Supervision and Lines of Responsibility for Nephrology Fellows
The program director coordinates all aspects of the nephrology fellows’ education and training, including their supervision by faculty members. Fellows are provided with responsibilities consistent with their level of training. Appropriate faculty supervision is provided during all educational experiences. The specific mechanisms for proper supervision of fellows are as follows:
Nephrology fellows round and present clinical cases in inpatient rotation rounds, Nephrology Continuity Clinic, Outpatient Dialysis Ambulatory rotation, and Outpatient PD experience and receive one-on-one instruction and feedback in history taking, physical examination, and inpatient and outpatient management of nephrology patients. These case presentations may include review of clinical data, urinalysis, review of pathologic specimens, and imaging data. The data gathered are assimilated with current medical literature to develop assessment and plans well-founded on evidence-based medicine. Nephrology teaching faculty members interview, examine, and discuss assessment and plans with the nephrology fellows for all inpatient and outpatient encounters. During the Nephrology Intensive Care Unit and Nephrology Consultation rotations, the nephrology fellow directs a team of residents and medical students. This experience affords the opportunity to improve leadership, organizational, and educational skills by through the supervision and education of internal medicine residents and medical students.
The faculty members’ on-call schedule is structured such that the three separate supervising attendings are on-call at all times during the weekdays for the rotation which they are supervising (Intensive Care Unit rotation, Consultation rotation and Nephrology Transplant rotation). All nephrology faculty members are available for the fellows for the Outpatient Dialysis (Bond Street) Inpatient rotation. Nephrology fellows present all new patient encounters with the appropriate attending on nights and weekends. On weekends, the two (renal transplant and general nephrology) on-call attendings round with the on-call fellows. The program director serves as the backup attending for all supervision if a particular faculty member can not be reached. The division director serves as the backup faculty member for supervision if the program director is on vacation.
Procedures such as renal biopsy, urinalysis, placement of the temporary vascular access catheters, and hemodialysis and peritoneal dialysis procedures are supervised. Fellows’ advancement to independent performance of procedures is based upon successful completion of procedures as well as review with attending physicians who must certify residents based upon clinical and procedural competency.
All hemodialysis and peritoneal dialysis treatments are reviewed with the attending. At a time when it is after hours, the nephrology fellow discusses any placement of a vascular access catheter and hemodialysis, peritoneal dialysis, or continuous renal replacement therapy with the nephrology attending prior to the initiation of these procedures.
Fellows receive formal feedback to procedural competence as part of each post rotational evaluation. An electronic log of procedures which nephrology fellows are credentialed to perform is maintained.
During the first year, the fellow identifies one or two individuals to serve as their research mentor for the second year. Prior to implementation of research projects, the fellow is expected to undergo training on HIPAA as it relates to research, conflict of interest, and human subject or animal research. Fellows are expected to complete the 2 week long Methods in Clinical Research course in July/August after their first year. This course provides an excellent introduction to research methods, epidemiology and biostatistics. Details of this course: http://www.jhsph.edu/welchcenter/training/clin_res_intro.html
Throughout the course of any research project, the nephrology fellow meets regularly with the faculty research mentor to report progress and discuss the design and content of the project. 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 fellows and other interested attending faculty at various research conference and clinical conferences.