Curriculum
First Year Curriculum
During the first year, fellows are immersed in clinical nephrology training to develop the fundamental knowledge and skills required to become an outstanding clinical nephrologist. Through clinical experiences in the first year, fellows become proficient in the evaluation and management of the full spectrum of renal medicine, interpretation of urine sediment, renal replacement therapy, placement and management of temporary vascular catheters, and performance of percutaneous native and transplant kidney biopsies. The foundations of scholarly practice are built, clinical reasoning skills are honed, and longitudinal mentorship relationships are established.
First year fellows participate in five consultative inpatient services, nephrology continuity clinic, and electives at the Johns Hopkins Hospital and the Johns Hopkins Bayview Medical Center. The table is informative only, and rotations are distributed throughout the year.
| Rotation | Time |
|---|---|
| Inpatient Consults – JHH | 5 months |
| Inpatient Consults – Bayview | 2 months |
| Transplant | 2 months |
| Night float (6 nights per week) | 1 month |
| Elective / POCUS | 1 month |
| RRT week | 1 week |
| Outpatient Continuity Clinic | ½ day per week |
| Vacation | 1 month |
Second Year Curriculum
The 2nd year of fellowship has an increased focus on the ambulatory practice of Nephrology, scholarly development, and career planning. This year is highly customizable based on the chosen career tract. Fellows may pursue graduate work in the School of Public Health, pursue formal training in Clinical Education, enter a basic science research lab, or prepare for a private practice career.
| Rotation | Time |
|---|---|
| Research | 8-9 months |
| INPATIENT | |
| Consult | 1.5 months |
| Night float (6 nights per week) | 1 – 1.25 months |
| OUTPATIENT | |
| Hemodialysis | 10 months |
| Peritoneal dialysis | 9 months |
| Home HD | 2 months |
| Subspecialty Clinics | 2 months (1/2 day for 4 days/week) |
| Toxicology | 1 week |
| Continuity Clinic | ½ day per week |
| National Conference Attendance | 0.5+ months |
| Vacation | 1 month |
Rotations
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This service consults on patients in 5 different ICUs, as well as floor patients geographically located within the ICU building. This team consists of a nephrology fellow, supervising attending, and occasionally a critical care fellow, urology resident, medicine resident, and/or medical student.
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This service provides consultative services to Oncology, Gynecology, and surgical ICU and floor patients located within the Oncology building. This team consists of a nephrology fellow, supervising attending, medicine resident, and/or medical student.
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This service provides consultative services to non-ICU Medicine, Psychiatry, and Urology patients. This team consists of a nephrology fellow, supervising attending, medicine resident, and/or medical student.
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The Nephrology Transplantation Service is co-managed with the renal transplant surgery team. The inpatient nephrology transplant team consists of a transplant nephrology fellow, general nephrology fellow, supervising transplant nephrology attending, advanced practitioner, and internal medicine residents. During this rotation, fellows will gain substantial experience in the management of post-operative and chronic renal and liver transplant patients.
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This service provides consultative services to all of the general inpatient and intensive care units, which includes the John R. Burton Geriatric Care Center, and Maryland's only burn center. This team consists of a nephrology fellow, supervising attending, and on occasion a medicine resident, and/or medical student.
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The Nephrology Night Float was instituted to reduce fatigue experienced by fellows and to ensure patient safety. Night Float prevents an on-call fellow from having to work the following day after a night filled with frequent sleep interruptions. 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 overnight nephrology issues.
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This is a 1-week rotation early in the 1st year of fellowship to orient and educate fellows to outpatient HD, outpatient PD, vascular access, and operation and setup of CVVHD machines. Fellows learn to cannulate and decannulate permanent AV accesses.
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Fellows manage outpatient hemodialysis patients in his longitudinal rotation. Fellows work one-on-one with attendings during this 10 month long rotation. Each fellow rotates at two different dialysis units.
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Fellows manage home dialysis patients in this longitudinal rotation. Fellows follow a cohort of peritoneal dialysis patients for 9 months under the supervision of a dedicated attending. Each fellow attends at least 2 home hemodialysis clinics with opportunity for more in-depth home HD training if desired.
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In this 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. This is a true continuity clinic, with fellows following their own panel of patients (rather than an attending’s patients) for the duration of fellowship.
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Second year fellows pursuing a Clinical Educator or Clinical Practice pathway rotate through Nephrology subspecialty clinics and Transplant Nephrology clinics. Clinical fellows are expected to attend at least 30 sessions. Examples of specialty clinics include:
- Fibromuscular dysplasia
- Genetic renal diseases including ADPKD, vHL, Fabry, and tuberous sclerosis
- Glomerular disease
- HIV-related kidney disease
- Lupus nephritis
- Secondary hypertension
- Thrombotic microangiopathy
- Transplant clinic (recipient continuity)
- Transplant donor clinic
- Transplant evaluation clinic
- Vasculitis
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Examples of elective opportunities include:
- Hospice and Palliative Medicine
- Outpatient vascular access center
- Pediatric Nephrology
- POCUS
- Renal Pathology
- Radiology (Ultrasound)
- Specialty clinics
- Therapeutic apheresis services
- Urology clinic
- Vascular surgery
- Additional outpatient hemodialysis and peritoneal dialysis clinics
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All fellows are expected to pursue scholarly activity during their training. This includes mentored research that often begins in Year 1 and is mandatory in Year 2. Publication in the scientific literature and presentations at regional and national meetings are expected.
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Second year fellows attend, at a minimum, ASN Kidney Week and the NKF Spring Clinical Meetings. In addition, most fellows attend additional conferences and training courses throughout the year.