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department of MedicineSection of Nephrology and Kidney TransplantationFellowship Program
Based at Temple University Health Sciences Center which encompasses a 746-bed teaching hospital, the Nephrology Fellowship Program offers a two-year fellowship with an option for additional research years.
This first year is typically spent at Temple University Hospital. The fellow spends 4 months on Inpatient Consultation, 4 months on the Renal Inpatient and and 4 months on Transplant Services. Each service has one fellow and one attending, with medical students and house staff rotating through. One-third of our patients are referred from outlying hospitals, ensuring exposure to a varied and diverse experience. There are large tertiary referral practices in heart failure, cardiac, lung transplant and bone-marrow transplant services, and a liver transplant service has been recently initiated. Thus, the patient population we serve makes this fellowship a rich, varied and challenging experience. Fellows receive ample experience in all renal replacement modalities.
On the Inpatient Consult Service, a fellow and a faculty attending care for the 2 to 5 new and many follow-up consults each day. The primary responsibility of the consultation service is to answer requests for consultation on patients in Temple University Hospital to aid in the diagnosis and management of nephrologic problems within the context of the patient's other medical and surgical conditions. A broad range of fluid-electrolyte, acid-base, general nephrology and hypertensive problems that are common to a busy teaching hospital are seen, and this includes care of patients in many medical and surgical ICUs. Temple has the largest emergency room in the City of Philadelphia, and over one-third of consults are for critically ill patients in intensive care units. The average number of patients followed daily is 15.
The Renal Inpatient Service cares for patients with ESRD and other nephrologic problems. The primary responsibility of the chronic nephrology service is to provide medical care for all patients admitted to the inpatient service of the Section of Nephrology, arrange for ancillary studies and seek consultations. This service is responsible for the dialysis therapies provided to the patients with end-stage renal disease (ESRD) at Temple University Hospital. A faculty member and renal fellow supervise a medical resident, a medical intern and medical students assigned to this service, and the renal fellow plays an important part in their education. This service sees an average of two new patients a day and the average number of patients followed daily is 15. All chronic patients are followed until discharge. The chronic service is responsible for all the dialysis therapies provided to the patients with end-stage renal disease (ESRD) at Temple University Hospital. Typically, nephrologists round with the house staff team twice daily.
The combined medical-surgical Transplant Service provides concurrent care for patients with renal and other solid organ transplants. The team, with nephrologists, transplant surgeon, fellows, residents and students, meets daily to discuss inpatients and outpatients. Fellows also attend a weekly meeting where listing and other related solid organ transplant issues are discussed. While on the transplant service, the renal fellow attends at least one transplant clinic each week.
Acute Hemodialysis Unit. This is a 12-station unit staffed to provide hemodialysis for hospitalized patients with acute or chronic renal failure requiring hospitalization for medical or surgical complications of their renal or extra-renal diseases. It is also used to initiate hemodialysis treatment for patients with ESRD who require stabilization prior to entering an outpatient program, and to support the dialysis unit for our renal transplantation program. The nephrologists and nursing staff are responsible for all dialysis procedures in the hospital, and at any given time there are many patients in the intensive care units requiring regular and/or continuous hemodialysis.
Fellows are assigned to a faculty member for general outpatient nephrology, and they attend this practice at least one half day per week.
A general nephrology practice is mandatory for all trainees. Each fellow is assigned to an outpatient practice in general nephrology for one half day per week, where on average they see one to two new patients and three to five follow-up patients each session, under the supervision of a faculty member. During the second year (and beyond), fellows have multiple additional outpatient opportunities. In general this includes six months of outpatient dialysis, six months of outpatient transplantation and twelve months in an outpatient nephrology practice. Each practice meets once a week. Elective rotations in sub-subspecialty practices in renal transplantation, stones, glomerular diseases, and complex hypertension are optional. Typically, trainees pursing clinical careers will have multiple clinics each week, whereas those pursuing investigative careers will have one clinic each week.
Newly referred and follow-up patients are seen in the outpatient offices of the Section of Nephrology in the multidisciplinary, newly renovated Medical Office Building. All patients with renal disease, as well as renal transplant patients, are seen in these offices by one of the faculty attending physicians together with a fellow. This is a multispecialty practice shared with transplantation, endocrinology and rheumatology, and this facilitates patient care and program development in specific disease areas (e.g. diabetes, autoimmune renal disease, etc.)
The current total number of patients in the outpatient dialysis units is over 275, and many patients in other units come to Temple for hospitalization.
This takes many forms. The faculty attending staff at Temple consists of nephrologists who all have maintained a strong interest in teaching clinical nephrology. Our renal conference schedule is extensive, with at least four formal Section of Nephrology teaching conferences per week. This includes a summer introductory lecture series, weekly - renal grand rounds, research conference, clinical journal club, pathology conference, and vascular access conferences. There is an outpatient nephrology conference for senior fellows. Visiting professors are scheduled approximately once a month in the academic year; they lecture and meet with fellows and the faculty. There is a two year core curriculum in renal physiology and pathophysiology where topics are presented in a variety of forums to cover the major issues. There are many other conferences in the Department of Medicine and at the University, which many of our faculty and fellows regularly attend. All Fellows participate in house staff and student teaching activities, including inpatient and outpatient sessions, lecturing in the house staff core lecture series, and leading the various Section conference discussions.
All fellows participate in research projects. Fellows are encouraged to pursue investigative careers in clinical or basic research. During the latter part of the first year, after exploring the options, they select a research mentor and a research project. This can be a nephrology faculty member or an investigator outside the Section; however, the mentor and the project must be approved by the fellow research committee. This consists of Drs. Madaio, Silva, Kelepouris and I. Lee. Progress is monitored regularly by mentors and the faculty. At research conference, second year fellows present their research plans in early fall and their progress reports periodically throughout the year. Senior fellows report on progress once each year. Trainees who pursue investigative careers are expected to apply for extramural funding, as this process serves to consolidate plans and promote project development. Additionally, fellows may elect to pursue graduate courses relevant to their research.
Specific areas of ongoing research are described under individual nephrology faculty on our web site, and fellow applicants, trainees, students and other interested parties are strongly encouraged to read sites for the details.
Fellows who elect to pursue careers as clinical nephrologists are also expected to carry out research projects under the supervision of faculty mentors. However, they will participate in additional outpatient practices and inpatient procedural activities (e.g. renal biopsies, access placement, etc.) to help solidify their clinical nephrology education. Nevertheless, participation in mandatory research training sessions for all trainees, in clinical and basic investigation, is required.
Applicants should apply for the Nephrology Fellowship Program at Temple University Hospital through ERAS (Electronic Residency Application Service), an Internet-based application process developed by the Association of American Medical Colleges (AAMC). Applicants will be required to submit an application including three letters of recommendation, medical transcripts and other supporting credentials such as USMLE certificate, ECFMG certificate, etc. For more information about the application process or to register on the ERAS web site, please go to http://www.aamc.org/audienceeras.htm. The Section will contact candidates for interviews after review of completed applications. Interviews generally last one full day and include meetings with faculty, fellows and a conference.
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Contact Information:Department of Medicine Section of Nephrology and Kidney Transplantation 3322 N. Broad Street Suite 201 Philadelphia, PA 19140 T: 215-707-4600 F: 215-707-9697
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