Nephrology fellowship - Clinical Rotations

Fellows spend one month blocks, two times per year on the following rotations:

Harborview Medical Center Consult Service

This 350-bed county-owned hospital is a major center for the care of various common acute and chronic medical problems. The emergency service, surgical ICUs, trauma unit, burn center and medical surgical intensive care units are the most active in the region, and Harborveiw provides extensive eposure to the management of severe fluid and electrolyte and acid-base disorders, acute renal failure, intoxications, and other common nephrologic disorders. During the inpatient nephrology rotation, fellows will be supervised by an attending nephrologist and will round with staff daily for 2-3 hours, see new consults daily, perform a history and physical examination, write a consult report in the medical record, present the patient to staff, and assist and consult with primary inpatient teams until discharge or signoff. Fellows will teach medicine residents and medical students on the nephrology rotation. Fellows will present one inpatient weekly at nephrology clinical conference, discuss differential diagnosis, evaluation, therapy, and review current nephrology literature. Fellows will expect to spend approximately sixty hours per week on this rotation. Call is shared with the NKC fellow and the VA Dialysis Fellow. Specific compentency based goals include comprehensive care of patients with acute renal failure (pharmacology, nutrition, acute dialysis (hemodialysis and pertioneal dialysis), continuous veno-venous hemofiltration (CVVH), hemodialysis (CVVHD), and dialfiltration (CVVHDF), patients with unexplained renal disease (nephrotic syndrome, abnormal urine sediment, abnormal GFR), and those with hypertension and suspected secondary hypertension.

Northwest Kidney Centers

During the dialysis rotation, fellows will follow patients on dialysis, and attend nephrology clinic. Fellows will attend Quality Assurance/Quality Improvement conferences, supervise general and ESRD care of patients, write monthly progress notes on dialysis patients, and study textbooks, peer-reviewed literature, and national ESRD guidelines. Fellows will see new patients with chronic kidney disease in clinic and coordinate multidisciplinary pre-ESRD care. Particular attention will be paid to issues unqiue to renal failure including renal osteodystrophy, anemia, hypertension and electrolyte abnormalities. Fellows will present current articles in basic and clinical science at Nephrology Journal Club, and attend renal physiology lecture. Fellows will spend approximately 16 hours per week at the NKC. An additional 5 hours per week are spent in their outpatient continuity clinic and 20 hours per week at the University of Washington Medical Center outpatient clinics. Educational and practice goals are development of knowledge of basic science, clinical practice, and current literature in ESRD that is broad and deep, and to acquire expertise in care of hemodialysis, peritoneal dialysis and pre-dialysis patients. Fellows will study the Kidney Diseas Outcomes Quality Initiative (K-DOQI) of the National Kidney Foundation in order to understand clinical pathways used in ESRD care.

University of Washington Medical Center Consult Service

The nephrology fellow on the UWMC inpatient service will round with staff for 2-3 hours, see 1-3 new consults daily, perform a history and physical examination, write a consult report in the medical record, present the patient to staff, and assist and consult with primary inpatient teams until discharge or signoff. Fellow will expect to spend approximately 60 hours per week on this rotation. Specific goals of mastery are: fluid and electrolyte disorders, acute renal failure, acute dialysis including hemo-, peritoneal and continuous veno-venous, hypertensive crisis management, pharmacology in renal failure, anemia management, and nutrition as it pertains to renal failure.

University of Washington Medical Center Transplant Service

During the transplant rotation, fellows will see kidney and pancreas transplant inpatients, follow the patient pre-operative assessment, through the transplant procedure and the post-transplant period to discharge, and round daily with the multidisciplinary medical - surgical transplant team. Fellows will evaluate pre-transplant donors and recipients and present the patients to the weekly transplant team conference. Fellows will present new literature articles twice during this rotation. Time spent on service will be approximately sixty hours per week. Competency goals are to master kidney transplantation and renal allograft biopsies. Specific goals are to develop expertise in donor and recipient pre-transplant evaluation, peri-transplant management, immune suppression and complications, performance and interpretation of renal biopsies, rejection management, immunocompromised infectious disease diagnosis and treatment, and management of allograft failure.

VA Puget Sound Consult Service

The overall goals of this rotation are to provide fellow training in in-patient consultative nephrology with comprehensive training in the initial evaluation and mangement of patients with acute and chronic renal failure, fluid and electrolyte disorders, and glomerular diseases and to provide the fellow with comprehensive training in the care of patients with end-stage renal disease including transplant patients.

VA Puget Sound Outpatient Dialysis

The VA is an ideal health care system to provfide modern training in the management of ESRD patients and in the utilization of innovative approaches to providing renal replacement therapy to urban and rural veterans. The Puget Sound VA Renal Dialysis Unit has been a national leader in home hemodialysis and it offers a unique opportunity for training, given its outstanding in-center hemodialysis center, peritoneal dialysis program, and active home hemodialysis program. In addition, VISN 20 has the largest number of highly rural counties among all the VISN's and provides a unique opportunity to train fellows on the issues related to rural renal care.

Continuity Clinics

One half-day clinic per week for 24 months will be spent at one of the following locations:

  • University of Washington Medical Center
  • Harborview Medical Center
  • Veteran's Affairs Puget Sound