Program Structure
Division of Nephrology and Hypertension
Fellowship Training Program
An applicant for fellowship may now apply through a two-year clinical research track. The availability of a three-year basic research track depends on the state of NIH funding for the program.
The first fellowship year in either track focuses heavily on clinical training. Toward this end, Georgetown has a strong clinical program in the Division of Nephrology and Hypertension. Our daily inpatient nephrology census has grown to an average of 30 to 45 patients with 30-40% of these patients in the medical and surgical intensive care units including patients with kidney, liver, pancreas, and small bowel transplantation. There are seven outpatient clinics that offer a wide range of nephrology and hypertension patients. In addition, our in-center and home hemodialysis and peritoneal dialysis programs provide full exposure to all forms of renal replacement therapies for ESRD patients. The enlarged clinical program thus provides a rich range of clinical experience for fellowship training.
Our fellows also rotate through the Nephrology Renal Transplant Service at the Washington Hospital Center (WHC) for one (or occasionally two) months. The WHC has the world’s largest acute cardiovascular admitting program, and performs more than 150 renal transplants annually. Although the nephrology training programs at Georgetown and Washington Hospital Center are separate, both hospitals share MedStar Health, Inc. as their corporate parent, and WHC fellows attend weekly scientific and clinical didactic lectures and our monthly renal biopsy conferences.
Program Structure
Fellows
Formative Evaluation
Evaluation procedures are in place to assess and document the clinical and technical competence of the renal fellows. Trainees are evaluated after each rotation by the attending physician or immediate elective supervisor for their comprehensive and specialized medical knowledge and provision of medical care as it relates to the field of Nephrology, including advanced skills in history-taking, physical examination, clinical judgment, management, and their ability to critically analyze clinical situations, make medical decisions and provide consultative advice. Trainees are also evaluated for technical proficiency, communication, humanistic qualities,professional attitudes and behavior, and commitment to scholarship as demonstrated within the clinical setting. This process is accompanied by regular, thorough and meaningful feedback to the trainees about their performance as this is essential to their continuing growth and development as nephrologists. In addition to the evaluation process described below, the Program Director meets with each trainee on a quarterly basis to provide structured feedback on performance, including appropriate counseling and other necessary remedial effort. The formative evaluation process is performed and documented by the following methods:
- Rotation/Elective Evaluations: All fellows are evaluated at the end of each rotation by the attending physician providing immediate supervision. This evaluation is confidential and documented in the ABIM-approved evaluation forms for subspecialties of Internal Medicine. All evaluations are discussed with the trainee and the evaluation forms forwarded to the Program Director for review and filing in the fellows' record.
- Procedure Logbooks: All fellows must keep a procedures logbook in which they document all procedures performed during their training. Procedures to be entered in the logbook include placement of temporary vascular access for hemodialysis, continuous renal replacement and related procedures, and percutaneous biopsy of both autologous and transplanted kidneys. Records should state the name and medical record number of the patient, date and type of procedure, indications and complications,and the name of the supervising physician. Each procedure entered should be verified and signed by the supervising physician. The procedures logbook should be kept up-to-date and forwarded to the Program Director at the end of each year for its review and filing in the fellows' record.
Summative Evaluation - Annual Performance Evaluation
At the end of each academic year the Program Director will review all evaluations for that year with the fellow and prepare a detailed, written evaluation of his/her clinical competence. This evaluation will stipulate the degree to which the resident has mastered each component of clinical competence and has acquired proficiency in each of the various procedural skills identified in the program's curriculum. This evaluation is aimed also at identifying and discussing with the trainee career goals and potential areas of interest for research training.
Faculty and Program
The trainees are given opportunities to evaluate in a systematic manner the educational effectiveness of the program by assessing the quality of the curriculum and the extent to which the educational goals have been met by the fellows. The trainees are provided with a form to evaluate confidentially the faculty and the training program formally in writing annually. The form asks for input on the general knowledge,clinical and/or bedside teaching, professional enthusiasm, knowledge of scientific and medical literature, role as mentor and research knowledge of the faculty member, together with an overall assessment and requests for additional comments relating to how the program could be improved or modified. Additionally, the faculty are evaluated annually by Medical Students, Interns and Residents for their teaching ability. All of these evaluations are received in confidence by the Chief of Nephrology who presents a synopsis of the main findings to the faculty. Divisional faculty meetings are held on a monthly basis. There is regular discussion of the training program at these meetings. The results of such evaluations are used for faculty counseling and for selecting faculty members for specific teaching assignments. The faculty provide input to program planning and development, and their response to the evaluations by the trainees, at the faculty meetings. Additionally, a divisional subcommittee is charged with responsibility for planning the didactic components of the teaching program of the Division and provides input to the faculty at the faculty meetings.
Mechanisms for Remediation
Any serious deficiencies or weaknesses identified during the annual performance evaluation or at any time during the fellowship will require remediation.Specific remediation will be determined by the Program Director and faculty.
Open Door Policy
Fellows are welcome to discuss personal problems, grievances, or request career counseling at any time.
