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Second Year Curriculum
The second year clinical experience is designed to build upon skills acquired during the first year primarily through a wide array of outpatient clinical rotations.
JHH Inpatient Consultation (Chronic)
There are two non-ICU consultation teams each is comprised of a nephrology fellow, a supervising attending, and occasionally urology residents, medicine residents, and/or medical students. Fellows will encounter a wide spectrum of diseases during this rotation including:
- Acute kidney injury from various causes (e.g. pre-renal azotemia, pregnancy, urinary tract obstruction)
- Rapidly progressive glomerulonephritis and vasculitis
- Primary or secondary nephrotic syndromes
- Acid-base and electrolyte disturbances
- Chronic kidney disease of all stages due to varying etiologies
- End-stage renal disease and related complications
- Drug toxicity
The Nephrology Night Float system was instituted and designed to reduce the destructive fatigue experienced by fellows who were on-call at night, with frequent sleep interruptions and need to come in to the hospital for acute patient evaluations and then working the following day. The night float system enhances fellows' performance both as learners and as practitioners and contributes to fellows' well-being. The night float fellow is present in-house at Johns Hopkins Hospital from Sunday to Friday 7 pm to 7 am. Saturday night coverage is provided by the weekend fellow on first call. The night float fellow is expected to finish all sign-out and continuity of care and be able to leave the hospital no later than 8 a.m. each morning. The responsibility of the night float fellow is to provide fellow coverage for urgent and emergent nephrology issues.
This rotation is a longitudinal rotation designed to help second year fellows to understand the requirements of managing hemodialysis patients in the outpatient setting. It is structured over the course of the year from September to May. Fellows work one-on-one with attendings during this year long rotation. Fellows rotate at two of our dialysis units. They have experiences with one attending for 4 months then switch to a second attending and nurse practitioner for the remaining half of the rotation. The topics covered include:
- Hemodialysis prescription and evaluation of adequacy
- Management and evaluation of vascular access and related complications
- Work-up and management of anemia
- Work-up and management of mineral bone disease and related complications
- Evaluation and management of risk factors for cardiovascular and peripheral arterial disease
- Evaluation and management of nutritional issues unique to patients receiving chronic hemodialysis
- Transplant referral and evaluation
During this longitudinal rotation, fellows will follow a cohort of patients undergoing chronic peritoneal dialysis under the supervision of a dedicated attending. This rotation is structured over the course of the year from September to May. Fellows rotate with one attending for the year and attend their peritoneal dialysis clinic monthly. Skills gained during this experience include:
- Evaluation of potential candidates for home dialysis therapies
- Referral, evaluation, and management of peritoneal dialysis catheters
- Diagnosis and management of acute and chronic peritoneal dialysis and home hemodialysis complications
- Evaluation and management of nutritional issues unique to patients receiving home dialysis therapies
- Transplant referral and evaluation
Nephrology Continuity Clinic
As in the first year, fellows will attend a one-half day weekly clinic (on the Bayview campus). Fellows evaluate and longitudinally manage ambulatory patients with wide-ranging renal issues under the supervision of nephrology attendings. Renal issues encountered during this clinic include but are not limited the following:
- Acute kidney injury
- Chronic kidney disease and related complications
- Chronic post-renal transplantation care
- Fluid, electrolyte, and acid-base disorders
- Genetic renal diseases
- Nephrotic and nephritic syndromes
- Tubulointerstitial disease
- Abnormalities of the urinary collecting system
- Drug-related renal toxicity
- Renovascular diseases
Second year fellows will rotate through nephrology subspecialty clinics and nephrology transplant clinics with nephrology faculty specialized in this area. They are required to attend four half-day specialty clinics of their choosing (with one being a transplant clinic) to work one-on-one with the attending. Clinical fellows are expected to attend 30 sessions during a total of 8 weeks of designated time. Specialty clinics available include:
- HIV-related kidney disease
- Home hemodialysis clinic
- Inherited renal diseases
- Lupus nephritis
- Secondary hypertension
- Thrombotic microangiopathy (and other diseases of complement dysregulation) clinic
- Transplant clinic (recipient continuity)
- Transplant donor clinic
- Transplant evaluation clinic
Based on the fellows individualized training track, they tailor their research to address these interests. Fellows will have research mentors/advisors to monitor their research progress. Fellows must complete a scholarly project during their fellowship and this rotation allows them to have dedicated time to complete these tasks. Fellows are allowed to complete more than one projective if they desire.
Additional elective experience is arranged for the following areas to suit the fellow's needs and interests:
- Conference attendance (2 weeks per year)
- Good Samaritan Hospital
- Line service
- Meetings with potential mentors
- Other scholarship (teaching, lecturing, writing)
- Outpatient hemodialysis and peritoneal dialysis clinics
- Outpatient vascular access center
- Renal Pathology
- Specialty clinics
- Therapeutic apheresis services
- Ultrasound skills
- Urology clinic
- Vascular surgery
Second year fellows are encouraged to attend ASN Kidney Week and the NKF Spring Meeting. Additionally, they are given time to attend other conferences during the year.
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