Nephrology Fellowship Overview
The goals of the MUSC Nephrology Fellowship are to:
Nephrology Consult Services which are divided into two services, ART (Ashley River Tower) Consult, and the main MUSC Hospital. These two buildings are two blocks apart. A wide array of disease states are encountered on these services including acute renal injury, acute glomerulonephritis and the care of the hospitalized end stage renal disease patient. One attending and two fellows cover ART and one fellow and one attending cover the main MUSC Hospital. Medical students and medicine housestaff may also rotate on service. Exposure to acute hemodialysis and continuous renal replacement therapies is extensive. Fellows are also exposed to AKI in the setting of VAD therapies and ECMO. There is a team of Advanced Practice Providers who help to provide ESRD care for stable ESRD patients.
Renal Transplant Service is a medical-surgical service that provides care for renal transplant patients. One hundred eighty-five renal transplants were performed at MUSC in 2014. The general nephrology fellow is part of the medical-surgical team and rounds with the transplant attending, transplant fellow and the attendings on all renal transplant patients. In addition, the fellow is involved in Transplant clinics, pre-transplant evaluations, and management of medical complications post transplant. The fellow is responsible for the dialysis support for transplant patients with primary non-function, etc. Specifics of transplant medicine such as immunosuppression, treatment of rejection and management of opportunistic infections and when and how to perform renal transplant biopsy are emphasized.
The VA Nephrology Service is involved in acute inpatient and outpatient services for acute and chronic renal disease and hypertension. The fellow rounds with an attending at the VA as a consultant and sees all nephrology patients that are admitted to the hospital as well as any new consultations. With the attending physician for that rotation, the fellow at the VA is responsible for running the outpatient dialysis unit associated with the hospital. The fellow will gain experience rounding on outpatient dialysis patients and the management of dialysis access problems, anemia and bone mineral disorders. The attending and fellow also provide primary care to the VA patients who have dialysis services provided outside of the VA system and for the veterans with renal transplants. There is an Advanced Practice Provider who helps to provide ESRD care for the outpatient unit.
Home Dialysis Month: Home dialysis modalities (peritoneal dialysis and home hemodialysis) are an important part of renal replacement therapy. MUSC has approximately 41 patients receiving home therapies, including peritoneal dialysis and home hemodialysis. Each fellow is required to spend a month each year in the Home Unit to learn management of PD and home hemodialysis.
Interventional Radiology Month: Fellows rotate through Interventional Radiology during their first year of fellowship to build procedural skills in percutaneous kidney biopsy and temporary hemodialysis line placement.
Elective Months: When not on a clinical service, there are many opportunities for further study. Electives available include Pediatric Nephrology, Interventional Nephrology, Interventional Radiology, Renal Pathology, and Plasmapheresis.
The Rutledge Tower Teaching Clinic is a continuity clinic for the patients with any renal disease or hypertension at MUSC. Patients with a myriad of renal diseases are seen and followed over two years by a fellow in continuity. Typically each fellow will experience four to six patient visits during a 1/2-day clinic every other week.
The VA Teaching Clinic is a continuity clinic located in the Ralph Johnson Veteran's Administration Hospital. Activity in this clinic consists of four to six patient visits during a 1/2-day clinic for each fellow every other week. The VA ESRD Clinic is attended in addition to the VA Teaching clinic when the fellow is on service at the VA. Veterans who receive dialysis therapy outside of the VA system and veterans with renal transplants receive their primary care in this clinic.
The Transplant Clinic is attended four days a week when the fellow is assigned to the Transplant service. The fellow may see patients at all stages of the transplant process. Several faculty members attend each clinic and serve as educational resources and assist in the patient care.
Fellows will learn how to perform percutaneous native and transplant biopsies and temporary line placement for dialysis. In addition, fellows will learn the fundamentals of renal ultrasound.
Fellows take home call nightly and take telephone calls from patients, dialysis calls, and after hour consults from the VA or MUSC. Weekend call is handled by two fellows, and one attending.
Fellows participate in 4 weekly noon-time conferences including journal club, clinical case conference, renal biopsy conference, research conference and salt and water conference. Fellows present at all of these conferences.
All fellows are expected to complete a research project during their fellowship. In addition, fellows are strongly encouraged to submit their projects for publication and to present abstracts at regional and national meetings. Numerous clinical and basic research projects are ongoing in the Division. The research interests of the Division faculty are as described in their faculty biographies. However, research fellows are not constrained to work only in the division of Nephrology laboratories. In particular, strong programs on campus in Pharmacology, Molecular and Cell Biology, and Pathology offer additional outstanding opportunities for postdoctoral research training. There are multiple opportunities to participate in mentored clinical research.
MUSC offers a very supportive educational environment. Our faculty are educators at heart and are dedicated to helping fellows develop into independent nephrologists. We have a rich conference schedule including a "Intro Series" at the beginning of the academic year to get new fellows oriented to Nephrology. Fellows have the opportunity to present at renal biopsy conference, journal club, Nephrology Grand Rounds, and research conference. There is a dedicated renal physiology conference for fellows. Conference topics will help prepare fellows for the ABIM Nephrology Boards and are supplemented with board review question sessions. Fellows are provided with educational funds that may be used to support conference travel or to acquire approved educational materials. Additional travel support is available for fellows who present research at regional or national meetings. Five (5) days of CME time are provided (in addition to vacation time).
The mental and physical health of our fellows is very important to the Division. All fellows are provided a membership to the MUSC Wellness Center which is open seven (7) days per week. It is a 80,000 sq ft facility with a junior Olympic swimming pool, tennis, raquetball and squash courts, extensive group fitness classes, two weight rooms, and cardiovascular equipment. There is a dedicated Nephrology Fellow lounge in the Main Hospital with lockers, computers, and a comfortable couch. The Division actively seeks input from the fellows about how to improve their learning experience.