Clinical training is the focus of the first year and a half of fellowship and consists of equal time split between the Rhode Island Hospital Consult Service, Dialysis Service, Transplantation Service, the Miriam Hospital Nephrology Service, and the Providence VA Nephrology Service. Fellows receive exposure to the full gamut of procedures including both native and transplant kidney biopsies, internal jugular and femoral dialysis catheters, and plasmapheresis. In addition, a two month ambulatory block experience is provided in transplant nephrology, pediatric nephrology, nephrolithiasis management, interventional nephrology, peritoneal dialysis, home hemodialysis, resistant hypertension management and renal pathology. In addition, while on the Rhode Island Hospital Consult Service, fellows perform renal consultations on obstetric and gynecologic patients at Women & Infants Hospital.

During the second year, fellows attend an outpatient dialysis unit once a week to provide ongoing care to a panel of hemodialysis patients. This complements the fellows’ weekly renal and hypertension clinic where they perform outpatient consultations and provide continuing care to varied group of patients. Moonlighting is also allowed with the approval of the fellowship program director.

The Renal Transplantation Program began at the Rhode Island Hospital in early 1997 and is now the largest in New England. Clinical training in renal transplantation involves evaluation of prospective transplant recipients and donors, care of patients during the post-transplant period, longitudinal follow-up of stable recipients, and management of complications of transplantation in both the office and hospital setting.

Conferences are scheduled five times per week. Each week includes a Case Management Conference for discussion of interesting clinical cases, Board Review Conference, and Renal Grand Rounds consisting of talks by faculty, fellows and invited speakers. In addition, there are monthly Basic Science, Transplant, Clinic, Dialysis, Kinetic Modeling, Journal Club, and Renal Pathology Conferences which are led by our nephropathologist, Jennifer Dailey. A twelve-week introductory lecture series in basic nephrology is given each summer for new fellows, and there are three radiology lectures each year.

Six months of the second year are devoted to scholarly research. Fellows select faculty members to work with them in the planning of clinical or laboratory projects, and to provide training and guidance during the course of their studies. These projects provide the fellow with in-depth knowledge in a specific area of Nephrology and will hopefully yield worthwhile findings that can be published in medical literature. Recently fellows have presented posters at the American Society of Nephrology’s Kidney Week and National Kidney Foundation’s Spring Clinical Meeting as well as published in journals such as the American Journal of Kidney Disease, Hemodialysis International, Clinical Kidney Journal, Clinical Nephrology, Seminars in Dialysis, and the Rhode Island Medical Journal.

In addition to teaching medical students and residents rotating on our inpatient services, fellows present to the division during weekly Tuesday Case Conference. Each fellow also presents an annual Renal Grand Rounds on a topic of her or his choosing. Many of our fellows also participate in The Warren Alpert Medical School Renal pathophysiology course as well as the Bryant University Physician Assistant School renal course.

Call schedule for fellows is one out of every seventh night and one out of every fourth weekend. Night call is taken by long-range pager or from home, and mainly involves both handling problems by telephone, and going to the hospital for an emergency consultation or dialysis.

Fellows have 4 weeks of flexible vacation time and typically work 2 or 3 of the following holidays – Independence Day, Victory Day, Labor Day, Columbus Day, Thanksgiving, Christmas, New Year’s Day, Presidents Day, Memorial Day resulting in a number of holiday long weekends.

A unique aspect of our program is the opportunity for fellows to rotate internationally. More than 50 percent of our fellows participate in some form. Opportunities include formal medical education programs, research, and exposure to clinical care. We currently have arrangements with Zhejiang University SOM Affiliated Hospitals in Hangzhou, China where fellows can elect for a 2-4 week on-site rotation under the supervision of local faculty. Exposure to general nephrology as well as acupuncture with a specific focus on kidney care are available. We also have an arrangement with Moi University SOM in Kenya. Fellows have the opportunity to present at the annual western Kenya renal CME conference and also to experience a 2-4 week in-patient rotation under the supervision of Brown or local teaching faculty. More sites are expected to be available in the future. Expenses for these opportunities are covered by the division.

Our patients come from a wide range of socio-economic, ethnic, and cultural backgrounds, enriching the clinical experience. Our outpatient panels reflect this diversity. Our inpatient base at Rhode Island Hospital, the largest hospital in Rhode Island and the only Level I trauma center in southeastern New England, provides a breadth of renal pathologies from common to rare. Our rotations at Miriam Hospital, a community teaching hospital, and the Providence VA Medical Center, ensure extensive exposure to ‘bread and butter’ inpatient nephrology and the opportunity to practice in a smaller setting.

Nephrologists who have completed The Warren Alpert Medical School of Medicine’s Nephrology Fellowship are fortunate to have a variety of career choices ranging from academic nephrology to solo practices and a variety of geographic choices from north to south. Indeed, estimates of manpower needs in nephrology forecast increased employment opportunities in the United States over the next decade. Our graduated fellows report a high degree of satisfaction with their preparation for the practice of nephrology. This impression is supported by their success in passing the American Board of Internal Medicine nephrology certifying examination. Over the last 25 years our fellowship continues to have a perfect record: every graduate who has sat for the board examination has been certified in nephrology.

Completion of three years of residency in internal medicine is a prerequisite for the renal fellowship. International medical graduates are required to obtain a “J-1 Exchange Visitor visa.”

Consultative care for patients admitted to intensive care units and general medical/surgical floors at Rhode Island Hospital as well as Women’s and Infants Hospital. Team includes an attending, a fellow, and usually 2-3 residents and medical students.
 

Primary and consultative care for patients admitted to intensive care units and general medical/surgical floors on maintenance hemodialysis or peritoneal dialysis.

Primary and consultative care for patients admitted to Rhode Island Hospital with a history of solid organ transplant. General nephrology fellows take the role of the “transplant fellow” on this rotation and gain exposure to the full gamut of transplant care including immunosuppression management, common complications, and transplant kidney biopsy.

Consultative care for patients admitted to the Miriam Hospital typically including Acute Kidney Injury, electrolyte disturbances, maintenance hemodialysis and peritoneal dialysis, and transplantation.

Consultative care for patients admitted to the Providence Veteran’s Hospital typically including Acute Kidney Injury, electrolyte disturbances, maintenance hemodialysis and peritoneal dialysis, and transplantation.

While on ambulatory block fellows have an opportunity to rotate with experts in various niche fields of nephrology including transplant nephrology, pediatric nephrology, stone clinic, interventional nephrology, peritoneal dialysis, home hemodialysis, resistant hypertension clinic and renal pathology. Fellows with a particular interest can tailor their block experience to garner exposure early in fellowship.

For the outpatient continuity clinic, the fellow is paired with a faculty member for the entirety of the two years. This allows for the fellow to develop their own panel of patients during the course of the fellowship.

For 6 months in the second year of fellowship, fellows work 1:1 with a faculty member seeing outpatients who are receiving maintenance dialysis. This experience includes exposure to the full gamut of ESKD care including Dialysis prescriptions, Anemia management, Bone-mineral management, and transplantation support.

Held daily at noon during the summer, these lectures are designed to give the first-year fellows a rapid introduction to key topics in nephrology and also serve to reinforce basic concepts for second year fellows.

Held Monday at noon during the winter and spring, these lectures are designed to be interactive, with faculty presenting cases and questions for the fellows to discuss.

Held every Tuesday at noon, the case conference is a chance for the fellows to present cases from their rotations to the faculty. The fellow presents the cases to open a discussion on how other fellows or faculty would approach the clinical scenario prior to reviewing the relevant pathophysiology and treatment options.

Nephrology Journal Club is held on Wednesdays with Dr. Tang and Dr. Shah. Fellows alternate between presenting a recent trial or a classic trial in nephrology. Particular emphasis is placed on critical appraisal of the literature. Once a month, fellows participate in a international peritoneal dialysis journal club.

Held monthly, the renal pathology conference is run by our Tony Chang and Kammi Henriksen, nephropathologists at the University of Chicago, to provide an in-depth review adult and pediatric cases using findings on light microscopy, immunofluorescence, and electron microscopy to discuss the differential and most likely diagnosis.

Held every Friday at noon, renal grand rounds invites local, national, and international leaders to present on topics in clinical care, basic science, and translational research. The last Friday of each month is reserved for Transplant Grand Rounds.

Held every Tuesday morning at 8 AM, the Department of Medicine Grand Rounds invites local and national leaders in medicine, medical education, and research to discuss cutting edge topics.