Clinical Curriculum

Inpatient Consult Service

This service provides nephrology consultation for all patients, except for solid-organ transplant recipients or those with chronic dialysis-dependence. The consult team is staffed by one nephrology faculty attending, 1-2 fellows, and several medical residents and students. 

Fellows are exposed to a broad range of pathology, including acute kidney injury, electrolyte disorders, and glomerular disease.  They develop expertise in managing continuous renal replacement therapy (CRRT) and participate in the multi-disciplinary care of patients with advanced cardiopulmonary disease requiring ventricular assist devices (VADs) and extracorporeal membrane oxygenation (ECMO).  

Chronic Dialysis Service

This service provides consultation for patients with end stage renal disease (ESRD) who are on hemodialysis or peritoneal dialysis.  

Transplant Service

This service cares for hospitalized patients with kidney, kidney-pancreas transplants as well as other solid organ transplants such as heart, lung and liver transplants.  Fellows work with a multi-disciplinary team, including transplant nephrologist, transplant coordinators, transplant surgeons, medical and surgical residents, pharmacists, and social workers.  Fellows participate daily morning sit-down rounds to review the inpatient service with all the transplant nephrologists. They also attend a weekly listing meeting where outpatient transplant candidates are discussed with a multi-disciplinary team for decisions regarding active-listing for kidney and/or kidney-pancreas transplant on our program’s wait list. 

Primary Renal “Yellow” Service

This is a resident-run service, supervised by a nephrology faculty attending and fellow to care for all of our primary patients from our dialysis units or various clinics. It is designed to give internal medicine housestaff high-quality and broad exposure to patients with a variety of renal disorders, including glomerular disease, kidney transplant, advanced chronic kidney disease, and ESRD. Patients are considered candidates for this service if they are cared for in the Temple outpatient nephrology practice and have presentations that offer educational value for the residents.. This service presents an outstanding opportunity for the fellow to engage in the clinical education of housestaff and gain experience as a team leader.

Outpatient Clinical Experience

In contrast to the traditional model followed by other programs, our program is designed so that fellows fully immerse themselves in either an inpatient or outpatient experience. When rotating on outpatient block, fellows do not have any inpatient responsibilities. The outpatient experience is protected for both first-year second-year fellows. Second-year fellows have a continuity clinic throughout the year, and first-years rotate off inpatient blocks to do an outpatient rotation.
 
Outpatient general nephrology clinic: Nephrology fellows manage and develop their own cohort of general nephrology patients along with a faculty preceptor. Fellows have their own clinic space and see new consults, their own established patients, and patients acquired while on the inpatient service.

Outpatient Transplant clinic:  Fellows receive comprehensive exposure to outpatient management of both new transplant recipients and long-term established ones. They also participate in the evaluation of kidney transplant candidates and kidney donors.

Outpatient hemodialysis:  Fellows are exposed to the comprehensive care of dialysis outpatients, including water treatment, multi-disciplinary rounds with dieticians, social workers and nurses, vascular access management, palliative care, and transplant referral.  

Home dialysis clinic: Second-year fellows are assigned to a longitudinal home dialysis clinic with a faculty mentor.

Lupus Nephritis Clinic:  Fellows join a faculty member with expertise in lupus nephritis in a dedicated lupus nephritis clinic. Patients are discussed and co-managed with our rheumatology colleagues who have their own lupus clinic on the same days. We also work closely with our rheumatology colleagues to conduct clinical trials and participate in collaborative scholarship. 

Vascular Clinic/Interventional Nephrology: Fellows attend vascular clinic with our vascular surgeons to learn about dialysis access placement and shadow interventional nephrologists to observe placement of tunneled dialysis catheter and management of fistulas and grafts.

Multi-Disciplinary Hypertension Clinic:  Fellows join a faculty member with expertise in complex hypertension to manage patients collaboratively with endocrinology and cardiology. They have the opportunity to learn how to interpret 24-hour ambulatory blood pressure reports.
 

Didactic Curriculum

The Nephrology faculty is committed to teaching.  Each year members of the faculty are recognized for their dedication to medical education with teaching awards from the house staff in the Department of Medicine. 

Mid-Atlantic Kidney Boot Camp The first year of nephrology fellowship begins with an inter-institutional educational seminar with faculty and fellows from nephrology training programs in and around Philadelphia.  It is a two-day experience that provides an orientation to the fundamentals of caring for nephrology patients. 

Nuts and Bolts Series:
During the summer, as first year fellows begin their inpatient service, we have a series of introductory lectures in nephrology.  Lectures are for 60 minutes, 3 days per week, on topics relating to dialysis, transplantation, electrolyte emergencies, and procedures in nephrology.  

Renal Pathology Conference (weekly) 
Every Wednesday at 9am, throughout the year, biopsy conference (renal pathology) is held at the 10-headed teaching microscope with our renal pathologist, Dr. Jared Hassler.  All new biopsies are presented and discussed, as well as old biopsies of high teaching value, including light microscopy, immunofluorescence, and electron microscopy.  Both native and transplant biopsies are discussed in this conference.

Journal Clubs (weekly) 
Starting in September, every Monday at noon, the entire nephrology division participates in a journal club. Articles are presented by either faculty or fellows, and include a review of statistical techniques, methods for critical appraisal of the literature, and presentation of either classic, seminal articles in nephrology or newly-published articles of high value. We also have inter-disciplinary discussions with colleagues in endocrinology, urology, and rheumatology. 
  
Renal Grand Rounds (weekly) 
Every Wednesday at 4pm, starting in September, the entire nephrology division participates in Grand Rounds.  This conference features a range of speakers, including invited experts, clinical vignettes presented by first and second-year fellows, and Temple nephrology faculty.  

Core Concepts in Nephrology: 
Every Thursday at noon, starting in September, all fellows meet for a 60-minute lecture on a core topic of nephrology, including electrolytes, home dialysis, and transplantation.  This conference emphasizes active-cased base learning. 

Kidney Self-Assessment Program (weekly)
On Friday’s at noon, faculty and fellows do board-style questions from the American Society of Nephrology’s Kidney Self-Assessment Program (KSAP).