Fellow Driven Program Improvement
Work-live balance is a critical component to a successful career in medicine. Therefore, we have established a fellow-run committee called the Fellowship Improvement Committee, which is chaired by the Chief Fellow with representation from the first year fellow class. The committee also includes the APD, PD, and faculty members from all facets of the program (research, clinical, transplant, and education). The committee meets on a regular basis and reports directly to the division chief. This committee is tasked with reaching out to alumni, applicants, faculty, and current fellows to stay on top of needs and issues of not only current fellows but emerging needs of the program. This committee continues to make a real impact into improving the work-life balance of our fellows.
Clinical Inpatient Rotations (all purely consult services)
- Acute (ICU) Nephrology Service — Interventional and consultative support (including CVVHDF) for patients in the intensive care units at Duke University Hospital except patients on maintenance renal replacement therapy or with a kidney transplant.
- Floor Nephrology Service — Consultative support to patients admitted directly to the general medicine wards at Duke University Hospital except those on maintenance renal replacement therapy or with a kidney transplant.
- Transplant Service — Fellows on the transplant rotation work one-on-one with a nephrology transplant attending in a mix of inpatient and outpatient settings. This fellow will be responsible for all kidney transplant consultations throughout the medical center, as well as all inpatient transplant kidney biopsies. Fellows will also have three half-days of transplant clinic per week, rotating through a variety of clinics performing new living donor evaluations, new recipient evaluations, post-operative follow-up, and long-term follow up visits. In addition, the fellow will attend transplant listing conference and monthly M&M conferences. Therefore, a first-year fellow will have direct access to all aspects of kidney transplantation.
- Maintenance Hemodialysis Service — Consultative care for patients already on maintenance hemodialysis admitted to Duke University Hospital except for patients admitted to the ICU.
- Durham VA Medical Center Service — Consultative care for a mixture of fluid and electrolyte problems, acute and chronic dialysis, transplantation and general nephrology.
Outpatient Clinical Immersion
Throughout their fellowship, all fellows maintain a half-day continuity clinic. These clinics alternate from Duke to the VA each week.
In order to facilitate a deep outpatient experience, each fellow will rotate through three 2-week long outpatient blocks during the first year of fellowship. This will allow for a wide exposure to a variety of experiences. During these 2-week blocks the fellows will NOT be on the call schedule and weekends will be free. All conferences in which first year fellows present will be scheduled during this period so they will not have to present journal club or grand rounds while on an inpatient service.
These rotations will include:
- Transplant donor and recipient surgery
- Permanent vascular access creation and maintenance
- Outpatient management of transplant patients
- Palliative Care
- Hypertension Clinic
- Duke Lupus Clinic
Each fellow also participates in an outpatient dialysis rotation (6 months) and attends a monthly peritoneal dialysis clinic during the 2nd year of training.
Individualized Career Development- Scholar Pathways
What to Expect in the Second Year of the Clinical Concentration Pathway
The Division has a long history of training outstanding physicians in the practice of Nephrology and we actively encourage applicants who desire a career in practice to apply. Clinical fellows will also complete a quality improvement or research project as part of the second year of training. The clinical concentration pathway consists of additional time on the clinical services and potentially elective experience tailored to the interests of the individual with possibilities including
- The Transplant Concentration
- The Geriatric and Palliative Care Concentration
- Home Suitable Dialysis Concentration
What to Expect in the Second Year and Beyond in the Investigator Pathways
For fellows pursuing an academic career, the second and third years of the fellowship include intensive research training under the direction of a faculty mentor, with multiple sources of funding available including an NIH funded T32 training grant, an HSR&D grant through the VA Medical Center, other extramural grants, and endowment sources available to the Division. A mentoring committee is established for each research fellow to assist the primary mentor in guiding the fellow. Additional years of training are often desirable and often available for a small number of outstanding candidates for a career in academic medicine. Fellows can decide to enter this pathway AFTER joining the fellowship program.
Duke Nephrology Weekly Conferences
Multiple nephrology conferences are available throughout the academic year including journal club, GN club, pathology conference, clinical and research core curriculum, multidisciplinary conferences and grand rounds.
How is Mentorship Provided?
Each fellow works with faculty members to create a mentorship committee, which will last for the entire duration of the fellow's time at Duke. This committee consists of a research mentor and two to three individuals with related scientific interests at Duke University. This committee meets semi-annually to review progress, discuss plans, formally establish expectations, and help guide career development. After each meeting, the trainee should write a summary of the meeting and present this to the Mentorship Committee members, the division chief and the training program director. In addition basic science pathway fellows will have an opportunity to join the Lefkowitz Society for additional mentorship.
Ongoing Quality Improvement Projects
As part of the ACGME requirements our Nephrology Fellowship has developed a robust quality improvement (QI) program. The Duke Nephrology QI Program led by faculty member Blake Cameron, MD, MBI. All fellows will participate in the program throughout their fellowship training. Fellows with a strong interest in QI will have the opportunity to join the Learning Health Systems Training Program (LHSTP). The LHSTP is a novel educational program designed to train fellows in the skills needed to become physicians who are able to understand and obtain individual patient and clinician practice level data from the LHS as data scientists, analyze the data to inform current clinical questions and processes, integrate findings with published research evidence to practically solve clinical problems.