The Pediatric Nephrology and Hypertension Fellowship training program is designed to train pediatricians in clinical and research skills so they can develop into excellent clinical nephrologists, outstanding researchers and educators. We also have an active combined Medicine-Pediatrics Nephrology Fellowship training program.
While all nephrology fellows will gain extensive experience in the evaluation and management of high blood pressure in children and teens, our program uniquely offers an opportunity for a special concentration in pediatric hypertension. Fellows who choose this clinical path will receive additional intensive training and experience in our dedicated hypertension clinics. In addition, specialized training in the use and analysis of ambulatory blood pressure monitors and the potential to become an ASH Clinical Specialist in Hypertension is available.
We benefit from being a part of the largest medical center in the world, the Texas Medical Center. Our inclusion in these exceptional academic facilities of the University of Texas Health Science Center at Houston allows our fellows to seamlessly collaborate with mentors beyond the Department of Pediatrics, including the Center for Clinical Research and Evidence-Based Medicine, the Center for Healthcare Quality and Safety, the Graduate School of Biomedical Sciences, the Institute of Molecular Medicine, and the School of Public Health. Our 3 year curriculum combines structured didactics, a busy clinical service, and mentored scholarly activities. The fellowship program is accredited by the Accreditation Council for Graduate Medical Education (ACGME).
Haendel Muñoz, M.D.
Hometown: Lima, Perú
Medical School: Universidad Peruana Cayetano Heredia
Pediatrics Residency: Florida State University
Sean Hebert, M.D.
Hometown: Baton Rouge, LA
Medical School: Louisiana State University
Pediatrics Residency: University of Texas Medical School – Houston
During the 36 month training period, each fellow will spend 12 months on our inpatient clinical service. The remaining months of fellowship are reserved for scholarly activity and electives (Pediatric Urology, Renal Pathology, and Renal Radiology). Throughout training fellows spend 1 afternoon each week in a continuity outpatient clinic and an additional afternoon in a rotating sub-specialty clinic such as transplant or hypertension. Though each fellow’s schedule is individualized, a basic outline is provided below.
The first year serves to create a solid clinical base in pediatric nephrology. This year is also used to begin basic coursework in the Clinical Research Curriculum, and to work with a mentor to begin to narrow the scope of scholarly interests. As the fellow on the nephrology service for 3-4 months, you will receive hands-on training in managing patients admitted to the nephrology service at Children’s Memorial Hermann Hospital. In addition, you will gain expertise in providing consultation to other services including the PICU, NICU, general pediatrics, and all other teams. We also provide consultation services to the University of Texas M. D. Anderson Cancer Center, the Women’s Hospital of Texas, and LBJ Memorial Hospital (the Harris County Hospital for indigent patients). Fellows learn to manage many disorders, including acute kidney injury and chronic kidney disease, hypertension, fluid and electrolyte imbalances, acid-base disorders, new and relapsing nephrotic syndrome, acute and chronic glomerulonephritis, hemolytic-uremic syndrome, new and established renal transplant recipients, as well as both peritoneal and hemodialysis patients. Our fellows learn to manage all acute dialytic modalities hemodialysis, peritoneal dialysis, and continuous renal replacements in the form of both CRRT and SLED.
Though not always completed in the first year, two months of fellowship are devoted to the outpatient Pediatric Dialysis Unit. The fellow works with dialysis nurses and our faculty to learn the technical aspects of dialysis procedures, vascular access, how to set up and troubleshoot dialysis machines, and understand some of the duties of the dialysis Medical Director.
During the first year, fellows also identify their chosen research tract: basic or clinical scientist. They select members of the Scientific Oversight Committee (SOC) and begin the early phases of their research project.
The second year of fellowship is devoted more to pursuit of scholarly activity. Fellows ideally complete the clinical research training provided in the Clinical Research Curriculum and may opt to begin advanced coursework by pursuing a Masters in Clinical Research through the Center for Clinical Research and Evidence-Based Medicine. They will begin work on their research project under the guidance of their mentors and SOC. Clinical responsibilities will include outpatient clinics two days a week, 3-4 months of inpatient nephrology service, and monthly weekend coverage.
The fellow will complete his or her research projects and write the related abstracts and manuscripts. In addition to their main scholarly project, many fellows often use this time to also publish case reports, present posters at national scientific meetings, and coauthor book chapters and review articles. Fellows complete the rest of their required service time, with the final inpatient month spent as “acting attending”, in which they will supervise residents in a capacity similar to an attending, with ongoing support from the nephrology attending.
What does the program offer for additional research support?
Previous fellows have found the assistance of our divisional biostatistician, Cynthia Bell, invaluable in the development of high quality research design and analysis. Cynthia Bell is often part of the fellow’s SOC committee. Each fellow receives a yearly $500 stipend for educational expenses. Fellows are not expected to secure funding for salary support.
What is the call schedule?
There is no in-house call: call for the on-service fellow is taken from home. Fellows, with the assistance of the program director, make their own call schedule for service and weekend coverage. In the unusual instance when the fellow is in house overnight for a sick child, they are not allowed to work more than 30 consecutive hours. The fellows are also not allowed to average more than 80 hours per week over a two week period. Moonlighting hours, though allowed, are included in the 80 hour work week limit. Fellows average 5-6 days per month without clinical responsibilities, even while on service.
What are the night call responsibilities?
When on service, fellows take call from home 4 nights per week (Monday through Thursday). Throughout the fellowship and regardless of rotation, each fellow spends on average one weekend per month on inpatient call (Friday evening through Sunday). There is always an attending on call.
What comprises the structured didactics?
There are 3-4 hours of educational meetings each week. As a whole, these meetings provide a comprehensive and well-rounded education for the fellow.
- Weekly Patient Care Conference/Signout- discuss the inpatient nephrology service patients
- Weekly Education Hour- core lectures in Pediatric Nephrology
- Monthly Journal Club- two current articles are presented by a fellow and a faculty member. The fellow is trained in critical appraisal of the literature
- Monthly Research Meeting- fellows and faculty update the division about their ongoing research projects
- Bimonthly Board Review- sample board prep questions are reviewed and discussed as a group
- Annual Nephrology Core Curriculum series- at the beginning of each academic year, all pediatric and adult nephrology fellows participate in a 2 month course that provides an introduction to nephrology concepts.
- Monthly RUN conference- (Radiology-Urology-Nephrology) – interesting cases are discussed at this multidisciplinary meeting
- Weekly Renal Grand Rounds
- Weekly Pediatric Grand Rounds
- Monthly Renal Biopsy Conference
- Monthly Transplant Biopsy Conference
- Monthly Transplant Journal Club
- Monthly Pre-transplant Hour- discuss new transplant referrals and evaluations
- Weekly Dialysis CQI meeting- (only during dialysis rotation) multidisciplinary meeting in which the outpatient dialysis program is discussed, included patient issues and quality initiatives
How is the fellow’s progress assessed?
Fellows meet individually with the Fellowship Program Director and mentor multiple times a year to review the clinical/research progress. Additional feedback is provided by regular meetings with the SOC committee. We have recently added a novel forum for ongoing direction of fellows’ research, the eGFR (establishing Great Fellows Research) Happy Hour. Finally, each fellow is required to take the annual ABP subspecialty in-training exam in March.
How do I Apply?
We typically take 1 or 2 fellows per year starting July 1st. We encourage interested applicants to
contact us 12-15 months before the anticipated start time. Please apply through ERAS.