Nephrology fellowship - Training Pathways

The Division of Nephrology at the University of Washington offers three training pathways that lead to board eligibility in Nephrology.

Basic Science

Three-year program with a first clinical year followed by two research years.

The basic science pathway is defined as a program where the trainee concentrates and acquires skills predominantly in the molecular, biochemical and cellular aspects of kidney-related research, and develops an understanding of how this basic research may be translated from the bench to the bedside. Most individuals undertaking laboratory research training are supported in their research years by an NIH training grant, "Research Training in Renal Disease (Shankland/PI)," and must be U.S. citizens or permanent residents. Most individuals completing basic science research training seek to pursue academic careers as physician-scientists with independent research laboratories.

The basic science training program generally consists of:

  • Initially working under the direct supervision of a faculty member in nephrology doing basic laboratory studies related to mechanisms of renal disease. Emphasis will be on acquisition of basic research laboratory skills, experimental design, data analysis, and an in-depth understanding of the relevant research literature.
  • The opportunity to supplement renal research training with experience in a basic science department (Immunology, Biochemistry, Pathology, Biologic Structure, and other departments).
  • Options for formal coursework in basic science including molecular biology, statistics, mechanisms of disease, etc. Other topics in related or unrelated fields may be pursued depending on trainee interest.
  • Biomedical research integrity training. In order to retain NIH training grant support, all research fellows at the UW are required to have documented attendance at a series of lectures and workshops on the principles and ethics of research.

Upon completion of the program, trainees will be prepared to function effectively as independent investigators in academic departments and to compete for independent research grant support. Of those who completed training in this track during the past 10 years, 88% are currently in academic positions. The Division of Nephrology at the University of Washington is internationally recognized for its expertise in a wide range of areas including renal failure, diabetic nephropathy, and glomerular disease.

PhD Basic Science Training Program

We strongly encourage PhDs to apply to our leading kidney research program. The goals fo the PhD Basic Science Training Program is to enable the trainee to utilize their molecular and cellular skills and knowledge towards disease-based processes.

The training of PhDs in our program will specifically focus on kidney injury and repair, including regeneration, under the mentorship of Drs. Duffield, Nelson and/or Shankland.

The 1st year Basic Science curriculum in kidney disease for PhDs and MD/PhDs is as follows:

MD/PhDs:

  • Cell Culture basic methods with cell lines, generation of primary cells develpment of cell based assays with examples of functional readouts.
  • Basic understanding of molecular biology: from PCR methods through to molecular cloning of genes. Use of bacteria to generate copies of DNA. Sequencing.
  • Basic understanding of mouse genetics: modern genetic tools and pitfalls.
  • Bioinformatics platforms and their uses: multiplexing, arrays, mini-arrays. Analsyis of data.
  • Basic approaches to designing experiments: controls, timepoints, timecourses, critical endpoints, basic statistical approaches.

PhDs:

  • Attend Core Curriculum Division of Nephrology conferences
  • Comprehensive knowledge of Nephrogenesis and Anatomy (Med Student Level)
  • Comprehensive knowledge of kidney physiology (Med Student level)
  • Basic knowledge of kidney pathologis terminologies and specialized cells of the kidney
  • Overview of kidney related gene defects in humans
  • Overview of systemic diseases that have kidney disease as a component
  • Vascular and metabolic and endocrine consequences of chronic kidney disease

Clinical and Translational Research

Three-year program with a first clinical year followed by two research years.

The clinical and translational research pathway is defined as a program where the trainee focuses on epidemiology, trials, outcomes and other clinical and translational studies, and acquires a Master's degree from the School of Public Health or Epidemiology at the University of Washington. This pathway recognizes that many clinical and translational research studies will incorporate methodologies and technologies from basic science. Didactic coursework is combined with a clinical and translational research project under the joint mentorship of a nephrology faculty member and a faculty member in the School of Public Health. Most individuals completing this training seek to pursue academic careers with an emphasis on clinical and translational research and outcomes research.

Several large clinical and translational research projects and trials utilizing data and biorepositories assembled through major multicenter studies are headed by faculty at the UW and are currently used by faculty and trainees in our program. The clinical science training program consists of:

  • Formal coursework leading to a master's degree in epidemiology (MPH or MS) with emphasis on epidemiology, biostatistics, data management, and research design. Translational topics in other fields may be pursued depending on trainee interest (e.g. pharmacokinetics, biomarker discovery).
  • Hands-on clinical and translational research experience. Under combined mentoring, the trainee will design and carry out a clinical or translational study on an important nephrologic topic. Present trainees are pursuing topics in atherosclerosis and cardiovascular disease in renal failure, the effects of uremia and bone disease, and other areas.
  • Seminars and tutorials in research design, research methodology, and statistical methods will focus on the specific studies the trainees are conducting to provide immediate and ongoing review of projects in progress.
  • Biomedical research integrity training. In order to retain NIH training grant support, all research fellows at the UW are required to have documented attendance at a series of lectures and workshops on the principles and ethics of research.

Given the current high level of interest in clinical and translational research training, the faculty within the School of Public Health and Community Medicine is a critical resource for our program. The School is the only accredited school of public health in the Northwest and is highly regarded nationally. There are five departments within the School: Biostatistics, Environmental and Occupational Health Sciences, Epidemiology, Global Health, and Health Services. Extensive interdepartmental and inter-school collaboration for research and training provides students with expertise in a broad range of public health problems. The School has 158 primary faculty. In 2013, the School had 1232 enrolled students in all its programs. It offers both master’s and PhD-level training in epidemiology and biostatistics. Courses in the Department of Epidemiology provide a rigorous introduction to both observational studies and randomized controlled trials, primarily as they relate to investigation of disease etiology, evaluation of diagnostic and screening tests, therapeutic intervention, and disease prognosis. Courses in the Department of Biostatistics cover quantitative techniques for analysis of data from medical studies: statistics, principles of estimation and hypothesis testing, sample size, evaluation of statistical significance, and survival analysis.

Upon completion of the program, trainees will be prepared to function effectively as independent investigators and teachers in clinical research and epidemiology, in nephrology, and in academic or public health environments. Of those who completed clinical science training, 88% are currently in academic positions. One hundred percent our trainees have obtained an MS or MPH degree during their training.

Clinician Educator Training in Nephrology

The purpose of this pathway is to train fellows interested in pursuing academic careers as future clinician educators. Individuals accepted into this pathway will complete two years of clinical nephrology.

The important role of clinician educators in academic medicine has become very apparent in recent years. Clinician educator's roles in academic medicine include teaching and mentoring students, residents and fellows in clinical settings; teaching medical students in classroom settings; involvement in clinical and educational administrative leadership; performing educational and clinical research; excellence in direct patient care; and teaching and leadership in the community. Although there is a demand for clinician educators in academic nephrology, the necessary training for success is not commonly provided during nephrology fellowship training.

The clinician educator in nephrology pathway at the University of Washington is a mentored pathway, and the mentor and the mentoring team will be chosen during the first month of fellowship. An individualized plan for the two year fellowship is created with the mentoring team and fellow. The pathway will focus on building skills in the following areas: clinical nephrology, teaching skills, curriculum design, administration, and scholarly work. Fellows will be expected to participate in mentored involvement in medical student, resident, and fellow teaching. Fellows will also be involved in developing curriculum for resident and fellow education. Fellows will also receive mentored guidance in dialysis administration and fellowship program administration. All fellows will be required to complete at least one scholarly project preferably in educational research or a project integrated into the research programs of the division. Clinical skills will be developed during the 24 months of clinical rotations. However, two months of elective time are offered along with protected time during other rotations. Elective time may be used for research projects or existing electives in radiology, pediatrics, and pathology. Fellows are also encouraged to develop an area(s) of clinical expertise and to learn new skills such as ultrasound or catheter placement skills. Training in time management skills will also be provided for clinician educators in recognition of diverse demands which clinical educators face in academic medicine.

Appropriate candidates will be encouraged to apply to the Teaching Scholars Program at the University of Washington which is a one-year professional development program for educators in the health professions. The program goals are to develop academic leaders, promote scholarly innovation, and enhance teaching skills. A separate application is required for this program which is a competitive application process. If accepted, fellows participate in this program for a half day per week during the second year of fellowship.

Fellows interested in continuing to build clinical and academic skills will be encouraged to apply to the University of Washington Renal Transplant or Dialysis Fellowship program.

Example Timeline

First Year

  • Mentoring team identified and plan the focus of the fellowship experience
  • Identify clinical area of expertise
  • Design a research project with a realistic expectation to complete over the two years
  • Identify teaching focus (medical student, resident, fellow, curriculum design)
  • Clinical rotations

Second Year

  • Teaching scholars program option (September-June, 1/2 day per week)
  • Abstract and paper completed
  • Administrative duties
  • Clinical rotations and elective time

Third Year Option

  • Possible Dialysis Fellowship or Transplant Fellowship
  • Possible grant for extra research years

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Stephen A. Geraci, Donna R. Devine, Stewart F. Babbott, Harry Hollander, Raquel Buranosky, Regina A. Kovach, Lee Berkowitz AAIM Report on Master Teachers and Clinician Educators Part 3: Finances and Resourcing The American Journal of Medicine October 2010 (Vol. 123, Issue 10, Pages 963-967).

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