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  1. 1. 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 curriculum. 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
  2. 2. 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 attending. 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
  3. 3. 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 use. 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)
  4. 4. 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 procedures. 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 conferences. 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 year). 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.
  5. 5. The research will need to be approved by the program director and the renal resident advisory committee. 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.