Nephrology Fellowship

Education and research

The division supports an active clinical inpatient and outpatient service at both Virginia Commonwealth University Medical Center and the McGuire Veterans Medical Center. Faculty, housestaff, students and fellows attend daily consult and ward rounds. In addition, the division presents a series of renal physiology lectures, renal grand rounds, a journal club, research and clinical conferences.

Housestaff and fellows participate actively in the inpatient and outpatient dialysis units in both institutions. The division also supports an active kidney and pancreas transplantation program.

Fellowship training

The nephrology fellowship at VCU is a multi-year fellowship allowing for individualized training in clinical nephrology, hypertension, transplantation and basic/clinical research.

The clinical rotations of the nephrology fellowship are structured as follows:

VAMC consult rotation

One fellow will work with an attending physician, medical resident(s) and medical student(s). Responsibilities include inpatient consultations and dialysis and attendance at designated outpatient clinics. Fellows will become familiar with SLED or slow low-efficiency dialysis to treat acute renal failure. The McGuire Veterans Affairs Medical Center is a major referral center for the VISN and performs open-heart surgery, and heart and heart-lung transplantation. In addition, a spinal cord unit provides numerous consults with various renal problems unique to this population.

VAMC dialysis rotation

One fellow will work with the attending nephrologists in the outpatient dialysis unit. Responsibilities will include caring for patients with chronic renal disease who are on hemodialysis or peritoneal dialysis, arranging for access surgery and attendance at designated outpatient clinics.

VCU Medical Center consult

The fellow assigned to the consult service will work with an attending nephrologist, medical resident(s) and medical student(s). Responsibilities include the performance of all inpatient consultations, supervision of all dialysis procedures in the ICU setting and supervision of the care of any patient with acute renal failure including dialysis needs as they arise. Fellows will become proficient in all forms of continuous renal replacement therapy. In addition, the fellow will have ample training in percutaneous native kidney biopsies.

VCU Medical Center dialysis

This fellow will work with an attending nephrologist and a physician’s assistant. This fellow will be responsible for the coordination of the inpatient dialysis schedule and the care of any hospitalized chronic hemodialysis or peritoneal dialysis patients. In addition, the fellow will care for patients on chronic outpatient hemodialysis who either have access problems or some other barrier to their assignment to one of our free-standing dialysis units. Communication with the appropriate referring nephrologist particularly at the time of admission or discharge is crucial. Information regarding hospital course, procedures performed and results as well as discharge medications should be related to the referring physician.

VCU Medical Center transplantation

Fellows will work with one of two full-time transplant nephrologists and nurse practitioners. Responsibilities include attendance at daily transplant clinic where pre-transplant evaluations and post-transplant management issues are addressed. In addition, the fellows will work closely with the transplant surgery department. Other responsibilities include the medical management of any hospitalized transplant patient, performance of all percutaneous transplant kidney biopsies and supervision of any dialysis required on post-transplant patients. Visit the Hume-Lee Kidney Transplant Center Website.

Chronic outpatient dialysis

Time will be allotted for attendance at one of the Gambro facilities in order to familiarize trainees with the operation and complexities associated with an outpatient dialysis unit.

Research training

Some fellows may begin a research program during the first year, but in general, the second year is a time for more intensive excursion into either clinical or basic research. Although time will be somewhat protected during the research phase, the fellow will continue to participate in weekend and night call and will attend clinic at least one-half day per week. It is recommended that the fellow obtain information early with regard to available research projects within the division by speaking to different faculty members. A plan for the second year of the fellowship needs to be submitted in writing to the program director in December of the first year.

Other points of interest

Access surgery

The renal fellow will work with the two vascular access coordinators to schedule access procedures with the surgical resident assigned to the Transplant Service or interventional radiology as needed. Fellows will work closely with the surgical staff to try to ensure as many fistulas as possible are performed.

Faculty attending service

This service is designed to care for any elective or procedural admissions (access placement, renal biopsies, uncomplicated CAPD-peritonitis). Care is provided by the fellow and attending nephrologist on the appropriate service. In general, the consult service carries the responsibility for biopsy patients and other patients who are not yet on dialysis. The dialysis service is responsible for any ESRD patients admitted expressly for access placement, peritoneal dialysis issues and other chronic dialysis patients who require an uncomplicated hospital admission. Transplant patients will be the responsibility of the transplant service.

Night and weekend coverage

Fellows provide the after hours coverage of the VCU Medical Center and Veterans Affairs Medical Center on a rotating basis. In general, the call schedule will be every third or fourth night. Call may be taken from home. Whenever possible there should be a face-to-face sign out of any potential problems to the person on call. This step is particularly important on the weekends when a plan of care should be tentatively outlined particularly for more complex or ICU patients.

After hours hemodialysis

The on-call fellow is expected to remain in the hospital for at least the first hour while any acute patient is being dialyzed in the ICU. Any new acute dialysis patient being dialyzed in the Gateway 4 Dialysis unit or any unstable patient in this unit will require the fellow’s attendance during the first hour as well. If the patient is stable at that time and the nurse in charge feels comfortable with the fellow going home, then he/she may take the remainder of his call from home, unless another acute problem would require him/her to return.

Fellows’ schedule

Fellows’ schedules are prepared in advance by the program director. The division head or the program director must approve any changes in this schedule. Any change to the clinic schedule must receive the approval of the program director.

Vacation

Fellows are permitted three weeks of vacation annually. Vacation time may not be carried over from one year to the next. Vacation should be taken preferentially from the rotations marked VCU Medical Center Dialysis or VAMC Dialysis. Vacation time should not be taken from VCU Medical Center Consult, VAMC consult or transplant rotations. In unusual circumstances when time must be taken from these rotations, arrangements must be made in advance by speaking directly with the program director who will assign another fellow to cover this time period. Only two of the three weeks may be taken consecutively without the program director’s approval.

Outpatient clinic

The Ambulatory Care Center Renal Clinic is held on Tuesdays from 1 to 4 p.m. and is the primary continuity care clinic. There is generally a clinical conference for the hour prior to clinic start and lunch is frequently provided. This clinic is designed to provide continuity of care for patients with renal problems and attendance is mandatory for all fellows who are currently assigned to VCU Medical Center rotations. There are additional outpatient clinics at VCU Medical Center, the Veterans Affairs Medical Center and Dialysis Units to which the fellows may be assigned during various rotations.

Procedures

Fellows will have ample opportunity to perform central line insertion for dialysis, do percutaneous native and transplant biopsies. Since documentation of skill and competence in procedures is a requirement of the American Board of Internal Medicine in order to qualify for the nephrology subspecialty examination, it is imperative that each fellow maintains an accurate and up-to-date log of procedures performed. It is the fellows’ responsibility to maintain procedural logs accurately and present them to the program director every three to six months at a minimum so that board eligibility may be certified.

Fellowship contact information

Program Director

Susan DiGiovanni, M.D.
P.O. Box 980160
Richmond, Virginia 23298-0160
Phone: (804) 827-1743
E-mail: sdigiova@mail2.vcu.edu

Coordinator

Lessie Jordan
P.O. Box 980160
Richmond, Virginia 23298-0160
Phone: (804) 828-9683
E-mail: ljordan@hsc.vcu.edu

Application

Applications will be accepted via the Electronic Residency Application Service ERAS.

Research

Research in the division includes clinical protocols in renal pharmacology, pharmacodynamics of diuretic agents, antihypertensive agents, graded renal insufficiency, renal abnormalities in liver disease and hormonal effects on blood pressure. Faculty members at the Veterans’ affairs hospital are investigating the regulation of human salt consumption. New additions to the faculty include two Ph.D. scientists to help rebuild our basic science research program. Projects they are working on include the mechanisms of renal salt handling and the implications this has for the pathogenesis of hypertension and the mechanisms of injury in glomerulosclerosis.

Conference
Fellows will be responsible for presenting at Renal Grand Rounds approximately two to three times throughout the academic year. This presentation is a lecture format and should address topics of general clinical interest.

A listing of all the major clinics/conferences at both institutions follows:

Monday

VA Renal Clinic (9 a.m.)

Tuesday

Renal Clinic Conference (noon to 1 p.m.), ACC Fourth Floor
VCU Medical Center Renal Clinic (1 to 4 p.m.)
VAMC Fellows Clinic (1 to 4 p.m.)

Wednesday

VAMC Fellows Clinic (1 to 4 p.m.)
Core Lecture Series (4 p.m.)

Thursday

VCU Medical Center Medical Grand Rounds (noon to 1 p.m.) MSB Auditorium
Renal Grand Rounds (4 to 5 p.m.), Sanger Hall, Room 8-068
Journal Club/Research Conference (5 to 6 p.m.), Sanger Hall, Room 8-068 every other Thursday

Friday

VA Medical Grand Rounds (8 to 9 a.m.)
VA Dialysis and Transplant Clinic (9 a.m. to noon)
Fellows’ Conference (noon to 1 p.m.), Sanger Hall, Room 8-058

Attendance is mandatory for Renal Grand Rounds, Fellows’ Seminar and Research Conference whether you are assigned to the VCU Medical Center or to the VA. If assigned to the VCU Medical Center, all divisional conferences are mandatory. Medical Grand Rounds also should be attended at the location to which you are assigned.

Attendance will be taken at all mandatory conferences and the fellow must attend at least 70 percent of these conferences in order to satisfactorily complete the program.