There are five services utilized in our clinical teaching rotations.  A first year clinical fellow will have approximately 9 of 12 months dedicated to a mixture of these services, while a second year clinical fellow will experience approximately six months of clinical rotations. The remainder of the clinical time is elective time is devoted to electives and research activities that can be tailed to each individual fellow's career goals.  Each of the clinical rotations noted below is staffed by an attending physician who performs teaching rounds daily with the fellow.

Transplant
The Transplant Service is a medical-surgical service that performs a large number of renal transplants. The fellow is part of the medical-surgical team and rounds with the transplant fellow and the attendings on all renal transplant patients.  In addition, the fellow makes rounds with one of the Transplant Nephrologists and is involved with them in Transplant clinics, pretransplant evaluations, and management of medical complications. The fellow is responsible for the dialysis support for transplant patients with primary nonfunction, etc.  Specifics of transplant medicine such as immunosuppression, treatment of rejection and management of opportunistic infections and when and how to perform renal transplant biopsy are emphasized. 

Consults
The Nephrology Consult Service is divided into three services (ART Consult, Acute Consult, and Chronic Consult)  which are a demanding services that sees patients on other services in the hospital with renal disease, renal dysfunction, hypertension or other renal related problems. A wide array of disease states are encountered on these services from acute renal injury to the care of the end stage renal disease patient who may require other services. An attending, a fellow and one or more residents staff the ART and Acute consult service. Exposure to acute hemodialysis and  continuous renal replacement therapies is extensive.  

VA
The VA Nephrology Service is involved in acute inpatient and outpatient services for acute and chronic renal disease and hypertension.  The fellow rounds with an attending at the VA as a consultant and sees all nephrology patients that are admitted to the hospital as well as any new consultations. With the attending physician for that rotation, the fellow at the VA is responsible for running the outpatient dialysis unit associated with the  hospital.  The attending and fellow also provide primary care to the numerous VA patients who have dialysis services provided outside of the VA system. In addition, the attending and the fellow provide primary care for the veterans with renal transplants.

Electives
When not on a clinical service, there are many opportunities for further study. One month of elective time must be spent at the Peritoneal Dialysis unit. Other optional electives that our fellows have enjoyed include Pediatric Nephrology, Interventional Nephrology, Renal Pathology, Plasmapheresis, Radiology and Extended Clinic Months. In addition, time is available for fellows to devote to research projects in which the fellow may be involved.