First-Year Fellowship Curriculum
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Curriculum for First-year Clinical Rotations
First-year clinical fellows attend all scheduled conferences and serve on rotating clinical services as determined by assignment on the first day. The clinical services each have a supervising attending, often a student and/or resident house officer which require teaching from the fellow. The areas of emphasis in the first year are described below:
A. HUP INPATIENT SERVICE (16-20 weeks the First Year; 4-6 weeks in ICU only the Second Year ):
Educational Purpose: To provide a varied and comprehensive inpatient and dialysis experience using all the patient material in the hospital. Instruction and teaching at the bedside and in conferences with medical students and medical residents.
Principal teaching method: Attending teaching rounds, bedside discussions, conferences, computer teaching programs, literature review, and direct supervision of procedures.
Educational Content: Exposure to all major renal diseases on medical and surgical services, intensive care units, obstetrics, and psychiatry. Thorough exposure to end-stage, chronic and acute renal failure.
Mix of diseases: Acute renal failure, chronic renal failure, end-stage renal disease, ICU nephrology, diagnostic nephrology, serum electrolyte disturbances, bone disease, stones, urologic diseases, and obstetrics, glomerulonephritis, interstitial nephritis.
Patient characteristics: Adults and adolescents, women and men, and geriatrics.
Types of clinical encounters: Primary care, bedside consultation.
Procedures: Hemodialysis, continuous renal replacement therapy (SCUF, CVVH, CVVHD, CVVHDF), peritoneal dialysis, catheter insertion, renal biopsy and urinalysis.
Services: Inpatient Consultation and primary care.
Ancillary educational material: Books, library journals, computer/Up-to-date, Medline.\
Evaluation: Fellows evaluated monthly with semi-annual conference to review evaluation.
Site's resource: Comprehensive tertiary hospital.
B. VAH INPATIENT SERVICE (4-8 weeks):
Educational Purpose: To provide a varied and comprehensive inpatient and dialysis experience using all the patient material in the hospital. Instruction and teaching at the bedside and in conferences with medical students and medical residents.
Principal teaching method: Attending teaching rounds, bedside discussions, conferences, computer teaching programs, literature review, and direct supervision of procedures.
Educational Content: Exposure to all major renal diseases on medical and surgical services, intensive care units, and psychiatry. Thorough exposure to end-stage, chronic and acute renal failure.
Mix of diseases: Acute renal failure, chronic renal failure, end-stage renal disease, ICU nephrology, diagnostic nephrology, serum electrolyte disturbances, bone disease, stones, urologic diseases, glomerulonephritis, and interstitial nephritis.
Patient characteristics: Adults, women and men, and geriatrics.
Types of clinical encounters: Primary care and bedside consultation.
Procedures: Hemodialysis, peritoneal dialysis, catheter insertion, renal biopsy, and urinalysis.
Services: Inpatient consultation.
Ancillary educational material: Books, library journals, computer/Up-to-date, Medline.
Evaluation: Fellows evaluated every six months with annual conference to review evaluations; faculty evaluated yearly.
Site's resource: Comprehensive tertiary hospital.
C. HUP TRANSPLANT (8-12 weeks):
Educational purpose: To provide a varied and comprehensive inpatient and outpatient experience using all the patient material in the transplant practice. Instruction and teaching at the bedside, and in ambulatory practice sites, and in conferences with medical students and medical residents.
Principal teaching method: Attending teaching rounds, bedside discussions, conferences, computer teaching programs, and literature review. Direct inpatient and outpatient supervision.
Educational content: Exposure to all aspects of surgical and medical transplantation. Thorough exposure to evaluation and long term post-transplant care.
Mix of diseases: Acute renal failure, chronic renal failure, kidney transplantation, liver transplantation, multi-organ transplantation, serum electrolyte disturbances, bone disease, general nephrology, urologic diseases.
Patient characteristics: Adults, women and men.
Types of clinical encounters: Bedside consultation and ambulatory nephrology, outpatient transplant clinics.
Procedures: Renal transplant biopsy, hemodialysis, continuous renal replacement therapies, peritoneal dialysis, and urinalysis.
Services: Consultation and principal care. Diagnostic transplant nephrology and therapy.
Ancillary educational material: Books, library journals, computer/Up-to-date, Medline.
Evaluation: Fellows evaluated monthly with semi-annual conference to review evaluation.
Site's resource: Comprehensive tertiary hospital and clinical practice environment.
D. PRESBYTERIAN HOSPITAL (8 weeks):
Educational Purpose: To provide a varied and comprehensive inpatient and dialysis experience using all the patient material in the hospital. Instruction and teaching at the bedside and in conferences with medical students and medical residents.
Principal teaching method: Attending teaching rounds, bedside discussions, conferences, computer teaching programs, literature review, and direct supervision of procedures.
Educational Content: Exposure to all major renal diseases on medical and surgical services, intensive care units, obstetrics, and psychiatry. Thorough exposure to end-stage, chronic and acute renal failure.
Mix of diseases: Acute renal failure, chronic renal failure, end-stage renal disease, ICU nephrology, diagnostic nephrology, serum electrolyte disturbances, bone disease, stones, urologic diseases, glomerulonephritis, and interstitial nephritis.
Patient characteristics: Adults, women and men, and geriatrics.
Types of clinical encounters: Primary care and bedside consultation.
Procedures: Hemodialysis,, continuous renal replacement therapy, (SCUF, CVVH, CVVHD, CVVHDF) peritoneal dialysis, catheter insertion, renal biopsy and urinalysis.
Services: Inpatient consultation and principal care.
Ancillary educational material: Books, library journals, computer/Up-to-date, Medline.
Evaluation: Fellows evaluated monthly with semi-annual conference to review evaluation.
Site's resource: Comprehensive primary and tertiary hospital.
E. CHILDREN'S HOSPITAL CONSULT SERVICE (4 weeks in the First or Second Year ):
Educational Purpose: To provide a varied and comprehensive inpatient and dialysis experience using all the patient material in the hospital and in ambulatory practice. Instruction and teaching at the bedside and in conferences with medical students and medical residents.
Principal teaching method: Attending supervision and teaching rounds, bedside discussions, conferences, computer teaching programs, and literature review.
Educational Content: Exposure to all major renal diseases on pediatric services including, intensive care units and obstetrics. Thorough exposure to end-stage chronic and acute renal failure on the inpatient service and in the ambulatory dialysis unit.
Mix of diseases: Congenital disorders, neonatal and pediatric ICU, Acute renal failure, ESRD, diagnostic nephrology, serum electrolyte disturbances, bone disease, stones, urologic diseases, and obstetrics.
Patient characteristics: Infants, children and adolescents, girls and boys.
Types of clinical encounters: Bedside consultation and ambulatory pediatric nephrology.
Procedures: Hemodialysis, continuous renal replacement therapy , peritoneal dialysis, catheter insertion, plasmapheresis, transplant renal biopsy, and urinalysis.
Services: Consultation and principal care. Diagnostic nephrology and therapy.
Ancillary educational material: Books, library journals, computer/Up-to-date, Medline.
Evaluation: Fellows evaluated monthly with semi-annual conference to review evaluation; faculty evaluated yearly.
Site's resource: Comprehensive tertiary hospital and clinical practice environment.
F. RADIOLOGY (2 weeks in the First or Second Year):
Educational purpose: To provide first hand exposure to diagnostic imaging modalities and therapeutic/interventional maneuvers to evaluate kidney disease, the genitourinary tract, and renal vasculature, and to evaluate and maintain vascular access. Instruction and teaching at radiology practice sites and in conference with radiologists.
Principal teaching method: Through observation of teaching, direct interaction with radiologist and staff, attending teaching rounds, conferences, computer teaching programs, literature review.
Educational content: Exposure to all major uro-nephrologic diseases and vascular access from an imaging and therapeutic interventional perspective.
Mix of diseases: Acute renal failure, chronic renal failure, diagnostic nephrology, bone disease, stones, urologic diseases, and obstetrics.
Patient characteristics: Adolescents and adults, women and men, and geriatrics.
Types of clinical encounters: Radiology consultation in a hospital setting in hospitalized and ambulatory patients.
Procedures: Observe: IVPs, lithotripsy, CAT scans, MRI. nuclear medicine, ultrasonography, percutaneous, nephrostomy, angiography, tunneled and nontunneled catheter insertions, other vascular access procedure.
Services: Diagnostic nephrology and therapy.
Ancillary educational material: Books, library journals, computer/Up-to-date, Medline, radiology library.
Evaluation: Fellows evaluated after two week rotation.
Site's resource: Comprehensive tertiary hospital and clinical practice environment.
G. OUTPATIENT NEPHROLOGY (24 months during the first two years):
(HUP, Presbyterian, Outpatient Dialysis Units, Transplantation Clinic)
Fellows attend a regular, weekly, half-day outpatient, attending supervised, clinical practice during the first year. During the second year, fellows attend an outpatient subspecialty nephrology practice every other week throughout the year and on alternate weeks attend outpatient dialysis rounds (6 months) or ambulatory renal transplant practice (6 months), under supervision of a faculty member. At each ambulatory clinic session the fellow, under the supervision of an attending should expect to see on average, one – two new patients and three – five follow up patients. After completing their second year, board eligible fellows typically continue elective outpatient nephrology experiences in dialysis, renal transplantation, hypertension, glomerulonephritis, or stone clinic.
Educational purpose: To provide a varied and comprehensive general nephrology outpatient, transplant, and chronic dialysis experience using all the patient material in the outpatient setting. Each fellow will have continuity experiences in general outpatient nephrology, outpatient dialysis, and outpatient transplantation during the first two of training.
Principal teaching method: One-on-one supervision in the outpatient office setting and dialysis units and transplant practice.
Educational content: Exposure to all major renal diseases including general nephrology, end-stage renal disease, dialysis and transplantation.
Mix of diseases: Chronic renal failure, end-stage renal disease, glomerulonephritis and tubulointerstitial nephritis, diabetic nephropathy, hypertension, diagnostic nephrology, serum electrolyte disturbances, bone disease, stones, and urologic diseases and transplantation.
Patient characteristics: Adults, men and women, and geriatrics.
Types of clinical encounters: Ambulatory general nephrology, outpatient dialysis, outpatient transplantation. The general nephrology practice includes consultation, care and management of patients with renal disease. During the dialysis experience, there is a major emphasis on access planning and management of anemia, osteodystrophy, hypertension, dialysis adequacy and nutrition. The transplantation experience includes donor and recipient evaluation, and management of all aspects of care after transplantation.
Procedures: Dialysis, urinalysis.
Services: Consultation and principal care. Diagnostic nephrology and therapy.
Ancillary educational material: Books, library journals, computer/Up-to-date, Medline.
Evaluation: Fellows evaluated every six months with annual conference to review evaluation.
Site's resource: Comprehensive tertiary hospital and clinical practice environment.
