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The intent of the Nephrology Fellowship Program, jointly held with Brigham and Women Hospital, is to train future leaders in academic nephrology. This is accomplished by providing our renal fellowship trainees with rigorous clinical training in nephrology and unparalleled resources for cutting-edge basic science and clinical research over a period of four years. The successful applicant will have strong evidence of superior clinical skills during internal medicine residency as well as exceptional ability and commitment to an academic research career.
The educational experience includes formal didactic talks, clinical renal practice, acquisition of expertise in a wide variety of renal, hypertensive and fluid-electrolyte disorders, extensive training in renal transplantation, dialysis, and extracorporeal therapy and versatility in performing a number of specialized procedures. Clinical learning and experience is largely acquired through one-on-one supervised patient care.
The clinical rotation comprises equal rotations on the dialysis, consult, ICU and transplant services. The clinical fellow spends roughly half the rotation time at MGH and BWH. A short rotation at the West Roxbury VA Hospital is also included. Each fellow will also have a half-day outpatient clinic supervised by a faculty member.
Several venues are utilized to achieve the program's overall goals in providing quality training in patient care, teaching, and research:
This is traditionally the core of the learning process. It is carried out on a daily basis both in the clinical (inpatient and outpatient) and research settings.
These include the following standard texts of Nephrology as well as material assembled into syllabi by faculty.
Other tests and journals, as well as bibliographic search capabilities are available in the Division of Nephrology's Library, the Housestaff Library, MGH Treadwell Library, and the Harvard Countway Library. Bibliographic searches are also available through the hospital's computer system.
In addition to the above listed formal conferences, a series of lectures are given at the beginning of the academic year on dialysis, transplantation and the care of renal emergencies.
Each fellow has the opportunity to attend one national nephrology meeting each year. Such meetings include the annual American Society of Nephrology Congress or the spring clinical meetings of the National Kidney Foundation. Research fellows may attend these meetings to present their abstracts in oral and/or poster formats. Fellows may also attend the annual nephrology postgraduate courses held at Harvard-Affiliated Hospitals.
Teaching is a very effective way of learning. As such, the fellows have ample opportunities to teach in this training program. In addition to the daily bedside teaching of medical students and residents attending renal rounds, fellows also prepare for case presentations during renal grand rounds, clinical case conferences, and give formal talks that are presented to the division's staff on three or more occasions each year. They also present their research findings in the weekly laboratory meetings. Many fellows also participate with the MGH/BWH faculty in teaching renal physiology and pathophysiology to first and second year medical students at Harvard Medical School.
This concise handbook provides some of the practical points and pearls of nephrology practice and a framework for further reading. It provides differential diagnoses and approaches to management of common renal diseases. It also lists specific rotations, daily seminars and useful hospital services phone numbers, and is distributed at the beginning of the fellowship.
Each fellow will spend 3.5 months on the inpatient consultation service, 2 months at MGH, and 1.5 months at BWH. The consultation service at MGH also covers the Massachusetts Ear and Eye Infirmary. During this period, the fellow is expected to acquire experience in:
The Fellow will see all requests for consultation called into the Renal Consultation service. After seeing the patient, the fellow discusses the problem with the visit for the Renal Consult service, writes an initial note after communication with the attending nephrologist, and follow-up notes as considered appropriate. Medical Residents rotating on the Renal Service may also take this role, and students are also involved in working up and following these patients. A fixed time is designated each day for the fellow (+/- student and resident) to meet with the attending nephrologist to discuss progress and plans. The fellow sees all of the Division of Nephrology patients admitted to the hospital, whatever the reason for admission is. If the patients are admitted to the Renal Visit on the private medical service, the fellow and the visit will act as the primary caretakers (in concert with the medical house staff) during hospitalization. When patients are admitted to the medical ward service or other non-medical services, the fellow acts as a consultant giving input as needed an appropriate. The fellow also manages any problems with peritoneal dialysis patients.
Each fellow will be exposed to dialysis and extracorporeal therapies during 3.5 months of the training, divided between MGH and BWH. During this rotation, the fellow evaluates all initial consults when hemodialysis is considered even if it is not imminent, supervised by the dialysis attending of the month. The clinical experience includes:
The activities on the Transplantation Service include the transplant donor and recipient evaluation, hospital admission of patients receiving transplants or those with transplants who are suffering from acute or chronic complications, as well as the outpatient management of patients post-transplant. Each fellow will have 3.5 months of experience on an active renal transplant service divided between MGH and BWH. The fellow is trained in the pre and post-transplant management and follow up of patients. During the rotation, the fellow attends two to three outpatient transplant clinics a week and participates in management decisions. This transplant experience includes the following:
The fellow will spend one-half day each week in the ambulatory practice setting, seeing the entire spectrum of outpatient nephrology. The fellow will evaluate the patients and formulate plans and will discuss the case with the attending physician. The fellow is responsible for communicating with referral physicians and for longitudinal follow-up of these patients when appropriate. The rotation will expose fellows to:
A number of electives, usually 2-4 weeks, are available for the renal fellows. They include:
Fellows will receive hands-on training, including the indications, contraindications, complications, and interpretation of results of the following procedures:
Fellows are encouraged to acquire the knowledge base (that includes cost-effectiveness) and expertise in the following procedures:
Please visit the Faculty Development web site for more information on the MGH guidelines for research fellows.
The main elements of the Mass General research training program are:
Basic and clinical research activities involve several NIH-supported initiatives directed by the Mass General Division of Nephrology staff. These include
In addition, research on the induction of tolerance across concordant and discordant species is carried out in the Transplantation Biology Research Center on the 9th floor of Building 149 in the Navy Yard, one floor above the Renal Unit's research laboratories. Fellows joining ongoing research projects in any of the above programs will receive intensive training in a multidisciplinary environment and be closely supervised by senior and junior faculty preceptors. There are ample opportunities for training in diverse disciplines of membrane biology, biophysics, immunology, cell adhesion, development, biochemistry, biophysics, cell signaling, structural biology and outcomes, and epidemiology research. This provides a multi-disciplinary approach in the study of one of the most heterogenous organs in the mammilian organism - the kidney. These approaches are applied in many cases to clinically relevant diseases such as nephritis, acute renal failure, electrolyte disorders, polycystic kidney disease, bioincompatibility, allograft rejection, and vasculitis.
Acquisition of new research tools is most effectively accomplished through the daily interaction of the fellow with an assigned person who already has the required methodological skills, and is able to transmit this knowledge in a friendly and comprehensive manner. Formal lectures are also offered that introduce the fellow to laboratory or to clinical investigation. In addition, Mass General has established "The Society of Fellows." Among the activities of this society is a formal introduction of fellows to the residents and staff, a lecture series on grant writing, bioethics, conflict resolution, job hunting, and time management in two career families. At Mass General, several such summer/fall programs specifically designed for new post-doctoral fellows are offered. Examples include "Current Techniques in Molecular Biology," a one month intensive course offered in July of each year, and covers the theory and practice of major molecular biology techniques including Bioinformatics. This course is followed by "Introduction to Laboratory Techniques in Molecular Biology," a more specialized two week intensive course offered by the Department of Molecular Biology at Mass General. The third course "Issues in Physiologic Investigation" reviews specific principles, tools, and methodologies for investigating physiologic questions, paying particular attention to the relative strengths and weaknesses of various methodologies. In addition to the formal course content, participants are exposed to a cadre of physiologic investigators, providing opportunities for faculty interaction and networking. "Design and Conduct of Clinical Trials," surveys the theory and practice of clinical trials, reviews design and conduct of clinical research, and enables participants to conceive, plan, propose, and develop effective clinical trials. Content essential to the design and conduct of clinical trials are covered including the components of phase I - IV studies, the design and writing of study protocols, issues regarding patient recruitment and selection, human subjects, the informed consent process and regulatory issues. For additional course lists, see the MGHCRnet. Opportunities are available to further supplement the didactic programs described above. There are a number of opportunities for fellows to enrich their fundamental scientific knowledge with courses at Harvard College, Harvard Medical School, Harvard School of Public Health, and Massachusetts Institute of Technology (MIT). A wide choice of relevant courses provides flexibility in structuring the overall fellowship program. In addition to these formal courses, a weekly lecture series, combined with clinical and research journal clubs, weekly laboratory meetings, and daily contacts with the mentor and the Program Director provide the other important venues for enhancing intellectual growth and development of the fellow in clinical investigation and basic research.
Trainees generally choose a mentor prior to beginning the fellowship. During the interview process, they also have the opportunity to learn about the work being done in various laboratories, to consider specific research projects, and to discuss training and the research environment with current fellows. Clinical fellows with no previous laboratory experience are encouraged to work closely with their chosen mentor to develop a plan for the research years. If, however, such trainees are not able to identify a specific mentor and project area, the decision can be deferred until after initiation of the clinical year of training. To aid in this effort, the Division of Nephrology has devised a seminar series during the summer and fall sessions of every year during which preceptors present their respective research. The trainees are then encouraged to meet with all of their potential preceptors in the training program to further discuss their career development plans. In addition, first year clinical fellows are encouraged to discuss their goals with more senior fellows, both for general advice and for more detail about the overall research directions previously chosen by other fellows. In this manner, the trainees enter the research training program already familiar with the skills and interests of the entire faculty as well as personal knowledge of potential mentors. This process provides a smooth transition into the research arena, and presents the appropriate environment where enthusiasm among faculty and colleagues can be readily displayed to the young trainees in helping them choose such a career. Fellows are also encouraged to write a brief research grant proposal under the guidance of the mentor, a process that helps crystallize the candidate's research plans, and provides a training forum in grant writing.
During the research years, direct guidance of the trainee is the immediate responsibility of the individual preceptor. Fellows are however encouraged to interact with the other principal investigators and their personnel in the program, a process that will increase their overall knowledge base, and expose them to new fields and techniques that could be invaluable in their pursuit of independent scientific careers. The clinical fellows serving at Mass General will meet with Dr. Amin Arnaout and Dr. Hasan Bazari both formally and informally. During these sessions, any issues related to the program are discussed, and any necessary refinements/improvements in the program are implemented as a result. At Mass General, the research fellows will also have formal or informal (bimonthly) meetings with Dr. Arnaout, during which any issues regarding their research training, environment and progress are reviewed and discussed. The fellows are also given adequate exposure to other faculty through several forums such as the visit of the month rotation, the formal year-round lecture series given by various principal investigators, the weekly presentation of clinical cases at the joint MGH/BWH Renal Grand Rounds, the weekly dialysis, transplantation, pathology and radiology conferences through participation in regularly scheduled journal clubs, and the weekly intra- and inter group presentations. The fellowship program is overseen by a supervisory committee made up of two staff members from each hospital. The committee meets quarterly to monitor progress of the fellows. Evaluations are communicated to each of the clinical fellows to provide them with opportunities for improvement and to help them refine their clinical and technical skills. Feedback to the research fellows is provided on a quarterly basis, after consultation with their preceptors and research colleagues. Each trainee meets several times a year with the Supervisory Committee to evaluate his/her progress and to make any necessary modifications in the program.
Both the Division of Nephrology and Massachusetts General Hospital are equal opportunity employers. Before beginning the MGH/BWH Joint Fellowship Program in Nephrology, a candidate should have completed at least two (preferably three) years of training in internal medicine. Interested applicants should submit their application through ERAS by July 15 as this will facilitate timely review and interview scheduling. We will invite outstanding candidates for a one-day interview process to be scheduled in September and October. We do sponsor visas for exceptional renal fellowship candidates. We will be participating in the Nephrology Fellowship Match using the NRMP system and their listed dates.
Please click here to begin your application through ERAS
For additional information, please contact:
Wendy De MilleManager, Nephrology Academic Affairs and Dialysis ServicesDivision of Nephrology Massachusetts General Hospital 55 Fruit Street, GRB 1008DBoston, MA 02114 Phone: 617-726-3706
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