The bulk of the first year of training is devoted to learning inpatient and outpatient clinical Nephrology. The fellow leads the inpatient consult teams at Tulane Hospital and affiliates (UMC/VA), helps organize the service, and teaches residents. Outpatient experiences include: UMC clinic, a clinic with diverse patient population that provides training in healthcare disparities; the VA clinic, structured as a chronic kidney disease clinic for veterans; and DCI hemodialysis, where the fellow learns routine care of chronic hemodialysis patients. The fellow learns and perfects Nephrology procedures, such as temporary dialysis catheters, kidney biopsies of native and transplant kidneys, hemodialysis, including continuous therapies, and peritoneal dialysis. The fellow also participates in clinical and bench research.
The second year fellow will expand fundamental medical knowledge to include more esoteric aspects of Nephrology (the genetic disorders leading to hypertension, for example). By the beginning of the second year, the fellow should be well versed in hemodialysis. The second-year fellow will have more in-depth coverage of peritoneal dialysis. The fellow will also perform more detailed research during this year. The fellow will continue to develop interpersonal skills, leadership, clinical education and ethics.
Attendings will supervise both first and second year fellows while performing all clinical duties. For consult rotations, teaching and management rounds are combined, with an attending physician conducting both. The fellow also makes weekly dialysis rounds with an assigned attending at the Tulane DCI Dialysis unit. The physicians use these times to advance patient care, but also to teach fellows the art and science of obtaining and processing accurate historical and physical examination data. These topics are also emphasized in clinical conferences. Although the fellows are already trained as internists, Nephrologists take holistic care of many of their patients so general history and physical exam skills are emphasized. Additionally, aspects specific to Nephrology are emphasized.