Division of Nephrology Fellowship Program Guide

2017-2018

University of Utah Nephrology Fellowship Program

Introduction ...............................................................................................................................3

FellowSelectionPolicy/Process .......................................................................................................3

NephrologyFellowshipProgramTrainingSites..........................................................................................4

InpatientSites...........................................................................................................................................4

OutpatientSites........................................................................................................................................4

NephrologyTrainingProgramSchedule.....................................................................................................5

DivisionofNephrologyFacultyMembers ........................................................................................8

NephrologyClinicalTrainingProgramCurriculum....................................................................................11

ClinicalCurriculumIntroduction..............................................................................................................11

Corecompetencies..................................................................................................................................11

Progressiveobjectives.............................................................................................................................14

NephrologyResearchTrainingProgram...................................................................................................15

Clinicalresearchcurriculumaspartof2-yearclinicalfellowship..............................................................15

Researchfellowshipcurriculumforfellowson3-yearresearchfellowship...............................................16

ScheduleA.Trainingprograminclinicalresearchcurriculum...................................................................17

ScheduleB. Basicresearchcorecourses..................................................................................................20

GuidelinesforPromotionandGraduation...............................................................................................21

NephrologyFellowshipWork,DutyHours,MoonlightingandOn-CallPolicy............................................22

NephrologyFellowStipendandBenefits.................................................................................................23

NephrologyFellows:Currentandgraduatesinprevioustenyears...........................................................25

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Introduction (RETURN TO TABLE OF CONTENTS) The University of Utah Nephrology Fellowship Program is dedicated to providing the highest quality clinical and research training in the subspecialty of Nephrology. It is accredited by the Graduate Medical Education Committee of the University of Utah and by the Residency Review Committee of the ACGME. There are two programs:

1) The two-year Clinical Program - based at the University Hospital, Huntsman Cancer Hospital and the Salt Lake Veterans Affairs Medical Center. Upon completion, Fellows are board eligible in Nephrology. This program provides primarily clinical training; however, in addition to excellent clinical training, the University of Utah Nephrology Clinical Fellowship Program is designed to provide experience in clinical research. Fellows m a y o p t t o p a r t i c i p a t e i n e i t h e r on-going faculty clinical research projects o r develop related research interests of their own.

2) The three-year Research Program - involves one year of clinical training and two years of basic or clinical research. The clinical year may be done at the beginning or the end of the fellowship and is structured identically to the clinical experience of a year in the two-year clinical fellowship. The two years of research are spent under the direction of a faculty member within the Division of Nephrology.

This guide provides comprehensive information about all aspects of the Program, including:

¨ Goals and objectives ¨ Nature of sites where training is performed ¨ Types of clinical encounters ¨ Patient case-mix characteristics ¨ Procedures and services ¨ Educational activities and resources, including didactic training and conferences ¨ Nature of supervision and evaluation of fellow’s performance ¨ Faculty research activities ¨ Fellow research opportunities and policies ¨ On-call and vacation policies ¨ Former Fellow information ¨ Fellow selection policy

Fellow Selection Policy/Process (RETURN TO TABLE OF CONTENTS) To be eligible for a fellowship in the Division of Nephrology at the University of Utah School of Medicine, an applicant must:

1. Be a graduate of a U.S. or Canadian medical school accredited by the Liaison Committee on Medical Education (LCME) and have 3-years residency in an ACGME-approved program, OR

2. Be a graduate of a college of osteopathic medicine in the United States accredited by the American Osteopathic Association (AOA) and have 3-years residency in an ACGME-approved program, OR

3. Be a graduate of a medical school outside of the United States who meets one or more of the following qualifications:

4. Has a currently valid ECFMG certificate plus at least one year training in an ACGME approved program, OR

5. Has a full and unrestricted license to practice medicine in a US licensing jurisdiction plus at least one year training in an ACGME-approved program, OR

6. Is a graduate of a medical school outside the United States who has completed a Fifth Pathway program provided by an LCME-accredited medical school.

a. Be eligible for American Board of Internal Medicine prior to the time they begin training

The Division of Nephrology requires the following documentation for application: 1. Completed fellowship application through ERAS 2. Curriculum Vitae and Personal Statement through ERAS 3. Three letters of recommendation through ERAS 4. International Medical Graduates must include the following in addition to the above:

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a. Copy of green card, visa (J-1), or documentation of U.S. citizenship b. Valid ECFMG certificate with Clinical Skills Assessment certification c. Evidence of previous training in the United States

Selection Criteria for Interviewing Applicants The Nephrology faculty, in a joint meeting, reviews applicants who meet the criteria. Based on the quality of the application and academic credentials, the applicant is subsequently invited for an interview. On the interview day, applicants receive an information packet and interview with members of the Division of Nephrology and current Nephrology fellows. At the conclusion of the interview, the interviewers complete a standard evaluation form for each applicant they interviewed. The results are tallied and form the basis of the preliminary rank order. The University of Utah Nephrology program participates in the National Residency Matching Program (NRMP, aka “the Match”) for all entering fellows. We do not offer out-of-match positions.

Nephrology Fellowship Program Training Sites (RETURN TO TABLE OF CONTENTS) Inpatient Sites

1. University Hospital (UH) - This is a tertiary care facility with 528 operating beds located on the University of Utah Health Sciences Center Campus. It contains surgical, neurosurgical, burn, and medical intensive care units; a newly remodeled 5-station acute dialysis unit with support for hemodialysis, peritoneal dialysis, therapeutic apheresis and continuous renal replacement therapies; radiologic services with modern renal-related procedures and diagnostic vascular and radionucleotide imaging; electron microscopy for renal biopsy material; biochemical and serologic laboratories; a nutrition support service; and relevant social services. A close working relationship exists with other services including surgery, urology, obstetrics, gynecology, neurology, cardiology, rheumatology, pediatrics and psychiatry.

2. Salt Lake Veterans Affairs Medical Center (VAMC) – This is a tertiary care facility with 121 operating beds located adjacent to the University of Utah Lower Campus and approximately one-half mile from University Hospital. It contains surgical and medical intensive care units, a 10-station newly remodeled dialysis unit that performs acute and chronic hemodialysis and supports continuous renal replacement therapies and peritoneal dialysis, radiologic services with modern renal-related procedures and diagnostic vascular and radionucleotide imaging, electron microscopy for renal biopsy material, biochemical and serologic laboratories, a nutrition support service, and relevant social services. A close working relationship exists with other services including surgery, urology and psychiatry.

3. Huntsman Cancer Institute (HCI) – This tertiary care facility has been designated as a Comprehensive Cancer Center by the National Cancer Institute and is among the top cancer centers in the world. A close working relationship and collaboration exists with the hematology/ oncology services.

Outpatient Sites

1. University Hospital Renal Clinic – Located on the A level of the University Hospital, this 11-room clinic is the site for all general nephrology, nephrolithiasis, post-transplant and pre-transplant patients associated with the University of Utah.

2. University of Utah Peritoneal Dialysis Clinic – Located in Research Park 3. VAMC General Nephrology Clinic – Located on the 4th floor of Building 1 (main hospital

building) at the VAMC, this clinic is the site of ambulatory care for VA general nephrology, pre- and post-transplant patients.

4. VAMC Dialysis Clinic – Located within the dialysis unit, this clinic is the site of outpatient follow-up of VA hemodialysis, peritoneal dialysis and post-transplant patients.

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Nephrology Training Program Schedule (RETURN TO TABLE OF CONTENTS) The two-year clinical fellowship and the one clinical year of the research fellowship are comprised of four major rotations that cycle throughout the year. The following schedules are based on the Program’s current policy of having four fellows (A through D below) doing clinical service together. Yearly schedule for fellows on clinical service (only 1 year for research fellows) Year 1 (1 block = 4 weeks) U=University Hospital; VA=VA Hospital; OP=Outpatient; TP=Transplant

Block 1 2 3 4 5 6 7 8 9 10 11 12 13 U A B C D A B C D A B C D A VA B C D A B C D A B C D A B OP C D A B C D A B C D A B C TP D A B C D A B C D A B C D

Year 2 (1 block = 4 weeks) U=University Hospital; VA=VA Hospital; OP=Outpatient; TP=Transplant

Block 1 2 3 4 5 6 7 8 9 10 11 12 13 U A B C D A B C D A B C D A VA B C D A B C D A B C D A B OP C D A B C D A B C D A B C TP D A B C D A B C D A B C D

University Hospital (3 months yearly)

Monday Tuesday Wednesday Thursday Friday 8 AM General

Nephrology continuity clinic at U of U (Fellow Group A)

Ward duties (All day)

Ward duties (All day)

General Nephrology continuity clinic at U of U (Fellow Group B)

Ward duties 9 AM 10 AM 11 AM Didactics

(11:30 -12:30) Noon Ward duties Signout

(12:30-1:00) 1 PM Pathology

conference (1:00-2:00)

2 PM 3 PM 4 PM Clinical

conference 5 PM Research

conference VA Hospital (3 months yearly)

Monday Tuesday Wednesday Thursday Friday 8 AM General

Nephrology HD Rounds/ Ward duties

HD Rounds/ Ward duties

General Nephrology

Ward duties 9 AM

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10 AM continuity clinic at U of U (Fellow Group A)

continuity clinic at U of U (Fellow Group B)

11 AM Didactics (11:30 -12:30)

Noon Signout (12:30-1:00)

1 PM HD Rounds/ Ward duties

VA Nephrology Consult clinic (12:30 pm)

HD Rounds/ Ward duties

Pathology conference (1:00-2:00)

2 PM 3 PM 4 PM Clinical

conference 5 PM Research

conference Outpatient nephrology and research (3 months yearly)

Monday Tuesday Wednesday Thursday Friday 8 AM General

Nephrology continuity clinic at U of U (Fellow Group A)

Research/ QIP

General Nephrology continuity clinic at U of U (Fellow Group B)

U of U GN clinic 9 AM VA PD Clinic

or Transplant Clinic

10 AM 11 AM

Noon Research /QIP VA Nephrology follow-up clinic (Starts at 12:30 pm)

Research/QIP Research Didactics (11:30 -12:30)

1 PM Signout (12:30-1:00)

2 PM Pathology conference (1:00-2:00)

3 PM 4 PM Clinical

conference 5 PM Research

conference

Transplant nephrology at University Hospital (3 months yearly) Monday Tuesday Wednesday Thursday Friday 8 AM General

Nephrology continuity clinic at U of U (Fellow Group A)

Post-transplant GN clinic

Pre-transplant clinic

General Nephrology continuity clinic at U of U (Fellow Group B)

Inpatient transplant 9 AM

10 AM 11 AM Didactics

(11:30 -12:30)

Noon Inpatient transplant

Inpatient transplant

Inpatient transplant

Inpatient transplant

Signout (12:30-1:00)

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1 PM Pathology conference (1:00-2:00)

2 PM 3 PM 4 PM Clinical

conference 5 PM Research

conference

Division of Nephrology Faculty Members (RETURN TO TABLE OF CONTENTS)

Name Interests Jo Abraham, MD, MPH Clinical trials in hypertension Clinical Assistant Professor glomerulonephritis and CKD Director, Nephrology Fellowship Program Adhish Agarwal, MD Clinical care & Outcomes Research Assistant Professor Faris Ahmed, MD, FASN Clinical transplant nephrology Clinical Assistant Professor Laith Al-Rabadi, MD Glomerular Diseases, Clinical care Clinical Assistant Professor Clinical transplant nephrology Srinivasan Beddhu, MD Randomized trials and epidemiology Professor of CKD and dialysis patients Alfred K. Cheung, MD Clinical trials in CKD, dialysis and

Professor Professor hypertension; vascular access basic science lab Chief, Division of Nephrology Epidemiology in CKD and dialysis Monique E. Cho, MD Metabolic and cardiac complications of CKD Assistant Professor Martin C. Gregory, MD, PhD. Alport Syndrome Clinical Professor Isaac Hall, MD Kidney transplant predictors & outcomes Assistant Professor Acute kidney injury Yufeng Huang, MD, PhD. Pathogenesis of diabetic nephropathy Research Associate Professor and kidney fibrosis Bellamkonda Kishore, MD, PhD. Purinergic regulation of renal function, Research Professor pathology and experimental therapies Donald E. Kohan, MD, PhD. Hypertension, Renal physiology, Ion transport Professor Polycystic kidney disease Man Li, PhD. Genetic epidemiology of Assistant Professor kidney function and CKD

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Marcus Pezzolesi, PhD, MPH Diabetic nephropathy, genetics, Assistant Professor kidney disease Nirupama Ramkumar, MD, MPH Renin angiotensin system, hypertension, Assistant Professor Ion transport, renal physiology Aylin Rodan, MD, PhD Ion Transport, Renal Physiology, Assistant Professor Potassium Homeostasis Kalani Raphael, MD, MS Chronic kidney disease outcomes Associate Professor Acidosis and CKD progression Fuad Shihab, MD Chronic cyclosporine nephropathy Clinical Professor Renal transplantation outcomes Biomarkers in kidney transplants Yan-Ting Shiu, PhD. Biophysics of vascular access stenosis Research Associate Professor Ets-1 in vascular biology Christi Terry, PhD. Adipokines in the vasculature Research Associate Professor Vascular access stenosis and development Christof Westenfelder, MD Stem cells in acute kidney injury Professor Renal actions of erythropoietin Chief, Renal Section VA Salt Lake City Healthcare System Tianxin Yang, MD, PhD. PPAR gamma, obesity, clock genes Professor Collecting duct signaling Off-campus faculty Marcellus Assiago, MD Clinical care in Southern Utah Clinical Assistant Professor Terrence Bjordahl, MD Clinical care in Salt Lake City Clinical Assistant Professor Yaw Boateng, MD, PhD Clinical care in Southern Utah Clinical Assistant Professor

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Scott Eppich, MD Clinical care in Utah County Staff Physician Nasimul Ghani, MD Clinical care in Idaho Falls, ID Staff Physician Arsalan Habib, MD Clinical care in Salt Lake City Clinical Assistant Professor Associate director, Off campus operations Bruce Horowitz, MD Clinical care in Northern Utah and VA Clinical Professor Siddhartha Kakani, MD, MHA Clinical care in Utah County Staff Physician Andrea Nelson, MD Clinical care in Salt Lake City Clinical Instructor Abinash Roy, MD Clinical care in St. George, UT Clinical Associate Professor Harry Senekjian, MD Clinical care in Northern Utah Clinical Assistant Professor Girish Singhania, MD Clinical care in Northern Utah Clinical Assistant Professor Robert Yenchek, MD Clinical care in Salt Lake City Clinical Assistant Professor Tahir Zaman, MD Clinical care in Salt Lake City Clinical Instructor

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Nephrology Clinical Training Program Curriculum (RETURN TO TABLE OF CONTENTS) Clinical Curriculum Introduction

The Nephrology Fellowship Clinical Training Program is designed to provide individuals with the opportunity to achieve the fundamental knowledge, procedural skills, practical experience, and professional and ethical behavior necessary for the subspecialty of Nephrology. Fellows care for patients with the full spectrum of renal disorders at all stages of the disease process. Efforts are made at every point to emphasize the integration of fundamental medical knowledge, disease prevention, social, psychological, and economic issues. This section describes the clinical curriculum. The first part presents an outline of the Clinical Program goals and objectives. Subsequently, the full clinical curriculum is described, relating Clinical Program goals and objectives to the manner in which they are achieved. Overview of Clinical Program Goals and Objectives The Nephrology Fellowship Clinical Training Program is structured around goals and objectives derived from three major sources:

• ACGME Core Competencies; • ACGME subspecialty requirements for Nephrology training programs • additional input derived from University of Utah Nephrology faculty

These various components are combined to achieve an integrated set of goals and objectives that cover all aspects of the training program. In this first section, an overview of the training program’s goals and objectives is presented, broken down by the six core competencies and then the specific Nephrology areas. This should be reviewed so that Fellows understand each of these components. The following section, devoted to the detailed curriculum, then combines the core competencies and specific nephrology issues into an integrated and comprehensive set of goals and objectives. Core competencies 1. Patient care - Fellows must be able to provide patient care that is compassionate, appropriate, and

effective for the treatment of health problems and the promotion of health. Fellows are expected to:

a. communicate effectively and demonstrate caring and respectful behaviors when interacting with patients and their families

b. gather essential and accurate information about their patients c. make informed decisions about diagnostic and therapeutic interventions based on patient

information and preferences, up-to-date scientific evidence, and clinical judgment d. develop and carry out patient management plans e. counsel and educate patients and their families f. use information technology to support patient care decisions and patient education g. perform competently all medical and invasive procedures considered essential for the area of

practice h. provide health care services aimed at preventing health problems or maintaining health i. work with health care professionals, including those from other disciplines, to provide patient-

focused care 2. Medical knowledge - Fellows must demonstrate knowledge about established and evolving

biomedical, clinical, and cognate (e.g. epidemiological and social-behavioral) sciences and the application of this knowledge to patient care. Fellows are expected to:

a. demonstrate an investigatory and analytic thinking approach to clinical situations know and apply the basic and clinically supportive sciences which are appropriate to their discipline

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3. Practice-based learning and improvement – Fellows must be able to investigate and evaluate their patient care practices, appraise and assimilate scientific evidence, and improve their patient care practices. Fellows are expected to:

a. analyze practice experience and perform practice-based improvement activities using a systematic methodology

b. locate, appraise, and assimilate evidence from scientific studies related to their patients’ health problems

c. obtain and use information about their own population of patients and the larger population from which their patients are drawn

d. apply knowledge of study designs and statistical methods to the appraisal of clinical studies and other information on diagnostic and therapeutic effectiveness

e. use information technology to manage information, access on-line medical information; and support their own education

f. facilitate the learning of students and other health care professionals 4. Interpersonal and communication skills - Fellows must be able to demonstrate interpersonal and

communication skills that result in effective information exchange and teaming with patients, their patients families, and professional associates. Fellows are expected to:

a. create and sustain a therapeutic and ethically sound relationship with patients b. use effective listening skills and elicit and provide information using effective nonverbal,

explanatory, questioning, and writing skills c. work effectively with others as a member or leader of a health care team or other professional

group 5. Professionalism - Fellows must demonstrate a commitment to carrying out professional

responsibilities, adherence to ethical principles, and sensitivity to a diverse patient population. Fellows are expected to:

a. demonstrate respect, compassion, and integrity; a responsiveness to the needs of patients and society that supercedes self-interest; accountability to patients, society, and the profession; and a commitment to excellence and on-going professional development

b. demonstrate a commitment to ethical principles pertaining to provision or withholding of clinical care, confidentiality of patient information, informed consent, and business practices

c. demonstrate sensitivity and responsiveness to patients’ culture, age, gender, and disabilities 6. Systems-based practice - Fellows must demonstrate an awareness of and responsiveness to the

larger context and system of health care and the ability to effectively call on system resources to provide care that is of optimal value. Fellows are expected to:

a. understand how their patient care and other professional practices affect other health care professionals, the health care organization, and the larger society and how these elements of the system affect their own practice

b. know how types of medical practice and delivery systems differ from one another, including methods of controlling health care costs and allocating resources

c. practice cost-effective health care and resource allocation that does not compromise quality of care

d. advocate for quality patient care and assist patients in dealing with system complexities e. know how to partner with health care managers and health care providers to assess,

coordinate, and improve health care and know how these activities can affect system performance

Specific renal competencies - Fellows will acquire expertise in:

1. An understanding of normal renal biology including: a. Renal anatomy and histology b. Renal physiology, including in the elderly c. Fluid, electrolyte and acid-base regulation d. Mineral metabolism

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e. Blood pressure regulation - normal and abnormal f. Renal drug metabolism and pharmacokinetics, including drug effects on renal function and

including in the elderly g. Renal function in pregnancy h. Basic immunologic principles, including mechanisms of disease and diagnostic laboratory

testing relevant to renal diseases i. Medical genetics

2. Prevention, evaluation, and management of general nephrologic disorders including: a. Acute renal failure b. Chronic renal failure c. End-stage renal disease d. Fluid, electrolyte, and acid-base disorders e. Disorders of mineral metabolism including nephrolithiasis and renal osteodystrophy (including use

of lithotripsy) f. Urinary tract infections g. Hypertensive disorders h. Renal disorders related to pregnancy i. Primary and secondary glomerulopathies including infection-related glomerulopathies. This

also entails a basic understanding of immunologic mechanisms of renal disease and the laboratory tests necessary for their diagnosis.

j. Diabetic nephropathy k. Tubulointerstitial nephritis including papillary necrosis l. Genetic and developmental renal diseases including renal cystic diseases, hereditary

glomerulopathies and interstitial nephritis, phakomatoses, systemic diseases with renal involvement, congenital malformations of the urinary tract, maternally inherited mitochondrial diseases, and renal cell carcinoma.

m. Vascular diseases including atheroembolic disease n. Disorders of drug metabolism and renal drug toxicity o. Renal disorders associated with the elderly including altered drug metabolism p. Renal cystic diseases without a recognized genetic basis q. Nutritional management of general nephrologic disorders

3. Pre- and post-renal transplant care including: a. Pre-transplant selection, evaluation and preparation of transplant recipients and donors b. Immunosuppressant drug effects and toxicity c. Immediate postoperative management of transplant recipients d. Immunologic principals of types and mechanisms of renal allograft rejection e. Clinical diagnosis of all forms of rejection including laboratory, histopathologic and imaging

techniques f. Prophylaxis and treatment of allograft rejection g. Recognition and medical management of nonrejection causes of allograft dysfunction including

urinary tract infections, acute renal failure, and others h. Understanding major causes of post-transplant morbidity and mortality i. Fluid, electrolyte, mineral and acid-base regulation in post-transplant patients j. Long-term follow-up of transplant recipients in the ambulatory setting including economic and

psychosocial issues k. Principles of organ harvesting, preservation and sharing l. Renal disease in liver, heart and bone marrow transplant recipients

4. Dialysis and extracorporeal therapy including: a. Evaluation and selection of patients for acute hemodialysis or continuous renal replacement

therapies b. Evaluation of end-stage renal disease patients for various forms of therapy and their instruction

regarding treatment options c. Drug dosage modification during dialysis and other extra-corporeal therapies d. valuation and management of medical complications in patients during and between dialyses and

other extra-corporeal therapies, and an understanding of their pathogenesis and prevention

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e. Long-term follow-up of patients undergoing chronic dialysis including their dialysis prescription modification and assessment of adequacy of dialysis

f. An understanding of the principles and practice of peritoneal dialysis including the establishment of peritoneal access, the principles of dialysis catheters, and how to choose appropriate catheters.

g. An understanding of the technology of peritoneal dialysis including the use of cyclers h. Assessment of peritoneal dialysis efficiency using peritoneal equilibration testing and the

principles of peritoneal biopsy i. An understanding of how to write a peritoneal dialysis prescription and how to assess

peritoneal dialysis adequacy j. The pharmacology of commonly used medications and their kinetic and dosage alteration with

peritoneal dialysis k. An understanding of the complications of peritoneal dialysis including peritonitis and its

treatment, exit site and tunnel infections and their management, hernias, plural effusions and other less common complications and their management

l. An understanding of the special nutritional requirements of the hemodialysis and peritoneal dialysis patient

m. An understanding of the psychosocial, economic and ethical issues of dialysis n. An understanding of dialysis water treatment, delivery systems and dialyzer reuse o. An understanding of end-of-life care and pain management in the care of patients undergoing

chronic dialysis. p. Evaluation, selection and management of patients for therapeutic plasma exchange

5. Personally conducting the following procedures: a. Urinalysis b. Percutaneous biopsy of native and transplanted kidneys c. Peritoneal dialysis d. Placement of temporary vascular access for hemodialysis and related procedures including use

of vascular ultrasound guidance e. Acute and chronic hemodialysis f. Continuous renal replacement therapies g. Therapeutic plasma exchange

6. Understanding indications, complications (if relevant), and interpretation of the following procedures: a. Placement of peritoneal catheters b. Renal imaging - ultrasound, CT, IVP, MRI, angiography, and nuclear medicine studies c. Therapeutic plasmapheresis d. Radiology, angioplasty and declotting of vascular access

7. Special areas in the management of patients of renal diseases including: a. Psychosocial and economic issues confronting patients with renal disease b. Ethical issues relevant to care of patients with renal disease c. Optimizing the relationship of the nephrologist with other health care providers d. Optimizing mechanisms towards achieving life-long learning as a nephrologist e. Quality assessment and improvement, patient safety, risk management, preventative medicine, and

physician impairment as it relates to the nephrologist Progressive objectives The objectives of the nephrology fellowship program are designed to reflect a progressive increase in learning. The learning principles are based on Bloom's taxonomy, describing progression through the six learning domains: knowledge, comprehension, application, analysis, synthesis and evaluation. In practice, the program's objectives change every 6 months of the 2-year training period. These four 6-month periods' progressively changing objectives are summarized in the sections addressing the three major rotations - general nephrology, dialysis and transplantation. These progressive objectives are reviewed with the fellows by the Program Director at the beginning of each 6-month rotation, i.e., each time the objectives change. A detailed description of these objectives is described in the fellowship curriculum.

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Nephrology Research Training Program (RETURN TO TABLE OF CONTENTS) Clinical research curriculum as part of 2-year clinical fellowship

1. Research Sites – Clinical research is conducted primarily when the Fellows are on the OP rotation. The OP service, which comprises three months each year, allows a substantial amount of time for research, without having inpatient responsibilities. Additionally, several opportunities exist for Fellows to become involved in ongoing multicenter collaborations.

2. Research Schedule - Within the first month of Fellowship, Fellows meet with all clinical research faculty to discuss possible clinical research projects and mentorship. Basic research projects are not realistic during the two years of Fellowship. Fellows are expected to become involved in projects already in progress and not to be responsible for designing a new project. Fellows are not expected to obtain independent funding to support their salary or research activities. After identifying a mentor and project, Fellows are actively involved in the faculty-directed clinical research project while on each OP rotation.

Goals and Objectives of Research Program

1. Understand fundamentals of clinical research including basics of research design, data analysis (biostatistics), public policy, economics, health education, designing trials, recruiting subjects, responsible use of informed consent, standards of ethical conduct of research, clinical epidemiology, and outcomes analysis.

2. Gain hands-on experience with conducting a clinical research project including research design (where feasible), data analysis, subject recruitment, data collection, and manuscript preparation.

3. Understand principles of grant writing. 4. Provide sufficient exposure to clinical research to allow Fellows to make an informed decision about

pursuing a career involving clinical research. 5. Provide sufficient exposure to clinical research to allow Fellows to critically assess clinical

research literature and to be competent in using available medical informatics systems. Bibliographic retrieval and critical appraisal skills are of paramount importance.

6. Become a co-author on a published manuscript or abstract, or present research at a national meeting.

Educational Training Didactic courses

1. CRC course - Fellows interested in clinical research attend a 2-day general clinical research course given in August of their first year by the Clinical Research Center at the University of Utah. Topics covered include basics of research design, ethical conduct of research, responsible used of informed consent, data analysis (biostatistics), public policy, economics, health education, designing trials, recruiting subjects and other epidemiology issues, and outcomes analysis.

2. Division of Nephrology Clinical Research course – Fellows attend 8 one-hour sessions over the course of each year devoted to understanding clinical research. The course is taught by Dr. Beddhu.

3. The research mentor-fellow relationship is the primary means by which Fellows will achieve training in clinical research.

Nature of Supervision - Fellows should select a project and mentor by September 1 of the first year of Fellowship and inform the Nephrology Fellowship Program Director of their selection. For the next 22 months, the Fellow’s clinical research activities will be guided by the Mentor. This involves frequent meetings (at least every two weeks during the OP rotation and every two months during other rotations) between the Fellow and mentor during which all aspects of conducting the clinical research projects are addressed.

Means of Fellow Evaluation – The mentor provides the Fellow with ongoing informal feedback. In addition, the mentor meets with the Nephrology Training Program Director semiannually to report on the Fellow’s progress. The Training Program Director also discusses the research progress with the Fellow

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during their semi-annual meetings. Evidence of successful completion of the Fellow research requirement includes presenting an abstract at a national or regional meeting, publishing an abstract or manuscript, and/or presentation of the research to the Division of Nephrology for the one hour research conference. Research fellowship curriculum for fellows on 3-year research fellowship

1. Research Sites – Basic or clinical research are conducted at the VA or at University Hospital, depending upon the location of the mentor.

2. Research Schedule - Research fellows identify a mentor within the first month of their fellowship. Depending upon the fellow's preference and the number of clinical fellows, the research fellow will do their clinical year either at the beginning or the end of their fellowship. Once the fellow starts in the laboratory, they will do this exclusively for two years with the exception that they will maintain a ½-day general nephrology continuity clinic throughout their entire fellowship.

Goals and Objectives of Research Program

1. Understand fundamentals of basic or clinical research. For both clinical and basic research, this includes research design and data analysis (biostatistics). For clinical research, this also includes public policy, economics, health education, designing trials, recruiting subjects and other epidemiology issues, and outcomes analysis.

2. Gain hands-on experience with conducting a basic or clinical research project including research design (where feasible), conducting the study, data analysis, and manuscript preparation. It is expected that the fellow will generate at least one peer-reviewed original research publication from this work, although this is not a requirement for graduation from the program.

3. Understand principles of grant writing. 4. Provide sufficient experience in basic or clinical research to allow Fellows to make an

informed decision about their academic career choices. 5. Provide sufficient exposure to basic or clinical research to allow Fellows to interpret basic and

clinical research literature. Educational Training Didactic courses

1. Clinical Research Training Track for Physician-Scientists. All fellows engaging in clinical research are given the option to enroll in the Masters of Science in Clinical Investigation (MSCI) at the University of Utah. The MSCI is a two-year post-graduate experience that emphasizes epidemiology, clinical outcomes, clinical trials and health services research. The MSCI is funded by a Clinical and Translational Scientist Award (CTSA) of the NIH. Additional funding to support the program is provided by the Vice President for Health Sciences. The program is composed of formal didactic coursework, a longitudinal seminar series, and a mentored clinical research project. Fellows who successfully complete the program are eligible for a Master’s Degree awarded by the School of Medicine. Fellows successfully completing the program are awarded a Master’s Degree in Clinical Investigation. This degree is offered by the General Clinical Research Center, which has been designated as a degree-granting academic department within the SOM. The academic year for the TPCI program begins the second week of July and runs through the last week in May.

2. The curriculum during Year 1 of the MSCI program begins with a six-week intensive block of didactic course work and workshops (Schedule A). Fellows take a set of core courses in epidemiology, data management, bioethics, biostatistics and the research seminar series. Workshops in grant writing and the preparation of clinical research protocols are also offered. The curriculum focuses on community intervention studies, an epidemiology seminar and a computer practicum. During the six-week intensive block, the renal fellow will design and initiate their research project in conjunction with their preceptor.

3. Advanced, didactic coursework is continued through the fall and spring semesters (Schedule A). Courses are given two afternoons each week or in brief blocks over Thursday, Friday and Saturday

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morning. The mentor-based clinical research project continues. During the second year, effort is focused on the clinical research project. However, during the fall semester of the second year, all fellows are required to take a weekly one-hour course entitled "Scientific Integrity & Ethics of Scientific Research". This course meets federal requirements for training grants and is described below.

4. During the late fall semester or early spring semester of the second year of the MSCI program, fellows will prepare (with the aid of his/her mentor) an application for a career development award through the NIH, the Department of Veterans Affairs, or an appropriate professional society. At the conclusion of the second year, a master’s thesis is submitted which can also serve as a research paper of publishable quality. Throughout the two-year program, fellows are required to attend a longitudinal research seminar series, given on two Friday afternoons per month. This series covers a wide variety of subjects of interest to students and also provides an opportunity for camaraderie amongst all MSCI participants, not just those in the Nephrology Training Program. All enrollees to date have ample time during the two years to complete their clinical research projects and to be highly competitive for NIH funding.

5. Fellows will be expected to participate by presenting their research at these research conferences as described above. Fellows will attend the annual American Society of Nephrology meeting each of these two years and will be expected to present their research at this meeting during the third year. Fellows also will be encouraged to present their research at the annual National Kidney Foundation meeting as well as any relevant regional conferences.

Schedule A. Training program in clinical research curriculum

INITIAL BLOCK (6 weeks)

MDCRC 6010 Introduction to Epidemiology. Covers the basics of epidemiology including: measures of disease frequency, measures of effect, basic study designs, confounding bias, stratification, and causal reasoning. This course is presented in two-hour sessions, two days a week for the first three weeks of the block.

MDCRC 6020 Data Management. Covers managing databases for research, including problems and solutions for data management, database design, table linkage, confidentiality issues and data security. The course is presented in six two-hour sessions.

MDCRC 6430 Bioethical Issues in Clinical Research. Ethical issues and standards for scientific investigation are covered in depth. Course- work emphasizes the history and evolution of research norms and practices, institutional expectations and standards, and the process of review and oversight for experimental protocols. Additional material covers ethical issues and public policy linked to genetic research. Case-based problem solving is used to cover interactions with the Institutional Review Board. This course is presented in two hour blocks, once weekly.

MDCRC 6000 Introduction to Biostatistics. Basic statistics with emphasis on medical and epidemiologic research problems, including description of data, theoretical distribution, experimental design, hypothesis testing, comparison of groups, correlation, confidence intervals and sample size estimation. This course is presented in two-hour blocks, once weekly.

MDCRC 6410 Research Seminar Series. This course is presented during the intensive introductory course and throughout the fall and spring. The course is presented for two hours on every Friday afternoon throughout the intensive introductory course and on the second and fourth Fridays of the fall and spring semester. Each seminar begins with the presentation of a clinical issue related to health care delivery or epidemiology. Discussions follow based on the methods used for defining epidemiologic and other health care issues. The seminars are designed to illustrate the process of scientific discovery in clinical investigation, provide examples of how innovative approaches and methods were applied and to discuss obstacles that impede progress. Visiting faculty from other

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universities participate in the seminar series. MDCRC 6100 Epidemiology Seminar. Key papers describing

epidemiological methods are discussed followed by critical reviews of representative studies illustrating the application of these methods. This course is presented in two two-hour blocks each week for the first three weeks.

MDCRC 6030 Computer Practicum. This course is designed to afford hands-on practice with statistical software (e.g. Stata). Students learn to merge databases, analyze data, scientific graphing, Monte Carlo simulation, and sensitivity analysis. This course is offered in two-hour blocks twice weekly during the last three weeks.

FALL SEMESTER YEAR ONE

MDCRC 6040 Design and Implementation of Clinical Trials. This course defines clinical trials and reviews drug registration trials, phase I, II and III trials, clinical endpoints, surrogate endpoints, pharmacokinetics, drug-drug interactions, data and safety monitoring, criteria for closure and single versus multi-institutional trials. Case- based sessions covering clinical trials in occlusive heart disease, arthritis, asthma and oncology provide informative examples of trial design and potential pitfalls. This course is presented in a weekly two- hour block.

MDCRC 6240 Community Intervention Studies. Strategies are presented for designing and implementing field intervention trials. Methods of analysis are covered, including cluster randomization and time series analysis. This course is presented as a one day intensive experience totaling 8 hours of lectures and tutorials.

MDCRC 6230 Health Services Research. This course focuses on measurement of clinical outcomes and includes scale development, reliability and validity, study design, misclassification bias, co-morbidity, severity of illness scores, organizational structure and quality of life measurements. The course is taught as 3 intensive 1- day blocks every 2 months.

MDCRC 6130 Introduction to Decision Analysis. This course serves as an introduction to the subject of decision analysis related to health care and includes concepts, creation and evaluation of decision trees, Markov chains, sensitivity analysis and incorporation of patient preferences with utility analysis. This course is presented as a two and one-half day intensive experience totaling sixteen hours of lectures and tutorials.

MDCRC 6120 Cost Effectiveness Analysis. The material presented covers concepts used in the economic evaluation of health care programs, foundations of cost effectiveness analysis, interpreting and critiquing the literature of cost-effective analysis, and constructing these analyses. This course is presented as a two and one-half day intensive experience totaling sixteen hours of lectures and tutorials. OPTIONAL

MDCRC 6110 Intermediate Epidemiology. Students enrolling in this course must have completed MDCRC 6010, Introduction to Epidemiology. Intermediate Epidemiology covers research design and conduct of epidemiologic studies, including assessing effect modification, stratification, matching, sampling and reasoning with causal diagrams. This course is presented in a weekly two- hour block during the second six weeks. OPTIONAL

SPRING SEMESTER YEAR ONE

MDCRC 6140 Intermediate Decision Analysis. Students enrolling in this class are required to have completed MDCRC 6130, Introduction to Decision Analysis. The intermediate decision analysis course is a practicum in designing and constructing a decision analysis model to solve an actual health care problem. A problem is provided and students are instructed in methods to solve the problem utilizing decision analysis. This course meets in two one-day blocks, each eight hours in duration. In the first block the problem is presented; in the second block students present their solution to the problem.

MDCRC 6200 Meta Analysis. This focuses on the meta-analysis approach combining quantitative data. Subjects covered include statistical methods, eligibility

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criteria of studies, tests of homogeneity, summary measures, sources of variation and sensitivity analysis. This course is presented in a weekly two-hour block throughout the last six weeks. OPTIONAL

MDCRC 6210 Regression Models. Students enrolling in this course must have completed MDCRC 6000, Introduction to Biostatistics and MDCRC 6010, Introduction to Epidemiology. The course in regression models covers linear regression, logistic regression, Poisson regression, Cox regression, and includes methods for correlated data (generalized estimating equations and mixed models), testing model assumptions, and assessment of model fit. This course is presented in a weekly two-hour block.

MDCRC 6220 Survey Methods. Students must have completed MDCRC 6210. The course on survey methods covers the design and analysis of surveys, including questionnaire development, sample designs, stratification, clustering, multi-stage sampling, and the analysis of data generated from these complex designs. This course is presented as a two and one-half day experience totaling sixteen hours of lectures and tutorials. OPTIONAL

FALL SEMESTER YEAR TWO

INT MD 7570 Scientific Integrity & Ethics of Scientific Research. The course meets federal ethics requirements for training grants. The series covers topics of general interest in ethics and science. Topics include the norms of scientific inquiry and the nature of scientific misconduct; conflicts of interest (including the university policy); intellectual property and technology transfer; responsible authorship and editorial policies; and protection of research subjects and research with animals. Sessions are panel discussions featuring responsible administrators, scientists and physicians from a wide range of disciplines, and faculty in philosophy and law. The course meets 12 times during the fall semester and each meeting lasts for 1 hour. Course coordinator is Leslie Francis, Professor of Philosophy and Law.

1. Division of Nephrology Statistics course – Fellows attend 10 two-hour sessions held on Thursdays

from 4:30-6:30 PM dedicates to understanding medical statistics. The course is taught by members of the nephrology division as well as University of Utah statisticians.

2. Division of Nephrology Clinical Research course – Fellows interested in clinical research, but not enrolled in the CTSA program, attend a one-hour session each month devoted to understanding basics of research design, data analysis (biostatistics), public policy, economics, health education, designing trials, recruiting subjects and other epidemiology issues, and outcomes analysis. The course is run by Dr. Beddhu and is largely based on the JAMA publications devoted to these areas.

3. Fellows engaging in basic research will be required to take the Basic Research in Nephrology Curriculum. This curriculum involves required core and elective courses. Core courses are taken during the first year and involve training in biostatistics (MDCRC 6000) (Schedule A), scientific integrity and ethics of scientific research (INT MD 7570) (Schedule A), and basic research techniques. Since every basic research laboratory utilizes some degree of physiologic, cell biologic, and molecular biologic techniques, fellows will be given the option to take core courses in these areas (Schedule B). In addition, they may take a course on scientific lecturing and writing (Schedule B). Depending upon the nature of the basic research project, fellows will be offered courses on an elective basis. While multiple courses exist, given the Nephrology Training Program research activities, it is anticipated that they will most likely take one or more of the courses described in Schedule C. These courses are intended to supplement learning that occurs in the laboratory due to interactions with the preceptor, collaborators, and laboratory members.

4. During the fall and spring semesters of year 2 of research training (depending on the application due date), trainees will apply for mentored research grants, such as an NIH K08, an American Heart Association Scientist Development Grant, or similar funding.

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Schedule B. Basic research core courses.

FALL SEMESTER YEAR ONE

BLCHM 6400 Genetic Engineering. This course covers essential techniques used in genetic engineering. Topics include the use of restriction endonucelases, amplification of DNA sequences using PCR, Southern and Northern blotting, properties of cloning vectors and their use in constructing genomic and cDNA libraries, DNA sequencing and sequence analysis, creating and detecting mutations in DNA and introducing these mutations into a genome (transgenic and knockout models ), and expression of proteins. Held in 2-hour weekly sessions.

FALL AND SPRING SEMESTER YEAR ONE

PHYS 7910 Practicum in Physiology. A laboratory-oriented practicum emphasizing the practice of physiological technique as it pertains to specific research problems. Course covers membrane models, ion selectivity, intracellular pH and Ca2+ regulation. Recording surface potentials, ionic currents, nerve discharge and documentation of nervous activity with antibody markers are taught. The second half of the practicum emphasizes assays involving antibodies including receptor binding, and radio immunoassays. Microfluorometric analysis, confocal microscopy, in-vivo drug assay and genetic markers in disease are given practical consideration. Held in three hour sessions once a month.

ANAT 7790 Fluorescence Microscopy and Digital Imaging. Laboratory and lecture course of basic and advanced microscopic techniques. Phase contrast, fluorescence, and confocal microscopy. Digital image-processing, quantitative analysis, and production of publication-quality images. Held in 1-hour sessions once a month.

FALL SEMESTER YEAR TWO

ANAT 7690 Scientific Lecturing and Writing. Course teaches guidelines for writing clear scientific papers and delivering good lectures. Lectures, discussion, homework assignments and submission of a new original scientific paper in an area chosen by each student. Held in hourly sessions once a month.

Schedule C. Selected highly relevant basic research courses Physiology PHYS 6010 Systemic Physiology II. Must have had basic physiology. Emphasizes

physiological principles of major organ systems. Three hours weekly in fall semester. Molecular Biology

MBIOL 6420 Genetics and Genome. The Genetics and Genomes course covers the basic principles of genetics in both prokaryotes and eukaryotes, and the basic mechanisms of genome structure and replication. Mechanisms governing the transmission of genetic information are covered in bacteria, fungi, flies, worms, and vertebrates, including mutagenesis, transposons, suppression, epistasis, recombination, mosaics, gene knockouts, and two hybrid analysis. The genomes section of the course covers the organization of genes on chromosomes, chromatin structure, DNA replication and repair, gene silencing, chromosome inactivation, imprinting, and genome evolution. Three hours weekly in fall semester. MBIOL 6440 Gene Expression. This course covers transcriptional and post- transcriptional mechanisms of gene regulation. Lectures cover recent advances in these fields with material based on the primary literature. The transcriptional regulation section of the course covers, basic mechanisms of gene activation and repression, chromatin remodeling machines, regulation of transcription activation by signal transduction cascades. The post-transcriptional section covers mechanisms regulating RNA processing (splicing, editing, and transport), translation and mRNA stability. Three hours weekly in spring semester.

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Cell Biology

MBIOL 6480-2 Cell Biology II. Must have had basic cell biology. The course covers: 1. cell structure/function and intracellular trafficking. 2. Signal transduction, cell cycle and apoptosis. 3. Cell-cell communication, differentiation and tissue maintenance. Each section consists of a series of lectures that explore the basic concepts associated with the various topics. Each section has an in class exam and a writing assignment in the form of a mini grant proposal that encourages the identification of important scientific problems and the formation of a testable hypothesis, the creation of a research plan to test the hypothesis and the presentation of this material in an acceptable and persuasive format. 3 hr weekly in fall semester.

The research mentor-Fellow relationship is the primary means by which Fellows will achieve training in basic or clinical research. Nature of Supervision - Fellows should select a project and mentor by September 1 of the first year of Fellowship and inform the Nephrology Fellowship Program Director of their selection. For the next 23 months, the Fellow’s research activities will be guided by the Mentor. This involves frequent meetings (at least bi-weekly during the two years of research). Means of Fellow Evaluation – The mentor provides the Fellow with ongoing informal feedback. In addition, the mentor meets with the Nephrology Training Program Director semiannually to report on the Fellow’s progress. The Training Program Director also discusses the research progress with the Fellow during quarterly meetings between the Research Fellow and the Training Program Director. Fellows are expected to be a first author on at least one publication in a peer-reviewed journal. In addition, they are expected to present their research at least once annually at national meetings. Guidelines for Promotion and Graduation

1. Clinical Track – 2-year clinical fellowship - Promotion from 1st to 2nd year – The criteria for promotion are listed in the General Nephrology, Dialysis, and Transplant tables. All of these criteria must be met in order to be promoted. They must have been met within the last month of the 1st year of fellowship. Failure to meet all criteria will result in review by all Clinical Faculty with whom the Fellow has had contact in the past year, and placement on probation. The Fellows must demonstrate satisfactory performance over the next 1 month of clinical activities, as determined by the criteria for performance during year 1, in order to be allowed to continue in their training. Any exceptions will be determined on an individual basis by the entire Clinical Faculty, and will be based on all circumstances surrounding the Fellow’s activities.

2. Graduation – The criteria for graduation are listed in the General Nephrology, Dialysis, and Transplant tables (labeled as 2nd year performance). All of these criteria must have been met over the last 3 months of fellowship in order to graduate. Failure to meet all criteria will result in review by all Clinical Faculty with whom the Fellow has had contact in the past year, and a decision made on a necessary course of action. Such action may include, but is not limited to, requirement for additional clinical activities, counseling, or other actions.

3. Research Track – 1-year clinical fellowship. The criteria for graduation are listed in the General

Nephrology, Dialysis, and Transplant tables (labeled as 2nd year performance). Note that these criteria are labeled 2nd year since they pertain to the 2nd year clinical fellows, but they apply to fellows doing only 1 year of clinical fellowship. These criteria must have been met over the last 3 months of fellowship. All of these criteria must be met in order to graduate. Failure to meet all criteria will result in review by all Clinical Faculty with whom the Fellow has had contact in the past year, and a decision made on a necessary course of action. Such action may include, but is not limited to, requirement for additional clinical activities, counseling, or other actions.

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Nephrology Fellowship Work, Duty Hours, Moonlighting and On-Call Policy

Work and duty hours 1. ACGME requires that Fellows not work more than 80 hours per week averaged over a 4-week

period. Our program requires than Fellows will work no more than 70 hours per week when averaged over a four-week period. In reality, Fellows rarely work more than 60 hours per week.

2. Fellows are required by ACGME to be free of all work obligations for one day out of seven over a 4-week period. The Division strictly adheres to this policy. In reality, over the course of the Fellowship, Fellows are free of all work obligations for substantially more than the ACGME- required minimum.

3. The ACGME requires that adequate time for rest and personal activities is provided by a 10-hour time period between all daily duty periods and after in-house call. There is no in-house call (see below). Fellows rarely have to return at night to the hospital from home while on call.

4. The Division of Nephrology recognizes that fellow moonlighting can be complementary to the fellowship training experience. However, any fellow choosing to moonlight must do so with the clear understanding that fellowship training is their first priority and any actions interfering with the fellowship training program are strictly prohibited. Each moonlighting activity must be approved in advance by the program director using the moonlighting authorization form. This form must be signed by the program director before any moonlighting can begin.

5. The following restrictions apply to fellow moonlighting: a. The fellow must be performing satisfactorily in the program. b. If a fellow chooses to “moonlight,” he or she is responsible for their own liability coverage. Even if

this activity is being performed at the University, or an affiliated hospital, and/or additional compensation is being provided to the fellow, it is outside the scope of a fellow’s duties as a house officer. As per the GME office, the fellow should not wear a University lab coat or nametag while moonlighting.

c. If the fellowship director feels that the fellow’s “good standing” is at risk by the time spent moonlighting, he or she can prohibit such moonlighting even without placing the fellow on probation. This action and an explanation for it must be transmitted to the fellow both in person and in writing and to the fellow’s file.

d. As per GME regulations, fellows should not work more than 80 hours a week, when averaged over a four week period. Hours worked include training program hours and moonlighting hours.

e. Fellows may not moonlight while on-call. 6. Fellows will be on-call about one out of four days. All call is from home – there is no in-house call.

Fellows average one weekend in four on call (5 PM Friday to 8 AM Monday) and one weekday (Monday-Thursday) in four on call. The Outpatient (OP) Fellow (3 months/year) is never on call. The Transplant (TP) Fellow is on call 1 weekday/week and 2 weekends/month. The VA Fellow is on call 2 weekdays/week and no weekends. The University Hospital (UH) Fellow is on call 1 weekday/week and 2 weekends/month. The on-call UH Fellow covers the UH General Nephrology and Transplant Services, answering all phone calls, seeing and writing notes on all established inpatients (weekends) and new admissions (nights and weekends), writing necessary dialysis orders and following patients on dialysis, and any other business relevant to covering the Nephrology and Transplant Services. The VA Attending takes weekend call when the UH Fellow is on weekend call. When the residents are on- call, they cover only University Hospital General Nephrology Service. The TP Fellow takes call when the residents do on the weekends, but covers only the UH Transplant Service and the VA. Attending and clinic physicians are responsible for supervising all care provided to inpatients and outpatients, respectively. The Attending physician is on-call 24 hours a day, provided backup to the Fellow as needed. When residents are on call, the VA Fellow sees only VA acute dialysis patients only on Saturday morning, with VA Attending coverage.

7. Fellows receive three weeks of paid vacation each year. All applications for leave, or special requests with respect to the call schedule, must be submitted at least eight weeks preceding the intended absence.

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An example of a monthly block schedule is as follows. Note that the OP Fellow is not included. On the weekends where the resident and TP Fellow are on together, the resident covers University Hospital and the TP Fellow covers the transplant service at the University Hospital and all inpatients at the VA Hospital.

Sun. Mon. Tues. Wed. Thurs. Fri. Sat.

VA Fellow

TP Fellow

U of U Fellow

VA Fellow

Resident/TP

fellow

Resident/TP

fellow

Resident/TP fellow

VA Fellow

TP Fellow

U of U Fellow

VA Fellow

U of U Fellow

U of U Fellow

U of U Fellow

VA Fellow

TP Fellow

U of U Fellow

VA Fellow

Residents/ TP fellow

Residents/ TP fellow

Residents/ TP fellow

VA Fellow

TP Fellow

U of U Fellow

VA Fellow

U of U Fellow

U of U Fellow

U of U Fellow

8. Policies regarding medical leave, family leave, maternity leave, leave for examinations, educational leave, sexual harassment, physician impairment and disability, jury duty, counseling services, and grievance procedures can be found in the University of Utah Housestaff Policies and Procedures Manual. This manual is distributed to all new Fellows at orientation during first week of Fellowship. Information can be obtained prior to then by contacting the Fellowship Director (Dr. Abraham) or by contacting the Graduate Medical Education Office at 801-581-2401 or grad.mededuc@hsc.utah.edu.

9. There is no liability insurance by the University of Utah for clinical activities outside the State of Utah or outside the country. Fellows will, therefore, perform all clinical activities in the State of Utah.

Nephrology Fellow Stipend and Benefits

1. Fellows are paid PGY4, PGY5 or PGY6 salaries according to University of Utah School of Medicine policy (Job Class 0253). For 2017-18, this is $62,236 for PGY4, $64,299 for PGY5, and $66,618 for PGY6.

2. Benefits include Hospital and Medical insurance (premium costs shared between UH and the Fellow), dental insurance (nominal monthly charge), group life insurance up to salary amount but not to exceed $25,000 at no charge (additional life insurance may be purchased), 24-hour accident insurance, malpractice insurance, long-term disability insurance, and parking. Other benefits, such as reduced tuition, bookstore discount and others are offered to all University employees. More details can be found in the University of Utah Housestaff Policies and Procedures Manual.

3. Fellows are provided with the following: a. Pager b. Offices at VA and UH (shared with other fellows) c. Texts and handouts (see Curriculum) d. One trip to the American Society of Nephrology Annual Meeting, including registration, airfare,

meals, and hotel expenses. e. A computer at the VA and UH (shared with other fellows). f. Access to UpToDate

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Policy on Fellow Teaching and Supervision of Residents – Fellows interact with residents on the inpatient wards, during VA clinics, and in division conferences. Fellows are expected to behave in a professional manner towards residents. This includes answering resident questions to the best of the fellow’s ability, directing the resident towards known appropriate learning resources, and notifying residents of the timing of attending rounds each day (since the time may change from day to day). Fellows may teach residents as they are able, but the burden of resident teaching, as it relates to the nephrology rotation goals and objectives, falls on the attending. Fellows may assign inpatients to residents, but attendings have the final approval for all assignments. Fellows may supervise temporary dialysis vascular access placement by residents only after the fellow has demonstrated mastery of this skill and such mastery is documented in their record. Fellows and residents may not render decisions about nephrology patient care (including general nephrology, dialysis and transplant), either written or verbally, without the attending’s verbal or written approval. Hence, fellows may not direct residents to advise primary providers, or their assistants (e.g., nurses, technicians, residents) on medical matters without the direct guidance on such matters by the attending.

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Nephrology Fellows: Current and graduates in previous ten years (RETURN TO TABLE OF CONTENTS) Name and current position Years in

Program Board Certified in Nephrology

Josephine Abraham, MD 2004-2006 Yes Assistant Professor Division of Nephrology University of Utah

Arsalan Habib, MD 2004-2007 Yes

Assistant Professor Division of Nephrology University of Utah

Madhukar Chelamcharla, MD 2004-2007 Yes Private practice Terrence Bjordahl, MD 2005-2007 Yes Assistant Professor Division of Nephrology University of Utah

Jay Reddy Kaluvapalle, MD 2005-2008 Yes Private practice Kalani Raphael, MD 2006-2009 Yes Assistant Professor Division of Nephrology University of Utah

Duncan McGregor, MD 2007-2009 Yes Private practice Christopher Rich, MD 2007-2009 Yes Private practice Emily Peterson, MD 2009-2011 Yes Private practice Cuong Nguyen, MD 2008-2011 Yes Private practice

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Magdalena Sikora, MD 2009-2011 Yes

Private practice Karl Roos, MD 2009-2012 Yes Private practice Vidya Raj Krishnamurthy, MD 2009-2012 Yes Private practice Nirupama Ramkumar, MD 2010-2013 Yes Assistant Professor, Division of Nephrology University of Utah

Andrea Nelson, MD 2011-2013 YesClinical Instructor Division of Nephrology University of Utah

Yuqiang Ge, MD 2011-2013 YesPrivate practice Nestor Almeida, MD 2011-2014 YesPrivate practice Aaron Fearday, MD 2012-2014 Yes Private practice Amanda Hall, DO 2013-2015 Pending Private practice Owolabi Oguyenne, MD 2013-2015 Yes Private practice

Zachary Freestone, DO 2014-2016 Pending Private practice

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Tahir Zaman, MD 2014-2016 Yes Clinical Instructor Division of Nephrology University of Utah

TrevorSmith,MD 2015-2017 Current clinical fellowUniversityofUtahInternalMedicineResidency

DivyaRaghavan,MD 2015-2017 Current clinical fellowUniversity of Illinois College of Medicine at UrbanaInternalMedicine BradleyLong,MD 2016-2018 Current clinical fellowUniversityofUtahInternalMedicineResidency

PaceRomney,MD 2016-2018 Current clinical fellowGuthrie/Robert Packer Hospital Program InternalMedicine