Clinical Training Program
The clinical training program gives fellows a broad and deep learning experience in all aspects of clinical nephrology. Rotations include renal consultation on the inpatient services at Boston Medical Center (formerly Boston City Hospital and University Hospital) and VA Boston Health Services. Boston Medical Center is a 600-bed tertiary care referral hospital, which also has a significant primary care patient population. Renal fellows are responsible for patients referred to the renal service and for offering consultations to the medical, surgical and pediatric services. Approximately 12 – 20 new consultations or admissions per week are typical. Frequently seen clinical problems include post-operative acute renal failure, various forms of glomerulonephritis and vasculitis, interstitial nephritis, electrolyte disorders, hypertensive emergencies and advanced chronic kidney disease from a variety of conditions. During this rotation, fellows learn to perform acute hemodialysis and peritoneal dialysis, to establish vascular access for dialysis or hemofiltration, and to perform native and transplant kidney biopsies.
An attractive feature of the program involves a rotation at the VA Boston Health Services. Here fellows share responsibility with a Renal fellow from the MGH/Brigham and Women’s program and are supervised by senior BU and Harvard faculty. Fellows interact with the resident house staff in the care of patients with a wide variety of acute and chronic renal problems. This rotation encompasses inpatient and outpatient dialysis, clinical transplantation, and Renal and Hypertension clinics.
Four months of the clinical training program are spent on dialysis/transplantation rotation at the Boston Medical Center. During this rotation the fellow is responsible for the care of any patient on chronic dialysis (HD and CAPD) admitted to the hospital. The transplantation program at the Boston Medical Center is under the joint supervision of the Renal Section and Transplant Surgical Staff. Unlike in many other centers where transplantation is largely a surgical service, our renal fellows participate actively in the post-operative care of new kidney transplant patients during their transplantation rotation. Fellows also evaluate potential kidney transplant candidates and provide long-term follow-up of post-transplant recipients in the transplantation clinic. They attend a weekly transplant meeting to discuss new kidney recipients and donors and communicate with referring nephrologists. Fellows perform all outpatient transplant biopsies under the supervision of a transplant nephrologist to learn the procedure and they review the pathology results on site with our renal pathologist. Throughout the year, our faculty members give multiple lectures covering all aspects of transplantation, and fellows are guided in the selection of key papers for independent study. Fellows also have the opportunity to join our surgeons in the operating room to observe the transplant procedure.
Ambulatory nephrology is an important part of the clinical training program. Renal fellows attend a half-day continuity clinic every week at Boston Medical Center during the clinical and post-clinical years where they have primary responsibility for an outpatient population with all aspects of kidney disease. In the second year of training, fellows have the opportunity to follow a cohort of patients undergoing hemodialysis with close supervision by the staff nephrologist assigned to the same shift. Fellows also directly manage outpatients on peritoneal dialysis through our large peritoneal dialysis program comprising over 50 outpatients seen by fellows and staff in monthly outpatient visits.
In addition to their role as consultants at the various hospitals, fellows on these rotations serve as teachers. Because the Renal Section has a strong reputation for excellence in teaching, electives for students and residents are well subscribed throughout the year. Renal fellows fulfill a major role as teachers of these trainees, organizing daily work rounds and assigning new patients for initial work-up by residents or students. Second year fellows interested in medical education serve as preceptors in the physical diagnosis course and can arrange other opportunities to enhance their credentials as future medical educators.
Full-time members of the renal attending staff supervise all aspects of the clinical training program. The fellow on each of the rotations (Boston Medical Center consult services, the Dialysis/Transplant service and the VA Boston Health Services) works with a renal attending physician, who rounds daily. In addition, the attending is readily available to the fellow at all times for advice and urgent consultations. The tradition of the Renal Section emphasizes personal attention and involvement by the staff during their months as renal attending physicians, while affording fellows increasing responsibility in the decision making process. Faculty are readily available throughout training to mentor fellows in their research as well as in career development.