Nephrology Fellowship

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  • Fellowship Program Information

    The Division of Nephrology at the University of Mississippi Medical Center supports a threefold mission:

    • Deliver cutting-edge and compassionate care for all types of kidney disease.
    • Train the nephrologists of tomorrow for the state of Mississippi.
    • Improve the understanding of the nature and treatment of kidney disease through basic science and clinical research.

    The Division of Nephrology at the University of Mississippi Medical Center strives to provide state-of-the-art care to the kidney patients of the state of Mississippi. Our services include both in hospital and outpatient consultation and full-service inpatient and outpatient dialysis. In addition we are the only renal transplant center in the state of Mississippi and provide comprehensive care of transplant patients in both the inpatient and outpatient setting.

    Our faculty has varied areas of academic focus and expertise that collectively allow us to provide care for unusual diseases and complicated patients as only an Academic Center can.

    We also pride ourselves on our dedication to education on all levels of the medical curriculum, teaching medical student, residents and our own nephrology fellows. The nephrology training we provide our fellows is an intensive clinical experience that includes all facets of nephrology practice.

    Goals

    We have adopted the Nephrology Core Curriculum set forth by the American Society of Nephrology and The American Society of Nephrology Program Directors Committee to help us direct the training and education of trainees in Nephrology. We have designed a program intended to meet the Core Curriculum requirements, which we will outline below.

    • To promote excellence in clinical nephrology by providing or developing:
      • a fundamental understanding of renal physiology and pathophysiology;
      • expertise in the use of hemodialysis, peritoneal dialysis, hemofiltration, and continuous dialytic technique;
      • expertise in the performance and interpretation of renal biopsies;
      • exposure to renal transplantation with the emphasis upon the immunological and medical care of the allograft recipient;
      • exposure to and guidance in the care of patients with a broad range of clinical disorders of renal function, fluid and electrolyte balance, acid base disturbances, hypertension and the full range of internal medicine problems affecting these patients.
    • To establish a critical and logical approach to problem solving by participation in a supervised experience in laboratory and/or clinical investigation.
    • As the interest and ultimate goals of each nephrology fellow will vary. The ultimate goal of the University of Mississippi Medical Center's nephrology training program is to provide each individual the education they need to achieve their personal goals. In addition, all fellows completing two years of clinical fellowship training at UMMC will be eligible for board certification in nephrology.

    Lectures, conferences and seminars

    The division's commitment to education is manifest, in part, by a full menu of educational offerings. Regularly scheduled conferences include: Weekly division-wide sign-in and sign-out rounds, biweekly pathology conference, monthly morbidity and mortality conference, weekly fellow conferences including board preparation, monthly clinical case conferences, quarterly joint conferences with other division, monthly research conferences and three journal clubs per month.

    Clinical nephrology rotations

    During the first year, three to four months will be spent on the University Blue Service which provides consultative care to patients with Stage IV-V CKD and ESRD, three to four months on the V.A. Renal Service, two months on the transplant service and one month on an outpatient dialysis rotation called "Introduction to clinical nephrology".

    During the second year of the fellowship training program, fellows will spend four months on the Red Service which provides consultative care to patients with acute kidney injury, two months on the transplant service and at least two months doing research while the other four months of the year are available to do electives or continue with research.

    Each year the fellows have a Chronic Kidney Disease Continuity Clinic that meets weekly.

    During the second year, in addition to the Chronic Kidney Disease Clinic, each fellow has longitudinal outpatient experiences in in-center hemodialysis, home hemodialysis/peritoneal dialysis, and chronic transplant outpatient care.

    University Hospital consult services

    There are two consultative services that generally follow between 10 and 20 patients and provide comprehensive care to patients with: acute renal failure, chronic kidney disease and end-stage renal disease. Some specific examples include: management of post-operative and trauma victims with acute renal failure, management of patients with acute toxic nephropathies, management of chemotherapy related nephrologic problems, as well as consultation for maintenance of chronic dialysis on ESRD patients admitted to other services. In addition, this service is frequently consulted for assistance in the management of complicated fluid, electrolyte, and acid base disturbances.

    University Hospital currently has five intensive care units, including a 20-bed medical intensive care unit, a 20-bed cardiology-cardiac surgery intensive care unit, a 20-bed surgical intensive care unit, a 10-bed bone marrow transplant unit, and a 10-bed neurosurgical unit. University Hospital, as a whole, maintains approximately 750 operational beds. The nephrology services also provide consultation services to the 124-bed Mississippi Methodist Rehabilitation Center and the Wiser Hospital for Women.

    Although primarily a consultative service, this service may, on occasion, be assigned some ward patients at the discretion of the attending physician.

    Educational goals for the nephrology fellow on this service rotation include:

    • Development of expertise in percutaneous renal biopsy techniques.
      Experience with continuous renal replacement therapy (CVVH/D/F) using PrismFlex and SLED.
    • Experience in Hemofiltration for the treatment of refractory congestive heart failure.
    • Expertise in the area of acute peritoneal dialysis.
    • Understanding of acid base, fluid and electrolyte abnormalities, and expertise in their management.
    • Experience in the management of intensive care unit patients with acute renal failure.
    • Expertise in routine nephrological consultation for patients with CKD and ESRD.
    • Assessment and management of complications of vascular access.
    • Mastering the evaluation and work-up of new and unusual presentations of acute renal failure, including ingestions of toxins.

    Renal transplant service

    The renal transplant service at the University of Mississippi Medical Center is composed of a multi-disciplinary patient care team including surgeons, nephrologists, social workers, dietitians and nurses. Currently, approximately 80-100 kidney transplants are performed each year. Each nephrology fellow will spend a total of four months on the renal transplant service during his training.

    Patients admitted for transplant or for surgical complications post-transplantation are admitted to the Transplant Surgery Team but are followed by transplant nephrology in consultation. Patients admitted with medical issues post-transplantation are admitted to the Transplant Nephrology Team directly. The nephrology fellow is expected to be involved and familiar with patients on both sides of the service. There are usually four-12 patients in the hospital at any given time.

    Renal transplant clinic is held twice weekly on Monday and Thursday from 9 a.m.-noon. The nephrology fellow on the transplant service is expected to attend their regular scheduled continuity clinic while on the service. Nephrology trainees are required to participate in at least one transplant operation as an observer and are welcome on any organ procurement procedure as well. The transplant evaluation clinic is held on Friday from 9 a.m.-noon.

    Educational goals to be achieved by the nephrology fellow during rotation on the renal transplant service include:

    • An understanding of the advantages and disadvantages of transplantation vs. dialysis as well as deceased-donor vs. living-related transplantation.
    • Expertise in determination of appropriate candidates for renal transplantation.
    • Ability to recognize an appropriate deceased or living-related donor and an understanding of the appropriate use of marginal donors.
    • A basic understanding of histocompatibility and the role of tissue-typing in transplantation
    • Expertise in the workup of patients with both acute and chronic allograft dysfunction including competence in performing percutaneous allograft biopsies.
    • Familiarity with immunosuppressive medications with an understanding of both the common side effects and potential interactions with other drugs.
    • Expertise in medical management of long-term post-transplant complications, including infection and malignancy.
    • Expertise in the ambulatory care of post-renal patients including an understanding of appropriate health maintenance procedures. 

    VA nephrology service

    The Veterans Affairs Medical Center in Jackson, Mississippi, is an integral part of the Nephrology Fellowship Training Program at the University of Mississippi Medical Center and each fellow is required to rotate for four 1 month blocks in the first year of their nephrology training. The V.A.M.C. Nephrology Service offers a unique educational training opportunity by providing experiences with consultative nephrology, management of the acute medical problems of the chronic dialysis patient, and experience in outpatient long-term follow-up of the ambulatory chronic dialysis patient.

    The 16-chair dialysis unit facility at the VA provides chronic dialysis to approximately forty (40) veterans who choose to dialyze in center at the VA hospital. During rotations at the VA, nephrology fellows are actively involved in providing chronic dialysis care to the patients. This experience provides all first-year fellows an opportunity for exposure to the administrative aspects of running a dialysis unit, including working closely with the nursing personnel, understanding quality assurance monitors for dialysis units, monitoring adequacy of dialysis, and providing on-going care for a cohort of healthy dialysis patients. A renal dietitian and a renal social worker are available to assist in the management of these chronic dialysis patients and participate actively in the multi-disciplinary healthcare team. A variety of quality assurance monitors are in place for the dialysis unit including infection control, patient safety, blood pressure control, urea reduction assessment for adequacy of dialysis, and a recirculation vascular access patency assessment.

    The VA nephrology clinic meets on Monday mornings and Friday mornings for approximately 3 hours. Patients seen in the clinic include chronic hemodialysis patients, renal transplant patients who are veterans, patients with chronic renal insufficiency who are in conservative management protocols, and patients recently discharged from the hospital seen by the nephrology service in consultation who may require post discharge nephrologic follow-up. Our nephrology fellows have traditionally found VA clinic experience to be very rewarding.

    The consultative nephrology service provides care for patients throughout the 375 bed Jackson VA Medical Center Hospital with all manner of nephrologic or fluid and electrolyte problems. This service provides the nephrology trainee an opportunity to gain expertise in renal biopsy techniques, utilizing both CT as well as ultrasound guidance. Trainees also gain exposure to acute hemodialysis and peritoneal dialysis with an opportunity to develop expertise in the placement of temporary hemodialysis access.

    Outpatient dialysis

    Our outpatient hemodialysis unit at the Jackson Medical Mall currently provides chronic dialysis care for 155 patients. In the second year, the trainee will follow a shift of patients (~30) for 6 months, by rounding with an attending in the unit every week and participating in monthly lab reviews.

    Home dialysis experience in home hemodialysis and peritoneal dialysis is obtained at our Home Training Unit, which is connected to our outpatient clinic. This has facilitated patient consultations with dialysis nurses and the recruitment of patients to the Home Dialysis Program. We now offer CAPD, CCPD, standard 3-day/week home hemodialysis and 5-day/week dialysis with the NxStage machine. During the second year, the fellow will round in the home training unit for 6 months. Faculty supervision for this rotation includes the involvement of attending faculty of the University of Mississippi Medical Center.

    Both of these rotations provide a longitudinal experience of outpatient care of chronic ESRD patients and help prepare the trainee for this important aspect of nephrology.

    Outpatient clinics

    • Renal Transplant Clinic - Clinic is held twice weekly on Monday and Thursday from 9 a.m.-noon. Fellows on transplant go to all transplant clinics and typically attend transplant clinic during the "Introduction to Nephrology" month in the first year. Second-year fellows attend transplant clinics when they are assigned to the Transplant Service. As with the outpatient dialysis, the goal is a longitudinal experience in caring for transplant patients in an outpatient setting.
    • General Nephrology Clinic - First- and second-year fellows attend a weekly outpatient clinic which serves patients with all types and stages of renal disease. They follow a core of patients longitudinally over the two-year curriculum. They see two to three new patients per week.

    Electives

    • Renal Pathology - A one-month elective rotation in renal pathology is available under the direction of Dr. Steve Bigler and Dr. Jack Lewin in the Department of Pathology at the University of Mississippi Medical Center. During this rotation, the trainee will become familiar with the spectrum of staining techniques available for utilization with kidney biopsy material, will assist in the preparation of tissue for examination, and will review all renal biopsies during the month with Drs. Bigler/Lewin. In addition, a teaching file of renal pathology cases is available and the trainee will be expected to spend time during the rotation reviewing teaching case files in renal histopathology. A syllabus from renal biopsy conferences is available for background reading and review during the rotation, and the trainee is expected to become competent in basic evaluation of light microscopy specimens, immunopathology specimens, and electron microscopy of kidney biopsies.
    • Tissue Typing/Organ Procurement - A one-month elective rotation in specialized aspects of renal transplantation is available to the interested fellow. This rotation consists of two weeks with the tissue typing laboratory and two weeks working with the Mississippi Organ Procurement Agency. A tissue typing syllabus has been prepared by Dr. Shirley Schlessinger and is available for review by the trainee during the tissue typing portion of the rotation. This includes background information on the methodology of tissue typing as well as a variety of sample cases demonstrating the utilization of tissue typing in the evaluation and management of potential transplant patients. The trainee spends time in the tissue typing laboratory during which he will perform tissue typing on himself under the supervision of the tissue typing technologist and will have an opportunity to personally review cross matches and typing of patients in preparation for transplantation. This elective is specifically designed to assist the nephrology fellows in preparing for their board certification examinations, which include histocompatability questions.

      The Organ Procurement portion of the rotation includes two weeks with the Mississippi Organ Procurement Agency during which the trainee is expected to gain an understanding of medical, social, and legal issues pertaining to organ donation, procurement, and distribution. The trainee will participate in educational seminars and in-services provided by the organ procurement coordinators, will review organ procurement guidelines, and will become familiar with policies currently guiding distribution of procured organs. It is expected that the trainee will attend and participate in at least one organ recovery during his two-week rotation, including assisting in the actual recovery procedure.
    • Access Surgery - A one-month elective rotation can be arranged with UMMC vascular surgeons or with an access surgeon outside UMMC (with permission of the Program Director). A training agreement is required between UMMC and outside entities. This rotation has been popular with the fellows and they gain experience in placing tunneled vascular access, performing fistulograms and with mechanical declotting of thrombosed AV access.
    • Pediatric Nephrology - The major goals of this rotation in pediatric nephrology are (1) to acquire clinical knowledge and experience in pediatric nephrology; and (2) to develop skills in managing children requiring acute and chronic peritoneal and hemodialysis as well as transplantation. These goals will be attained by providing primary pediatric nephrology care in collaboration with the pediatric resident for inpatients on pediatric nephrology service at Batson Children's Hospital, provide consultation for children with suspected renal diseases and complications of fluid and electrolyte balance. The fellow will be responsible for rounding on a daily basis on all patients to provide clinical supervision of the patients medical evaluation and therapy. Teaching rounds on the inpatients will be held on a regular basis with the attending pediatric nephrologist who will review all consultations. The trainee will also attend renal clinics at the Pavilion and Batson Children's Hospital and will be responsible for evaluation and follow-up of the patients referred to the program. These responsibilities will provide the trainee within a limited time frame the experience in the care of a wide variety of patients with all types of kidney diseases, hypertension, urologic abnormalities, disorders of fluid and electrolyte balance including end stage renal disease and transplantation. During this period, the trainee will also share in presenting cases at the combined (with adult nephrology) Renal Biopsy Conference and discuss pertinent articles at the Nephrology Journal Club.

    Scholarly activity

    All fellows are required to complete a research project on a basic, clinical, or behavioral topic in the broad field of nephrology. Research opportunities are available in the division's basic laboratories (Drs. Juncos, Liu) or in various clinical research projects (Drs. Kokko, Kirchner, Schlessinger, Dreisbach, Fulop and Zsom)

    Administrative details

    • Vacation - Nephrology fellows can expect to take three weeks of personal vacation time during each year of their fellowship. Vacation time should be planned in advance and discussed with the Division and Program Directors. Fellows will routinely also receive several days off during either the Christmas or New Year holiday and in some cases both.
    • Call schedule - Nephrology fellows at UMMC routinely take weeknight call and weekend call. Call is taken from home. The weeknight call, Monday through Thursday, rotates on a nightly basis evenly between fellows. The weekend call, Friday night to Monday morning is covered by one fellow each weekend and the fellows rotate this responsibility evenly on a weekly basis. The fellows are assigned the first call designation with a faculty nephrologist always providing backup support. The designated attending, fellow, and a resident attend weekend rounds. In general, even during the call, an attempt is made to make it an educational process whenever possible.
    • Scientific meetings - Fellows should plan to attend one scientific meeting each year. Because of the availability of funding for fellow travel from the National Kidney Foundation and the American Society of Nephrology, the fund limit for each fellow is $800 per year for fellows presenting abstracts of their work. It is expected that each fellow will submit at least one abstract to a scientific meeting during his education tenure. Fellows will receive additional funding to attend any meeting at which they will present an oral or a poster presentation.

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