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The University of Texas-Houston Health Science Center


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The University of Texas-Houston Health Science Center

  1. 1. Pediatric Nephrology Rotation Page 1 PEDIATRIC NEPHROLOGY ROTATION Residents assigned to the pediatric nephrology rotation work in a team of one senior Pediatric or Medicine-Pediatric resident (PGY-3 or 4) and one or more PGY-1s. Residents are exposed to both outpatient and hospitalized pediatric nephrology patients. Adherence to the 80-hour work week is mandated. Pediatric residents are required to fulfill a one-month block rotation in pediatric nephrology. The rotation occurs at Memorial Hermann Children’s Hospital (MHCH), The University of Texas Outpatient Clinics, UT MD Anderson Cancer Center and LBJ Hospital. Residents provide primary care for inpatients admitted to the Nephrology service at MHCH, see Nephrology consults on other services, and see patients in the Nephrology/Hypertension outpatient clinics. Residents are supervised by faculty in the Department of Pediatric’s Division of Nephrology and Hypertension. Transitional year residents may choose Nephrology as one of their Pediatric rotations. Residents are expected to attend all appropriate Department of Pediatric conferences. In addition, residents will attend the Division of Pediatric Nephrology/Adult Nephrology teaching conferences. Pediatric Nephrology: Daily Teaching Rounds Multidisciplinary Rounds Pediatric Renal Grand Rounds Patient Care Conference Monthly Pediatric Uroradiology Conference Pediatric Renal Transplant Conference Pediatric Resident Seminar Pediatric Nephrology/Adult Nephrology: Renal Biopsy Conference Clinical Case Conference Renal Grand Rounds Visiting Professor Program Mandatory Clinics: Monday afternoon General Nephrology Clinic Tuesday afternoon General Nephrology Clinic Wednesday afternoon General Nephrology Clinic alternating weekly with Pediatric Renal Transplant Clinic Thursday afternoon Hypertension Clinic or LBJ Pediatric Nephrology Clinic Clinics to attend if time allows: Thursday Peritoneal dialysis clinic Daily hemodialysis rounds Wednesday afternoon UTMDACC Pediatric Nephrology Clinic
  2. 2. Pediatric Nephrology Rotation Page 2 The goals and objectives listed below are covered through rounding on the inpatient service, discussions about patients seen on an outpatient basis, various conferences, reading in a pediatric nephrology/hypertension syllabus updated yearly to contain the best review articles on general topics in pediatric nephrology and hypertension that would be important for general pediatricians to know, review articles and other handouts. Residents will have access to computer-based literature searches as well. Each resident is required to give a talk on a nephrologic subject of his/her choice during the rotation. The resident is also responsible for preparing a patient care conference at morning report with attending supervision and attendance. Residents will also be evaluated on their effectiveness and willingness to teach medical students. Residents will also learn nephrology related skills such as the urinalysis, techniques for accurate 24 hour urine collection and interpretation, how to take an accurate BP, ambulatory blood pressure monitoring, the use of random urine studies and interpretation of radiographic tests related to nephrology. Residents will have a check-list of nephrologic conditions that must be covered during the month through patient care, lecture, rounds or reading. Residents receive a pre-test to evaluate their level of knowledge at the start of the rotation and a final written examination containing many questions from PREP and the Pediatric Nephrology Boards as well as those developed by the faculty. This examination must be passed in order for the resident to receive credit for the rotation. Legend for Learning Activities AR – Attending Rounds GR – Grand Rounds OC Outpatient clinics DPC – Direct Patient Care JC – Journal Club RC – Research CAT – Critically Appraised Topics MDR – Multidisciplinary Conference E/C – Ethics/Communication Rounds SC – Specialty Conferences MR – Morning Report Conferences 1 FS – Faculty Supervision NC – Noon Conferences RS – Resident Seminar NM – Nephrology Manual SL – Subspecialty and Text Lectures Legend for Evaluation Methods for Residents AE – Attending Evaluation PDR – Program Director’s Review (twice DSP – Directly Supervised Procedures annually) MR – Morning Report IE – In-Training Exam FS – Faculty Supervision & Feedback 1 Specialty Conferences include Renal Biopsy Conference, Clinical Case Conference, Renal Grand Rounds, Pediatric Uroradiology Conference, Journal Club, Renal Transplant Conference, Pediatric Renal Grand Rounds
  3. 3. Pediatric Nephrology Rotation Page 3 Principal Educational Goals and Objectives by Relevant Competency The principal educational goals for residents on this rotation are indicated for the relevant ACGME competencies. The tables below each goal list the corresponding educational objectives, the relevant learning activities and the evaluation methods for each objective. The educational goals and objectives are applicable to both PGY-1 and PGY-3/4 residents as they are both ‘naïve’ to pediatric nephrology experience and the expected competency level demonstrated by the residents should reflect their respective level of experience. A. Patient Care GOAL: Differentiate between normal and pathological states related to the renal system. Principal Educational Objectives Learning Evaluation Activities Methods 1. Describe the age related changes in blood pressure AR, SL, NM, AE, PDR, IE, including normal ranges from birth through adolescence SC, FS FS and learn to personally measure BP accurately. 2. Differentiate transient hematuria from clinically AR, SL, NM, AE, IE, PDR, significant gross or microscopic hematuria. SC, DPC, FS FS 3. Differentiate transient proteinuria from clinically AR, SL, NM, AE, IE, PDR, significant persistent or intermittent proteinuria. SC, DPC, FS FS 4. Describe the findings on clinical history and AR, SL, NM, AE, IE, PDR, examination that would suggest renal disease and SC, FS FS require further evaluation and treatment. 5. Apply measures of glomerular and tubular function to AR, SL, NM, AE, IE, PDR, determine normal versus abnormal kidney function. SC, FS FS Learn to perform urinalysis GOAL: Evaluate and treat common renal diseases presenting in the outpatient setting. Principal Educational Objectives Learning Evaluation Activities Methods 1. Evaluate and manage the child with a urinary tract AR, DPC, NM, AE, FS, infection. MR, NC, SL, FS PDR 2. Determine the need for and the extent of the AR, DPC, NM, AE, FS, radiographic evaluation required for the patient with a MR, NC, SL, FS PDR UTI. 3. Evaluate the patient who presents with hematuria AR, DPC, NM, AE, FS, and/or proteinuria. MR, NC, SL, FS PDR 4. Diagnose and manage the patient with hypertension. AR, DPC, NM, AE, FS, MR, NC, SL, FS PDR 5. Learn to diagnose and manage common fluid and AR, DPC, NM, AE, FS, electrolyte disturbances with intravenous and oral MR, NC, SL, FS PDR rehydration.
  4. 4. Pediatric Nephrology Rotation Page 4 GOAL: Evaluate and manage complicated diseases of the renal system in consultation with a Pediatric Nephrologist. Principal Educational Objectives Learning Evaluation Activities Methods 1. Diagnose and manage patients with acute and chronic AR, DPC, SC, AE, FS, glomerulonephritis including nephrotic syndrome. SL, NM, FS PDR 2. Diagnose and manage renal diseases associated with AR, DPC, SC, AE, FS, systemic diseases, e.g., systemic lupus, hemolytic- SL, NM PDR uremic syndrome, ANCA positive diseases, and Henoch-Schoenlein Purpura. 3. Diagnose and manage issues related to bone disease AR, DPC, SC, AE, FS, commonly seen in children with renal disease including SL, NM PDR growth retardation, renal tubular acidosis, and rickets B. Medical Knowledge GOAL: Describe kidney development and measures of renal function. Principal Educational Objectives Learning Evaluation Activities Methods 1. Discuss the normal neonatal development of the kidney AR, NC, SL, SC, AE, IE, PDR both anatomy and function. NM 2. Discuss measures of renal function including GFR, AR, NC, SL, SC, AE, IE, PDR urinary concentration, proximal tubular function, and NM acid-base handling. GOAL: Discuss the physiology of issues related to renal function. Principal Educational Objectives Learning Evaluation Activities Methods 1. Discuss handling of drugs by the kidney and dosing of AR, NC, SL, SC, AE, IE, PDR medication for chronic kidney disease NM 2. Discuss fluid and electrolyte problems in childhood. AR, MR, NC, AE, IE, PDR SL, NM 3. Discuss structural problems of the kidney including AR, MR, NC, AE, IE, PDR vesicoureteral reflux, obstructions of the urinary tract, SL, NM urolithiasis and bladder dysfunction. 4. Discuss abnormal kidney development such as cystic AR, MR, NC, AE, IE, PDR diseases of the kidney, hypoplasia, dysplasia, SL, NM abnormalities of renal position, and prune belly syndrome
  5. 5. Pediatric Nephrology Rotation Page 5 GOAL: Discuss issues involved with complicated renal disease generally managed by a Pediatric Nephrologist. Principal Educational Objectives Learning Evaluation Activities Methods 1. Discuss the etiologies, complications and diagnosis and AR, SL, SC, NM AE, IE, PDR management of chronic kidney disease including osteodystrophy, anemia, growth failure, developmental delay, hyperlipidemia and progression to ESRD. 2. Discuss the principles of renal replacement therapy AR, SL, SC, NM AE, IE, PDR including hemdialysis, peritoneal dialysis, CVVHD and SLED. 3. Discuss the principles and management of the child AR, SL, SC, NM AE, IE, PDR with a renal transplant. C. Professionalism and Interpersonal Skills and Communication GOAL: Develop skills to effectively teach others. Principal Educational Objectives Learning Evaluation Activities Methods 1. Present a lecture on the nephrologic subject of AR, DPC, SL, SC AE, FS, PDR his/her choice and present a case conference at morning report and biopsy conference 2. Demonstrate instruction of medical students in an AR, DPC, SL, SC AE, FS, PDR effective, enthusiastic manner. D. Systems-Based Practice GOAL: Function as part of an interdisciplinary team in the management of children with renal diseases. Principal Educational Objectives Learning Evaluation Activities Methods 1. Discuss the psychosocial and financial aspects of the AR, MDR, E/C AE, FS, PDR child with renal disease. 2. Communicate and work effectively with AR, MDR, E/C AE, FS, PDR psychiatrists/psychologists, Child Life, nutritionists, and case managers to provide financial and psychosocial support for children with end stage renal disease and renal transplant. 3. Discuss use of home and school monitoring of AR, MR, NC, SL, AE, IE, PDR disease including urinary dipsticks, and BP NM monitoring
  6. 6. Pediatric Nephrology Rotation Page 6 E. Practice Based Learning GOAL: Learn to utilize and integrate technological advances in the care of children with renal disease Principal Educational Objectives Learning Evaluation Activities Methods 1. Learn to utilize electronic medical record to provide AR, MDR, E/C AE, FS, PDR documentation of patient’s medical care, provide better communication among medical staff and the multiple patient care sites and communicate with referring physicians. Learn to utilize hand held technology to facilitate patient care. Learn HIPPA regulations governing privacy. 2. Residents are encouraged to be creative in trying to AR, MDR, E/C AE, FS, PDR improve technological or other area of medical practice that can improve medical care and communication