The clinical year offers a graduated experience covering the urologic problems of childhood and adolescence. By the end of the year the trainee will be well versed in both the outpatient evaluation and treatment of common and complex urologic problems as well as the diagnostic means of arriving at an appropriate clinical plan. This will include the care of children with congenital urologic anomalies affecting the genitourinary tract, the evaluation and treatment of children with tumors, the evaluation and management of childhood trauma, non-surgical renal disease, and urinary tract infections as well as the evaluation and treatment of the newborn. The fellow will be facile in the in depth evaluation of patients as relates to history taking, physical examination, the ordering and interpretation of indicated diagnostic studies and the planning of appropriate treatment, both surgical and non-surgical. Trainees will know how to obtain appropriate information from parents, guardians and, when possible, the patient him- or herself. They will learn how to communicate this information to all appropriate individuals, including the patient (appropriate to his/her level of understanding), family members/guardians and referring and other involved physicians and health care providers. They will know how to communicate the appropriate information to other members of the diagnostic and therapeutic team to best utilize the facilities available and expedite appropriate management.
The pediatric urology fellow, with guidance from the program director, will select surgical cases on which to scrub. He/she will be expected to be the primary surgeon or teaching assistant on all index cases, when possible. After gaining adequate surgical experience the pediatric urology fellow will be expected to be the teaching assistant on all other cases when scrubbed. All surgical cases will be directly supervised by the assigned attending physician.
Additionally, the pediatric urology fellow will be involved in the education of medical students rotating through the pediatric urology service as well as general urology fellows. He/she will be responsible for reviewing both out patient and inpatient evaluations and work ups of the other fellows and students as well as assisting the general urology fellows in the operating room when appropriate. These educational responsibilities will always be under the supervision of the chief of the service or another attending pediatric urologist.
Children’s National has an internationally recognized state of the art diagnostic radiology and imaging department with a first class faculty. For the past 27 years there has been a weekly case-management conference with the review of all pertinent studies for the week attended by radiology faculty, radiology trainees, and all members of the urology division. Fellows present cases that are discussed in detail. All complex problems are brought to this conference for treatment planning and group discussion. At the end of training the fellow will be well versed in this area.
Children’s National provides a full service Spina Bifida Clinic that manages over 350 active patients with neuropathic bladder disease. The pediatric fellow will participate in those clinics with progressive responsibility throughout the year. All intersex patients referred to Children’s National are managed by a multidisciplinary team including pediatric urology, endocrinology, genetics and psychology. The pediatric fellow will be involved in the evaluation and management of all of those patients.
Finally, the pediatric urology fellow will be expected to pursue academic activities, both clinical and laboratory based, with the production of at least one paper suitable for presentation at an academic meeting and publication in the appropriate literature. This would be done in conjunction with an attending pediatric urologist, and, when possible, a general urology fellow and/or student.
The pediatric urology fellow is expected to be at one of the assigned facilities each workday and on weekends when the situation arises. He/she will take secondary call by phone on a daily basis unless there are scheduling conflicts, the general urology fellow taking primary call. He or she will have alternate weekends free of call. The general urology fellow will consult with the pediatric urology fellow when appropriate. An attending pediatric urologist will always be on call and will be called by the pediatric urology fellow, or general urology fellow if the pediatric urology fellow is not immediately available, for any problem that requires his/her input or when surgical intervention is required. The pediatric urology fellow will never be on call without attending backup and the attending will be available as dictated by the guidelines of Children’s National.
The pediatric urology fellow will have no completely independent patient care; all outpatient and surgical activities will be supervised directly by an attending pediatric urologist. However, the goal is to establish a qualified pediatric urologist. Therefore, as the year progresses the pediatric fellow will gradually establish his/her own clinical practice to be done in conjunction with the practice of one of the attending physicians. The pediatric fellow will independently evaluate these patients and plan a course of management, presenting that plan to the supervising attending physician. Management both pre and post treatment will be the responsibility of the trainee.
The pediatric urology fellow will be evaluated quarterly by all attending physicians involved in the training program as well as by the general urology fellows he/she has supervised. The pediatric urology fellow will meet with the Program Director quarterly to review these evaluations and discuss his/her progress. At that time the fellow will have the opportunity to discuss the program and any recommendations by the fellow as to how it can be improved.