Pediatric Nephrology Fellowship

The Pediatric Nephrology Fellowship program is designed to prepare talented individuals for research careers in academic medicine. Fellows enter the program after completing three years of residency in pediatrics and are expected to commit three or more years to their postdoctoral training in nephrology. Twelve months are devoted to training in clinical nephrology, and two or more years are spent in research activities. One candidate is accepted into the program each year.

The educational experience in Pediatric Nephrology at Yale University School of Medicine and Yale-New Haven Children’s Hospital is unique and is designed so that postdoctoral fellows experience a continuum of learning in both the clinical arena and research laboratory throughout the duration of the training period. The training program allows intense clinical experience during all three years as well as an early introduction to either laboratory or patient-oriented research in the first year of the program. We are fortunate to enjoy a close relationship with our adult nephrology colleagues and participate with them in combined educational conferences as well as a combined training grant. The aims of our training program are:

• Provide a comprehensive clinical curriculum to enable trainees to develop clinical expertise in all aspects of pediatric nephrology
  
• Train individuals in contemporary research skills and methodologies, both clinical and basic, to enable them to successfully pursue careers as academic pediatric nephrologists and to become local and national leaders in the field

Salary support for our fellows is provided by the hospital and the university. Yale University School of Medicine is committed to increasing representation of women and members of minority groups among its postdoctoral trainees and faculty, and we particularly encourage applications from such candidates.

Yale-New Haven Children's Hospital (YNHCH) is the a full-spectrum pediatrics facility for the state of Connecticut. YNHCH provides primary care to children in the New Haven area, Level One trauma care, and tertiary care to patients from a wide referral base including Southern Connecticut and Eastern New York. There is a full range of pediatric subspecialists available 24 hours per day. The hospital is directly linked to the Yale University School of Medicine by a skywalk. The hospital's location within the larger 900-bed Yale-New Haven Hospital allows for the provision of a full complement of state-of-the art services while prioritizing the unique needs of children.

Fellows participate in the evaluation and management of patients on the pediatric inpatient service, pediatric ICU, neonatal ICU and pediatric specialty center. Patient problems encompass the full range of clinical renal disorders, including fluid and electrolyte disturbances, acute and chronic renal failure, glomerulonephritis, interstitial nephritis, nephrolithiasis, hypertension, intoxications, inherited renal diseases and urinary tract abnormalities. A pediatric nephrology faculty member serves as attending physician at all times, and conducts teaching rounds daily. These teaching sessions provide supervision and training in the practical aspects of patient management, as well as instruction in the pathophysiology that underlies the clinical practice of nephrology.

Fellows receive training in percutaneous renal biopsy and renal replacement therapies. They gain experience in the use of peritoneal dialysis, hemodialysis and continuous veno-venous hemofiltration/dialysis (CVVH). Experience in chronic dialysis is also provided, as fellows participate in the treatment of patients with chronic ambulatory peritoneal dialysis (CAPD) and in-center hemodialysis. Fellows are involved in an active renal transplantation program throughout their training acquiring expertise in managing the acute postoperative care and the long-term follow-up of these patients.

Fellows participate in outpatient renal clinics under the supervision of the faculty, where they gain expertise in the evaluation and management of common renal disorders not requiring hospitalization, the assessment and treatment of childhood hypertension and the long-term follow-up of patients after discharge from the inpatient and transplant services.

These clinical experiences are designed to provide progressive education and expertise in the care of children with renal disorders and related diseases.

Fellows spend 5 months of the first year staffing the inpatient service. A dedicated fellows’ clinic in which each fellows manages his/her own panel of patients occurs twice monthly throughout all years of the fellowship, providing an opportunity to develop deep longitudinal relationships with a subset of patients. Fellows are also required to participate in a variety of general nephrology clinics which provide substantial exposure to common nephrological conditions. Fellows will also spend a significant portion of the first year gaining experience managing chronic dialysis patients in our off-site unit. The dialysis component of the training program also provides another continuity experience as fellows will continue to staff these patients throughout all years of training. It is expected that fellows will identify a scholarly project during the 2nd half of the first year. Ample time is provided for each fellow to explore potential projects and mentors.

• Learn to gather accurate and essential information from families, children, and medical records from referring physicians.
• Develop and implement effective management plans.
• Use information technology and other resources to access new knowledge.
• Obtain initial introduction to therapeutic and diagnostic procedures.

Fellows spend 2 months during each of the 2nd and 3rd year staffing the inpatient service. Fellows’ continuity clinics and dialysis coverage continue during these years as noted above. Fellows have the option to pursue electives in pathology, radiology and urology. Other rotations may be organized based on the particular learning objectives of each trainee. The major focus of the latter years of training is the development of a set of research skills and substantial progress on a scholarly project.

• Acquire new knowledge through analysis and evaluation of therapeutic initiatives.
• Exercise accountability and responsibility for learning from past experience.
• Begin to develop strategies to optimize patient care.
• Perform competently essential procedures.
• Interact with broad spectrum of health care professionals to provide effective, complex care.
• Demonstrate excellence and sensitivity in caring for patients and families.
• Provide effective and professional consultation to referring physicians.
• Refine clinical judgment and decision-making regarding diagnostic and therapeutic dilemmas.
• Understand evidence based and cost-conscious strategies to develop effective care.

The longitudinal design of our fellowship program allows each fellow to develop, progressively, more sophisticated skills in either bench or clinical research.

• Apply an open-minded, analytic approach to choosing a research project and mentor.
• Exercise accountability in acquiring research skills.
• Understand limitation of research project.
• Adhere to ethical standard of research.

• Develop expertise in area of research endeavors.
• Demonstrate command of domain of research project and related areas.
• Access relevant data and pursue new ideas and avenues related to initial studies.
• Present data coherently and effectively.
• Gain experience in preparation of research materials for publication or presentation.

Our fellowship program is aimed at preparing trainees for careers as independent investigators, thus fellows spend a minimum of two years in research activities, and often extend their research training to three years. This extension provides fellows with additional time for course work, and, more importantly, allows them to undertake more challenging research projects. It is our perspective that the acquisition of high- quality research skills is fundamental to a viable long-term career in academic medicine. The core of the trainee research experience is the pursuit of a specific project under the direct supervision of a member of the faculty. The Yale University School of Medicine is unique in having a large group of outstanding investigators who are nationally and internationally recognized leaders in a broad range of biomedical disciplines relevant to nephrology and hypertension. Specifically, the program includes faculty with expertise in developmental biology, molecular genetics, cell biology and experimental pathology, cellular and molecular physiology and encompasses state of the art technology and approaches. The overall emphasis of the program is on research of the highest quality, regardless of the specific focus.

It is the philosophy of the program that preceptors should be chosen by trainees rather than assigned. To this end, each fellow is provided with extensive information, advice and time to make a careful and deliberate selection of preceptor and project. During the first six months of fellowship, each trainee will have many opportunities to meet with the faculty whose research programs are of possible interest to them, and may spend 7-10 days in their laboratories, prior to choosing a preceptor. Each fellow will choose a preceptor with the advice and approval of the program director. The research training begins during the second semester of the first fellowship year. To ensure progress towards a successful career as a physician-scientist, a Scholarship Oversight Committee (SOC) is established for each fellow, as recommended by the American Board of Pediatrics.

A training grant from the National Institutes of Health can provide salary support for U.S. citizens or individuals holding permanent residency in the United States who are pursuing basic research during their fellowship. Potential research mentors in adult and pediatric nephrology for basic research include:

• Peter Aronson
• Lloyd Cantley
• Julie Goodwin
• Shuta Ishibe
• Gary Desir
• William Chang
• Robert Safirstein
• Stefan Somlo
• Alda Tufro

Examples of mentors from outside of nephrology include Michael Caplan, Richard Flavell, Ruslan Medzhitov, Jordan Pober and Bill Sessa.

All trainees will give oral presentations at least yearly as part of a monthly Nephrology Research Conference. In addition, each fellow attends departmental Child Health Research Seminars weekly, and fellows are encouraged to attend research seminars relevant to nephrology in the Departments of Pediatrics, Internal Medicine, Cellular and Molecular Physiology, Cell Biology, Pathology, Molecular Immunology and Human Genetics.

There is also the opportunity to pursue advanced degrees (MSc, MEd, PhD) which can be arranged on an individual basis.

• Writing of case reports
• Co-authoring of chapters or review articles with faculty members
• Submission of interesting patient cases to national forums (Pediatric Academic Societies, American Society of Pediatric Nephrology, American Society of Nephrology, Eastern Society for Pediatric Research, Annual Dialysis Conference)
• Committee involvement (Quality and Safety, Graduate Medical Education)
• Teaching via didactics to a variety of audiences (residents, medical students, PA students)
• Attendance at regional and national conferences
• Involvement in a quality improvement projects
• Participation in the peer-review process

The Pediatric Nephrology Fellowship participates in the fall pediatric sub-specialties match. Early application is recommended. All completed applications are reviewed through the Electronic Residency Application Service (ERAS). A completed application must have the following:

• At least three letters of recommendation (a letter from your program director is highly recommended)
• A personal statement
• Your medical school transcript
• Your curriculum vitae
• Medical School Performance Evaluation
• Parts 1, 2 and 3 of the USMLE, taken within the seven-year time frame, or equivalent scores
• ECFMG Status Report (if foreign medical graduate)
• Current photograph

To be eligible of the fellowship program you must meet the following requirements:

• Completion of an ACGME approved pediatric residency
• Acceptability for CT licensure
• J-1 Visa holders are eligible to apply. We currently do not accept other visa types.
• Applicants must register for the Match through the NRMP