US News & World Report Best Hospital 2013Nephrology Fellowship

Curriculum

Fellows will be trained in all aspects of care for the renal patient, including – but not limited to – acute kidney injury, chronic kidney disease, glomerular diseases, diabetic nephropathy, renal transplantation, hypertension, fluid and electrolyte disorders, management of the end-stage patient, and nephrolithiasis.

Below you will find sections detailing:
Tracks | Typical Rotation Schedules | Rotations | Conferences | Unique Learning Opportunities

Tracks

  1. Two year General Nephrology Fellowship
  2. One year Transplant Nephrology Fellowship
    Intended for an additional one year of focused, intensive transplant nephrology training after completion of an accredited general nephrology fellowship program.

Typical Rotation Schedules

In the Nephrology Training Program, you will rotate through consults at VCUHS (separated into floor and ICU consults), Transplant at VCUHS, Consults at McGuire VA, and outpatient Dialysis at McGuire VA. During your second year, you will have approximately 4-6 months of elective and/or research.

Typical 1st Year Rotation Schedule Location Length
Inpatient ICU Consult VCUHS 2-2.5 Months
Inpatient Floor Consult VCUHS 2-2.5 Months
Transplant Service VCUHS 4 Months
Inpatient Consults VAMC 2 Months
Outpatient Dialysis VAMC 2 Months
Typical 2nd Year Rotation Schedule Location Length
Inpatient ICU Consult VCUHS 1 Month
Inpatient Floor Consult VCUHS 1 Month
Transplant Service VCUHS 2 Months
Inpatient Consults VAMC 1-1.5 Months
Outpatient Dialysis VAMC 1-1.5 Months
Hypertension Clinic Elective VCUHS 1-1.5 Months

Rotations

VCU In-Patient Consult Service
The in-patient consultation service is a clinically busy service, with a census of about 30-40 patients. This service is subdivided into ICU and floor patients, each covered by one fellow. The typical day runs from about 6 a.m. until 6 to 8p.m.  The nephrology consult fellow is responsible for initial evaluation and subsequent management of all hospitalized patients referred for consultation. Fellows work in concert with the ward residents and medical students to provide the necessary care and will be overseen by the nephrology ward attending.

The ICU fellow is responsible for all patients, ESRD and non-ESRD, admitted to any ICU at VCUHS. Dialysis procedures in the ICU are always performed in the unit (we travel to the patient).

The floor fellow is responsible for any initial and follow-up consultations in the non-ICU setting. The floor fellow will see all peritoneal dialysis patients; however, chronic hemodialysis patients in the non-ICU setting will be cared for by the VCUHS Dialysis service.
(back to rotation schedules)

VCU Transplant Service
Fellows will gain experience in the initial work-up of transplant candidates, care of patients immediately post-transplant, and long-term follow-up of patients with a functional allograft.

  1. Nephrology fellows spend 6 months rotating on the transplant service, 4 months during the first year and 2 months during the second year.
  2. Responsibilities include the initial evaluation, management, and follow-up of patients on the inpatient transplant service, including pre and post-transplant care.
  3. Fellows participate in Transplant Clinic 5 half-days per week during their transplant rotations in addition to their regularly scheduled half-day of nephrology clinic.
    (back to rotation schedules)

McGuire VA In-Patient Consult Service
The in-patient consultation service usually consists of approximately 15-20 patients and includes any renal consultations admitted to the McGuire VA Hospital. This includes any ESRD patient admitted. This service follows a similar pattern to the VCU consult service, which includes organizing and planning rounds with the attending faculty member. The consult fellow oversees all patients on the service, including those being followed by medicine residents and medical students.  
(back to rotation schedules)

McGuire VA Outpatient Dialysis Service
The McGuire VA has a 16-bed dialysis unit, which is covered by a nephrology fellow and staffed by all VA Nephrologists. During this rotation, fellows follow all ESRD patients receiving maintenance hemodialysis. Fellows are responsible for day-to-day care of these patients, troubleshooting intra-dialytic complications, and access issues. Fellows perform formal rounds with the attending physician on all patients in the unit, focusing on all aspects of ESRD management, including, access, hypertension, anemia, secondary hyperparathyroidism, acidosis, etc.
(back to rotation schedules)

Conferences

    Nephrology Grand Rounds
    This conference series is prepared on an annual basis with presentations given by internal and visiting faculty members and VCU Nephrology fellows.  Fellows present two times each year on topics of their choice. 

    Board Review Questions
    This program is led by doctors Susan DiGiovanni, M.D. and Imran Fatani, M.D.and is based on the NephSAP question and answer series provided by the American Society of Nephrology. This is an interactive conference in Q&A format, and is based on the topics provided by ASN, including: Glomerular Disease, Transplantation, FEN, CKD, ESRD, Geriatrics, Genetic Diseases, Renal Pathology, etc..

    Renal Biopsy Conference
    Renal Biopsy Conference is held in lieu of Renal Grand Rounds the 4th Thursday of each month. This conference is led by Drs. Massey and Vinnikova jointly. 

    Journal Club
    Faculty members select articles and assign one to each of two fellows each month. The fellow reviews and presents the article, which includes salient methods, results, discussion, and study dissection/critiques. 

    Fellows’ Didactic Lectures
    All VCU and VA faculty members participate in this weekly lectures series, and is encompasses all aspects of nephrology, hypertension, and transplantation.  During the summer months of July and August, there are two lectures each day with an emphasis on ESRD, urea kinetics, CRRT, and PD to acquaint you to these dialysis modalities. 

    Research Conference
    This monthly conference highlights the various research methods and techniques throughout the university. This will include lectures from Division faculty members, other researchers from VCU (outside of Nephrology) and often visiting physicians from outside institutions. First-year fellows will attend a research seminar held on Wednesday evenings from 5-6pm for the months of July and August.

  • Fellows also have the opportunity to rotate through:
  • Hypertension clinic, focusing on resistant and difficult to treat hypertension
  • Pediatric Nephrology
  • Plasmapheresis
  • Interventional Radiology
  • Home dialysis clinics, focusing on peritoneal dialysis and home hemodialysis