Pediatric Nephrology Fellowship

In the first year, the fellow will have four months assigned to the inpatient service, three months assigned to the dialysis unit and five months of elective rotations, outpatient clinics and scholarly activity. During the first year, the fellow will develop a basic understanding of renal function in health and disease, the various types of kidney disease, procedures and techniques in the assessment of kidney structure and function. Fellows will also establish an association with one or more faculty members (as mentors) for clinical and/or basic research and a Scholarly Oversight Committee will be developed. The fellow will have two months assigned solely to scholarly activity.

In the second year, the fellow will have four months assigned to the inpatient service, two months in pediatric dialysis and two months in elective rotations and outpatient clinics. Fellow will begin in-depth assessments of specific areas of clinical nephrology and will further develop their teaching expertise. By this time, trainees should be in the midst of a research project, have abstract(s) ready for submission to a local regional or national meeting, and begin writing a formal report as a paper for publication. The second year of the program will have a total of four months dedicated to scholarly activity. This period of research will have a detailed timeline with periodic reviews with the corresponding mentor and SOC.

In the third year, fellows will have four months of inpatient, on-call service, two months of dialysis and six months of dedicated scholarly activity. The fellow will complete their initial research, finish papers for publication and will be encouraged to submit a research grant for future funding. This period of research will have a detailed timeline with ongoing periodic reviews with the corresponding mentor and SOC.

During the dialysis rotation fellows will acquire longitudinal experience in the therapeutic modalities of outpatient hemodialysis and peritoneal dialysis and how to manage the patients with End Stage Renal Disease. Acute dialysis, hemofiltration and transplant experience is obtained during the inpatient rotation and also at the transplant clinic located in the Miami Transplant Institute (MTI).

For radiology, fellows will develop expertise in the interpretation of imaging tests during the weekly Uro-Radiology Conferences where they are in charge of selecting cases, helping to collect images and reviewing them during and/or after the conference.

Each trainee will be exposed to issues of renal pathology by direct contact with the renal pathologists and will be taught the basic principles of this discipline. All fellows will be required to attend the monthly Pediatric Renal Biopsy Conference. Fellows will have an opportunity for a one-month elective in renal pathology.

During the inpatient experience fellows are required to see and discuss evaluation and plan-of-care for each patient admitted to the renal service or consultations. This is usually done during the daily rounds, but, as necessary, may occur at any time of the day or night. Attending faculty are readily available to discuss complex or difficult patients and to develop recommendations.

Fellows carry the first-call beeper for all inpatient consultations and admissions of the patients being followed by the Division of Pediatric Nephrology. They are responsible for the evaluation and plan-of-care for these patients after proper discussion with the nephrology attending. All new admissions are placed under a pediatric house staff team and followed by the renal service on a daily basis. The attending in the pediatric nephrology service supervises the fellow and makes daily rounds seeing and examining each patient. Usually rounds are done twice daily (morning and afternoons), or as required depending on acute unstable patients in the pediatric or neonatal intensive care units. The pediatric nephrology trainee is responsible for rendering consults to other services such as the Pediatric Surgical Unit, PICU and Newborn Special Care Center. Fellows acquire experience in various procedures including, ambulatory blood pressure monitoring; Aquapheresis; bedside renal ultrasound; continuous renal replacement therapy; renal ultrasound and therapeutic plasma exchange.

Fellows may also be required to see patients in the emergency room in consultation at Holtz Children’s Hospital.

Outpatient clinics are held in different locations, including UHealth hospital and clinic facilities. Fellows are responsible for starting the clinics on time and coordinating with the nurse liaison for each clinic. In addition, fellows are assigned continuity clinics and primary patients on a rotating basis during the periods in which they are not on the inpatient service. Still, when they cannot attend clinics, they remain involved in the follow-up of their patients through the discussion in the weekly outpatient review. After each patient is seen in clinic, the fellow writes their notes and discusses findings and the plan of care with the renal attending. Fellows are responsible for following all clinic laboratory results from patients seen in the corresponding clinic and implement plans of care discussed during the outpatient clinic review. Participation at the monthly transplant conference will teach the criteria of selection for transplant and management of complications post-renal transplant.

The fellow’s responsibility for teaching will include informal discussions with medical students and pediatric house officers. Medical students and medical house officers on elective in pediatric nephrology will work closely with the fellow during the four months that they are on the inpatient service. During the clinic rotation, the teaching of students and house officers will be done by the fellow, together with the renal attending. The fellows’ presentations will be reviewed prior to their delivery at a conference and there will be a critique of the conference provided by the pediatric nephrology faculty. A strong emphasis on developing teaching skills and the ability to communicate complex information will be the goal of this training program as these skills are particularly pertinent to the care of children with renal disorders. The trainee will be precepted by the renal attending in all areas of patient care; however, the level of responsibility in teaching and patient care will increase during each year of the training.

The scholarly activity and research component of the three-year fellowship is signatory to the program. Faculty and fellows participate jointly in developing projects that enhance the learning, safety and quality of pediatric nephrology care and promote clinical and translational research programs in pediatric renal disease that will contribute to ongoing treatment and drug discovery for pediatric kidney disease patients. Each of the pediatric nephrology faculty are involved with intramural and extramural projects that are open to participation by the fellows. Moreover, new and innovative projects are welcome and will be supported if they reach a satisfactory level of feasibility and competence. Quality improvement initiatives and case reports are used as introductory to a more focused publication initiative. From the beginning of the fellowship, the scholarly activity should be a primary focus of the entire experience.