Curriculum

Fellows are assigned six months of consultative inpatient clinical nephrology, seven months of dialysis, three months of research, six months of transplantation, and two elective months.

Inpatient rotations
Inpatient rotations are split between inpatient consultation services, hemodialysis service and transplantation service.

The inpatient consult service focuses on consultative nephrology service at Geisinger Medical Center. The clinical settings range from the emergency department, medical and surgical wards, and intensive care units. When assigned to the inpatient service the fellow is part of a team consisting of an attending nephrologist, residents, a clinical pharmacist, as well as additional trainees (medical students, pharmacy students).

The inpatient dialysis service provides care and oversight of patients with end stage renal disease admitted to the hospital. Nephrology service is responsible for all aspects of care related to renal support and acts as co-managers in conjunction with hospitalist and other primary services.

The nephrology transplantation service offers a wide variety of clinical experiences including inpatient transplantation consultative services, allograft biopsies and interpretation of pathology data, outpatient follow up of transplant recipients, pre-transplant evaluations, donor evaluations, and a comprehensive curriculum of lectures and presentations aimed at developing the knowledge base needed to develop competency in transplantation nephrology.

Outpatient rotations
Outpatient continuity clinic weekly. During this clinical experience, fellows will be exposed to a wide range of outpatient nephrology cases, and learn the skills necessary to manage a busy nephrology practice.

Outpatient dialysis experience is divided by modality into outpatient hemodialysis, home hemodialysis and peritoneal dialysis. Fellows will care for a panel of hemodialysis patients organized in shifts. The fellows will see their patients in two separate visits to the affiliated outpatient dialysis unit on Justin Drive Road, Danville, approximatively two miles from the GMC campus. The home hemodialysis experience will be at Selinsgrove Davita in Selinsgrove approximatively 12 miles from the GMC campus, two days a month while on research or elective month. The peritoneal dialysis clinic will be one or two days a month on campus at GMC.

Didactics
The didactic curriculum runs 10 consecutive months with conferences every Tuesday and Friday in the form of lectures, journal club, board style question review, and case presentations. We participate in monthly renal pathology conference and quarterly combined conferences with our colleagues in rheumatology and endocrinology.

Call is one weekday every week (Monday-Thursday) and one weekend every month.

Evaluations are performed monthly on each fellow in all rotations. The assessment of clinical knowledge is done formally each spring with the nephrology in-service examination.

Sample rotation
Rotations begin at 7 a.m. through 5 p.m. in general. Each rotation has a single or multiple preceptors. The inpatient work load entails rounding on inpatients and completing notes and communications with the primary service team prior to the end of the work day.

Outpatient clinical responsibilities are assigned based on which rotation the fellow is on. Inpatient fellows have less outpatient clinic, whereas dialysis fellows and research fellows have more outpatient clinic. Each inpatient service is staffed by a member of the Department of Nephrology. Outpatient clinics have assigned preceptors that are department staff. While on research rotation, fellows work independently under the guidance and direction of their department mentor and/or research attending physician.

Sample yearly schedule

Year 1   Year 2
 5 Inpatient consults  1 Consults
 3 Dialysis  3 Transplant
 3 Transplant  4 Dialysis
 1 Elective  3 Research
   1 Elective