During the first year of fellowship, the trainee will have rotations at several sites within the UCSD Health System. At the University Medical Center in Hillcrest the fellows will spend time on three different rotations with each having a very different focus. Equal time will be spent on the Inpatient Consult Service, the Outpatient Dialysis and Apheresis Service, and the Kidney Transplantation Service. First year fellows will also rotate on the inpatient consult service at Thornton/CVC. The rotation at the San Diego Veteran’s Administration Medical Center is designed to mimic real-world nephrology with simultaneous inpatient and outpatient responsibilities. On all rotations the fellow functions as the primary nephrologic care-giver and coordinates all care with other clinical services. Throughout the entire fellowship trainees attend a weekly ½ day continuity clinic. The clinic assignments may be changed at six-month intervals to broaden the patient exposure. The fellows also attend three to four weekly conferences that cover the core curriculum, research presentations, clinical cases, journal clubs, quality assurance and pathology reviews.
During the second year of the two-year clinical fellowship, time is divided between additional inpatient training and outpatient electives tailored to the interests of the trainee. These have included additional exposure to Peritoneal Dialysis, Apheresis, and Transplant or rotations outside our division in High Risk Obstetrics, Palliative Care, Pediatric Nephrology, Urology or Interventional Radiology. This can also include time for scholarly activities.
Hillcrest Inpatient Consult Service
Consultations involve patients with acute kidney injury (of all causes), chronic kidney disease, electrolyte disorders, hypertension, toxicological emergencies, and patients requiring acute apheresis therapy. Fellows obtain extensive experience with all aspects of inpatient nephrology with a concentration on ICU care and intermittent and continuous dialysis for acute kidney injury. Procedures performed by the fellow on this rotation include the placement of temporary access for dialysis and native kidney biopsies. The consultation service usually consists of medical students, medical residents, the nephrology fellow, and a nephrology attending (faculty) physician. The fellow supervises and instructs the student and resident, and formulates a diagnostic and treatment plan for each consultation. These formulations are discussed with the nephrology attending physician during daily consultation rounds.
Hillcrest Outpatient Dialysis Service
The fellow takes primary responsibility for those patients receiving chronic hemodialysis and peritoneal dialysis at the University. With over 120 patient’s total, the fellow are educated in all aspects of the provision of chronic outpatient dialysis, including access complications, dialysis adequacy, anemia and renal osteodystrophy management. Fellows are also exposed to the administrative side of maintaining an accredited and successful outpatient dialysis program including water treatment, patient selection and transition from CKD to ESRD, and performance improvement. The fellow works as part of a multidisciplinary team including the attending physician, nursing staff, social work, dieticians and dialysis technician all dedicated to providing quality care for patients with ESRD. Fellows also care for patients receiving chronic apheresis for disorders such as TTP, myasthenia gravis, or Waldenstroms macroglobulinemia. Fellows will have the opportunity to perform native and transplant kidney biopsies during this rotation.
Hillcrest Kidney Transplantation Service
During the transplant rotation, the fellow is exposed to all aspects of kidney transplantation. At UCSD, the nephrology service maintains a strong relationship with the transplant surgeons. We provide care from the immediate pre-operative period, through the immediate post-operative hospital stay and in short- and long-term follow-up outpatient clinics. The transplant program has an accredited renal transplant program with dedicated faculty to further focus and improve the quality of the training received by the fellow. Additionally the fellow attends the pre-transplant patient selection meetings and is exposed to the kidney transplant selection criteria. Frequent transplant biopsies are performed by the fellow and the pathology is reviewed with pathologists specializing in kidney disease.
VA Medical Center Rotation
The VA rotation most closely mimics the experience of practicing nephrologists. The fellow balances their time between the care of chronic hemodialysis and peritoneal dialysis patients, an inpatient consult service and several weekly clinics. The VA has a state of the art dialysis center with a chronic hemodialysis population of seventy patients. The inpatient consultations present a wide range of kidney disorders with a high percentage of electrolyte disorders, acute kidney injury and chronic kidney disease. Procedures performed here will include temporary access placement for dialysis and kidney biopsy. Clinics focused on Hypertension, Chronic Kidney Disease Transitioning to Dialysis, and Peritoneal Dialysis are attended by the fellow.
Thornton and Sulpizio CVC Rotation
This is also a consult only service. As with the Hillcrest rotation fellows will obtain extensive experience with all aspects of inpatient nephrology with a concentration on ICU care and intermittent and continuous dialysis for acute kidney injury. Apheresis modalities are frequently used such as stem cell collection and photopheresis. The patient population seen on this rotation are unique as the Thornton Hospital specializes in advanced Hematology and Oncology while the CVC specializes in advanced Cardiac and Pulmonary Care. The Procedures performed by the fellow on this rotation include the placement of temporary access for dialysis and native kidney biopsies.