatric Urology for two
Wednesdays each month while on the outpatient rotations.
As is true for the inpatient service, the renal resident will continue to be on call for the
inpatient service every third weekend throughout the year.
The outpatient service permits time in the afternoons for reading, preparing presentations,
thinking about possible research projects or case reports for publication, correction of
patient letters, meeting with individual faculty and communicating with other
subspecialty residents, pediatric residents and allied health staff such as pharmacy,
nutrition, social service, nursing,etc.
Renal Resident Electives
The renal resident will have a one- month elective in pediatric radiology and a one-month
elective in pediatric pathology during the first year. This will be arranged with the chief
of each of these divisions in conjunction with the pediatric nephrology program director.
The electives are provided to give a broader idea of procedures that are commonly used
by the pediatric nephrologist in diagnosis. These services should also allow for
considerable time for reading.
PGY 5: (Second Year Renal Resident)
The second year will include both clinical and research blocks of time. The clinical
blocks will be four months of inpatient and four months of outpatient. There will be
three months of research time.
The inpatient and outpatient experience for the second year renal resident is essentially
the same as the first year. However, the resident is expected to have the ability to
formulate patient care diagnosis and treatment plans more precisely and expeditiously.
The renal resident should be able to work with more confidence in relating to patients,
parents, residents, other faculty and paramedical personnel. His/her presentations during
attending rounds should be more concise, accurate and clear. Pages and outside phone
call should be better handled. There should be a decreasing need for prolonged
explanations by the renal attending as related to patient care issues. The number conflicts
with other services should be minimized.
The call schedule will be the same. The renal attending will continue to advise on
handling all patient care calls, but the need for extended discussion will be minimized.
The renal biopsies and handling of dialysis patients are expected to go much more
smoothly. However, the renal attending will continue to directly supervise all
The renal resident presentations at the Wednesday morning renal conference and during
the renal seminar schedule will continue. However, we expect his/her teaching
performance to continue to improve.
The renal resident will continue to be responsible for the radiology and pathology
Research Block: three months
During this period of time, the program director and renal resident will identify a research
mentor who may or may not be a pediatric nephrologist. He/she will do a literature search
and develop a plan for research, which continue through the next academic year (PGY
This period of time is essential, since a published first authored peer reviewed article is a
prerequisite for completion of the program and being eligible to take the sub-board exam.
There is also ample time to write a case report for publication. The conference and call
schedule with associated responsibilities will continue during this block of time.
PGY 6 (Third Year Pediatric Renal Resident)
The third year pediatric renal residency will be entirely basic and/or clinical research. A
research mentor and plan of research will have been identified before the third year
begins. This is an essential prerequisite for the renal resident to begin her/his research.
The research will need to be approved by the program director and the renal resident
The primary goal is to do research that results in the publication of a first authored peer
reviewed paper. The secondary goal is to submit the research for presentation at a
regional or national meeting.
The conference and call schedule with associated responsibilities will continue
throughout the year.
Fellowship Advisory Committee
A fellowship advisory committee will be identified to review the renal resident progress
every six months. This will be done utilizing two letters of evaluation. One written by
the Program Director in consultation with the renal faculty and the second written by
renal resident to offer his/he incites as to his/her progress and the support received.
The renal fellow will take the pediatric renal in-service exam at the end of each year.