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Policies and Procedures 4. Nephrology Fellow/Attending Interactions

1. Introduction Nephrology fellows are, at all times, and on all inpatient and outpatient rotations, assigned to an ECU nephrology attending physician. The nephrology fellow is expected to take on the responsibility of patient care while under the supervision of this assigned attending. The attending physician is expected to respect the autonomy of the nephrology fellows while maintaining ultimate responsibility and knowledge of the clinical status of the patient. Striking an appropriate balance between fellow autonomy and attending control is imperative and should be part of fellow and attending evaluations. This document outlines the expected interactions between the fellows and attending physicians in the clinical settings each fellow is likely to encounter. Details of supervision, attending rotations, mechanisms of communication, and call schedules for the rotations are outline elsewhere in the nephrology fellowship or the attending physician policies and procedures manuals. II. Consult and Service rotations (inpatient) An attending physician is assigned to nephrology consults at all times. All consults including emergency room evaluations are to be presented to the attending physician on the consult service. The nephrology fellow is expected to round on, or assign residents or students to round on, all patients requiring follow-up of previous consults and to present these findings or assist the other trainees in the presentation of these patients to the attending physician during attending rounds. Attending teaching rounds will take place every day. Attendings are expected to be physically present for, and to evaluate the performance of, all procedures including supervision of hemodialysis, CRRT, renal biopsies, and peritoneal dialysis evaluation. Patients on the service are under the direct care of an ECU Nephrology attending and team. The nephrology fellow is expected to oversee residents, interns and students as they care for these patients. The fellow is NOT expected to write daily notes, rather they should focus on diagnosis, treatment plans and management. The service fellow will work closely with the supervising attending. Attending teaching rounds will take place every day. Attendings are expected to be physically present for, and to evaluate the performance of, all procedures including supervision of hemodialysis, plasmapheresis, renal biopsies and peritoneal dialysis evaluation. III. Outpatient rotation An attending physician is always assigned to the outpatient clinic which includes pre-dialysis clinic, PD clinic and the hemodialysis unit. When fellows are on this rotation, they are responsible for evaluating new urgent referrals, urgent clinic or dialysis patient problems under the direct supervision of the outpatient attending. IV. Ambulatory Experiences - The acute transplant clinic, the chronic transplant clinic, the fellow’s peritoneal dialysis clinic, the fellow’s nephrology continuity clinic, and the fellow’s outpatient hemodialysis cohort are all supervised by an assigned attending physician. Each patient seen is to be presented to the supervising nephrology attending. The nephrology attending is required to examine all patients seen in these clinics and to document their findings. The fellow shares the documentation responsibilities in these patients.