Job Description

Goals Continued

Baylor College of Medicine and Department Summary:

The Pediatric Critical Care Nephrology Instructor program at Baylor College of Medicine provides specialized training for graduates of Pediatric Critical Care, Pediatric Nephrology, or Perinatal/Neonatal Medicine fellowships to foster future clinical research collaboration between pediatric nephrologists, pediatric intensivists, and neonatologists and to provide additional training in extracorporeal therapies.

There are three available tracks for the instructors depending on their background and future career development.

Critical Care

This additional training is for critical care physicians who wish to enhance their understanding of fluid and electrolyte management, acute kidney injury diagnosis and management as well as application of renal extracorporeal therapies in the pediatric intensive care unit. Additionally, it is a platform to gain more experience in renal replacement therapy utilization especially for those who seek to serve geographic areas where expertise in pediatric dialysis is limited.

Nephrology

The instructorship is also available to graduates of pediatric nephrology fellowship programs. The goal of this program is to provide education in the theoretical and practical aspects of critical care medicine to help instructors develop a high level of competence in managing patients with life-threatening illnesses with a high degree of physiological instability. The instructors will be expected to complete an original clinical research project in the area of pediatric acute kidney injury or renal replacement therapy while gaining full expertise in all extracorporeal therapies offered by Texas Children’s Critical Care Nephrology program.

Neonatology

For neonatology graduates interested in further training in Critical Care Nephrology, an optional one-year of training is available through the Critical Care Nephrology Instructor Program. The goal of this program is to provide education in the theoretical and practical aspects of nephrology as practiced in the critical care setting, specifically the NICU to help instructors develop a high level of understanding of dialytic and nondialytic therapies for common renal diseases in the neonate.

Summary

The increasing complexity of the patients cared for intensive care units has led to need for development of niche expertise in emerging fields. More than 60% of the pediatric intensive care unit patients have highly complex comorbidities and are in increasing need of sophisticated life support. The available extracorporeal support modalities have increased in number and complexity, and this trajectory is expected to remain steep for the foreseeable future. The continued development of novel extracorporeal therapies and improved care for critically ill patients has led to a growing interest in critical care nephrology as a career path. Bridging disciplines will allow optimal management of knowledge accumulation to handle the increasing complexity in the critical care setting. Training of competent individuals in specialized centers with adequate patient volume is essential for spread of expertise across the discipline.

The Renal Critical Care Service includes care of patients in the intensive care units. The overall goals of the instructor year are to develop a deeper knowledge of the epidemiology, etiology, pathophysiology, and management of acute and chronic kidney disease and a sophisticated understanding of renal replacement therapy and other extracorporeal therapies in the critical patient.

Goals

Develop a deeper knowledge of the epidemiology, etiology, pathophysiology, and management of acute and chronic kidney disease in the general ICU, cardiac ICU, neonatal ICU, and other special care areas such as bone marrow transplant unit and cardiac and non-cardiac step-down units.

• Employ critical thinking and evidenced based medicine to independently generate the appropriate differential, workup, and synthesis of diagnostic data for the patient with acute and acute on chronic renal failure.
• Enhance understanding of the etiology and management of fluid and electrolyte derangements and acid base disorders in the ICU.

Goals Continued

Develop a sophisticated understanding of renal replacement therapy in the critical patient, including:

• Understand the basic principles of renal replacement therapy in all modalities, including solute transport, fluid management, dose delivery, adequacy assessment, and complications.
• Understand the critical decision making behind the evaluation and selection of patients requiring renal replacement therapy and the timing of initiating RRT in critically ill patients.
• Become familiar with optimal size and placement of hemodialysis/pheresis catheters for an individual patient and consequences of suboptimal size or positioning.
• Gain basic understanding of initial prescription for and adjustment of renal replacement therapy.
• Gain hands on experience in monitoring of renal replacement therapy, including evaluation of therapy goals.
• Recognize and manage complications and unintended consequences of dialysis.
• Develop deeper understanding of effects of dialysis on therapeutic drug metabolism and pharmacokinetics and dosage adjustments required while on RRT.

Develop more advanced knowledge of additional extracorporeal therapies utilized in the ICU, such as extracorporeal liver support and apheresis.

• Understand the indications and contraindications for ELS in acute and acute on chronic liver failure, the benefits, and limitations of ELS as a bridge to transplant and the ethical implications of utilizing ELS in this capacity.
• Become familiar with apheresis therapies such as therapeutic plasma exchange utilized in the ICU.
• Understand complexities, prescription, and basic troubleshooting of tandem extracorporeal therapies such as CRRT+ECMO or CRRT+TPE.

Job Duties

The Renal Critical Care Service includes care of patients in the PICU, TICU, NICU levels II-IV and CVICU. Patients in these areas may be cared for as either consultant patients or as primary service patients. Indications for consultation include, but are not limited to, medically complex patients (i.e., patients with sepsis and multi-organ dysfunction, neurologic disorders, solid organ transplant, bone marrow transplant, congenital heart disease, and prematurity) for acute kidney injury with fluid overload, electrolyte disturbances, and hypertension. Primary renal patients are also frequently medically complex and may require intensive care management for non-renal illness or complications related to their renal disease (i.e., a chronic peritoneal dialysis patient with peritonitis and sepsis, fluid overload and hypertensive urgency in a chronic dialysis patient, a patient with newly diagnosed ESRD, or a new renal transplant). Maintaining strong lines of communication with all service involved in the care of patients is imperative to providing excellent care in the ICUs.

Minimum Qualifications

• M.D. (or equivalent), ACGME Accredited Residency in Pediatrics and Fellowship in Pediatric Critical Care, Pediatric Nephrology, or Perinatal/Neonatal Medicine. Clinical rotations will vary depending on the background of the individual applicant but would be expected to include front line roles in the ICUs.
• Candidate must be Board Eligible or Board Certified in Pediatrics and Pediatric Critical Care, Pediatric Nephrology, or Perinatal/Neonatal Medicine.
• Minimum Certification/Licenses/Registration: Licensed by the Texas Medical Board.

Baylor College of Medicine is an Equal Opportunity/Affirmative Action/Equal Access Employer.

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