The Department of Internal Medicine’s Section of Nephrology has partnered with the Palliative Care Program to develop and launch a combined Nephrology and Hospice & Palliative Medicine (HPM) fellowship program through the Accreditation Council for Graduate Medical Education’s (ACGME) Advancing Innovation in Residency Education (AIRE) program.
When in fall 2019, the ACGME announced the call for AIRE proposals, Nephrology Fellowship Program Director Ursula C. Brewster, MD, associate professor of medicine (nephrology) and Hospice and Palliative Medicine Fellowship Director Laura J. Morrison, MD, FAAHPM, FACP, associate professor of medicine (geriatrics) jumped at the chance to submit the program.
“The conversation started at the Nephrology Program Director level at one of our national meetings. What could we do? How could we be creative and augment the education in our field?” explained Brewster. “We saw the need for this training and decided to try it.”
The combined fellowship will lead to ABIM board eligibility in both nephrology and HPM. This innovative program will condense the time commitment required for the two programs from three years to two years and integrate the fellowships to train skillful nephrologists who can address the enormous need for palliative care in the practice of nephrology, and hospice and palliative medicine specialists who possess expertise in kidney supportive care.
“We've identified subpopulations of patients who may specifically benefit; there's a pretty large group of older patients with declining kidney function, who may or may not be eligible for or wish to pursue dialysis. We want to optimize the support around symptoms, psychosocial and spiritual care, and decision making that may arise. Patients already on dialysis also may have unmet needs for additional support around symptom management and other domains like advance care planning, specifically decisions around how their dialysis regimen may be able to shift or be discontinued in line with their goals as they near the end of life,” said Morrison. “It's about doing our best to align patient values and goals with the treatment options available.”
“To have formal training and a skill set in end-of-life conversations would be a benefit of this program, and would be highly utilized both in the outpatient chronic setting and the inpatient setting. Our fellows are always stunned with just how sick everybody is that they're taking care of across all the ICUs in the hospital. To learn the skillset of a palliative care doctor combined with a nephrologist goes very well hand-in-hand,” added Brewster.
Fellows accepted to the program will spend most of their first year on nephrology services and the majority of their second year on HPM rotations, with some variability between sites. Fellows will participate in teaching conferences for both Nephrology and HPM programs over the two-year training period. The potential for innovation in creating collaborative clinical, educational, and scholarly opportunities is one of the exciting aspects of this AIRE initiative.
Ideal candidates to the program will be highly qualified PGY-3 Internal Medicine residents in ACGME-accredited residency programs (PGY-4 if doing a Chief Resident year), or be board certified by the ABIM within three years of graduation. Candidates interested in academic careers at the intersection of nephrology and HPM clinical care, education, and research are best suited to this rigorous combined training experience.
Each participating institution is recruiting one fellow into this program during the current application cycle to start training in July 2021. Candidates should submit materials through the ERAS, and a special track in the NRMP match within the nephrology programs at each site will be used for application to the program.
In addition to YSM, the new fellowship is offered at the University of Pennsylvania and the University of North Carolina.
Interested candidates should contact any one of the programs directors for additional information.
- Yale
- Ursula Brewster (Nephrology)
- Laura Morrison (HPM)
- University of Pennsylvania
- Amanda Leonberg-Yoo (Nephrology)
- Laura Dingfield (HPM)
- University of North Carolina
- Koyal Jain (Nephrology)
- Gary Winzelberg (HPM)
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