Training
Inpatient Training
Inpatient experiences consist of the consult services at both RRMC and the VA, a kidney-liver service at RRMC, and the kidney transplant service at RRMC.
Consult
The inpatient consultation services at both training sites consist of a faculty attending physician, a nephrology fellow, second or third-year internal medicine residents, and medical students. Daily consult rounds are conducted with the attending physician during which time various aspects of clinical nephrology are taught. Fellows become proficient in performing kidney biopsies, placement of temporary hemodialysis catheters, and providing hemodialysis, peritoneal dialysis, and continuous renal replacement therapy.
Kidney Liver Service
The Kidney Liver Service offers a unique experience that provides care for critically ill patients with both liver failure and kidney disease. The primary focus of this rotation is developing mastery of continuous renal replacement therapy. Fellows become comfortable managing severe electrolyte disturbances in patients with profound hemodynamic instability.
Inpatient Kidney Transplant
The strength of our kidney transplant rotation is that the service is primarily run by nephrology. Fellows, in conjunction with the attending transplant nephrologist, participate in approving deceased donor kidney offers, assess kidney transplant candidacy, develop the immunosuppression plan for each patient, and manage kidney transplant complications. Through this experience, fellows become adept in managing immunosuppression and caring for the immunocompromised patient.
Outpatient Training
For their outpatient experiences, all fellows will spend one half-day per week in a general nephrology continuity clinic. Fellows will devote one year of continuity clinic each at RRMC and the VA GLAHS. The outpatient clinic at RRMC is a tertiary-level nephrology clinic consisting of patients who primarily follow at UCLA along with patients from the surrounding community seeking second opinions from our expert faculty. In this setting, fellows gain experience in all aspects of nephrology. At the VA GLAHS, fellows share time between two general nephrology clinics and a hypertension clinic. They gain experience in all facets of general outpatient nephrology, including chronic kidney disease, electrolyte and acid-base disorders, glomerular disease, hereditary kidney disease including polycystic kidney disease, and resistant and secondary hypertension. The fellows will also gain valuable experience in electronic consultations, which are being increasingly utilized by health care systems to allow nephrologists to provide subspecialty expertise and assistance to primary care providers via electronic chart review.
Fellows also gain a comprehensive transplant experience through rotations in the outpatient transplant clinic, where they participate in all facets of transplant care, including early and late post-transplant care, evaluation of kidney transplant candidacy, and living donor assessments.
Outpatient Dialysis
The chronic hemodialysis rotation occurs at the VA GLAHS dialysis unit. This is an immersive experience caring for nearly 120 chronic hemodialysis patients at the West Los Angeles VA campus. The goal of the rotation is to provide fellows with the experience necessary to run their own dialysis unit. Fellows are supervised by a dialysis attending and gain experience in all aspects of chronic hemodialysis, including mineral bone disorders, anemia management, adequacy, and vascular access.
Fellows also take advantage of a large peritoneal dialysis population at RRMC. The emphasis of the rotation is in developing the expertise to be able to successfully run a peritoneal dialysis program upon graduation. Fellows assess peritoneal dialysis candidacy, participate in home visits, observe peritoneal dialysis catheter placement with the vascular surgeon, and manage the peritoneal dialysis prescription and dialysis complications.
Seminars
Pathophysiology Course - weekly
Transplant Journal Club/Case Conference - bi-weekly
Renal Grand Rounds - weekly
Journal Club/Case Conference-weekly
Pathology Conference - Monthly
Attendance at National Meetings
Fellows are given financial support to attend academic meetings, such as the American Society of Nephrology Renal Week, the National Kidney Foundation Spring Clinical Meeting, or the American Transplant Congress.
Salary and Benefits
Salaries and benefits may be found at http://medschool.ucla.edu/gme-housestaff-salaries
Further Training
Fellows will have the opportunity to pursue scholarly work during both the first and second years. The fellow will select a mentor with whom he/she will work on a research topic. It is a requirement of the program for a fellow to produce at least 2 peer-reviewed co-authored publications. Our Division also has the ability to offer another year of training in transplant Nephrology. The American Society of Transplantation-Accredited Transplant Nephrology Fellowship provides a third year of clinical training specializing in renal transplantation. We encourage fellows to take advantage of all of the educational opportunities and resources available to them.