Nephrology is the study of renal function and dysfunction. As the kidneys play the major role in homeostasis of fluid, electrolytes, and acid-base status, derangement in a patient’s renal function may lead to numerous systemic manifestations. The objectives of the Nephrology Fellowship are to teach trainees the in-depth principles of renal physiology and pathophysiology. Trainees who have completed their fellowship will be experts in the evaluation and care of patients with all forms of renal derangement.
In addition, trainees are expected to participate in scholarly activity during their training. This activity can be either laboratory or clinically based.
Nephrology, by its nature, is a complex and growing field that continues to change constantly. Nephrologists often function at the frontiers of scientific knowledge, requiring a delicate balance of available data, experience, pathophysiology, and judgment to make real-life decisions. We believe that a strong understanding of physiology and pathophysiology will form the basis for fellow education and continued life-long learning.
The best way to achieve this goal of constant growth is to ensure that learning is self-directed and active. We expect to train fellows in methods that will allow them to become life-long learners and transition beyond the need for passive participation with didactic lecture. Some of our major goals will include helping trainees identify personal weaknesses in their education and strengthen those areas through a “learning by teaching” interaction. Developing independent, mature nephrologists capable of optimal care of patients with renal disease now and in the future will be our common goal.
The program content for nephrology is described in large part by the American Society of Nephrology in their special article “Nephrology Core Curriculum.” This is available in hardcopy form from the Nephrology Office. It is in the packet of information given to the fellows at the beginning of their training. In addition, educational goals and objectives for each rotation and experience are listed in the specific Educational Experiences section below.
Methods of Training
The main teaching method is through an apprenticeship model. Hospitalized patients are initially evaluated independently by the fellow and attending physician. The fellow then formulates a differential diagnosis and plan. This will then be reviewed by the attending physician who may prompt the fellow to provide more information, expand the differential diagnosis, and provide alternative plans. Important aspects of the history and physical exam will be reviewed and demonstrated at the patient’s bedside.
Outpatients will be seen by the fellow and then presented to the attending. The attending may prompt the fellow to provide more information, expand the differential diagnosis, and provide alternative plans. Important aspects of the history and physical examination will be reviewed and demonstrated with the patient. As the fellow gains more confidence, he/she will see the patients more independently, reviewing the patients with the attending. Outpatient dialysis patients will be seen by both the fellow and attending physician weekly. The fellow will be responsible for the day-to-day management of his/her own dialysis patients.
In addition to the apprenticeship model, there are numerous didactic sessions throughout the year to cover all topics in the core curriculum. These topics include both basic science and clinical medicine.
Ethics and professionalism are demonstrated through direct patient contact, discussion of patient care issues in various settings, and through didactic sessions.