Welcome to the Clinical Nephrology Training Program at Tufts Medical Center.
This 2-year program is designed to provide fellows with thoughtful and comprehensive training in clinical nephrology. Fellows gain experience in the full spectrum of nephrology care, from acute kidney injury, to chronic kidney disease, and then end-stage renal disease and the transplantation process.
Because we are part of a major academic medical center, we are able to provide fellows with the experience they need to launch a successful career in nephrology. This experience includes developing skills in medical education through our close relationships with the Tufts Medical Center Internal Medicine Residency program and Tufts University School of Medicine.
Another unique facet of our program is the close working relationship our fellows enjoy with our devoted faculty, learning from their clinical, research, and teaching expertise. By using mentorship as a major pillar of the training experience, we are able to ensure that each fellow learns first-hand from some of the nation’s best nephrologists.
Meet our current nephrology fellows >
To prepare our fellows for careers in clinical nephrology, we provide a wide range of clinical activities at Tufts Medical Center and St. Elizabeth's Medical Center (SEMC).
First- and second-year clinical fellows share responsibilities on five rotations:
Consult Service – Fellows spend 3-5 months on this rotation, gaining experience in kidney disease consultations. Highlights include learning how to place internal jugular and femoral venous access catheters, and supervising acute hemodialysis and continuous veno-venous hemofiltration. In addition, fellows perform percutaneous kidney biopsies.
Transplant Service – Fellows spend 3-5 months on this rotation, learning about the special medical needs of patients undergoing kidney transplantation or kidney donation, as well as those requiring immunosuppressive therapy. Because our Division takes part in over 50 transplants per year, fellows are able to participate in all phases of care for these patients. In addition, the transplant fellow performs consults and dialysis on inpatient liver, heart, lung, and bone marrow transplant recipients as requested.
Dialysis Service – Fellows spend 2-4 months on this rotation, providing care for patients on hemodialysis or peritoneal dialysis who are admitted to the hospital. The fellow on this service acts as a liaison between the outpatient and inpatient dialysis care teams.
St. Elizabeth's Medical Center Rotation – Fellows spend 3 months at SEMC, a 350-bed teaching hospital in Brighton, MA. Our fellows rotate at SEMC to gain a broader exposure to nephrology care in the community setting. At SEMC, fellows manage the inpatient Nephrology service, a Nephrology consult service, an outpatient hemodialysis population, and see outpatients in a weekly clinic. Fellows are also responsible for organizing, ordering, and coordinating all dialysis procedures including CVVH, acute hemodialysis, and peritoneal dialysis.
Independent Study Block – This 3-6 month block is designated for supervised learning under a faculty mentor. During this time, fellows can work on research and quality improvement projects, prepare review articles, case reports, or book chapters for publication, or self-arrange electives. These electives can be in pediatric nephrology, ICU nephrology, kidney pathology, transplantation, tissue-typing, or other topics.
Fellows also provide care long-term care for patients in three of our major clinics:
Kidney and Blood Pressure Center – Open since 1950, this center now has one of the busiest outpatient nephrology practices in the area. Fellows develop their own panel of 200-500 nephrology patients in two or three weekly clinic sessions where they are supervised by Division members. Except in unusual circumstances, they will always see the same patients with the same attending during the same time slot. To allow fellows to concentrate on the issues at hand, coverage of inpatient responsibilities is provided during clinic sessions. Support services include two transplant coordinators, two physician assistants, a full-time nurse, and a medical assistant/phlebotomist.
Dialysis Clinic, Inc. – Fellows provide care for a range of hemodialysis patients including high-functioning patients who live in the neighboring community, patients undergoing evaluation for home-hemodialysis and transplantation, and others with complex medical and social needs requiring access to a tertiary care setting. Fellows are assigned as the primary nephrologist (with supervision from staff) to a group of patients who they will in continuity over the course of the year.
Home Dialysis Clinic – Fellows manage a panel of home dialysis patients. Peritoneal dialysis and home hemodialysis patients meet with fellows, faculty, nurses, and support staff monthly in our Somerville facility. Fellows learn the unique features of these treatment modalities by taking responsibility for the dialysis prescription, access care, medications, and acute issues.
In addition to their clinical care experiences, trainees participate in a number of conferences that provide training in didactic review of pathologic and pathophysiologic principles, literature review, laboratory and research theory, and decision-making in complicated and difficult cases. Ethical, medico-legal, cost containment, and quality assurance issues are discussed both during clinical rounds and at clinical conferences.
The Division of Nephrology Fellowship Program conference schedule includes:
Held Tuesday mornings at 8:30 a.m., faculty prepare reviews on pathophysiology, disease states, management issues, and scientific background of Nephrology.
Research Conference is held every Wednesday at 4:00 p.m. to discuss research methodology, scientific approach, and study design. Faculty, fellows, and visiting professors present their recent work.
Held every Thursday at 8:30 a.m. to discuss the recent literature in a critical manner, faculty and fellow present articles of importance.
Harrington Rounds are the Division’s clinical conference held Friday at 2:00 p.m. to discuss the pathophysiologic, pathologic, ethical, and medical decision-making issues involved with challenging and complicated cases. Cases are selected, presented, and reviewed by clinical fellows on a rotating basis.
Pathology Conference is held every other month on Friday at 2:00 p.m. to review all kidney biopsies. Fellows provide a clinical overview of each case, with our renal pathologist explaining the histologic features.
Morbidity and Mortality Conference
Five times each year, clinical fellows will explore a quality improvement issue within our practice during a Morbidity and Mortality Conference. Fellows will either choose or be assigned a topic of patient care to review. A discussion about quality improvement follows.
Held every Wednesday at 8:00 a.m., Transplant Rounds is an opportunity to review transplant recipient and donor candidacy, discuss challenging transplant issues, and revise transplant protocols and policy.
Access Rounds is held every Thursday at 12:00 p.m. to review hemodialysis access issues in a multidisciplinary setting with Transplant Surgery and Interventional Radiology.
Every Friday at 9:30 a.m., DCI Rounds reviews hospitalized and recently discharged dialysis patients with a goal of coordinating inpatient and outpatient medical and nursing care. Additional topics of quality care in outpatient hemodialysis and peritoneal dialysis are discussed with a team of physicians, nurses, social workers, pharmacists, and dieticians.
Applications for our Fellowship Training Programs are processed by ERAS. Prospective applicants should visit http://www.aamc.org/eras to register. We strongly suggest all application material be submitted by July 1 to allow for prompt consideration. Deserving applicants will be invited for interviews between September and November, with positions offered in December through the match. Applicants interested in immediate openings for clinical-research positions should contact the program directly.
Scott J. Gilbert, MD
William B. Schwartz Division of Nephrology
Tufts Medical Center
800 Washington Street, #391
Boston, MA 02111