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.

Tracks

  • Two year General Nephrology Fellowship

Typical Rotation Schedules

In the Nephrology Training Program, you will rotate through services at VCUHS and the Hunter Holmes McGuire VA Medical Center. Each fellow has 3 weeks of vacation yearly and generally the schedule is adjusted over Christmas and New Years to give the fellows an additional 5-6 days off.

Typical 1st Year Rotation Schedule Location Length
VCU Floor Consult  VCUHS 2 Months
VCU ICU Consult VCUHS 2 Months
VCU Chronic HD VCUHS 2 weeks
Inpatient Transplant VCUHS 2 Months
Outpatient Transplant VCUHS 1 Months
VA Consults VAMC 2 months
VA Dialysis VAMC 1-2 months
Electives Variable 1 month
Vacation   3 weeks
Typical 2nd Year Rotation Schedule Location Length
VCU Floor Consult VCUHS 1 Month
VCU ICU Consult VCUHS 1 Month
Inpatient Transplant VCUHS 2 Months
Outpatient Transplant VCUHS 1 Month
VA Consults VAMC 2 months
VA Dialysis VAMC 2 months
Elective Variable 3-4 months
Vacation   3-4 weeks

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 and one attending.

The typical day runs from about 6 a.m. until 6 p.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 attending.

Floor consult rotation:
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 (this is staffed by a PA and nephrology attending though 1st year fellows rotate on this service to learn about the management of hospitalized patients on dialysis). Fellows see a wide variety of consults including patients with acute kidney injury, hypertension, fluid and electrolyte disorders, hypertension, and glomerulonephritis.

ICU consult rotation:
The ICU fellow is responsible for all patients admitted to any ICU at VCUHS.). Consults are seen the Medical Respiratory ICU, Cardiology ICU, Cardiothoracic ICU, Surgical ICU and Burn ICU. Fellows are often consulted on patients with acute kidney requiring dialysis, overdoses and poisoning requiring dialysis, dialysis in patients on ECMO and severe heart failure with LVADs and total artificial hearts. Fellows also assist in management of patients with severe hypertensive crises and fluid and electrolyte disorders. Dialysis procedures in the ICU are always performed in the unit (we travel to the patient

VCU Transplant Service

VCU Transplant inpatient service
On the inpatient transplant service, the fellow will follow all patients requiring a consult that has an organ transplant. You will care for patients immediately post renal transplant as well as patients with heart transplants, liver transplants and patients with combined organ transplants (heart-kidney, liver-kidney, kidney-pancreas). The fellow will work directly with a Transplant Nephrology faculty member.

VCU Transplant outpatient service
Approximately 200 renal transplants were performed in the last year at VCUHS. On this rotation fellows will see patients for both pre and post-transplant care in the outpatient setting with our transplant faculty. We have 5 full time faculty members dedicated to renal transplant.

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.

McGuire VA Outpatient Dialysis Service
The McGuire VA has a new 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.

While on services at the VA Medical center, fellows also attend outpatient clinics including a new consult clinic, kidney stone clinic, home dialysis clinic and renal transplant clinic. They also participate in journal club at the VA weekly.

Continuity clinic
Continuity clinic occurs weekly. Fellows will rotate between having clinic at VCU (Tuesdays) and VAMC (Wednesdays). Fellows cover their own panel of patients and see 6-8 patients per clinic session. They are also able to collaborate with a renal pharmacologist in our clinic at VCU that will help the fellow co-manage anemia

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 1-2 times each year on topics of their choice.

Case Conference
Every Friday, there is a case conference with lunch provided where fellows discuss interesting cases with an attending in an interactive format.

Board Review
Weekly conference led by the Program Director and is based on NephSAP and KSAP questions 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 monthly. This conference is jointly led by Drs. Massey and Vinnikova.

Journal Club
Faculty members and fellows select articles and present 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.

Unique Learning Opportunities

Fellows also have the opportunity to rotate through:

  • Hypertension clinic, focusing on resistant and difficult to treat hypertension with Dr. Sica
  • Home dialysis clinics, focusing on peritoneal dialysis and home hemodialysis with Dr. Gehr
  • Glomerulonephritis specialty clinic with Dr. Kidd
  • Pediatric Nephrology
  • Plasmapheresis
  • Interventional Radiology
  • Palliative care