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OUTPATIENT EXPERIENCES:

1. Continuity Clinic

Fellows will maintain a continuity clinic one half day per week on Wednesday’s for the duration of the two-year fellowship. Fellows will on average be responsible for four to eight patients per ½-day clinic. The continuity clinic will provide the fellow with the opportunity to gain experience in the outpatient management of a wide variety of renal diseases. Fellows will have the opportunity of observing the natural history of many diseases over this two-year period. Specifically, the fellow should expect to gain significant clinical experience in the outpatient management of: Hypertension (both primary and secondary) Diabetic nephropathy Chronic kidney disease and its complications Renal disorders of pregnancy Urinary tract infections Tubulointerstitial renal diseases including artheroembolic disease Disorders of mineral metabolism including nephrolithiasis, hypercalcemia, and magnesium disorders Disorders of water, sodium and potassium Evaluation of hematuria and proteinuria Fellows will have a unique opportunity to impact on patient outcomes with patient education directed at cessation of smoking, salt restricted diets, adequate glycemic control in diabetes, good control of blood pressure and life style modification. Fellows will follow at least 25% of patients from each gender. The continuity clinics will not be interrupted by more than 1 month, excluding a fellow’s vacation time. Fellows will keep a healthspan patient log of all continuity clinic encounters and this will be submitted to the program on a quarterly basis. The continuity clinic templates according to level of training and type of rotation are outlined below.

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Fellow Clinic Templates

1 2 3 4 5

N 8:00 – 9:00 N 1:30 – 2:30 Recip 8:00 – 9:00 R 8:00 – 8:30 R 1:30 – 2:00

R 9:00 - 9:30 R 2:30 – 3:00 R 9:00 – 9:30 R 8:30 – 9:00 R 2:00 – 2:30

R 9:30 – 10:00 N 3:00 – 4:00 R 9:30 – 10:00 R 9:00 – 9:30 R 2:30 – 3:00

N 10:00 – 11:00 R 4:00 – 4:30 N 10:00 – 11:00 R 9:30 – 10:00 R 3:00 – 3:30

R 11:00 – 11:30 N 4:30 – 5:00 R 11:00 – 11:30 R 10:00 – 10:30 R 3:30 – 4:00

R 10:30 – 11:00 R 4:00 – 4:30

R 11:00 - 11:30

Revised 11/26/12

1 = nonhospital months 2 = hospital fellow (consults and service) 3 = fellow on transplant or outpatient who will be doing recip evals 4 = nonhospital fellow from March 15th of their 2nd year to end of training if they are not staying with ECU Nephrology and maintaining a clinic 5= hospital fellow (consults and service) from March 15th of 2nd year to end of training if they are not staying with ECU Nephrology and maintaining a clinic

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OUTPATIENT EXPERIENCES (continued):

2. Acute Transplant Clinic

Fellows will see an average of 6 (range of 3-8) acute transplant patients (< 4 months out) once a week on Thursday mornings in the Moye Medical II clinic on the 1st floor. These patients will be shared between 2 fellows. Fellows will only see these patients when they are on a non-hospital rotation. Fellows on inpatient rotations such as consults or service will not see these patients. Fellows will follow acute transplant patients for 4-6 months during the 2013-14 academic year with anticipation of each fellow following acute transplant patients for 4 months during each academic year thereafter. 2 teaching attendings (Dr. Bolin and Lai) will be in the clinic each session.

The acute transplant clinic is a combined medical-surgical clinic and therefore the fellow will have the opportunity to interact with the transplant coordinators and transplant surgeons. The fellows will learn how to administer immunosuppressive medications including side-effect profile and drug-drug interactions, manage medical complications of transplantation, treat infections and diagnose/treat acute rejection.

3. Outpatient Hemodialysis Shift

Fellows will round on an afternoon hemodialysis cohort at ECU Dialysis for 4 months over the course of their 2 year fellowship. Rotations will be divided into 2 back-to-back months in each academic year. Fellows will select their teaching attending/dialysis shift for each month and must do so 2 and preferably 4 weeks prior to the beginning of the rotation. Fellows will see up to 5 patients in their 1st year of training, increasing the number upwards at the end of the 1st year so that they see up to 10 patients during their 2nd year of training. The fellow is expected to round a minimum of 1 time by the 15th of the months and be prepared to present the patients in a comprehensive manner to the supervising attending. Rounds include a limited exam (heart, lungs, access, edema). The teaching attending will either provide the fellow’s monthly notes or tell them how to obtain the notes. These should be completed by the 15th of the month to aid in the comprehensive presentation.

4. Peritoneal Dialysis Clinic

Fellows will see 1-3 peritoneal dialysis clinic patients per month in their own PD clinic. It may take up to 6 months to acquire a PD patient. During outpatient rotations in the 1st year, fellows must attend (shadow) as many faculty clinics as possible. During the 2nd year, fellows may attend (shadow) faculty clinics based on the individual fellow’s interests or wish to gain additional experience.

A supervising attending will be assigned to each of the fellow’s monthly PD clinics.

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5. Chronic Transplant Clinic

Fellows will see an average of 8-12 patients per session for 12 months over the course of their 2 year fellowship on an alternating month basis. These patients will be shared between 2 fellows. Fellows will see these patients at the ECU Nephrology Clinic on Tuesday mornings when they are on non-hospital rotations. Fellows on inpatient rotations such as consults or service will not see these patients. Fellows will follow chronic transplant patients for 4-6 months during the 2013-14 academic year with anticipation of each fellow following chronic transplant patients for 4 months during each academic year thereafter. Dr. Bolin (and Jawa-TBA) are the attending supervisors in this clinic.