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University of Nebraska Medical Center

Rotations

Fellows conduct rounds

Our clinical curriculum provides fellows flexibility to focus on career interests while preparing to function as high-quality, independent nephrologists.

Schedule

First year

First-year fellows divide their inpatient time among the three nephrology services: inpatient consult, 15 weeks; transplant, 14 weeks; and VA, 14 weeks. Other focused time: Outpatient, four weeks; vacation, four weeks, National Kidney Foundation Meeting, with costs paid, one week.

Fellows attend an outpatient longitudinal nephrology continuity clinic, and participate in an educational curriculum, including didactic sessions, hands on experiential workshops, and interactive conferences.

Second year

Fellows spend six months rotating through the three inpatient services, and then have six months of elective time, designed to align with fellows’ interest. Fellows also participate in an outpatient longitudinal dialysis curriculum training to manage outpatient dialysis patients Trainees will also learn to manage home hemodialysis and peritoneal dialysis patients. Fellows continue the half day per week continuity clinic.

Elective time is routinely used to design and conduct clinical research projects, QI projects, or other scholarly activities. Recent fellows have developed expertise in interventional nephrology and achieved procedural certification. Other options: clinical emphasis in transplantation, critical care, home dialysis, hypertension, renal pathology, or other career interests.

A typical second year schedule: Consult service, nine weeks; transplant service, 9 weeks; VA service, 8 weeks; elective/outpatient, 20 weeks; vacation, four weeks; ASN meeting, one week; and home dialysis training, one week.

Call schedule
In order to optimize work-life balance, our fellows are free from all clinical duties for three out of every four weekends. We incorporate residents into the call schedule, allowing fellows to only cover evening call approximately one night per week. All overnight call is home call.

Core Consult Inpatient Rotation

Through UNMC's primary clinical partner, Nebraska Medicine, our fellows participate in our core consult service, which provides inpatient consultative nephrology to all non-transplant patients.

This rotation provides a rich exposure to management of critical care patients with such renal issues as, acute kidney injury, fluid and electrolyte disorders, hemodialysis-related complications, glomerulonephritis, and dialysis including continuous renal replacement therapy.

In addition to a nephrology faculty and a nephrology fellow, there are typically three or four internal medicine residents rotating through this service. The fellows and residents divide the work of the service, which allows the fellow to develop experience in a supervisory role.

The fellow typically sees 8-12 patients on their own, and the remainder of the patients are seen by the residents under the supervision of the fellow. Medical students and observers often rotate on this service as well, and fellows have the opportunity to play an active role in student education.

Transplant Rotation

Typically, 140-170 patients per year receive transplants through Nebraska Medicine’s nationally renowned kidney and kidney-pancreas transplant program, with some traveling from across the United States. Our team provides longitudinal care for more than 1,200 patients, affording fellows exposure to both acute and long-term issues in kidney transplantation. 

The Nebraska Medicine transplant center frequently employs innovative strategies to living kidney transplantation including the use of kidney paired donation and transplant chains.  The kidney transplant service includes a transplant faculty member, a general nephrology fellow, a transplant advanced practice provider, as well as other multidisciplinary team members.  The inpatient census averages approximately 10 patients. 

Fellows work in a kidney transplant clinic on short- and long-term post-transplant follow-up, as well as donor and recipient evaluation clinic.

VA Rotation

The rotation through the VA Nebraska-Western Iowa Health Care System consists of inpatient and outpatient consultative nephrology. The census typically runs between 5-10 patients, and is managed by a nephrology faculty, nephrology fellow, and a resident.

During the VA block, fellows participate in two half-day VA nephrology clinics.

Kidney Biopsies

Fellows develop skills and proficiency in performing ultrasound-guided kidney biopsies.  Both native kidney and transplant kidney biopsies are performed with regularity in the division.  Further, an early cadaver lab experience allows fellows to practice in a low-stress setting.