The Nephrology Fellowship Program is a two-year fellowship that includes both clinical training and research experience required by the Accreditation Council for Graduate Medical Education (ACGME) for board certification in Nephrology. All renal trainees (Fellows) must have completed an internal medicine residency, approved by the ACGME, and be board-eligible or board-certified in Internal Medicine. First-year fellows receive four weeks of orientation, training and education prior to to starting on service or taking calls. This allows them the opportunity to meet faculty and staff, master EMR, and understand hospital layout and processes. All fellows also receive a $1,200 yearly stipend to support continuing education activities such as the purchase of textbooks, conference attendance or board review course participation.
The clinical experience will include opportunities for the management of inpatient and outpatient acute and chronic renal disease. The inpatient experience includes rotations through our acute consult, dialysis and renal transplantation services. The outpatient clinical experience includes a weekly continuity clinic, a monthly peritoneal dialysis clinic and at least three months of outpatient exposure to the evaluation and care of renal transplant recipients. All clinical encounters are directly supervised by a faculty member responsible for the care of patients as well as the education and mentoring of the trainees. During each rotation, training is 1-1, with one faculty member assigned to one fellow on service. While didactic teaching is scheduled through weekly conferences, much of the education will be provided at the bedside, as learning opportunities are often presented while processing patient data and formulating decisions for patient care plans.
The patients seen at Barnes-Jewish Hospital represent a wide spectrum of pathologic processes as well as cultural, racial, and economic diversity, thereby ensuring that trainees will develop a broad education not only in scientific approach but in cultural sensitivity, communication and lifestyle considerations as they formulate patient care plans. The hospital also is fully staffed with physicians of all specialties, nurses, patient care technicians, social workers and dietitians, allowing our trainees to experience a systems-based integrated and multidisciplinary practice.
Any fellow with a demonstrated interest in academic nephrology and either basic, translational or clinical research will have the opportunity to be on the research track. This allows fellows to add a third year to their fellowship in which to receive structured mentoring and training in research methodology, as well as instruction on writing manuscripts and grants and the delivery of scientific presentations. Designation to the research track does not require external funding for the third year, which is supported by the division.
Core competency expectations for fellows are as follows:
- Demonstrate proficiency in renal procedures, including the evaluation of urine sediment, the placement of dialysis access and the percutaneous renal biopsy. Fellows will be supervised until they have demonstrated competency in these procedures.
- Learn to write patient-specific prescriptions for all modalities of renal replacement therapy and plasmapheresis.
- Discern when a patient requires emergent renal replacement therapy and when alternative measures should be attempted.
- Demonstrate ability to evaluate chronic dialysis inpatients and develop case-appropriate diagnostic and therapeutic plans.
- Approach electrolyte abnormalities, acute renal failure and renal transplant complications with a clear and logical approach.
- Write or dictate comprehensive initial evaluation notes, with an emphasis on the assessment and plans.
- Demonstrate professionalism in communicating with other members of the health care team in a timely and respectful fashion.
- Independently perform urine evaluations and dialysis access placement without direct supervision by faculty.
- Demonstrate ability to address common complications of all procedures.
- Demonstrate ability to address common complications of all modalities of renal replacement therapy.
- Formulate an assessment and plan for each patient on their own, thereby demonstrating progressive autonomy.These patient care plans will be verified by their supervising faculty member before implementation.
- Demonstrate an ability to teach by being responsible for the education of medical students and internal medicine residents who are rotating through the renal service.
Second-year fellows also will be expected to present topics for the Renal Grand Rounds lecture series and provide in-depth critical analysis of published data in Journal Clubs.
- Present (either through oral presentation or publication) the results of their academic endeavors and research.