Inpatient Clinical Training
The inpatient consult service sees patients with acute renal failure, electrolyte and acid-base disorders, and severe hypertension, as well as following end-stage renal disease patients requiring hemo- or peritoneal dialysis. We maintain a service census of 20-25 patients, with 2-5 new consults per day. Critically-ill patients in our intensive care settings (MICU, SICU, heart and vascular ICU, neuro ICU, and associated intermediate care units) make up a third to a half of a typical census.
The transplant service performs 50-70 kidney and kidney/pancreas transplants per year. Fellows see patients in the clinic pre-transplant, present them in selection meeting, follow them in the hospital in the peritransplant period, and maintain follow-up in the post-transplant clinic setting. Fellows also see long-term follow-up transplant patients as part of the continuity clinic. The exposure to patient selection, advanced immunosuppressant therapies, post-transplant management, and long-term follow-up ensures that the fellow has a superior skill set in dealing with transplant patients in in- and outpatient settings.
Outpatient Clinical Training
A cadre of forty hemodialysis patients make up the core of the fellows’ outpatient hemodialysis experience. Fellows see approximately 20 patients in the peritoneal dialysis clinics monthly. We are proud of the amount of peritoneal dialysis training we offer our fellows, which enables them to not just be competent in that modality, but to advance the cause of peritoneal dialysis after fellowship. Fellows have the opportunity to attend a national extramural course in peritoneal dialysis as well, further expanding their abilities.
The fellows’ continuity clinic is held weekly (save for the fellow on the inpatient consult service at any given time). Fellows will see 1-2 new and 4-6 follow-up patients per clinic along with the attending. As a referral center, our outpatient patient mix includes both common (CKD, hypertension), advanced (renal transplant, CKD in other solid organ transplant patients), and unusual cases (e.g. atypical or complex glomerular disease presentations).
Fellows have the opportunity for elective rotations in critical care nutrition (e.g. TPN management), pediatric nephrology, renal imaging and intervention. Each fellow spends time during the second year on the apheresis service, and will be able to gain qualification in therapeutic apheresis such that, post fellowship, they would be qualified to be a medical director of an apheresis service per the American Society for Apheresis guidelines. Fellows on the apheresis service also interact with the transplant service in dealing with patients requiring plasma exchange for treatment of antibody-mediated rejection or reduction of donor-specific antibodies.
The first year of training is a busy clinical year. The second year brings more longitudinal exposure to chronic in-center hemodialysis and peritoneal dialysis. Research time is spread throughout the year to allow the fellow to initiate and complete a meaningful project. Depending on the interests and goals of the fellow, projects are possible in both basic and clinical science. A goal of this activity is a peer-reviewed manuscript, or other scholarly output at that level. Our fellows have had poster and oral presentations at national meetings; submitted peer-reviewed publications; written successful IRB protocols; and obtained extramural grant funding. While not all of our fellows plan to pursue clinical research after fellowship, motivated and skilled trainees will find challenging research work which can form the basis for further exploration.
Conferences are scheduled throughout the year, with specific sessions in July and August set aside for orientation topics. Fellows participate in planning and giving talks to the division, with additional time for this in the second year. The yearly renal medicine course for second-year medical students offers additional opportunities for small-group session teaching and facilitation.
Scheduled Conferences Include:
- Clinical case conference (each Tuesday, noon)
- Weekly conference (Tuesdays, 4 PM; topics rotate weekly)
- basic science
- grand rounds
- biopsy conference
- literature update
- Monthly departmental research conference
- Core curriculum (Thursday, noon) with emphasis on:
- renal physiology (spans both years)
- physiology of hemo- and peritoneal dialysis
- K/DOQI and NephSAP review
- Weekly sign-out rounds & case discussion (Friday afternoons)