Fellowship

THOMAS JEFFERSON UNIVERSITY
DIVISION OF NEPHROLOGY TRAINING PROGRAM
2009-2010

Faculty:

Joseph Y. Cheung, M.D., Ph.D. – Division Director
George C. Francos, M.D. – Associate Division Director/Director of Kidney-Pancreas Transplantation

James F. Burke, Jr. M.D. – Emeritus Professor
Stephanie DeLoach, M.D. – Asst. Director of Hypertension Research
Bonita Falkner, M.D – Director, Hypertension & Obesity Research
Rakesh Gulati, M.D., M.R.C.P. – Fellowship Program Director
Won Han, M.D. – Director, Acute Kidney Injury
Yonghong Huan, M.D. – Director of Peritoneal Dialysis & CKD
Dan Negoianu, M.D. – Director of Home HD & Acute Dialysis Unit
Pooja Singh, M.D. – Asst. Director – Living Kidney Transplant Program
Xue-Qian Zhang, M.D.
Jian Liang  Song, M.D., Ph.D.
Jufang Wang, M.D.

I.   Educational Program

The Nephrology Division at Thomas Jefferson University Hospital provides a comprehensive 2-year fellowship training experience.  Our overall goal is to furnish a highly structured clinical and research experience for trainees that they may develop the skills necessary to pursue successful careers in clinical nephrology and/or scientific investigation.  This goal is to be accomplished under the auspices of the University, whose general mission it is to provide state-of –the art, compassionate and cost-effective healthcare services, to teach future healthcare professionals, and to lead in the research, development and introduction of improved methods of healthcare delivery to benefit everyone.  The Division also offers a 1 year Transplant Fellowship program accredited by the American Transplant Society.

II.   Facilities and Resources

The Nephrology program at TJU includes: 3 outpatient hemodialysis centers with approximately 200 patients, a peritoneal dialysis program of approximately 20 patients, and an active renal transplant program with approximately 100 kidney and kidney/pancreas transplants performed annually. The division also operates a CKD Management Center and Hypertension Research Center.   The 800-bed teaching hospital has ACGME approved residencies in virtually all medical and surgical fields, and provides the opportunity for renal fellows to be involved in approximately 800-1000 clinical consultations annually.  Members of the division perform approximately 200 native and transplant kidney biopsies and 100 acute dialysis catheter insertions per year with the fellows.  Renal pathology provides on-campus histopathology, immunofluorescence, and electron microscopy.  Excellent radiology support is provided, encompassing ultrasound, MRI, CT scanning, nuclear medicine, and interventional radiology.  In addition to routine angiography, the interventional radiologists actively participate in vascular access management, including routine fistulograms, angioplasty, central catheter and stent placement, and thrombectomies. 

III.   Formal Education

The division participates in an active conference schedule.  All members of the division and the fellows are required to attend all conferences.  Regular conferences include the following:

1. Journal Club - twice monthly:  Attendings are responsible for selecting several papers that are reviewed in detail by the fellows. Attendings are responsible for directing the discussion with emphasis on critical review of the literature.
2. Research/Physiology Conference - monthly:  Fellows are responsible for presenting their research projects and reviewing major areas of renal physiology in depth.
3. Biopsy Conference - twice monthly:  The renal pathologist presents several recent, interesting biopsy cases along with a fellow teaching case.  Fellows are expected to write interesting case projects under guidance from Renal Attending and Pathologist.
4. Fellow/Attending Topic Review - twice monthly:  Fellows and attendings alternate in presenting detailed updates on various topics in clinical nephrology.
5. Renal Grand Rounds - monthly:  Outside speakers in nephrology and related fields are invited to give talks on current issues/recent advances.
6. Patient Care conference - weekly:  Difficult inpatient and outpatient cases are discussed.  This conference is attended by all attendings, fellows, transplant surgeons, dieticians, renal social workers, and transplant coordinators.
7. Autopsies & Death Review:  All deaths of patients who received care by fellows must be reviewed and autopsies performed whenever possible.  Fellows will receive autopsy results on all patients for whom the fellow had primary responsibility.

Other conferences include:  Weekly transplant journal club, monthly hemodialysis access conference, bimonthly bone/mineral metabolism conference, and monthly interdisciplinary conferences where psychosocial and ethical issues regarding chronic dialysis patients are discussed.

IV.   Clinical Rotations

Year one.  There are three hospital rotations during the first year.  Each fellow spends a total of 4 months on each of the three rotations.  One attending and one fellow staff each rotation.  The goals and objectives of the rotation or learning experience will be discussed by the faculty and fellow at the start of each rotation.  Each fellow will have direct supervision by faculty in all patient care activities.  Fellows must be able to provide patient care that is compassionate, appropriate, and effective for the treatment of health problems  and the promotion of health.  Fellows will provide effective and timely communication with Transplant Surgery/ICU Teams/Hepatology/Heart Failure Service/House Staff as warranted by clinical situations.

1. Inpatient dialysis -  The fellow will oversee the management of all dialysis patients on the primary nephrology service and will manage the renal/ dialysis care of all other chronic dialysis patients admitted to other medical/surgical services. 
2. Inpatient transplant -  The renal fellow will participate in all aspects of the transplant patient’s care.  The fellow will oversee the management of all transplant patients admitted to the primary nephrology service and will actively provide consultative care to all newly transplanted patients on the surgical service. The fellow will also perform transplant biopsies with the attending supervising. 
3. Inpatient consultation -  The fellow, along with medical residents and medical students assigned to this service, will provide consultative services for patients with acute renal failure, chronic renal failure, glomerular and interstitial diseases, fluid and electrolyte abnormalities, acid-bases disturbances, hypertension, and for patients in the bone marrow transplant unit.

Year two.  The second year is primarily a research/ambulatory care year.  However, the second year fellows will be responsible for covering the above rotations when the first year fellows go on vacation, take emergency leave, or are otherwise not working.

V.   Outpatient Experience

Year One.  Each first year fellow will be assigned to one attending’s outpatient clinic.  The fellow will work one on one with that attending in the outpatient office ½ day per week for the duration of their fellowship training starting in mid- July of their first year.  Fellows are expected to see 4-8 patients in one office session.   Each fellow is also assigned to work with an attending on one outpatient dialysis shift.  Shift assignments rotate quarterly for the attendings and the fellows.

Year Two.  Each second year fellow will continue to spend ½ day per week with their assigned attending in the outpatient clinic and will also continue to work with an attending on one or two outpatient dialysis shifts on a rotating basis.  In addition, on a rotating, quarterly basis, fellows work with attendings ½ day per week in peritoneal dialysis, transplantation, and pediatric nephrology clinic.

VI.   Research Experience

During the second year, fellows participate in either a basic science or clinical research project.  Research is expected to consume approximately 65% of the second year fellow’s time.  Fellows are responsible for presenting their data every 4 months during the year during basic science/research conference.  Fellows are expected to write at least one abstract or other scholarly project (case report, literature review, etc.) during their second year.  Presentation at scientific meetings is encouraged.

Application Process