Clinical Training
The two-year clinical program involves intensive experience and instruction in all areas of clinical nephrology. Fellows rotate through four clinical services as well as a fifth clinical/research elective rotation. The Consult Service is an intensive inpatient consultative nephrology service which exposes the fellow to all aspects of clinical nephrology and hypertension experienced in a hospital setting. The Transplant Service is committed to providing excellent care to all renal transplant patients. This is a combined surgical/medical service. Fellows participate in the care of transplant patients on this service through two separate rotations:
1.) On the Consult / Transplant Service, nephrology fellows are responsible for providing consultative care for patients who have been admitted to the inpatient Transplant Service, helping to assist with medical management and dialysis issues. Fellows on this service also provide consultative care for CKD (primarily ESRD) patients who have been admitted to other medical services.
2.) On the Outpatient / Transplant Service, fellows attend a twice-weekly Transplant Clinic and are responsible for daily pre-transplant evaluations for patients admitted to the Day Hospital. On this service, nephrology fellows also make rounds at Piedmont Dialysis Center, Inc. (or one of the other affiliated dialysis units) a large outpatient dialysis facility with an active home training unit. Fellows are heavily involved in the daily problems of outpatient dialysis including in-center hemodialysis and a variety of modalities of home peritoneal dialysis. The Outpatient Service provides the fellow the opportunity to see all new referrals to the outpatient nephrology service. Fellows are expected to pursue clinical research projects under the guidance of the faculty, and are given time to pursue this during their Elective rotations. This rotation can also be used to pursue in-depth education on a variety of clinical topics under the supervision of a clinical faculty member (either within or outside of the Nephrology Section).
All fellows are required to attend several outpatient clinics, in addition to the four major clinical rotations. Included are a twice-weekly Transplant Clinic, a weekly Renal Clinic (Renal OPD), and a twice-monthly Renal Clinic which is held at an outreach clinic at the Downtown Health Plaza in Winston-Salem.
In addition to the two-year clinical program, fellows may choose to enter a three-year combined nephrology/critical care training program, which includes emphasis on clinical research projects. Fellows must be accepted into this program by both the Nephrology Section and the Critical Care Section. This experience is designed to provide extensive experience in both clinical nephrology and intensive care medicine. Fellows spend 24 months in Nephrology followed by 12 months in Critical Care. At the conclusion of this three-year fellowship, fellows will be eligible for ABIM certification in both Nephrology and Critical Care.
The clinical Nephrology program at Wake Forest involves 2 years of training at the Wake Forest University Baptist Medical Center. This training experience includes inpatient consultation services, management of end stage renal disease, transplantation Nephrology, and outpatient Nephrology clinical activities. The outpatient dialysis population consists of approximately 550 patients, including both hemodialysis and peritoneal dialysis. Our patients are referred primarily from (but not limited to) Western North Carolina, Southwestern Virginia, and West Virginia. The Section on Nephrology cares for patients in affiliated satellite dialysis units in Winston-Salem (3 units), High Point, Lexington, Mt. Airy, Elkin, King, Thomasville, and N. Wilkesboro.
The 24-month curriculum consists of 4-6 months of acute inpatient consultation, 4-6 months of inpatient transplantation and chronic CKD consultation, 4-6 dedicated outpatient clinic months, 4-6 months of outpatient transplantation and satellite dialysis clinic exposure, and 4-6 elective months (for research and clinical electives). The fellows have 3 weeks of vacation annually. During the elective months, fellows may receive additional training and experience in the areas of Pediatric Nephrology, renal histopathology, radiology, urology, and transplantation. Additionally, all fellows are expected to complete a clinical research project with a faculty mentor during their elective time, with submission to a medical journal or national meeting upon completion of the project.
Following two years of training, the trainee will have confidence in evaluating and managing patients with a wide variety of kidney disorders, and will have had in-depth training in acute and chronic hemodialysis, continuous renal replacement therapy (CRRT), interpretation of urinalysis, renal biopsy, and dialysis catheter placement. Each fellow is expected to perform a minimum of 20 dialysis catheter placements and 10 renal biopsies prior to graduation from the program. In practice, our clinical fellows usually place far more than this minimum amount.
In all cases, fellows are supervised closely by nephrology faculty. Below are the approximate numbers of each service/procedure performed:
Inpatient or consultative nephrology services (750-1000 patients)
Continuous renal replacement therapy (50-100 patients, 750-1000 daily treatments)
Acute hemodialysis-inpatients (250-500 patients, 1000-1500 individual treatments)
Chronic hemodialysis-outpatients (20-30 patients, 5000-7500 individual treatments)
Peritoneal dialysis-inpatients (20-30 patients, 150-300 daily treatments)
Peritoneal dialysis-outpatients (2-5 patients, 1000-1500 daily treatments)