 |
Fellowship
Program
Educational Content
A. Patient Characteristics and Types of Clinical
Encounters, Procedures, and Services
The clinical activities of the Nephrology Division
are based primarily at three major university-affiliated
hospitals:
Buffalo General Hospital (BGH), the Erie County Medical
Center (ECMC), and the Veteran’s Administration WNY
Healthcare System (VAMC), each with its own flavor
of patient populations and the expertise of the faculty
base there. Each hospital is equipped with complete
pathology, laboratory, radiology and nuclear imaging
facilities. Buffalo General Hospital is a 742-bed
acute care medical center, ECMC is the regional trauma
center, burn unit, and AIDS center and the VAMC has
facilities for sophisticated scanning like the PET
Scan.
Nephrology fellows participate in the following clinics
at these hospitals:
|
Hospital/Site
|
Clinic
|
Day
|
Fellow Participation
|
|
ECMC
|
Renal Clinic
|
Thursday mornings
|
Fellows alternate bi-weekly for 2 years
(new patient and continuity clinic)
|
|
VAMC
|
Renal Clinic
|
Tuesday mornings
|
Fellows alternate bi-weekly for 2 years
(new patient and continuity clinic)
|
During continuity clinics, fellows see their own
patients to provide them with continuing care experience
with a wide variety of patient population. These
clinics are supervised by attending physicians and
the fellows’ experience is evaluated semi annually.
Fellows coordinate the inpatient nephrology consultation
services on a rotation basis at Erie County Medical
Center and the Buffalo Veterans Affairs Medical Center.
Fellows work under the supervision of a nephrology
faculty member at each institution.
Nephrology fellows are on-call at home on a rotating
basis at night and over the weekend for emergencies
at Erie County Medical Center and the Buffalo Veterans
Affairs Medical Center.
Program Goals and Objectives:
The goal of the Nephrology Fellowship Program at
the University at Buffalo is to provide a comprehensive
2-year training experience “that will enable the
trainee to acquire the knowledge, skills, clinical
judgment, attitude and values of professionalism
essential for the practice of Nephrology.” The set
of learning objectives for each subject area are
outlined in the Curriculum is accomplished through
the educational and patient care experiences in the
different rotations herein described.
Nephrology fellows assume progressively increasing
responsibility according to their level of training.
In the first module of the fellowship following orientation,
a second year fellow accompanies the first year fellow
on rounds at each hospital until they learn the system.
The first year fellow then assumes the primary responsibility
for organizing and teaching students on the consultative
service. They gradually assume a greater role in
the decision-making on patients in their continuity
clinics.
In the second year of the fellowship, for 6 months,
the fellow plays a major role in running the renal
transplant service at ECMC. This involves the most
complicated decision-making in Nephrology. In addition,
they serve as teaching attending for 1 month at the
VAMC. The second year fellows serve as a primary
physician for a small number of chronic dialysis
patients of whom they are expected to see each month,
write a monthly progress note, and take care of any
medical problems which arise.
The fellows are expected to present on a regular
basis at Journal Club throughout the 2 years of training.
They give Nephrology Grand Rounds twice yearly. The
second year fellows are expected to participate in
a research project, which will often lead to presentations
at national scientific meetings.
REQUIRED ROTATIONS:
- Renal
Consult Service:
This rotation at the Erie County Medical Center
and Veteran’s Administration WNY Healthcare
System focuses primarily on consultative and
ICU Nephrology. The Fellow consults on the
various renal disorders referred from the Emergency
Department, Medicine, Surgery, Rehabilitation,
Psychiatry Services and Skilled Nursing Facility.
Patient encounters on the Medical and Surgical
Intensive Care units provide opportunities
for the application of Critical Care nephrology.
Continuity of care for ESRD patients is achieved
through the Renal Consult Service’s follow-up
of hospitalized dialysis and transplant patients.
The Curriculum provides for 12 Consult Service
rotations in the first year and 1.5 modules
of Consult Service rotations in the second
year of training.
Learning
Objectives:
- To
give a comprehensive patient care experience
in the provision of consultative input
to the various renal disorders referred
to the Consult Service, including those
renal problems that occur in the context
of the medical and surgical critical
care settings.
- To enable
the Fellow to learn the indications,
contraindications, techniques, and complications
of the different procedures in Nephrology
and develop technical skills in the placement
of central and femoral venous catheters
for temporary dialysis access and skills
in the performance of renal biopsies
on native and transplant kidneys.
- To give training
experience in the use and interpretation
of the different diagnostic tests in
Nephrology, including renal imaging studies
and renal histopathology.
- To develop
clinical competence in the management
of the different dialytic modalities,
namely hemodialysis, peritoneal dialysis
and continuous renal replacement therapies.
- To entrust
the Fellow with increasing levels of
professional responsibilities in patient
care through less intense supervision
in the clinical setting as the Fellow
gains knowledge and experience during
training, while providing direct attending
guidance on daily teaching rounds.
- To provide
an opportunity for Fellows to teach and
supervise more junior trainees, i.e.,
medical residents and students on the
Renal Elective, in accordance to his
or her achieved level of competence.
- To enable
the fellow to develop skills in critical
literature appraisal through providing
Attending feedback on teaching rounds
and on Friday clinical case conferences,
as the Fellow presents a review of the
current literature on the renal disorders
encountered on the Renal Consult Service.
- Transplant Service Rotation:
This is a three module block rotation taken
on the second year of training at Erie County
Medical Center and Buffalo General Hospital.
Components of this rotation include management
of the transplant patients in the hospital
and clinic settings, transplant teaching rounds,
a joint Nephrology and surgical team evaluation
of potential transplant recipients and living
donors on weekly patient care meetings, and
active Fellow participation in the City-Wide
Transplantation Conference. While renal transplantation
is the main focus of this rotation, it also
includes non-transplant consultative Nephrology
and Renal Hypertension Clinic experience.
Learning
Objectives:
- To give a
focused training experience in renal
transplantation and provide a block of
time for the Fellows to concentrate his
or her readings on transplantation.
- To provide
patient care experience on the various
aspects of transplant Nephrology outlined
in the Fellowship Curriculum in the hospital
and ambulatory care settings.
- To enable
the Fellow to learn the screening process
and work up of potential transplant recipients
and living donors through focused discussions
on patient care meetings.
- To provide
an opportunity for the Fellow to interact
with the members of the Transplant Team,
the surgeons, transplant coordinators,
etc., and to develop an appreciation
for the vital role of each member in
the care of the transplant patients.
- To provide
a setting for the Fellow to demonstrate
academic growth through the Fellow’s
formal lecture presentation at the City-Wide
Transplant Conference.
- To give further
patient care experience in consultative
and ICU Nephrology (while the Buffalo
General Hospital rotation is assigned
primarily for training in Renal Transplantation,
the Fellow also responds to Renal referrals
requested from the different hospital
services.)
- ECMC Medicine D Rotation:
This rotation provides a structured mechanism
for the trainee to maintain his or her skills
in Internal Medicine/Inpatient Renal Service.
Taken for 2-3 modules in the first year and
1 module in the second year of training at
the Erie County Medical Center, the Medicine
D Service enables the Fellow to function as
a primary care provider and renal subspecialist
to acutely ill renal failure patients, including
dialysis and transplant patients admitted to
the Medical Intensive Care and Ward Services.
This rotation includes work-up and management
of medical, renal and non-renal problems, coordination
of patient care with other physicians consulting
on the patient’s case, dialytic and transplant
management, teaching and supervision of the
Medicine D House staff and student team. The
Attending Physician for the Medicine D Service
is a member of the Nephrology Faculty Staff.
Teaching Attending rounds are conducted daily.
Learning
Objectives:
- To provide
a structured opportunity for the Fellows
to maintain their skills in Internal
Medicine and function as a primary care
provider for acutely ill ESRD patients.
- To give the
Fellows an increased level of independence
in the evaluation, work-up and management
of medical problems and renal disorders.
- To extend
the Fellows’ experience in transplant
Nephrology to include direct patient
care experience in the evaluation and
management of acutely ill transplant
patients admitted for acute rejection,
infection, or other types of medical
illness.
- To enhance
the Fellows’ experience in ICU Nephrology,
beyond that of a renal consultative role
to the assumption of the overall care
of critically ill renal patients, as
the primary intensivist physician.
- To give practical
experience in the cost-effective use
of hospital resources and enable the
Fellow to learn the physician’s
role in discharge planning.
- To enable
the Fellow to learn the appropriate use
of referrals to other specialty fields
in patient management and to develop
an effective interaction with the consulting
physicians to coordinate the different
aspects of patient care.
- To provide
further opportunities for acquiring technical
proficiency in the performance of kidney
biopsy and placement of temporary dialysis
catheters.
- To give the
Fellow an active teaching role in the
education and training of more junior
trainees, i.e., residents and students
of the Medicine D team.
- Teaching Attending Physician Rotation:
This assignment is given to the second year
Fellow for one module at the Veterans Administration
WNY Healthcare System’s Renal Consult Service.
The Fellow conducts teaching rounds attended
by the first year Renal fellow and team of
medical students and residents on elective.
As junior teaching Attending, the Fellow makes
patient care decisions but confers with onsite
faculty on a daily basis. Clinical supervision
and guidance is provided by the assigned attending
for the module.
Learning
Objectives:
- To give a
structured opportunity for the Fellow
to have an increased level of responsibility
for making patient care decisions in
consultative Nephrology.
- To facilitate
the process of transition for the Fellow
from a trainee to a practitioner in Clinical
Nephrology, allowing a more independent
and active role in patient management
and administrative matters, while providing
onsite faculty support for this experience.
- To give experience
in the teaching and supervision of more
junior trainees, i.e., the first year
renal fellow, medical residents and students
on renal elective.
Educational
Content:
- All areas of
consultative and ICU Nephrology as outlined
in the first section of the curriculum
Teaching
Methods:
- Assignment
of junior attending role in the VAMC
Renal Consult Service in the second year
of Fellowship
- The following
also help prepare the fellows to assume
this role as a “teaching attending” on
the VA Consult Service:
- Informal
case discussions and formal lecture
presentations at the different
Nephrology conferences
- Teaching
and supervision of residents and
students on the Renal Consult Service
and Medicine D Rotations
- Preceptorship
of student renal workshop sessions
for the Internal Medicine Clerkship
Course
Educational
Materials:
- References dealing
on how to teach effectively from various
textbooks and journal publications.
B. Methodology for Teaching Nephrology:
In order to achieve the goals and objectives for
the fellowship program the following experiences
have been established for the purpose of teaching
Nephrology fellows. These include: A) the inpatient
nephrology experience, B) the ambulatory nephrology
experience, C) ambulatory rotations with other clinical
subspecialties, D) didactic conferences, E) a research
experience, F) continuing medical education and society
participation, and G) development of teaching skills.
- The
inpatient nephrology experience.
Nephrology fellows are responsible for the
performance of inpatient consultations as well
as the continued follow up of these patients
during their hospitalization. Through
this experience, the fellows develop and refine
their skills essential for the clinical evaluation
of patients with various renal disorders. These
skills include the development of appropriate
differential diagnoses, assessment of the need
for hospitalization, diagnostic evaluation
strategies and treatment plans. The fellows
also develop skills in providing consultation
services, to include communicating with the
referring physicians and ensuring support for
continuing care of the patients' renal condition.
In addition, Nephrology fellows participate
actively in the teaching activities of the
consultation team. Through this experience
the fellows also develop a comprehensive understanding
of the indications, contraindications, techniques,
and complications of percutaneous biopsy of
both autologous and transplanted kidneys, as
well as the interpretation of results from
this procedure. They also acquire the
knowledge of and skill in educating patients
about the procedure and in obtaining informed
consent. Faculty supervision is required
in developing these skills.
Fellows are expected to perform literature
research on topics appropriate to the case
at hand and make their findings available to
the primary care team. The fellows will
teach and supervise trainees on the primary
care team and renal service with regard to
specialized techniques, including dialysis
and extracorporeal therapy.
At each hospital, it is expected that the fellows
will dictate the consultation notes after the
patient has been presented to the attending
nephrologist and a differential diagnosis and
management plan has been formulated.
- The
ambulatory nephrology experience.
The residents attend nephrology and hypertension
continuity care ½ day per week clinics on alternate
weeks at the ECMC and VAMC throughout the two
years of training. During these clinics, they
have progressive responsibility for the care
of their patients and are appropriately supervised
by dedicated attending faculty members. The
goal of this experience is for the fellows
to gain expertise in the outpatient evaluation
and management of renal problems. The experience
provides an opportunity to develop an understanding
for the natural history of these conditions
over an extended period of time. They are assigned
specific patients to follow and are expected
to care for this group of patients that will
have progressive renal insufficiency and require
initiation of dialysis in the course of this
follow-up. The residents are expected to assist
in the decision to initiate dialysis and decide
on the type of dialysis best-suited for the
patient. They are expected to continue to follow
these patients while on dialysis, writing monthly
progress notes and discussing the patient with
the attending. The residents participate in
the evaluation of whether the patients are
suitable transplant candidates as well.
- Elective
rotations
- Dialysis
Elective:
The Fellowship Program offers this 4
week elective to give a more focused
training and experience in dialysis and
give a block of time for the fellows
to concentrate their readings on hemodialysis
and peritoneal dialysis. This rotation
may be taken during the first or second
year of training at the Cleve Hill Dialysis
Center.
Learning
Objectives:
To gain experience in the following patient
encounters:
- Direct
response to patient referrals from
the Dialysis Unit with supervision
from the Attending Physician.
- Monthly
assessment of chronic hemodialysis
patients, review of monthly routine
laboratory examinations and dialysis
and medical developments, coordination
of patient care with the dialysis
nurse, social worker and dietician.
- Monthly
assessment of chronic hemodialysis
patients, review of monthly routine
laboratory examinations and dialysis
and medical developments, coordination
of patient care with the dialysis
nurse, social worker and dietician.
- Monthly
assessment of chronic hemodialysis
patients, review of monthly routine
laboratory examinations and dialysis
and medical developments, coordination
of patient care with the dialysis
nurse, social worker and dietician.
- Attendance
of dialysis patient care meetings.
Teaching
Methods:
To gain experience in the following patient
encounters:
- Bedside
teaching
- Dialysis
Lecture Series
- Assignment
of dialysis topics for review and
presentation by the Fellow
- Pediatric
Nephrology Elective:
Fellows interested in learning the diagnosis
and management of renal disorders and
the use of the different renal replacement
techniques in the pediatric age group,
may take a 4-week elective at the Women
and Children’s Hospital of Buffalo. Patient
encounters on this rotation take place
in the hospital and ambulatory care settings.
The Fellowship Program also provides
for training experience in adolescent
Nephrology through a 4-session clinic
rotation at the Women and Children’s
Hospital of Buffalo Pediatric Clinic,
if the Fellow chooses not to take the
Pediatric Nephrology Elective. The Women
and Children’s Hospital of Buffalo Pediatric
Nephrology Elective Curriculum will be
followed for this rotation.
- Research
Elective:
The Fellowship Program offers opportunities
for basic science and clinical research
in Nephrology through the research elective
at either the Erie County Medical Center
or the Veterans Administration WNY Healthcare
System. The educational program description
for the research elective is outlined
in the research section of the curriculum.
- Renal
Pathology Elective:
This is a 4-week elective on renal histopathology
offered at the Buffalo General Hospital
under the teaching and supervision of
Dr. Pankewycz and Dr. Stefanick.
Learning
Objectives:
To give focused training in the immune
mechanisms and histopathology of renal
disease, and enable the Fellows to interpret
biopsy slides of common glomerular and
tubulointerstitial diseases in the native
and transplant kidney.
Educational
Content:
Immune mechanisms and histopathology
of the following:
- Minimal
change disease
- Focal
segmental glomerulosclerosis
- Membranous
glomerulopathy
- Membrano-proliferative
glomerulonephritis
- IgA
nephropathy
- Crescentic
glomerulonephritis and vasculitides
- Diabetic
nephropathy
- Lupus
nephritis
- Amyloidosis
- Light
chain nephropathy
- Immunotactoid
nephropathy
- Acute
allergic interstitial nephritis
- Tubulointerstitial
diseases
- Acute
transplant rejection
- Chronic
transplant glomerulopathy
- Cyclosporine
toxicity
Teaching
Methods:
- Review
of teaching slides
- Supervised
interpretation of current renal
biopsy slides
- Fellow’s
renal biopsy slide presentation
at the City-Wide Renal Pathology
Conference
Educational
Materials:
Renal Pathology with Clinical and
Functional Correlations by C. Craig
Tisher and Barry M. Brenner, Current
edition.
- Urology
Elective:
The Urology Elective is a procedure-oriented
rotation at the Veterans Administration
WNY Healthcare System aimed at providing
the fellows a training experience in
cystoscopy.
Learning
Objectives:
To provide opportunities for the Fellow
to develop familiarity with cystoscopy – the
indications, contraindications, technique
and complications through observation
followed by a supervised hands-on experience
in the performance of the procedure.
Teaching
Methods:
- direct
observation
- supervised
hands on performance of cystoscopy
Educational
Materials:
Standard textbooks in Urology pertaining
to the cystoscopy procedure.
- Surgical
Elective:
The surgery elective is a procedure oriented
rotation at the Erie County Medical Center
aimed at giving the fellows a training
experience in the surgical techniques
of certain dialysis access procedures.
Learning
Objectives:
To provide opportunity for the Fellows
to develop familiarity with the different
surgical procedures for dialysis access,
namely placement of permcath, PD catheter,
and AV fistula and graft surgery and
to provide a supervised hands on experience
in the placement of permcatheters and
peritoneal dialysis catheters.
Teaching
Methods:
- observation
of surgical dialysis access procedures
- supervised
hands on performance of permcath
and PD catheter placement
Educational
Materials:
Standard textbooks in Surgery on the
performance of AV fistulas and graft
surgeries, permcath and peritoneal dialysis
catheter placement.
- Nuclear
Medicine/Radiology Elective:
The Radiology elective is a skills-oriented
rotation at the Erie County Medical Center
or at the VA WNY Healthcare System aimed
at teaching the fellows interpretative
skills in renal imaging.
Learning
Objectives:
To give the renal fellow a learning experience
in the interpretation of radiological
studies, with emphasis on renal imaging
techniques, in preparation for clinical
practice in Nephrology.
Teaching
Methods:
- review
of teaching x-ray files
- a
supervised interpretation of current
radiological studies, specifically
renal imaging techniques
Educational
Materials:
Section on the interpretation of renal
imaging studies on standard radiology
textbooks.
- Interdisciplinary
interactions.
Nephrology fellows are provided opportunities
to interact professionally with physicians
from other disciplines whose expertise is required
in the care of patients with renal diseases.
These opportunities include collaboration in
the care of patients, elective rotations, and
multidisciplinary conferences.
- Didactic
conferences and lectures.
The conference schedule for the nephrology
fellowship program is tabulated below:
| Conference |
Day
of week |
Time |
Transplant (Multidisciplinary)
Conference BGH |
1st Tuesday
of the month |
4:00 –5:00 PM |
| Journal Club |
2nd Tuesday
of each month |
4:00 –5:00 PM |
| Research Conference |
3rd Tuesday
of each month |
4:00 –5:00 PM |
| Renal Pathology Conference |
4th Tuesday
of each month |
4:00 –5:00 PM |
Case Conference
Basic Science Conference |
Every Friday
of the month
At least 1
Friday per
month |
8:00 – 9:00 AM |
Fellows will be encouraged to participate
in several conferences, as follows. They will
be supervised for critical literature review
and will be encouraged to present in these
conferences.
| Lectures: |
fellows’ orientation
program |
| |
Dialysis lecture series |
| |
Transplantation lecture
series |
| |
Teaching sessions,
renal consult service |
| |
Nephrology lectures
for urology board review |
| |
Nephrology lectures
for internal medicine board review |
| |
Nephrology lectures
for medical grand rounds |
| |
Renal Workshops for
medicine clerkship |
Description of Lectures and Conferences:
- City-Wide
Transplant Conference: This
is a monthly, multidisciplinary team
conference that brings together the
transplant team – the nephrologists,
surgeons, organ procurement and transplant
coordinators to discuss topics of
interest in renal transplantation.
Often, the meeting is conducted informally
as an open interactive group discussion,
but a formal lecture may also be used
as the selected format for topic presentation.
Physician experts are invited to give
their input on transplant topics covered
by their field of specialty, i.e.,
ID Consultants are invited to discuss
infections in the transplant patients,
etc. Second year fellows are required
to present at least once on this city-wide
transplant conference
- City-Wide
Research Conference: This
is a forum for the presentation of
data from ongoing research investigations
by the faculty. The emphasis
of discussion is on research methodology. The
preliminary data obtained are analyzed
and an exchange of opinion takes place
as to possible directions for future
research studies by the staff. The
faculty and renal fellows present
at this conference which is conducted
monthly at the VA Research Center. Attendance
is open to other interested investigators
and faculty. Residents and students
on renal elective also attend this
conference.
- City-Wide
Journal Club: Selected current
basic science and clinical research
articles in the Nephrology literature
are taken up during this one-hour
session. Renal fellows present a synopsis
of assigned journal articles. The
studies presented are analyzed as
to experimental design, data interpretation,
validity of conclusions and potential
application to Nephrology practice
and research. These journal club sessions
are held monthly at the Erie County
Medical Center and serves a useful,
practical tool for teaching critical
literature appraisal to the fellows,
as well as to the medical residents
and students on renal elective.
- City-Wide
Renal Pathology Conference: This
is a monthly conference held at the
Buffalo General Hospital (BGH). Slides
of selected renal biopsies are presented
at this conference. The fellows give
the clinical data on their own patients
and this is followed by slide presentation
by the pathologist. A discussion ensues
about the individual faculty’s clinical
experience on the renal disease presented
and use of current therapeutic modalities
or treatment protocols in the management
of these diseases. A follow-up and
update on the patient's case is later
provided with emphasis on the treatment
given and the results of the therapy
employed. Further clinical developments
and complications, if any, or progression
of renal dysfunction are also noted.
The Nephrology Academic Faculty form
all of the teaching hospitals in Buffalo
and interested Nephrologists in private
practice attend this conference.
- Clinical
Case Conferences: The Erie
County Medical Center (ECMC) and the
Veterans Administration WNY Healthcare
System each holds a weekly Case conference
on Friday mornings. An interesting
case is presented by the fellow, selected
from the current renal service patient
roster. This conference is clinically
oriented, focused on putting together
actual patient data to identify the
renal problems. The clinical features
are analyzed in depth and renal physiology
is discussed as it applies to the
pathogenesis of the renal disorders
under discussion. Renal imaging films
are presented and laboratory data
and other diagnostic studies are interpreted
in the context of the patient’s case.
Pertinent literature update on the
renal disorders is discussed. Challenging
and interesting dialysis problems
and transplantation issues encountered
in the renal service also get selected
for presentation at these case conferences.
In the two year period of the fellowship
training, this conference covers a
wide spectrum of core curriculum/basic
science topics in Nephrology. Medical
residents and students on the renal
elective also give presentations at
these case conferences.
- Dialysis
Lecture Series: This is a
weekly lecture series at the Erie
County Medical Center held during
the Summer and Fall seasons. Lectures
are given by the faculty in a small
group teaching session, attended by
the fellows and residents and students
on the renal elective. The lecture
series covers core curriculum topics
in hemodialysis, peritoneal dialysis
and continuous renal replacement therapies.
- Transplantation
Lecture Series: Given at
the Erie County Medical Center, this
weekly lecture series held in the
Spring is given by the faculty staff.
These didactic sessions cover the
core curriculum topics in renal transplantation.
The fellows, medical residents and
students on renal elective attend
this lecture series.
- Orientation
Program: On the first week
of the renal fellowship training,
fellows are given an orientation program,
consisting of a set of lectures, focused
on teaching the fellows the process
of purposeful clinical data gathering
to identify common renal disorders
in consultative Nephrology. The fellows
are taught the basic essentials of
clinical volume status assessment
and interpretation of hemodynamic
data. The orientation lecture series
also covers the essentials of acid
base analysis and approach to common
electrolyte problems. The utilization
and interpretation of renal diagnostic
studies and renal imaging techniques
are discussed. The orientation program
also aims to give the fellows a working
knowledge on the different dialytic
therapies and includes a discussion
on the basic principles underlying
solute clearance and ultrafiltration
in hemo and peritoneal dialysis, the
methodology, routine orders, indications
for, and complications of these different
dialysis modalities. An introduction
to transplantation is give with lectures
covering the pre-operative medical
clearance of ESRD patients scheduled
for Cadaveric or living related renal
transplantation and immunosuppression
and medical management of new transplant
recipients in the immediate post-operative
period. During orientation program,
the program policies are discussed,
detailing the fellows’ lines of responsibilities
and defining the program expectations
and requirements of the Fellowship
training. The fellows are each given
a copy of the curriculum and program
policy manual.
- Teaching
Sessions on the Consult Service:
Teaching sessions are given by the consult
service attending to discuss renal problems
encountered on the consult service, or
to discuss renal topics requested by
the Medical residents or students on
elective. These sessions are informally
conducted and may also include practical
exercises such as the discussion of acid
base problems and sample board review
questions in Nephrology. Renal teaching
handouts are routinely provided to the
residents and students on the renal consult
rotation.
-
Nephrology Lectures for the Urology
and Internal Medicine Board Review: The
Nephrology faculty gives formal lecture
presentations covering common nephrology
topics for the Urology and Internal
Medicine Board reviews. Fellows are
provided copies of the schedule of
these lectures and are encouraged
to attend these board reviews.
- Nephrology
Lectures for Medical Grand Rounds: This
is the major clinical conference of
the University Department of Internal
Medicine. This 3-3 ½ hour academic
exercise takes place in a large off
campus conference room. It is multidisciplinary
and the faculty typically is comprised
of 3-4 individuals. The mix of faculty
usually includes 1-2 individuals not
on the faculty of the Internal Medicine
Department, such as out of town guests
or individuals from the disciplines
such as surgery, basic science, etc.
The conference is designed to explore
selected topics in depth and virtually
all conferences have a strong interest
for nephrology faculty and fellows.
- Medical
Students Renal Workshop Sessions: These
are clinical case workshops on common
disorders in Nephrology, given by
the faculty for the Internal Medicine
Clerkship Course. Fellows are assigned
to preceptor 1-2 of these sessions
during their second year of training
to enhance their teaching skills.
- Research
experience
An active research component is included within
the fellowship program. A meaningful research
experience with appropriate protected time
is available for each fellow as an elective
rotation. During this phase of training, the
fellows work under close guidance of a faculty
research mentor. Most often this involves a
clinical research project, which is usually
done in the second year of training. There
is a minimum of 3 months to be devoted to research.
The immediate goal of the research experience
is for fellows to learn:
- sound
methodology in designing and performing
research studies;
- the
correct interpretation and synthesis
of research data;
- the
purposes, goals and characteristics of
different phases (e.g. Phase I, II, III)
of clinical trials and understanding
of the significant differences;
- biostatistics
that will allow the trainee to interpret
the published literature and to critically
discriminate the impact of such work
to their clinical practice
- basic
elements of proper clinical trial design
including identification of target populations,
statistical power, proper statistical
tools and ethical concerns
- the
purpose and function of the Institution
Review Board and other regulatory bodies
that oversee the conduct of clinical
investigations
- design
of informed consent documents and understanding
of the ethics related to conducting clinical
trials, including issues of industry
sponsorship and conflict of interest
- to manage
a patient on a clinical trial, including
the ability to evaluate a patient’s eligibility
for participation in a specific clinical
trial; obtaining the necessary baseline
studies; writing the treatment orders
as directed in the protocol; following
a trial’s calendar for assuring that
required patient encounters, therapy,
diagnostic studies and data collection
are performed at the appropriate times;
and assessing and reporting responses
and adverse events appropriately
- general
working knowledge of what “translational
research” is, how it is performed and
what its value is.
- To participate
in, or have, didactic training in the
clinical trial process, including having
the opportunity to be involved in the
processes of designing research protocols,
writing clinical protocols, obtaining
regulatory approval for a clinical trial,
enrolling patients into clinical trials,
performing data analysis, manuscript
writing and making formal presentations
of data collected
- the
ability to seek out the existence and
details of available clinical trials
available at their institution and elsewhere
in the course of caring for their patients.
- find
funding resources for research studies
- Self-directed
learning
Nephrology fellows are expected to direct their
own learning through reading and utilization
of other learning media. In addition, each
hospital has a medical library, each with an
extensive collection.
- Continuing
medical education and society memberships
In addition to participating in the organized
didactic conferences established within the
fellowship program, the fellows are encouraged
to become members of the American Society
of Nephrology (ASN) and Renal Physicians Association.
- Development
of teaching skills
The program provides an environment for the
fellows in which the activities of teaching
are fostered and highly regarded. This includes
the education of not only medical students,
physicians, and other allied health personnel
but also the education of the patients. Second
year fellows spend one module of teaching attending
rotation at the Veterans Administration WNY
Healthcare System’s Renal Consult Service.
During this rotation, they conduct teaching
rounds attended by the first year renal fellows
and team of medical students and residents
on elective. As junior teaching attendings,
renal fellows makes patient care decisions
but confer with onsite faculty on a daily basis.
Clinical supervision and guidance is provided
by the assigned attending for the module.
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