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Policies and Procedures 5. Nephrology Fellow/Internal Medicine

Resident Interactions I. Overview Nephrology fellows will interact with residents in internal medicine and other medical specialties throughout their fellowship. Fellows will serve as teachers, supervisors, and may assist in the evaluation process of residents and students. Specific guidelines for the clinical rotations are outlined in this document.

II. Consult Rotation Internal Medicine and Family Medicine residents along with third and fourth year medical students frequently rotate on the consult team. The fellow is expected to coordinate the efforts of the trainees and assign them with new consults as appropriate. The fellow should assist in consultations providing teaching and learning opportunities for the team. All patients will be presented to the attending physician during daily teaching rounds. It is anticipated that residents and students will present the majority of the consults on attending rounds after the nephrology fellow has prepared them for this presentation. The attending or nephrology fellow should supervise all procedures performed on the service by a rotating resident. The nephrology fellow’s perception of the resident/student’s performance will be utilized in the evaluation process performed by the attending physician. The fellow is encouraged to provide feedback to the rotating trainees throughout the rotation so that their performance can improve with time on service. Nephrology fellows will also interact with residents and students on other services. To assure quality patient care and maximize teaching and learning opportunities the nephrology fellow should assure proper communication of recommendations to the team requesting consultation. III. Service Rotation The service is composed of 3 or 4 resident trainees, 1 to 3 medical students, and a supervising attending. On months where a fellow is assigned to the service, the fellow, with supervision from the assigned attending, is responsible for coordinating the efforts of the trainees with regard to patient care, education, and evaluations. All procedures performed by these individuals should be supervised by the nephrology fellow and/or attending.

IV. Outpatient Rotation During the outpatient rotation nephrology fellows will infrequently interact with residents or students. Most interactions are anticipated to occur when a patient requires admission to the hospital or transfer to the emergency room. In the event of such a patient transfer the nephrology fellow is expected to communicate the patient’s condition to the inpatient admitting resident or the emergency room physician or resident.

V. Transplant Rotation Nephrology fellows will frequently interact with students or residents rotating on the ECU transplant surgery service or another primary service. As consultants, the transplant fellow is expected to follow guidelines similar to those outlined for the consult service. Nephrology

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fellows are not expected to respond to surgical complications of the transplant patient and these questions should be routed to the surgical staff. The transplant fellow should, however, assist with medical management of the transplant patient as guidelines of consultation dictate.

VI. Continuity Clinic There should be little interaction between nephrology fellows and residents or students during their continuity clinic. Any interaction would likely represent a request for consultation or transfer for emergency or inpatient management. In these circumstances the nephrology fellow is expected to communicate appropriately with the accepting physicians. VII. Offsite – Eastern Nephrology Associates Vascular Access Center – Interventional Nephrology Rotation (elective) The nephrology fellow does not have any responsibility for teaching and /or supervising other subspecialty/internal medicine residents or other specialty residents while on an Interventional Nephrology elective.