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School of Medicine
Nada Alachkar, M.D.
Assistant Professor of Medicine
If you are interested in the Nephrology Transplant Fellowship, please email Dr. Nada Alachkar and attach your CV and a letter of good standing from your current Program Director.
1. The transplant fellowship builds the foundations for a broad knowledge base in transplant nephrology, by providing transplant fellow the exposure and opportunities to manage kidney and pancreas transplant patients, as referral from other physicians, as well as managed primary care patients.
2. The transplant fellow is expected to develop competency in providing compassionate and thorough care to a medically and socially diverse group of hospitalized patients.
3. Transplant fellow serves as team leaders on the transplant service and have opportunities to develop teaching, leadership, and management skills with residents and students.
4. Faculty will provide the transplant fellow with the education and experience necessary to become proficient in caring for inpatient and outpatients kidney and pancreas transplant patients.
The fellow will rate as valuable the importance of being a transplant nephrologist to a medically and socially diverse group of patients.
The fellow will be able to obtain and document a complete history and physical, formulate a thorough assessment and plan, and communicate this assessment to the transplant surgery or medical primary care team
The fellow will demonstrate the ability to make daily assessments of their patients and convey that information to the team through a variety of methods, including daily written progress notes
Specific educational goals are to provide clinical expertise and opportunities to gain experience in:
a. Immediate post operative management of transplant recipients, including administration of immunosuppressive medications and transplant induction protocols;
b. Diagnosis and management of delayed graft function.
1) Clinical diagnosis of all forms of delayed graft function including laboratory, histopathologic, and imaging techniques;
2) Post-transplant dialytic management;
3) Medical management of rejection, including use of immunosuppressive medications (pharmacology and risks) and other modalities (i.e. plasmapheresis);
c. Recognition and medical management of the surgical and non-surgical complications of transplantation including the differential diagnosis of acute and chronic graft dysfunction;
d. Diagnosis and management of acute and long-term infectious complications of solid organ transplantation.
e. Management of long-term non-infectious complications (hematologic, cardiovascular, metabolic) of kidney/kidney-pancreas transplant recipients in the inpatient setting.
f. Evaluation and selection of transplant candidates.
g. Preoperative evaluation and preparation of transplant recipients and donors.
The fellow will demonstrate a knowledge and understanding of the pathophysiology, diagnostic evaluation, and therapeutic management of a core group of transplant problems described above.
The fellow will attend and participated in the educational activities of the teaching methods provided by the transplant faculty.
The transplant fellow will demonstrate effective communication skills with the attending physician by discussing each consultation or admission in a timely fashion
The transplant fellow will discuss the ongoing care of each patient with the appropriate attending daily
The transplant fellow will demonstrate effective teaching and feedback skills with the renal fellow, interns, residents, and medical students.
The transplant fellow will model effective interpersonal communication skills with patients, families, and allied health professionals
The transplant fellow will demonstrate compassion and understanding to a group of socially, economically and racially diverse group of patients
The transplant fellow will rate as comfortable his/her ability to assume the leadership role on the healthcare team
The transplant fellow will model appropriate team function by including allied health professionals in management discussions
Practice-Based Learning and Improvement
The transplant fellow will incorporate basic knowledge of evidence-based medicine in evaluation and management of patient medical problems
The transplant fellow will continue the process of acquiring skills and documenting the procedures required by the ABIM, as listed in the procedure summary
The transplant fellow will model practice based learning and effective information seeking in the daily care of patients
The transplant fellow will demonstrate competence in the integration of inpatient and outpatient care, and a systems approach to care, by demonstrating appropriate follow-up/discharge plans for all patients he/she has admitted
The transplant fellow will demonstrate an awareness of issues cost-effective medicine in patient care, by discussing the cost implications of a case/month with the attending physician
The transplant fellow will rate as valuable the contributions of other members of the health care team into management plans for patients
The transplant fellow will routinely evaluate the socioeconomic needs of his/her patients, including health insurance, access to care and copayments necessary to provide care
Supervision of Fellows
The Transplant Nephrology fellow communicates any concerns to the transplant nephrology faculty member that might mandate review of the patient prior to rounds scheduled later in the day. The nephrology fellow contacts the nephrology teaching faculty member prior to the start of any form of renal replacement therapy or treatment of rejection, and writes initial orders in consultation with the faculty member. Transplant Nephrology Fellow will cover the Renal Fellow when absent for clinic, to ensure adequate management of the patients and to provide notes. All calls for admission to the service will go through the Transplant Fellow, although ultimate approval will come from the Transplant Nephrology Fellow or Attending.
The nephrology faculty member discusses patients and reviews the medical notes presented by the transplant fellow on a daily basis. The faculty member confirms the history, physical findings, assessment and plans after interviewing and examining the patient. The nephrology faculty member discusses with the transplant fellow any modifications of the above. The nephrology faculty member supervises procedures, such as placement of vascular access for hemodialysis or continuous renal replacement therapy, as well as hemodialysis, peritoneal dialysis or renal replacement therapy treatments unless the faculty member is not on the premises at the time of the procedure. The faculty member supervises all renal transplant biopsies.
In the ambulatory care setting during this rotation, the transplant fellow presents the patient’s history, physical examination, and assessment and plans to one of the nephrology teaching faculty preceptors for donor or recipient evaluation clinic. The nephrology faculty preceptor discusses the patient with the fellow at the time of visit and confirms the history, physical findings, assessment and plans after interviewing and examining the patient. The fellow is responsible for dictating the clinic note within two weeks of the visit. The faculty member who supervised the fellow for the particular patient is responsible for electronically signing the outpatient note within two weeks of the transcription. The fellow communicates other tests required for evaluation to the patients transplant coordinator at the time of the visit.