Table of Contents A. FOREWORD: FROM THE CHIEF OF NEPHROLOGY. NEPHROLOGY DIVISION FACULTY AND STAFF. SUMMARY OF THE FELLOWSHIP PROGRAM.
TEACHING ROUNDS AND CONFERENCES. TRAINEE EVALUATION OF PROGRAM. POLICIES AND PROCEDURES. RECRUITMENT AND RETENTION.
PROMOTION OF FELLOW TO THE NEXT LEVEL OF TRAINING. PERIODIC EVALUATION OF FELLOWS PERFORMANCE. LINES OF RESPONSIBILITY.54 APPENDIX 1: SYNOPSIS OF KING COUNTY ROTATION.54 APPENDIX 2: SYNOPSIS OF SUNY ROTATION.66 APPENDIX 3: SYNOPSIS OF THE VA ROTATION.71 APPENDIX 4: SYNOPSIS OF THE TRANSPLANT ROTATION.73 APPENDIX 5: SYNOPSIS OF THE AMBULATORY ROTATION.77 APPENDIX 6: SYNOPSIS OF THE INTERVENTIONAL ROTATION.81 APPENDIX 7: SYNOPSIS OF THE CONTINUITY CLINICS.84 APPENDIX 8: ATTENDING EVALUATION OF FELLOW AT END OF ROTATION.86 APPENDIX 9: TRAINEE ANONYMOUS EVALUATION OF ATTENDING.87 APPENDIX 10: SCHEDULE OF WEEKLY ACTIVITIES.88 APPENDIX 11: RENAL BIOPSY CHECK LIST.90 APPENDIX 12: STEP-BY-STEP GUIDE TO RENAL BIOPSY.91 APPENDIX 13: STEP-BY-STEP GUIDE TO CENTRAL VENOUS CANNULATION.96 APPENDIX 14: STEP-BY-STEP GUIDE TO ACUTE PD CATHETER INSERTION.99 APPENDIX 15: MENTOR SELECTION AND MEETINGS.101 1 APPENDIX 16: CHIEF FELLOW’S GUIDELINES.102 APPENDIX 17: ORIENTATION TO SUNY ROTATION.104 Nephrology Critical Care ……………………………109 A. Foreword: From the Chief of Nephrology Welcome to the Nephrology Fellowship at Downstate.
During your two years of fellowship, the faculty and staff of this division will guide you to acquire comprehensive knowledge and skills in nephrology that will make you fully prepared for your nephrology boards and as an outstanding practicing nephrologist or investigator. The faculty is enriched with the finest nephrologists, who will be available to you and will provide you with all the necessary tools you need to succeed. The faculty: fellow ratio is 2:1, providing you with the best level of teaching and supervision. How well you achieve your goals will depend on how much effort you put in as a learner.
The nephrology fellowship manual attached below is intended to help you navigate smoothly through the fellowship; you should however note that some issues may change as we encounter new situations. You are also to abide by all institutional policies as explained to you by the GME office. You will be covering three different hospitals in the course of the two years, all of which will give a different spin to your nephrology experience. By the end of the two years, you would have covered all contents of the curriculum.
Optional third year is available for ACGME accredited Nephrology Critical Care line, or non ACGME accredited fellowship training in Interventional nephrology or Renal transplant, or ESRD administration. However, in your first year, you should target to accomplish the following: 1. A thorough approach to the patient with kidney disease, taking appropriate history and physical examination and generating an appropriate differential diagnosis. A thorough understanding of the laboratory and imaging methods used to evaluate patients with kidney disease.
Learn as many procedures as possible and demonstrate competence. Have a thorough understanding of the principles of hemodialysis, peritoneal dialysis, plasmapheresis, and continuous renal replacement therapies. The fellow would also learn how to write both acute and chronic prescriptions and manage complications of these therapies. Understand the principles of immunosuppression and how to evaluate the potential renal transplant donor and recipient.
Learn to critically evaluate a scientific publication. Design a research project with a faculty or mentor, aiming to have an abstract for any of the annual nephrology meetings. In your second year, you should target to accomplish the following: 1. Acquire a thorough understanding of the pathophysiologic basis of kidney disease AND understanding of the management of the renal transplant recipient 2.
Acquire more competence in the first-year objectives 3. Prepare patients physically and mentally for outpatient dialysis and take care of all aspects of outpatient dialysis 4. Pick a topic of choice and prepare for renal grand rounds as part of acquiring presentation skills 5. Acquire the ability to work in the private practice setting, including an understanding of documentation and billing guidelines 6.
Acquire the highest level of professionalism and be prepared to represent the Nephrology Division at Downstate to the world The table below reflects Medical Content Categories used by the American Board of Internal Medicine for Board Certification in Nephrology. 3 In our effort to enhance your learning, the division will provide a benefit of $250.00 per year towards the purchase of books. You will also be refunded for expenses up to a maximum of $1000.00 towards participation and or presentation at an annual nephrology meeting. Please refer to this manual and make the best out of it.
Contact me if you have any suggestions. Salifu, MD, MPH, MBA, FACP Chair of medicine Saggi Subodh J, MD, MPH Professor of Medicine, Program Director Director, SUNY Ambulatory dialysis. Director, Pancreas transplant and extracorporeal therapies Subodh. Nephrology Division Faculty and Staff Area of Phone Name Picture Title Interest (718) 4 Professor and Renal Chair, Transplant Moro O.
Salifu, Department of and dialysis MD, MPH, MBA, Medicine. Outcomes MACP Chief, Division of research, 270-1584 Moro.salifu@dow Nephrology.edu Director, Dysfunction, Transplant Glomerular Program. Diseases, Distinguished Diabetic Eli A. Friedman, Teaching Nephropathy, MD, MACP, FRCP Professor of Uremia Medicine 270-1584 eli.friedman@do SUNY Downstate wnstate.edu Distinguished CKD, Barbara Delano, Service Epidemiology MD, MPH, FACP Professor; and Social Chairman, Dept determinates 270-2425 barbara.delano@ of Community of health downstate.edu Health – School of Public Health Professor of Fluid and Medicine Electrolytes Man S.
Oh, MD Director, Fluid and Electrolytes, 270-1565 Man.oh@dowstat SUNY Downstate e.edu Professor of AKI, clinical Medicine, trials, Anemia Program Director in CKD and Saggi Subodh, and Director, ESRD, MD, MPH SUNY ambulatory metabolomics dialysis.saggi@d Director, ownstate.edu pancreatic transplant and extracorporeal therapies 5 Associate Clinical Professor of Nephrology, Gary Briefel, Medicine, dialysis MD Nephrology and 613-8157 affiliate, Kings gary.briefel@dow County Hospital nstate.edu Area of Phone Name Picture Title Interest (718) Professor of Lipid Clinton D. Medicine, Metabolism Brown, MD Deputy chief of Atherosclerosi 270- nephrology and s in renal 1729/158 Clinton.brown@d Chair of IRB diseases 4 ownstate.edu SUNY Downstate Professor of Post- Medicine, transplant Mariana S. SUNY Downstate Metabolic Markell, MD Diseases, Diabetic 270-1584 Mariana.markell nephropathy, @downstate.edu Social determinant of health Associate Hemodialysis, Robert H. Barth, Professor of Infections, MD Medicine Nutrition, of Dialysis, VA Bone Disease 836-3762 Robert.barth@va Medical Center .gov Assistant Hemodialysis Professor of Medicine Mari Alex Michel Director, of Marie- Dialysis and 270-1584 alex.
affiliate Program go Director, VA medical center 6 Area of Phone Name Picture Title Interest (718) Mary Mallappallil, Assistant Professor Hemodialysis MD of Medicine, outcomes Director, CME 613-8153 Mary.Mallappallil Activities @downstate.edu Clinical Assistant Interventional Professor of nephrology Arye, Kremer.MD Medicine Director of Arye.kremer@ inpatient 760-0204 downstate.edu hemodialysis Clinical Associate Clinical Anthony J. Professor of Nephrology Joseph, MD Medicine and Hemodialysis 270-2198 Anthony.edu Clinical Assistant Hemodialysis Akten Sine MD Professor of Sine.akten@ Medicine 613-8175 downstate.edu Clinical Assistant Hemodialysis Professor of Ernie Yap MD Medicine Ernie.edu Assistant Hemodialysis Phillip Professor of Dialysis Goldwasser MD Medicine Director of CAPD, 836-3762 Phillip.goldwasse VA Medical r. Summary of the Fellowship Program The Nephrology Training Program at Downstate Medical Center began in 1964 and has operated continuously since. As of July 1, 2004, there will be ten (10) 7 fellows enrolled in a two-year program.
An optional third year, devoted to investigation, is contingent on gaining funding for suitable projects. Institutions participating in Downstate’s Nephrology Training Program include: Kings County Hospital Center (KCHC, 6 months) -KCHC provides a busy inpatient and outpatient consulting service for management of acute and chronic kidney failure as well as performance of acute hemodialysis (HD), and peritoneal dialysis (PD), and continuous renal replacement (CRP) therapy, femoral cannulations and percutaneous kidney biopsies. The renal fellow is responsible for coordinating medical care of all ESRD patients. CKD care is afforded in two renal clinic sessions each week.
At all times, supervision of the renal fellow is the responsibility of an attending nephrologist. University Hospital of Brooklyn (UHB, 9 months) -UHB provides a full menu of renal diseases including kidney transplant related experience. Acute dialysis care is a key focus of the service, and exposure to continuous renal replacement therapy is extensive throughout the year. Off site management of severely ill patients is conducted in the Cardio-Thoracic Intensive Care Unit, the active Medical Intensive Care Unit and a busy Cardiac Catheterization/ Intervention laboratory.
When the fellows are in UHB they rotate in 3 different nephrology services, which includes consult, transplant and vascular access services rotations. Brooklyn Veterans Hospital (BVH, 6 months) -With two assigned renal fellows, the BVH rotation focuses on managing ambulatory renal patients. This rotation supervised by Dr. Goldwasser and Mari-Alex Michel provides intensive training in the mechanics and medical support of patients on chronic hemodialysis.
In addition, the fellow provides primary care for the veterans with renal transplants. The two fellows take calls alternatively. UHB Transplant (3 month) -The Transplant Service performs approximately 90 kidney transplants each year and provides hemodialysis vascular access for patients at KCHC and UHB. Renal fellows do daily rounds with a supervising transplant nephrologist.
First year fellow does 1-month training and 2nd year fellow does 2 months training in transplant. Mount Sinai Hospital (1 Month) 8 Nephrology second year fellows to rotate through the Home Dialysis Program at Mount Sinai School of Medicine/Mount Sinai Hospital for their training in home dialysis, which includes Home Peritoneal Dialysis as well as Home Hemodialysis. Downstate fellows will be trained in learning how to screen appropriate candidates for Home Dialysis, learn different types of procedures needed to accomplish access to either peritoneal membrane for Home Peritoneal Dialysis or vascular access appropriate for home hemodialysis therapies. Fellows will be trained with Dr.
Jaime Uribarri, Home Dialysis Director. Fellows will also spend time in their outpatient Interventional facility to see PD catheters being placed under fluoroscopy, as well as observe in the Operating Room laparoscopic placement of PD catheters. Fellows will learn how to manage catheter post operatively, how to start low volume peritoneal dialysis immediate post op if needed. Interventional Nephrology (1 month)- The fellow will gain the required knowledge and experience in managing all kinds of vascular access problems.
The fellow is responsible for all dialysis patients at UHB and attends the weekly home dialysis clinics at Parkside. Clinics: Each fellow is expected to attend several outpatient continuity clinics: UHB, KCH, and VA outpatient clinics. The Transplant Clinics are attended when the fellow participates on those respective services. UHB Clinic: Typically, each fellow sees 4-8 CKD patients during a 1/2-day clinic and follows them over a two-year period, under the supervision of Dr.
Delano and other attendings. KCH Clinic: Typically, each fellow sees 4-8 CKD patients during 1/2-day clinics on Mondays and Wednesdays and follows them over a two-year period, under the supervision of Dr. Mary Mallappallil and Dr. Akten VA Clinic: The fellow sees 4-8 patients during a 1/2-day clinic for each fellow every week.
The fellows rotating at the VA attend this clinic, under the supervision of Dr Marie-Alex Michel and Phillip Goldwasser Transplant Clinic: The fellow sees 4-6 transplant patients during 1/2-day clinic under the supervision of Drs. Salifu, Saggi and Markell. Calls: Weekday calls begin at 5:00PM and ends at 8:00P. Weekend calls begin on Friday at 5:00PM ending at 8:00AM Saturday and then next fellow usually senior covers the Sunday 8 am to 8 am Monday.
However, to comply with the 10-hour and 16-hour rules (see below) the fellow leaves the 9 hospital at completion of their work and comes back at 10 hours later in the next morning. All telephone calls from patients at night and on weekends from their homes should be discussed with the attending on call. The fellows are on call an average of five times per month. Didactic Training: Clinical conferences, seminars, small discussion groups, journal clubs and one-on-one instruction are integral parts of the Nephrology Fellowship Program.