Clinical Curriculum
We have adopted a 6+2 block schedule for clinical rotations. Incoming fellows will have 6 weeks of inpatient services followed by 2 weeks of outpatient clinics/electives. This structure allows for greater focus on both inpatient and outpatient responsibilities while helping to maintain work-life balance. 1st year fellows will typically be paired with a 2nd year fellow during their ambulatory block to further support their development during the two years of training.
Inpatient Curriculum
Our training program provides a diverse experience to inpatient nephrology education. After an initial orientation, with dedicated lectures on core topics, fellows will start rotations in one of the inpatient consultative services. Each service, except for VA and Night Float, has an average daily census of 20 patients. Teams are composed of one attending and one nephrology fellow. Critical Care fellows, Internal Medicine residents, Emergency Medicine residents, and medical students will often rotate on inpatient services. Fellows are integral to both patient care and team-based teaching.
General Nephrology Inpatient Consult Services at the University of Maryland Medical Center
General Nephrology services provide a comprehensive, high-volume, high-acuity clinical experience across the full spectrum of inpatient nephrology. We emphasize hands-on teaching, fellow autonomy, and a collaborative learning environment. The General Nephrology Inpatient service is organized into two teams.
Consult 1 covers the Cardiac Care Unit, Neuro-Intensive Care Unit, Intermediate Medical Care, Labor and Delivery, in addition to multiple medical and surgical units, including our Bone Marrow Transplant Unit and Oncology services.
Consult 2 covers the Medical Intensive Care Unit, Cardiac Surgery Intensive Care Unit, Surgical Intensive Care Unit, as well as the famous Shock Trauma Building.
Fellows gain extensive experience in the evaluation and management of acute kidney injury, glomerular diseases, and complex electrolyte abnormalities. The service also provides robust exposure to renal replacement therapies, including CRRT, hemodialysis, and peritoneal dialysis.
Inpatient Transplant
Transplant Nephrology Services provide comprehensive and multidisciplinary care to organ transplant recipients. The average census is approximately 20 patients. The team consists of one fellow and one transplant nephrology attending. Trainees will co-manage newly transplanted individuals with Transplant Surgery and Pharmacy during multi-disciplinary rounds. Transplant Surgery and Internal Medicine serve as the primary admitting services, allowing trainees to focus on medical management of these complex cases as a consultant. They will learn how to manage immunosuppression in new and established transplant recipients in addition to being able to identify and handle the complications associated with transplantation.
VA Medical Center
This service covers the Baltimore Veterans Affairs Medical Center (VAMC). The VAMC is physically attached to the University of Maryland, allowing trainees to walk over from the Nephrology Office. The average census is 10-15 patients. Fellows will see a variety of general nephrology consults, critical care patients, and End-Stage Kidney Disease (ESKD) patients. Fellows also participate in a 2-hour weekly Acute Kidney Injury follow up clinic and a half-day VA continuity clinic during this rotation.
Night Float
To support fellow wellbeing, we use a night float system for after hour consults across the University, VA, and Transplant services. This home call model minimizes overnight responsibility for daytime fellows. The night float fellow covers 6 nights per week (Friday night off), with access to a dedicated call room as needed. Overnight fellows have no daytime duties, allowing time for rest, and benefit from recorded lectures and clear handoffs. Faculty are always available for support. Telemedicine consults are utilized for new VA consults as well.
Outpatient Service
University and VA Continuity Clinic
Fellows will manage their own panel of CKD patients in the outpatient setting. They will see a variety of pathologies including cardiometabolic renal syndrome, Glomerular disorders, electrolytes derangements, nephrolithiasis, and complicated pregnancies. Fellows will also direct advanced CKD care planning for different dialysis modalities, in addition to discussions on conservative care approaches.
- University of Maryland Continuity Clinic: Fellows will have 1 full day clinic per week while on outpatient and elective blocks.
- VA Continuity Clinic: Fellows attend a half day VA continuity clinic during their outpatient block and inpatient VA rotation.
Hemodialysis/Peritoneal Dialysis
Second-year fellows have a weekly dialysis clinic at the Parkview IDF unit on Mondays, during which they manage chronic hemodialysis patients and peritoneal dialysis patients. This is protected time for the fellows so they can focus on their ESKD outpatient experience. Fellows will also have dedicated sessions at one of the Davita Home Dialysis Units for additional PD and Home HD exposure.
Transplant Clinic
Fellows will learn to manage post-transplant recipients in the outpatient setting. They will gain experience managing immunosuppression and assessing for complications that are unique to transplant recipients. Trainees will also have the opportunity to assess pre-transplant individuals and participate in multi-disciplinary discussions regarding candidacy.
Electives
Elective activities include but are not limited to:
Polycystic Kidney Disease (PKD) Clinic
The University of Maryland is home to one of three NIDDK-funded PKD research and Translation Core Centers that provide innovative research resources to a national and international community of investigators. Fellows will rotate through our Polycystic Kidney Disease Subspecialty clinic for an in-depth learning experience. Under the supervision of our world-renowned PKD expert, Dr. Terry Watnick, trainees will see a variety of PKD patients from around the region and learn about different management options for these complex patients.
Glomerulonephritis (GN) Clinic
Fellows will rotate through our Glomerulonephritis Sub-specialty clinic for a more comprehensive approach to complex GN patients. Under the supervision of our GN specialist, Dr. Preeti Chandra, trainees will see a variety of GN pathologies and engage in discussions regarding management options and associated complications.
Toxicology
The University of Maryland is home to the Maryland Poison Center, one of 53 poison centers across the United States. Under the supervision of Dr. Joshua King, Medical Director of the Maryland Poison Center and dual boarded in Nephrology and Toxicology, fellows will have the opportunity to learn about complex toxicology cases and discuss management options including indications for medical management and extracorporeal treatment of poisonings.
Vascular Surgery
Trainees will have an opportunity during their second year of training to round with our vascular surgeon in the outpatient clinic. They will learn to properly assess and manage an AV access including complications such as stenosis, aneurysm, and infection.
Nephrology Point of Care Ultrasound (POCUS) Curriculum
Our POCUS curriculum covers nephrology focus topics including renal, bladder, cardiac and lung ultrasound and volume assessment. The program provides fellows with structured didactic lectures and hands-on bedside training to practice image acquisition and clinical interpretation under direct faculty supervision. Over the two-year fellowship, trainees progress towards independently obtaining and interpreting their own POCUS studies as an integral part of patient care.
Renal Pathology
All native and transplant kidney biopsies are performed in house by our fellows and faculty. We also offer a simulation lab to provide fellows hands-on instructions in renal biopsy techniques. Our experienced in-house renal pathologists partner with the fellowship program, leading interactive case-based renal pathology rounds twice each month.