Year 1 Rotation Summary
The first year consists of primarily inpatient clinical rotations, with fellows rotating between each primary hospital – Brigham and Women’s Hospital and Massachusetts General Hospital – as well as the Boston VA Healthcare System.
Brigham and Women’s Hospital
Brigham and Women’s Hospital is an 800-bed hospital in the heart of the Longwood Medical Area, home to Harvard Medical School. BWH is world renowned for its clinical and basic investigations into acute kidney injury, as the site of the first kidney transplant, and as the institution that developed the Kolff-Brigham kidney that made it possible to sustain life on dialysis. BWH and its affiliated hospitals serve a diverse patient population including the Mission Hill, Roslindale, Jamaica Plain, and Hyde Park neighborhoods of Boston, and its health centers extend to the southern and western suburbs, down to Foxborough and Gillette Stadium. BWH also benefits from a robust international referral base including cases from all 50 states and internationally from Bermuda to the Middle East and beyond. From bread and butter diabetes and hypertension to the rarest of presentations, fellows at BWH will see it all. The BWH renal services are divided into consult, ICU, dialysis and transplant services. BWH will feature exposure to SLE and autoimmune diseases, extensive onco-nephrology, given the close proximity and formal affiliation with Dana Farber Cancer Institute, as well as complex renal transplant cases and a robust solid organ transplant program including heart and lung transplants as well as ventricular assistive devices. BWH also serves a large outpatient dialysis population, both hemodialysis and peritoneal dialysis, and features a thriving interventional nephrology program managing all aspects of dialysis access.
Massachusetts General Hospital
Massachusetts General Hospital, the oldest and largest teaching hospital of Harvard Medical School, is a 1000-bed hospital situated on the banks of the Charles River and bordering Beacon Hill. MGH houses the largest hospital-based research program in the world, is consistently the top ranked hospital in the Northeast by U.S. News and World Report, and is the only adult hospital in New England to offer all types of transplants currently available. MGH and its affiliated hospitals serve a diverse patient population from nearby Beacon Hill and the North and West Ends of Boston to the North Shore, including Cambridge, Medford, Revere, and Chelsea, with opportunities to impact disadvantaged communities. MGH is similarly divided into four services – consult, ICU, dialysis and transplant. MGH is an international referral center and fellows will see everything, from rare presentations of routine conditions, to the rarest of disorders. MGH fellows will gain extensive exposure to ANCA, anti-GBM and other vasculitides through the world-renowned MGH Vasculitis and Glomerulonephritis Center, as well as extensive experience in renal transplant, especially living donor transplantation, as well as hepatorenal syndrome and renal consequences of liver transplantation. MGH also boasts a world-renowned calcific uremic arteriopathy (“calciphylaxis”) multidisciplinary program. Finally, like BWH, MGH serves a large outpatient hemodialysis and peritoneal dialysis population, and has an extensive access program staffed collaboratively between interventional nephrologists and radiologists.
VA Boston Healthcare System
The VA Boston Healthcare System (VABHS) cares for over 50,000 patients annually. The VA rotation alternates weeks at the West Roxbury VA, home to the inpatient service, and the Jamaica Plain VA, home to the continuity clinics and outpatient dialysis unit. Veterans served by the VABHS present with the full array of renal pathology, and the VA experience also exposes fellows to systems based practice within a closed healthcare system that takes full responsibility for patient care across the care continuum – the original accountable care organization. First year fellows benefit from the one-on-one attention of devoted faculty at the VA, while setting aside time to read and solidify their learning on what is generally a lighter rotation.
First year fellows attend weekly continuity clinics with an assigned preceptor from each primary hospital. Both BWH and MGH offer a mixture of general nephrology and transplant clinic opportunities, as well as sub-specialty clinics such as onco-nephrology or vasculitis clinics to which fellows can be assigned. As second years, fellows often choose to continue in their same continuity clinic at their identified academic home, although fellows can also explore new clinic experiences in second year and beyond.
Overnights at BWH and MGH are covered by a night float fellow Sunday through Friday nights from 8pm-6am. A short call fellow remains in each hospital until 8pm for any late day consults or dialysis needs. Saturdays are “long call” days covered by a first year fellow at each hospital until the next morning.
Night Float duties are covered primarily by second year fellows one week at a time for four weeks each over the course of the year. One night float fellow covers both BWH and MGH with the VA fellow and the attendings on the respective services available in the event of simultaneous needs at both hospitals. First years do one week of Night Float each during first year. There is limited Night Float the weeks of ASN Kidney Week, Thanksgiving, Christmas, New Year’s and the In-Training Exam with most nights those weeks covered as “long call” by an assigned first year fellow each night at each hospital.
First-year fellows have two weeks of electives. This includes a one-week selective focused on interventional nephrology and access management where they evaluate dialysis accesses in access clinic as well as observe and participate in access procedures including temporary and tunneled catheter placements and fistulograms and interventions including thrombectomy, angioplasty, and stenting. Options for the second elective week include: (1) Outpatient and home dialysis; (2) renal pathology; (3) Pediatric nephrology; (4) glomerulonephritis and onco-nephrology; and (5) renal palliative care.
Each fellow has 4 weeks of vacation that can be taken in one- or two-week increments, divided evenly between the two halves of the year. Second and third years have four weeks of vacation per year that they can utilize as they wish, coordinating any time off with their continuity clinic attending and any other clinical duties.
Year 2 Clinical Duties
Second year clinical duties vary slightly by track (Investigation Pathway vs Academic Clinician-Educator (ACE) Pathway). Generally, second year clinical duties are limited, with no formal rotation requirements other than night float, and otherwise include backup or coverage on a limited basis. All second year fellows cover four weeks of night float, as well as four weeks of jeopardy/backup coverage, ten Saturday dialysis sessions, and provide event coverage for 1st year fellows such as ABIM Internal Medicine exams, fellowship retreats, mid-year orientations, the Communication Skills Workshop, and evening events (Welcome Party, Winter Party, Graduation). Second year fellows also have a weekly continuity clinic. ACE Pathway fellows will have additional clinical duties related to their area of clinical expertise and to round out their nephrology clinical and education training.
Year 3 Clinical Opportunities
Third year fellows have no formal clinical duties but have a myriad of options open to them. Most third years opt to continue their continuity clinic experience. Other clinical opportunities can be tailored to fellow interest or area of clinical expertise and can include inpatient rotations, outpatient dialysis experiences, and a wide variety of sub-specialty clinic or procedural opportunities.
Simulation and Procedural Training
Our program includes significant procedural training and exposure, incorporating state-of-the-art simulation training with hands-on experience. Fellows begin the first year with simulation training at the BWH STRATUS Simulation center on both temporary central line placement and renal biopsy. Over the course of the year, fellows will gain ample experience in temporary access placement from their inpatient rotations as well as a deep appreciation for long-term access considerations and management from both formal interventional nephrology instruction and active access management experience. Fellows also learn, and experience, the logistics and troubleshooting of PD through hands-on demonstrations during formal didactics and during dedicated PD clinic sessions. Other opportunities include Point of Care Ultrasound (POCUS) exposure and communication skills training as part of our Communication Skills Workshop with standardized patients.
Our fellows are well prepared for the ABIM Nephrology certification exam. Fellows gain core knowledge through clinical experience as well as through didactics and conferences designed to ensure a well-rounded, broad and deep nephrology education experience. These sessions also include board preparation sessions drawing from ASN KSAP and NephSAP resources. All fellows take the In-Training Examination (ITE) as first and second years, which helps assess their progress and focus their preparation for the ABIM exam as third years. Finally, all fellows receive complimentary enrollment in the BWH Intensive Review of Nephrology Course and can obtain all course materials for a nominal fee. Our program boasts a 94% pass rate, including multiple perfect scores, over the past five years.
Wellness and Extracurriculars
Spending time together outside of the hospital helps build supportive and collegial relationships among fellows. We are happy to sponsor several social events including Welcome and Winter Parties, fellows’ nights out, a fellows’ Red Sox game, Fellowsgiving, and Fellow Appreciation Day. In addition to spending time together over food and fun, our fellows also join together for the ASN Fellow-in-Training (FIT) Bowl at Kidney Week (we are two-time defending champions)! We also enjoy sharing some swag, showing our appreciation for our fellows’ hard work, and keeping them warm for the winter with our gift of monogrammed fleeces for the holidays.
Our program recognizes that Nephrology training can be demanding at times, as we take care of a complex patient population; we are therefore dedicated to ensure the physical and mental well-being of our trainees. Our Wellness Division Leaders (Lea Borgi at BWH and Merranda Logan at MGH) continuously advocate for and share Wellness resources at both institutions; in addition to Program Leadership, they frequently meet with fellows to address and ensure their well-being.
The BWH Center for Faculty Development & Diversity Wellness Program
The MGH Center for Physician Well-Being