Education

SECOND YEAR NEPHROLOGY FELLOW – NEPHROLOGY RESEARCH

 General Description/ Educational Purpose:

Each second year nephrology fellow in Nephrology Research spends the second, (and optional but not required third/ fourth) year with a research mentor within or outside the Division of Nephrology.  The fellow chooses the research mentor during or prior to the first clinical year.  

 The second (and optional third) year of training is designed to further prepare the fellow for a career in academic nephrology or private practice by developing more extensive experience in outpatient and inpatient nephrology to develop independence as a clinical nephrologist, and by engaging in nephrology research and scholarly activity.  Currently, second year fellows engage in basic science research or clinical research.  Each fellow chooses the type of research and a mentor from a wide variety of research areas.  The fellow’s research is presented at divisional meetings (Renal Rounds, Renal Disease Interest Group Meeting, Basic Science Journal Club/Research Seminar) and, if possible, national meetings.  Fellows may produce results suitable for publication in peer reviewed journals.  

 Funding for the second year of fellowship may be provided via the program’s NIH training grant to eligible fellows pursuing basic science research. Fellows will be supported during the second year of fellowship if the grant is not available or if the fellow is ineligible. Possible third and fourth years of training may be funded by the fellow’s application for grant awards.  

 Educational Goals:

The goals of this year are to develop the education and expertise required to become successful in a career as a physician-scientist and/or a clinician educator as fellows pursue basic science, clinical science, or clinical research.  Depending on research interests, specific educational goals are to:

1. Learn principles of basic and clinical laboratory research methods, analysis experimental design and data analysis as well as develop skills in grant writing, oral presentations and publication of scientific data;
2. Apply scientific principles to biological problems in clinical medicine;
3. Advance a career in basic laboratory, clinical science research, and/or clinical education in the field of nephrology.
4. Advance the science of basic laboratory research, clinical research including case studies, and /or epidemiology by developing new methods and applications;
5. Use basic science, clinical research and/or epidemiologic methods to investigate the etiology of disease in human populations;
6. Develop methodologies for translating basic science, clinical research and/or epidemiologic research findings into clinical medicine;

g.   Develop critical assessment of medical literature in basic science, clinical research and/or epidemiologic clinical epidemiology, biostatistics, and clinical decision theory.

     (Second year Nephrology Fellows may elect to follow additional hemodialysis, peritoneal dialysis,  and /or renal transplant patients with supervising attending physicians throughout the year to gain additional longitudinal experience with outpatients. Second year fellows continue in the Nephrology Continuity Outpatient Clinic. These clinical activities help to develop the fellow into an independent nephrologist.)

     The curriculum is intended to give the fellow in nephrology research the opportunities to achieve  the cognitive knowledge, interpersonal skills, professional attitudes and behaviors, and practical experience required for independence for research in nephrology.  The opportunities to enhance humanistic qualities are also provided if research involves human subjects.

Teaching Methods:

Each fellow begins by reading extensively about the subject they have chosen for their project. The fellow is taught appropriate methods and their interpretation. As the fellow matures in the research environment, he or she is given more responsibility for research decisions. Most instruction is one on one, from more experienced laboratory faculty, fellows, and staff. Emphasis is placed on the fellows’ developing the ability to evaluate the research of others as well as perform and evaluate his/her own research. Ultimately, the fellow is guided in developing oral and written presentations of his/her work, and in developing grant applications for research support.

The faculty preceptor is responsible for the fellow’s development. Additional support is available at Divisional research conferences and journal clubs, as well as many research and clinical conferences at the institution.

Teaching methods involve contributing to writing grant applications for specific projects with which the fellow is involved.   The research mentor helps teach the fellow during sessions where laboratory data are reviewed and during lab meetings.  There is a Basic Science Journal Club/Research Seminar, Clinical Science Journal Club for all fellows where basic and clinical science research papers are critically reviewed.  There may be a separate Journal Club for each individual research lab.   There is a basic science journal club/research conference once a month where research from inside and outside the Nephrology Division is presented.  Fellows involved in basic science research may be asked to present their data at this conference. The Renal Disease Interest Group Meeting takes place once per month to discuss areas of clinical science research.  Fellows involved in clinical research may be asked to present at this conference.

Each fellow rotates through Methods in Clinical Research, sponsored by the Bloomberg School of Public Health.   Classroom instruction includes Statistics, Evaluation of Diagnostic Tests, and Skills in Publication of Data, Computer Skills and Small Group Sessions. 

Patient Characteristics/ Mix of Diseases/ Types of Patient Encounters:

Fellows in nephrology research are expected to cover for first year fellows during their vacation.  For NIH funded research, coverage of < 1 month is expected during the second year of fellowship.  For fellows involved in non-NIH research, the coverage will be between 1-2 months.  The rotation covered by fellows in nephrology research is usually the Nephrology Outpatient Dialysis Inpatient rotation, but occasionally the Nephrology Transplantation rotation.  Fellows cover 4 weekends during the second year.  For NIH funded research, coverage of 4-8 nights is expected during the second year of fellowship.  For fellows involved in non-NIH research, the coverage will be between 8-12 nights.  The fellow in Nephrology Research participates in the Nephrology Continuity Clinic ½ day per week during the second year. Twelve of these months will have been covered during the first year of fellowship.  

 Fellows pursuing Clinical Research may encounter inpatients or outpatients; however this is for research study purposes only.  For the Nephrology Research rotation, there are no specific patients assigned.

Procedures and Services:

The fellow in Nephrology Research may have certain laboratory procedures which the supervising mentor may wish to evaluate, but they are not associated with the ACGME competency evaluations.

Procedures performed during coverage of the inpatient service may include urinalyses; native and renal transplant biopsies, hemodialysis, peritoneal dialysis, chronic renal replacement therapies, and vascular access placement for hemodialysis or chronic renal replacement therapy and are evaluated as described in the General Description and Curriculum. For the Nephrology Research rotation, there are no specific procedures.

Reading Lists:

The specific reading lists for Nephrology Research will be determined by the type of research the fellow is involved.

Pathologic material:

Pathologic material may be involved in either basic science or clinical research. In the case of basic research, animal models may be involved. 

Other Educational Resources:

Fellows participating in nephrology research attend the American Society of Nephrology Annual Scientific Meeting.  In addition, the program director attempts to secure funds which will enable nephrology research fellows to attend other conferences as well through educational grants. The fellows in nephrology research are given a stipend to use for educational purposes. Courses are offered throughout the year by The Johns Hopkins School of Medicine regarding various topics in basic science, as well as Computer Skills by the Welch Library. The Johns Hopkins University School of Medicine offers a wide variety of classes to fellows for training in research ethics, humane treatment of animals, and HIPAA regulations.  Fellows pursuing basic science research are encouraged to audit relevant classes offered by basic science departments.  Fellows in research undergo training in research ethics and HIPAA issues. 

Methods of Evaluation:

The research fellow is evaluated by the research mentor on an informal basis as agreed upon by the fellow and the mentor. 

 (The supervising mentor may mention patient interaction as part of a clinical research project; however this is not formally evaluated.)

(Continuity Clinic evaluations are performed by Nephrology attendings that precept in the Nephrology clinic as described previously.) 

Responsibility/Supervision:

The nephrology fellow in basic science research is responsible for choosing a research mentor either during or before the first year of nephrology fellowship through formal and informal meetings.  The fellow is responsible for participating in writing grant applications for specific projects with which he/she is involved.   The fellow is expected to obtain additional funding after the second year.  The fellow performs experiments, collects data, and if possible, participates in authorship of publications with the supervision of the research mentor.  Oral presentations may be made in front of an Advisory Board.

Throughout the course of any research project, nephrology fellows meet regularly, in a one-on-one meeting, with their faculty member research mentor to report their progress and discuss the design and content of their projects.  Every nephrology fellow research project is supervised by a faculty mentor who is available to discuss any issues that may arise.  Fellows also discuss their progress with other residents and other interested faculty members at various research conference and clinical conferences.

(The fellow in the basic science track, covering for the first year fellows, has patient responsibilities as previously described.)