Fellowship Training Program

• Clinical Experience
• Fellow Rotations
• Research
• Teaching Conferences
• On-Call Schedule
• Benefits

Fellowship Training Program Overview

The Fellowship Program in Nephrology and Hypertension at the Cleveland Clinic is a 2-year traditional program that combines excellence in clinical teaching and academic medicine to produce the finest Nephrologists that can enter the practice of their choice after graduation. The Fellowship program is the focal point of the Department of Nephrology and Hypertension that excels in clinical nephrology, transplantation, and research. The strong clinical experience gained during fellowship is a hallmark of Cleveland Clinic training. This sets us apart from many academic centers. Yet, the Cleveland Clinic strives to be on the forefront of research and innovations in medicine, providing a foundation for the ample opportunities to participate in research during the fellowship. In addition, the program utilizes the latest innovations in education and evaluation to assess the educational and clinical progress of its fellows to assure that they will be fully competent Nephrologists on graduation.

The fellowship has recently expanded, now recruiting for 4 fellows per class. An optional third year for research can be arranged for the fellow that shows exceeding promise for a research career during their 2 years of training. The fellowship program is open to those who have completed a three-year internal medicine residency in an ACGME accredited program.

Clinical Experience

The Cleveland Clinic provides comprehensive diagnostic and therapeutic service for patients with renal disease and hypertension. The Department is renowned for its expertise in the areas of renovascular hypertension, primary aldosteronism and pheochromocytoma.

The Department advanced the science of hypertension secondary to renal artery stenosis and this remains an area of active investigation by several department members. The Department has established a Renal Stone Clinic in conjunction with the Department of Urology. This clinic specializes in diagnosing metabolic stone disease as well as prevention of kidney stones. The Department of Urology’s renown in the treatment of kidney stones provides ample volume of patients with complicated and unusual kidney stone disorders.

The Cleveland Clinic is the highest acuity hospital in the U.S. and the large number of ICU patients provides a unique exposure to patients with Acute Kidney Injury and all forms of renal replacement therapy modalities available. There is a robust renal and pancreas transplant program that performs approximately 160 transplants per year. The presence of cardiac, pulmonary, liver, intestine, bone marrow, and face transplantation programs provides great experience into renal complications in those patients. The large inpatient population also provides ample exposure to patients with end stage renal disease.

The outpatient Nephrology experience includes a fully functioning CKD clinic, general Nephrology clinics and specialty clinics in kidney stones and hypertension, among others.

There is a network of outpatient dialysis units as well as an outpatient peritoneal dialysis unit. Fellows have the opportunity to perform Nephrology-related procedures.

• Return to Top

Fellow Rotations

Continuity Clinic

Fellows participate in a weekly continuity clinic throughout the entire 24 months of fellowship. The patients are booked with the fellows, who act as the patient’s Nephrologist. All patient encounters are fully supervised by a member of the teaching staff, including documentation of such supervision in the medical record. There is a core set of teaching staff who are responsible for precepting in clinic. Evaluation tools such as direct observation and process improvement programs help enhance the fellows’ experience.

• Return to Top

Rotations:

Fellow rotations are 4 weeks in duration. There are 13 such “modules” per year.

Below is a sample template of the typical fellow rotation assignment. Because we continually strive to improve our program, these rotations may change year-to-year.

Year One

44 weeks of clinical experience

• 4 weeks clinical orientation
• 12 weeks renal transplant
• 8 weeks consultative Nephrology
• 12 weeks ICU Nephrology
• 4 weeks month in/outpatient dialysis
• 4 weeks outpatient specialty clinic
• 8 weeks research

Year Two

• 24 weeks
  • 4 weeks dialysis team senior fellow
  • 2 weeks dialysis catheter placement
  • 8 weeks consultative, ICU or transplant Nephrology
  • 4 weeks biopsy, ultrasound rotation
  • 2 weeks in/outpatient dialysis
  • 4 weeks outpatient dialysis (Hemo and PD)
• 28 weeks research and elective time

Intensive Care Nephrology

Cleveland Clinic Nephrologists have lead in the development of several techniques for treatment of acute renal failure such as continuous venovenous hemodialysis. Direct exposure to intensive care Nephrology through more than 300 consults per year across nine intensive care settings throughout the Cleveland Clinic Hospital provides fellows with experience in acute Nephrology that is unparalleled.

This purely consultative experience in ICU’s provides fellows exposure to patients with acute renal failure, volume disturbance, fluid/electrolyte and acid/base disorders. Fellows interact with physicians from multiple specialties including surgeons, anesthesiologists and medical intensivists. Much of the experience is related to the remarkably active cardiac surgery services that characterize Cleveland Clinic. To enhance the fellows’ education, the ICU teams have been split between a teaching and non-teaching service to better manage service requirements.

Renal Transplantation Service

The Cleveland Clinic’s kidney transplant program dates to January 1963. Since then, more than 2100 kidney transplants have been performed here. Each year, about 150 kidney transplants are performed at the Clinic. The Transplant Nephrologists work closely with the Transplant surgeons in the pre- and postoperative care of transplant candidates, as well as their long-term follow-up care. In this way, patient care is better coordinated and more seemless. The Clinic participates in a nationwide tissue typing and organ recovery program and also serves as the tissue typing resource for the Northeast Ohio region, offering state-of-the-art technologies such as DNA typing and flow cytometry.

The inpatient renal transplant rotation consists of joint rounds with the Nephrology and Surgical teams on all new or recent kidney transplant patients admitted to the hospital. Patient with kidney dysfunction in the setting of other organ transplantation are also seen in consultation. Fellows are expected to spend time in the immunology lab familiarizing themselves with the different methods of tissue and antibody typing.

Consultative Nephrology

Ward consults to the Nephrology service provide the foundation for general Nephrology knowledge. In addition to acute kidney injury, consults are placed for electrolyte and acid-base disorders, assistance with vasculitis or other auto-immune disorders as well as severe hypertension.

This purely consultative rotation pairs a fellow with a staff, often accompanied by residents and medical students, to care for patients on the general wards who are in need of Nephrologic consultation.

Specialty Clinics

The Department of Nephrology has a wealth of subspecialists in the fields of hypertension, CKD and Nephrolithiasis. This outpatient rotation will give the fellow exposure to these specialties and allow them to gain expertise in treating patients with these problems.

Senior ESRD Fellow

As a second year, the fellow will spend one month rotating through the inpatient primary nephrology service, which typically cares for ESRD patients. The fellow will gain experience managing such a service as a “junior staff” as well as have the opportunity to follow patients to their dialysis-related procedures, such as dialysis catheter placement and dialysis access revisions.

• Return to Top

Research

Fellows are expected to have a protocol submitted to the IRB by the end of their first year. They are expected to have completed a research project by the time they graduate. Fellows are paired up with a research mentor their first year after a line of research has been decided upon. A cadre of Nephrology staff also meet wit the fellows on a monthly basis to track the progress of their work and to give guidance and feedback as needed.

Electives

Fellows may take electives during their second year in areas such as transplant infectious disease, kidney stones or advanced renal transplantation. These electives are tailored to the future career interests of the individual fellow.

• Return to Top

Teaching Conferences

A rigorous curriculum has been developed and continues to be refined to provide fellows with an optimal learning environment, to stimulate active life-long learning and to foster expertise in Nephrology and Hypertension. Conferences focus on a 2-year repeating core curriculum series, weekly case conferences, monthly pathology conference, Grand Rounds, research conference and monthly journal club. Additional conferences include health care finance and research methodology.

• Return to Top

On-call Schedule

Fellows are on-call from home; there is no in-hospital call. Call will be split between ICU and ward services with 2 fellows on call each weekend and one fellow on call at night. Weekend calls are split evenly between all fellows, averaging one weekend per month. Week-night calls are split among the fellows with on average 3 nights on call per month for first-years and 2 nights on call for second years. Weekend rounds are attended and supervised by a member of the teaching staff.

• Return to Top

Benefits

Salary is commensurate with PGL-4/5 training. All fellows receive three weeks of vacation per year. Allowances are available for travel privileges, and other educational activities. For details on other benefits, including health care and insurance, contact the Cleveland Clinic’s Graduate Medical Education office at 216/444-5690.

Meeting Attendance

Attendance is expected at the National Kidney Foundation Annual Meeting for first year fellows and the American Society of Nephrology Annual Meeting for second year fellows. It is expected that fellows will submit an abstract to present at each of these meetings.

• Return to Top

More Information

The Cleveland Clinic Nephrology Fellowship participates in the NRMP matching program. Applications are only accepted through the ERAS electronic application service.

For additional GME information, please visit our Graduate Medical Education website.

For more information about the Nephrology and Hypertension Fellowship Program, please contact:
James F. Simon, M.D.
Cleveland Clinic Department of Nephrology and Hypertension
Desk Q7 9500 Euclid Avenue
Cleveland, OH 44195
Phone: 216.445.4891
Fax:216.444.9378
E-mail: simonj2@ccf.org.