Customizing Your Nephrology Education

Training is provided through extensive clinical, research and teaching opportunities. The body of knowledge relating to basic and clinical nephrology is a rapidly evolving and expanding subspecialty. The curriculum is based on the ACGME's core competencies which are patient care, medical knowledge, practice-based learning and improvement, interpersonal and communication skills, professionalism, and systems-based practice. Using extensive clinical material and conferences, fellows are trained to be experts in their field. The full curriculum is available upon request.

All nephrology teaching conferences at Yale are mandatory for all fellows, as we believe that nephrology is best taught through a combination of clinical practice and formal didactics. These didactic talks work through a two-year curriculum to insure that fellows have had an opportunity to learn about all the core topics in nephrology from experts in the field. In the summer, there is a crash course in clinical emergencies in nephrology and core physiology teaching sessions given by leaders in the field. Throughout the remainder of the year, we work through a two-year curriculum to ensure all topics are covered in a variety of formats.

A more thorough list of conferences is available if requested.

• Tuesday Afternoon Dialysis Conference Series: An informal lecture by core clinical faculty covering a full curriculum of ESRD subject matter. Also included in this series are some case based conferences.
• Friday Morning Renal Grand Rounds: Presentation by faculty and fellows on a variety of topics.
• Friday Noon Conference: This conference has a core summer conference series on electrolytes and acid base. Once this has been completed, this conference includes “Research in Progress” talked by faculty and fellows as well as a journal club series.
• Fellows Physiology Series (once per month): A fellow organized series where second year fellows divide up the core physiology topics and work with a faculty mentor to teach them to each other in an informal interactive conference.
• Fellows Pathology Slide Review (once per month): Fellows review Kidney Biopsy cases with select faculty and each other on a multi-headed scope.
• VA Case Conference Series (once per month): Informal case based conference series run by the VA faculty where a case is presented and then discussed around a table.

The Yale Nephrology fellowship offers individualized learning pathways for clinical track fellows who have an interest in pursuing more focused sub-subspecialty training in their fellowship.

The pathways are for fellows that have a particular career interest, and are not required for those wishing to undergo a more holistic general nephrology fellowship program.

Applications for these pathways will be completed at the end of the first year and are contingent on a positive review from the competency committee that the individual is performing ahead of scheduled milestones and can give up some general nephrology training for a more focused second year.

If you are a fellow who prefers more general training, you may want to participate in some parts of these pathways but may not want to participate in all the aspects of a particular pathway.

Please note, as a nephrology fellow, you will work with the program director and associate program director to design a second year that best meets your career trajectory goals, but some (such as those below) have more focus.

Each individualized learning pathway will have a track director. General clinical and academic experiences are designed to more comprehensively educate fellows in a particular area. Areas of interest not listed below will be designed and worked out on an individual basis with program leadership.

We have a large home dialysis program that all fellows will participate in. However, as an interested fellow in this pathway, you will expand your skill set and work with the primary mentors to become comfortable with the initiation and management of home dialysis modalities. You will have the option to join a nephrologist at the home dialysis clinic and participate in conferences and other academic projects.

Potential opportunities in this pathway include:

• Attend peritoneal dialysis monthly visits and home hemodialysis monthly visits in their second year
• Participate in the monthly PD consortium
• Participate in modality choice discussions with our multi-disciplinary team in the home dialysis clinic
• Shadow a biomedical engineer in the dialysis unit to learn about the water preparation process
• Go on home nursing visits to appreciate the safety assessment and trouble shoot issues that patients encounter every day
• Be involved in a quality improvement/research project related to dialysis
• Learn the responsibilities of a dialysis medical director of a home unit

As a fellow in this pathway, you will work with the primary mentors to become comfortable with the workup and management of complex hypertensive disorders. You will have options to attend clinics and do academic projects along the disease spectrum.

Examples of potential experiences in this pathway include:

• Dedicated renal hypertension clinic participation in the second year
• Participating in clinics such as endocrinology or cardiology, where other complex hypertension patients may be seen
• Participation in the monthly hypertension conferences and help in case selection and preparation
• Participation in ongoing hypertension quality improvement/research projects with academic faculty
• Potentially attain hypertension specialist certification

Primary Mentors

Dr. Jeffrey Turner and Dr. Aldo Peixoto

As a participant in this pathway, you will work with primary mentors among others to develop their own comfort with genetic diagnosis, counselling and management of patients with inherited kidney disease. Yale is a Center of Excellence for Polycystic Kidney Disease, and through those collaborations can offer a rich experience. You will learn about genetic testing modalities, genetic variant interpretation, and learn how to convey this information to patients and their families.

Examples of potential experiences in this pathway include:

• Weekly inherited kidney disease session with a primary mentor
• Monthly 1:1 teaching sessions with a primary mentor to learn about genetic analysis
• Opportunities to learn the role of a clinical geneticist, finding pathogenic mutations from whole-exome sequencing data in ADPKD patients as part of research studies
• Shadow APRN’s who run an advanced CKD management clinic for those with stage 5 CKD
• Learn about family planning and neurological complications as part of our Center of Excellence
• Participate in ADPKD Patient and Family Advisory Council
• Be involved with quality improvement or research projects in the field

Primary Mentors

Dr. Maryam Gondal and Dr. Whitney Besse

As a pathway fellow interested in sub-specialization in onconephrology, you will work alongside the primary mentor to care for patients with cancer who are high risk for kidney disease in various forms as acute kidney injury, chronic kidney disease, proteinuria, or hypertension. This track sees to provide targeted didactics and clinical experience that will allow confident kidney care of the patient with cancer.

Examples of potential experiences in this pathway include:

• Weekly clinics with the mentor
• Learn from the laboratory medicine faculty about the nuances of paraprotein detection by serum and urine testing
• Spend time with renal pathologists to learn the biopsy findings in patients with cancer
• Attending oncology tumor board to understand treatment option for patients with different malignancies and to understand how kidney disease affects those strategies
• Participate in quality improvement/research projects with mentors in onconephrology
• Become a member of the American Society of OncoNephrology and participate in writing of academic papers with a faculty mentor

Primary Mentors

Dr. Anushree Shirali

This track is designed to help prepare you for a career as a clinician educator. It will focus on excellence in clinical care, and on expanding your comfort level with education and the basics of research that clinicians undertake in academic settings.

Examples of potential experiences in this pathway include:

• Rotate through various sub-specialty clinics with our clinician educators and spend increased time in the home dialysis clinic to develop real expertise in this area
• Participate in the quarterly nephrology M&M conferences to gain experience in case selection and quality improvement methods
• Work to coordinate the Rastegar Physiology teaching conference with primary mentor
• May participate in the FAME (Fellows as Medical Educators) program, a multidisciplinary year-long course in the Department of Medicine where advanced sub-specialty fellows work as a group to explore learning theory, teaching skills, and curriculum development to prepare for careers as clinician educators
• Explore research and training options within the school of public health, and expand their abilities to use software to perform statistical analysis

Primary Mentors

Dr. Namrata Krishnan

Kidney disease crosses all political and geographic boundaries in the world. At Yale Nephrology, we view the critical role we all have to play in expanding the care we are so fortunate to have here at home, around the world to those patients with noncommunicable diseases, such as chronic kidney disease, and hypertension.

We have a long history of training international fellows, through our clinical fellowship program, or as partners with the International Society of Nephrology fellowship programs, and we are pleased to offer this experience as part of your traditional fellowship training as well.

By partnering with the Office of Global Health, we have developed a partnership within nephrology with Makerere University located in Kampala, Uganda.

With the help of the Yale/Stanford Global Health Scholars Program, fellows interested in pursuing a career in Global Health within Nephrology can complete a 6-week Global Health rotation during their second year of Nephrology fellowship.

As a fellow in this program, you will be both a learner and colleague, will provide care to patients with kidney disease, and will learn about the challenges in under-resources communities. You will also will act as educators for the residents and physicians on site, frequently running teaching sessions and attending conferences.

More information about this selective program is available on interview day for those with a specific interest in Global Health as a career path.