Clinical Training

Clinical training in nephrology and hypertension is based primarily at the 875-bed Yale-New Haven Hospital, which is located adjacent to the medical school, and the 522-bed Department of Veterans Affairs Medical Center (VAMC), which is located two miles away in West Haven. During the first year of clinical training, each fellow spends three months on the inpatient renal consultation service, three months on the inpatient end-stage renal disease (ESRD) service, three months on the VAMC nephrology service, and three months on the renal transplantation service.

While on the inpatient renal consultation service, fellows participate in the diagnosis and management of patients with fluid and electrolyte disturbances, acute and chronic renal failure, glomerulonephritis, interstitial nephritis, nephrolithiasis, complicated hypertension, intoxications, and related disorders. Fellows also gain experience with percutaneous renal biopsy under both CT and ultrasound guidance. Time spent on the ESRD service provides fellow training on all aspects of dialysis (hemodialysis and peritoneal dialysis), anemia management, treatment of renal osteodystrophy, evaluation and maintenance of vascular access for dialysis (AVFs, AVGs, and catheters). On the renal transplantation service, fellows are part of an interdisciplinary team that provides acute perioperative and long-term care for patients receiving renal allografts. Clinical faculty of the Section of Nephrology serve as attending physicians and conduct daily teaching rounds which provide instruction in the scientific disciplines that underlie the clinical practice of nephrology as well as supervision in practical aspects of patient care. During this time fellows receive extensive training in acute renal replacement therapies including peritoneal dialysis, hemodialysis and hemofiltration (CVVH, CVVHD, and SCUF). Placement of percutaneous dialysis catheters is also an important part of nephrology training at Yale.

Clinical fellows participate in the longitudinal care of patients with end-stage renal disease at Yale and VA outpatient dialysis centers. Fellows are assigned a small cohort of patients to follow under the supervision of one of the ESRD attending physicians. Fellows gain experience with chronic maintenance hemodialysis, CAPD, and automated peritoneal dialysis (APD). Fellows who elect a second year of clinical training will continue to follow their patients through the second year. They will also participate in our various ambulatory clinics, including the Peritoneal Dialysis clinic, the hypertension clinic, and the renal genetics program.

In view of the increasing importance of the practice of medicine in the outpatient setting, each clinical fellow spends one half-day per week in a renal consultation clinic for a total of two years. The clinics are based at Yale and the VAMC. The clinic is organized to afford fellows the opportunity of following patients longitudinally over the course of the year. This provides experience in the evaluation of common renal disorders not initially requiring hospitalization (proteinuria, hematuria, mild azotemia, nephrolithiasis, cystic kidney disease) and long-term follow-up of patients after discharge. Fellows also attend the Yale renal transplantation clinic two mornings per week during their time on the inpatient transplant service and may elect to attend these and other clinics, particularly the hypertension clinic, in the second year.

Didactic teaching conferences are a critical component of any nephrology training program. Renal Grand Rounds are held weekly and are attended by all trainees and faculty. This conference provides a forum to discuss interesting diagnostic and management problems, CPC cases, faculty research, and to review the literature on timely or controversial issues. Additional teaching conferences include a fellow's journal club and a comprehensive renal pathophysiology course that occurs weekly. A year long course that covers the theoretical and practical aspects of ESRD and transplantation is given on a weekly basis. Finally, a monthly renal pathology conference exists to instruct fellows on renal histopathology.