Pediatric Nephrology Training: Revisiting the Journey
Lynette Fillone –Alcala MD, FPPS, FPSN, FPNSP
2022
The Philippine Society of Nephrology is now celebrating its 50th Founding Year, and we often wonder how the training for nephrologists evolved. So we ventured to find answers to this part of history. As a trainee who happens to be the 10th Fellow in training at the University of the Philippines -Philippine General Hospital and currently in the middle of the pack of pediatric nephrologists in the country, I cannot help but wonder how training in Nephrology started and what was it like?
From the narrative of Dr. Carmelo Alfiler in the 40 years coffee table book, “Beyond Measure”, it was in 1986 when four pioneers, in the persons of Dr. Carmelo Alfiler, Dr. Myrna Rosel, Dr. Zenaida Antonio, and Dr. Vivina Chu, initiated talks to organize pediatric nephrology as a distinct subspecialty under the umbrella of the PSN. It was during that time that the certifying examinations were from the adult subspecialty board . The encounters are daunting because they make you delve into the peculiar adult illnesses and, at times, exciting because the examinees ask how we do pediatric nephrology.
In the 1990s when Dr Carmelo Alfiler assumed the presidency of PSN, there was a serious concern for the care of renal diseases in children worldwide, paving the way for the integration of pediatric nephrology in the context of nephrology training in the country. After a few years, the number of pediatric nephrologists grew, prompting the founding of the Pediatric Nephrology Society of the Philippines with 15 members in 1994. During this time, Dr. Carmelo Alfiler became the founding president, and the birth of the four pediatric nephrology training programs in the country, namely the Philippine Children’s Medical Center, The UP-PGH, the National Kidney and Transplant Institute, and the University of Santo Tomas Hospital came into being.
But it was only in 1998 that the subspecialty board of pediatric nephrology was created under the able presidency of Dr. Myrna Rosel. During her time, they streamline the process of certifying graduate trainees from the country’s four major pediatric nephrology training programs. Moving from a mentor-based training where fellows became Mini-Mes or younger versions of their mentors in terms of knowledge base, abilities, and practices, the call for a more scientific and standardized process of learning was embraced by the mother society of the PSN during the term of Dr Nazareno Rosales in 2002-2004. With the establishment of the Mission-Vision and goals of the society, steps were taken to improve the training of nephrologists in the country. To quote Dr. Coralie Dimacali, the need to standardize the examination, make objective questions, and scientific conduct of assessment paved the way for the evolution of nephrology training in the country. Institutions gather to revisit training manuals and protocols, formalize instructional designs, and align activities with the intended learning outcomes. They put structure into the teaching-learning activities, identifying skills that need to be developed, enhancing attitudes, and carving ethical mindsets to make nephrology training more relevant for the Filipinos, their families, and the community.
For the past two years into the COVID 19 Pandemic, another major haul into implementing fellowship training again happened. We need to enhance training to be receptive to the challenges of the times and take a backward step to safeguard our mentor’s and trainees’ mental health and safety as they navigate these crucial times. The core thrust to treat patients with primary renal diseases, address issues of emergent conditions and respond to the pandemic added to the task of making training more relevant and receptive. Preventive Nephrology and transition care must be embraced with the many problems besetting children and adolescents alike.
This 2022, the Fellowship Training Pediatric Accreditation Board (FTPAB) is again in its final steps to revise the training manual as the five fellowship training programs accreditation is underway. As we again embark on the new possibilities, we have not only moved forward for training to be more relevant in terms of knowledge acquisition and skills development, but the limitless access to what is happening in the other parts of the world has made learning more accessible, more complicated in certain situations but rewarding for many times. Walls have been toppled, engagements became more collaborative, and knowledge sharing has become more comprehensive and, at the same time, unique and distinct for the specific region where you are and from where you came from. For always, we stand by our core purpose of delivering renal care to all and for all.
