Clinical Curriculum
Training Environment
The 26-acre Health Sciences Center, home to both the Lewis Katz School of Medicine and Temple University Hospital (TUH), is the primary site of our program’s clinical experience. The Center delivers primary care to approximately 250,000 ambulatory patients and hospital care, to over 20,000 patients annually. TUH is a 746-bed teaching hospital with the busiest emergency room in the City of Philadelphia and has one of only two burn intensive care units in the Greater Philadelphia Area.
One-third of our patients are referred from outlying hospitals within the region, ensuring a wide variety of nephrology-related disorders and ample exposure to all modes of renal replacement therapies. The experience is enhanced by the fact that TUH is a large tertiary referral center for heart failure, cardiac transplantation, lung transplantation, liver and simultaneous kidney-pancreas transplantation. In addition, a large number of patients from the underserved areas of North Philadelphia present to Temple for an initial evaluation of inherited or acquired severe kidney disease due to a wide variety of causes.
Inpatient Clinical Experience
Inpatient Consult Service
This service provides nephrology consultation for all patients, except for solid-organ transplant recipients or those with chronic dialysis-dependence. The consult team is staffed by one nephrology faculty attending, 1-2 fellows, and several medical residents and students.
Fellows are exposed to a broad-range of pathology, including acute kidney injury, electrolyte disorders, and glomerular disease. They develop expertise in managing continuous renal replacement therapy (CRRT) and participate in the multi-disciplinary care of patients with advanced cardiopulmonary disease requiring ventricular assist devices (VADs) and extracorporeal membrane oxygenation (ECMO).
Chronic Dialysis Service
This service provides consultation for patients with end stage renal disease (ESRD) who are on hemodialysis or peritoneal dialysis. It is staffed by a nephrology faculty attending, 1 fellow, and a nurse practitioner.
Transplant Service
This service cares for hospitalized patients with kidney, kidney-pancreas transplants as well as other solid organ transplants such as heart, lung and liver transplants. Fellows work with a multi-disciplinary team, including transplant nephrologist, transplant coordinators, transplant surgeons, medical and surgical residents, pharmacists, and social workers. Fellows participate daily morning sit-down rounds to review the inpatient service with all the transplant nephrologists. They also attend a weekly listing meeting where outpatient transplant candidates are discussed with a multi-disciplinary team for decisions regarding active-listing for kidney and/or kidney-pancreas transplant on our program’s wait list.
Primary Renal “Yellow” Service
This is a resident-run service, supervised by a nephrology faculty attending and fellow to care for all of our primary patients from our dialysis units or various clinics. It is designed to give internal medicine housestaff high-quality and broad exposure to patients with a variety of renal disorders, including glomerular disease, kidney transplant, advanced chronic kidney disease, and ESRD. Patients are considered candidates for this service if they are cared for in the Temple outpatient nephrology practice and have presentations that offer educational value for the residents and medical students. This service presents an outstanding opportunity for the fellow to engage in the clinical education of housestaff and gain experience as a team leader.
Outpatient Clinical Experience
In contrast to the traditional model followed by other programs, our program is designed so that fellows fully immerse themselves in either an inpatient or outpatient experience. When rotating on outpatient block, fellows do not have any inpatient responsibilities. The outpatient experience is protected for both 1st and 2nd year fellows. 2nd years have a continuity clinic throughout the year, and 1st years rotate off inpatient blocks to do an outpatient rotation. The number of ½ day clinics in the outpatient setting is variable, depending on specific interests and fellowship year.
Outpatient general nephrology clinic: Nephrology fellows manage and develop their own cohort of general nephrology patients along with a faculty preceptor. Fellows have their own clinic space and see new consults, their own established patients, and patients acquired while on the inpatient service.
Outpatient Transplant clinic: Fellows receive comprehensive exposure to outpatient management of both new transplant recipients and long-term established ones. They also participate in the evaluation of kidney transplant candidates and kidney donors..
Outpatient hemodialysis: Fellows are exposed to the comprehensive care of dialysis outpatients, including water treatment, multi-disciplinary rounds with dieticians, social workers and nurses, vascular access management, palliative care, and transplant referral. They are paired with several faculty members throughout their training in order observe various approaches to care.
Home dialysis clinic: Fellows learn comprehensive care of both home hemodialysis and peritoneal dialysis patients at one of our 3 outpatient sites.
Renal Lupus Clinic: Fellows join one of the two nephrologists who specialize in glomerular disease and lupus nephritis in the Renal Lupus Clinic. Patients are discussed and co-managed with our rheumatology colleagues who have their own lupus clinic on the same days. We also work closely with our rheumatology colleagues to conduct clinical trials and participate in collaborative scholarship.
Vascular Clinic/Interventional Nephrology: Fellows attend vascular clinic with our vascular surgeons to learn about dialysis access placement and shadow interventional nephrologists to observe placement of tunneled dialysis catheter and management of fistulas and grafts.
Didactic Curriculum
The Nephrology faculty is committed to teaching. Each year members of the faculty are recognized for their dedication to medical education with teaching awards from the house staff in the Department of Medicine.
Our renal conference schedule is extensive, with at least three formal well-attended nephrology teaching conferences per week (described below). During conferences, fellow pagers are held and covered by other providers to maximize educational benefit.
Summer Introductory Lecture Series at the Gift of Life, Philadelphia
The first year of nephrology fellowship begins with an inter-institutional educational seminar with faculty and fellows from nephrology training programs in and around Philadelphia. It is a two-day experience that provides an orientation to the fundamentals of caring for nephrology patients.
Nuts and Bolts Series
During the summer, as first year fellows begin their inpatient service, we have a series of introductory lectures in nephrology. Lectures are for 60 minutes, 3 days per week, on topics relating to dialysis, transplantation, electrolyte emergencies, and procedures in nephrology.
Renal Pathology Conference (weekly)
Every Wednesday at 9am, throughout the year, biopsy conference (renal pathology) is held at the 10-headed teaching microscope with our renal pathologist, Dr. Jared Hassler. All new biopsies are presented and discussed, as well as old biopsies of high teaching value, including light microscopy, immunofluorescence, and electron microscopy. Both native and transplant biopsies are discussed in this conference.
Journal Clubs (weekly)
Starting in September, every Monday at noon, the entire nephrology division participates in a journal club. Articles are presented by either faculty or fellows, and include a review of statistical techniques, methods for critical appraisal of the literature, and presentation of either classic, seminal articles in nephrology or newly-published articles of high value.
Renal Grand Rounds (weekly)
Every Wednesday at 4pm, starting in September, the entire nephrology division participates in Grand Rounds. This conference features a range of speakers, including invited experts, clinical vignettes presented by first and second-year fellows, and Temple nephrology faculty.
Fellow board review (weekly or twice weekly)
Every Thursday at noon, starting in September, all fellows meet for a 60-minute lecture on a core topic of nephrology. Due to the comprehensive nature of this conference series, an additional lecture is often added to complete the questions and discussion. Board review “question of the week”, is circulated to fellows and faculty to provide exposure to high-yield questions, or questions of great educational value for the boards.
Outpatient nephrology conference (weekly)
This is an informal conference for all fellows, twice a month, Friday at noon, in which fellows and/or faculty can present interesting cases for discussion and provide additional literature review.