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 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.