Clinical Rotations and Electives
Fellows gain comprehensive and in-depth clinical exposure to a wide variety of acute and chronic kidney diseases during their in-patient and out-patient experiences. In-patient rotations include intensive experience with and training in diagnosis and management of acute kidney injury, critical care nephrology, glomerular and tubulointersitial kidney diseases, fluid-electrolyte disorders, hypertension, pergnancy, chronic and end-stage kidney disease, kidney stones, and various other renal disorders. Fellow's gain skill in placement of dialysis catheters, renal biopsy, acute and chronic hemodialysis, peritoneal dialysis, and continuous renal replacement therapy. There is ample opportunity for fellows to participate in teaching of medical students and residents from Penn and elsewhere.
Our educational progrm includes an extensive conference series, print and on-line educational materials, use of the Penn Simulation Center, and extensive bed-side teaching. Specific ambulatory educational programs are integrated into ambulatory continuity clinic epxerience, which also includes intensive preceptorship by our clinical faculty.
Inpatient Services - The Hospital of the University of Pennsylvania
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HUP In-patient service (14-16 weeks)
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Consult/chronic dialysis services (8-10 weeks):
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HUP Transplant (8-10 weeks)
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Veteran's Administration Hospital In-patient Service (6-8 weeks)
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Presbyterian Medica Centerl (6-8 weeks)
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Vacation (4 weeks per year - all Fellows)
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Continuity Clinic (one-half day per week)
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Electives (first year)
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Ambulatory Rotations (second year)
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Out-patient Hemodialysis Unit
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Peritoneal Dialysis
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Transplant (Pre-eval and Post-op)
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Continuity Clinic (one-half day per week)
Electives (second year)
When assigned to in-patient services all fellows are expected to attend all scheduled conferences unless urgent clinical matters prevail. Clinical services each have a supervising attending and often a student and/or resident who require teaching from the fellow.
A. HUP INPATIENT SERVICE (22-24 weeks the First Year):
Educational Purpose: To provide a varied and comprehensive in-patient experience with instruction and teaching at the bedside and in conferences with medical students and medical residents.
Principal teaching method: Attending teaching rounds, bedside discussions, conferences, 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 (6-8 weeks):
Educational Purpose: To provide a varied and comprehensive in-patient experience with 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 (8-10 weeks):
Educational purpose: To provide a varied and comprehensive in-patient and out-patient experience using all the patient material in the transplant practice with instruction and teaching at the bedside and in ambulatory pracrice sites and 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 (6-8 weeks):
Educational Purpose: To provide a varied and comprehensive in-patient experience with 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 (Elective):
Educational Purpose: To provide a varied and comprehensive in-patient experience with 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 (Elective):
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.
