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Curriculum

Curriculum

The program is organized to provide the fellow with meaningful experiences in clinical nephrology, teaching, and research. For details:


Program Overview

The ACGME-accredited Nephrology Fellowship program at Allegheny Health Network strives to provide an outstanding education in a nurturing environment that encourages the growth of the nephrology fellows by preparing them for a career path in clinical and academic nephrology. 

Established in 1991, the program offers nephrology fellows broad clinical experiences and resources to build their knowledge base, enhance their skills, and perform meaningful clinical research. The commitment of the faculty and program director to teaching and research is considered to be a significant strength of the program, in addition to diverse and comprehensive clinical experiences. 

Growth in knowledge base is enhanced by weekly core curriculum faculty lectures, clinical conferences, and focused discussions during inpatient and outpatient rounds. Development of clinical judgment, problem-solving skills, and experience in all of the core competencies is fostered by an environment that allows fellows appropriate independence in patient management with input from the nephrology faculty.

Fellows will become competent in a variety of procedural skills, including renal biopsy of native and transplanted kidneys and placement of temporary dialysis access catheters. They will also become competent in prescribing and supervising acute and chronic hemodialysis, peritoneal dialysis, and CVVHD. They will develop skill in interpreting diagnostic studies such as renal ultrasonography, excretory urography, renal angiography, radionuclide imaging of the kidney, renal biopsy and urine/serum chemistries. Fellows will also have exposure to interventional nephrology, and will have a significant opportunity to master the medical management of transplantation by participating in the care of a large number of kidney and simultaneous kidney-pancreas transplant patients.

The skills necessary for critical analysis of the scientific literature are stressed through participation in weekly conferences including Journal Club and research conferences. Fellows will also be expected to participate in independent research projects with a faculty member.

Finally, fellows will be responsible for supervising and teaching internal medicine residents and medical students on the clinical inpatient nephrology services.

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Rotations

The two year program is organized to provide fellows with meaningful experiences in clinical nephrology, teaching, and research. 

Below is a typical rotation schedule. Individual programs will vary:

Rotation Months
Year 1
AGH Inpatient Consults 6
AGH Inpatient Transplant 2
Dialysis 1
Elective 3
Year 2
AGH Inpatient Consults 5
AGH Inpatient Transplant 2
Dialysis 1
Elective 4
*Subject to change

Rotation Descriptions

AGH Inpatient Consults:  During this rotation the nephrology subspecialty fellow is provided with a diverse inpatient clinical nephrology experience and with the challenges of caring for the complications of inpatients who require ongoing dialysis in a major tertiary care setting. The nephrology fellow becomes proficient in inpatient consultations and follow-up, in handling the multitude of issues affecting patients with end-stage renal disease, in nephrologic critical care consultations, and follow-up including acute renal failure and oversight of continuous renal replacement therapies for acutely ill patients.

AGH Inpatient Transplant: During this rotation the nephrology subspecialty fellow cares for renal transplant patients. The nephrology fellows are given the unique experience of caring for patients prior to, during and after renal transplantation.

Electives: The fellow will select one of the following elective rotation experiences.

  • Ambulatory Rotation: During this rotation the nephrology subspecialty fellow cares for outpatients, providing nephrology consultations and follow-up in multiple outpatient settings.
  • Interventional Rotation (Access Center): During this rotation the nephrology subspecialty fellow is provided with exposure to interventional nephrology procedures including balloon angioplasty, declotting procedures, tunneled dialysis catheter placement, venogram, vein mapping, and stent placement.
  • Pathology Rotation: During this two-week rotation, second year nephrology fellows will become knowledgeable and experienced in handling and interpreting pathologic specimens related to the care of patients with nephrological disorders. Fellows will gain knowledge in interpreting light microscopy and immunofluorescence findings in diseases of the kidney.
  • Radiology Ultrasound Rotation: Second year fellows become knowledgeable and experienced in interpreting renal ultrasonography during this two week rotation. Fellows will become knowledgeable in recognizing and identifying the sonographic appearance of the normal kidney, ureter and bladder. They will also learn to interpret the pathologic ultrasound findings in diseases of the native kidney and renal allograft.
  • Research:  With prior approval, fellows may choose to dedicate an entire month to research. Fellows will work closely with the Research Director during this experience to learn and develop the necessary ethical research practices to allow them to successfully complete assigned research projects.

Dialysis Unit Rotation: During this rotation, nephrology fellows will gain “hands-on” experience and knowledge of the technical aspects of a dialysis unit including: performance of dialysis machine set up, alarm triage, and appropriate maintenance schedules; components of a water treatment system with ability to name components, frequency of testing with understanding of safety and consequences of malfunction; preparation of dialysis solutions and appropriate testing; cannulation of dialysis access; set up of home dialysis machines, change of transfer sets for PD, home water treatment systems and appropriate testing, and home dialysis education. First and second year fellows are assigned to a subset of chronic hemodialysis (HD) and home dialysis (PD and HHD)patients and will be responsible for the management of these patients. Fellows are responsible for coordinating and writing HD, PD, and HHD prescription orders. They will also complete weekly and monthly progress notes and discuss management issues with the dialysis unit faculty attending physician.

Longitudinal Experiences

Nephrology Continuity Clinic: During this experience, the nephrology subspecialty fellow is responsible for patients in a weekly outpatient clinic setting, providing consultative and follow-up care on a longitudinal basis throughout the two-year fellowship.

Transplant Clinic: During this experience the nephrology fellow is responsible for patients in a weekly outpatient clinic setting, providing follow-up care to transplanted patients throughout the two-year fellowship.

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Training Sites

Allegheny General Hospital (AGH)
320 E North Ave, Pittsburgh, PA

TMA Vascular Access Center
1597 Washington Pike, Suite A-14 Bridgeville, PA 15017

DaVita Dialysis Services
Northside, Thorn Run & Bloomfield locations

AGH Nephrology Associates
1136 Thorn Run Rd, Coraopolis, PA 15108

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Conferences

Fellow are given the opportunity to attend and/or present at various conferences throughout their training. This experience allows them to enhance their training by learning from their peers, participating in discussions, and building their confidence.   

Research Conference
The faculty conduct a formal research conference one to two times per month. The conference is designed to provide the nephrology fellows with the necessary guidance to conduct clinical research, including research design and methods. The conference also provides the fellows with a venue to learn the appropriate methods for ethical research practices.

Clinical Conference
The nephrology fellows present interesting cases and/or cases resulting in complications or death to a faculty moderator twice per month. The conference is conducted in an informal setting and provides a venue for the fellows to discuss adverse events and difficult cases and to provide suggestions for improvement in patient management.

Journal Club
The nephrology fellows present a formal conference to the faculty, visiting attendings, rotating internal medicine residents, and medical students twice/month. Journal Club is designed to enhance the nephrology fellow’s knowledge base and presentation skills. Residents typically select patient care issues that have arisen during their monthly rotations. The conference is mandatory for nephrology fellows, and all available nephrology faculty members are expected to attend as well. The fellows present articles from the current medical literature.

Renal Biopsy Conference
A renal pathologist presents a formal monthly conference to provide the nephrology fellows additional experience in interpreting renal pathology. The conference is designed to permit the residents to directly interpret slides in the presence of the faculty and renal pathologist and discuss pertinent findings. Pathology residents often attend this conference, providing multidisciplinary interactions between Pathology and Nephrology.

Transplant Biopsy Conference
The Transplant Team (consisting of surgeons, nephrologists, renal pathologist, fellow(s) and coordinators) meets twice each month to review and discuss transplant biopsies. The conference is held in the pathology department and is designed to increase the fellows' transplant pathology interpretive skills under the guidance of the faculty and renal pathologist.

Morbidity and Mortality Conference
The nephrology fellows present cases to review adverse events, near-misses and medical errors that will enhance their medical education and improve patient safety. Root causes are identified to explain these events, and an action plan is developed. Follow-up occurs at subsequent conferences until resolution is achieved.

Medical Grand Rounds
The Department of Medicine at Allegheny General Hospital presents Medical Grand Rounds each week which the nephrology fellows and faculty are required to attend. Lectures are presented by nationally recognized experts and enhance the nephrology fellows’ internal medicine knowledge base. Topics include areas of general interest to both internists and subspecialists.

Multidisciplinary Conferences

Patient Care Conference
A multidisciplinary conference is conducted once each year for every dialysis outpatient. Nephrology subspecialty fellows are required to attend these meetings for each of their assigned dialysis panel patients. Attendees include: the nephrology faculty attending and nephrology fellow caring for the patient, nurse manager, renal dietitian, and renal social worker. Each patient’s care plan is discussed in detail and recommendations are made for improvements in quality of care.

Transplant Conference
A multidisciplinary conference is conducted each week. Attendees include: the nephrology faculty attending and nephrology fellow assigned to the Nephrology Transplant Service, transplant surgeons, a renal social worker, and transplant coordinators. A review of prospective recipients for transplant surgery (kidney, pancreas, or kidney/pancreas) takes place, and input is gathered from the various disciplines involved in the decision-making process. The conference allows the nephrology fellow to participate in the multi-disciplinary venue necessary to determine if patients qualify as potential transplant recipients.

QA Conference
A multidisciplinary Quality Assurance (Q.A.) conference is held monthly in the dialysis unit. Attendees include: medical director of the Outpatient Dialysis Unit, nephrology fellow assigned to the dialysis unit rotation, facility administrator, charge nurse, renal social worker, and renal dietitian. Quality assurance issues pertaining to the dialysis unit and patients are discussed in detail. Participation in the conference provides the nephrology fellow with an overview of the responsibilities of a dialysis unit medical director.

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