The training program is designed to ensure the competence of the trainee in the clinical diagnosis and management of all disorders of the kidney and urologic system, fluid/electrolyte/acid-base homeostasis, and blood pressure in neonates, infants, children, adolescents, and young adults. It is expected that the integrated program of hands-on patient care, one-on-one teaching by the attending nephrology faculty, and didactic lectures will provide a strong foundation in clinical nephrology. Progressive clinical, technical, and consultative experiences will enable Fellows to develop expertise as a consultant in the specialty and emerge from the training program able to practice independently and competently in their field of training. The Fellowship training program incorporates into the curriculum mastery of each of the 6 general competencies identified by the ACGME (medical knowledge, patient care, professionalism, interpersonal and communication skills, practice-based learning and improvement, and systems-based practice). In 2014 and beyond, these competencies are to be folded into a set of training milestones that ultimately lead to a defined set of practice competencies.
The fellow assumes a major responsibility in the care of all infants and children hospitalized at the Kravis Children’s Hospital. Having completed training in general pediatrics, Fellows are expected to identify medical problems in all organ systems. When assigned to the in-patient service, Fellows interact with the full range of pediatric subspecialists at the Icahn School of Medicine at Mount Sinai, including pediatric urology, pediatric surgery, pathology, radiology, immunology, psychiatry, and organ transplantation (renal, liver, small bowel). Fellows initially evaluate all admissions and consultations and present a summary of the history, physical examination, laboratory evaluation, assessment, and plan of action to the attending nephrologist during renal rounds, held daily. Once the attending physician evaluates the patient and a plan is decided upon after detailed discussion with the fellow, the fellow guides the pediatric house staff in the workup and management the patient. The pediatric residency program at Mount Sinai is robust and with few exceptions (such as dialysis and chemotherapy) all orders are entered into the electronic ordering system by the residents; this highlights the clinical experience gained in supervising and teaching more junior physicians.
Many of the 200 in-patient consultations we are asked to perform yearly are requested from the pediatric (16 beds) and neonatal (35+ beds) intensive care units. The PICU opened a renovated, state-of-the-art unit in 2013 and the NICU will do the same in 2014. These units and the active pediatric cardiothoracic surgery and organ transplant programs provide abundant clinical material for Fellows to hone their skills at management of complex fluid, electrolyte, and acid-base disturbances. Trainees learn to assess glomerular and tubular function, perform percutaneous biopsy of native and transplanted kidneys, and administer all forms of renal replacement therapy including peritoneal and hemodialysis, and continuous veno-venous hemofiltration. Attention is given to the interpretation of radiologic examinations, including X-rays, ultrasounds, nuclear scans, MRI, CT and other imaging techniques applied to the kidney and urinary tract. Patient-focused instruction in diagnostic imaging is strengthened by seminars and didactic sessions offered by the radiology staff. Fellows are expected to gain competence in the interpretation and evaluation of renal pathology specimens, utilizing the multiple modalities of light, electron, and immunofluorescence microscopy. This goal is accomplished by close interaction with our renal pathologists, Drs. Fadi Salem and Stephen Ward, who acquaint the fellow with the full spectrum of renal histopathology and diagnostic techniques.