Department of Medicine

Nephrology Fellowship Rounding Responsibilities

Master
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Ben Taub Hospital (County Hospital) - There are two inpatient consult services: Acute and ESRD. There is one outpatient rotation. Cases at the county hospital are fascinating and fellows have a significant amount of autonomy. The ESRD service is responsible for all admitted patients who require chronic dialysis, as well as the patients who receive emergent dialysis only. We typically perform kidney biopsies as a part of the outpatient rotation. Fellows will complete 5 to 10 biopsies per month, place one or two temporary dialysis catheters, learn diagnostic renal ultrasonography, and participate in our interventional nephrology clinic. During a four-week block, the outpatient fellow will take one week of night float (Sunday to Friday) instead of clinic.

Michael E. DeBakey VA Medical Center – There are three inpatient services at MEDVAMC: Critical care, general nephrology, and kidney transplant/research. 

The critical care and general nephrology services are consultation services only. Fellows will get hands on experience with point-of-care ultrasound and will have opportunities for dialysis catheter placement while on the critical care rotation. 

MEDVAMC is one of only five VA medical centers in the country that perform kidney transplants. It is the only VA medical center that performs liver and heart transplantation (starting 2021). The kidney transplant service/research rotation is approximately 50% clinical with remaining time dedicated for academic/research time. Typically, all clinical fellows in our program will have approximately two to three months of research time averaged over a two-year period. During this rotation, the fellow will take one week of night float (Sunday to Friday).

Houston Methodist Hospital (Private) - The fellow at Houston Methodist rounds one-on-one with the attending. Most of the patients on this service are kidney transplant patients. Opportunities exist to perform transplant renal biopsies. The team is primary on all patients who have received transplants within the past six months. This fellow also covers the Pavilion for Women (1-2 consults a month) to care for pregnant women with kidney disease. 

Baylor St. Luke's Medical Center (Private) – There is one inpatient consult service and one outpatient rotation at this hospital. The inpatient service is a typical academic team with a faculty, nephrology fellow, up to two residents, and one student. Care is provided to a variety of patients with kidney disease, including those on continuous dialysis or status post complex cardiac surgeries. 

The fellow on the outpatient rotation has two weeks of night float (Sunday to Friday) and the remaining two weeks will be spent in a variety of outpatient clinics. There is also time for independent study.

MD Anderson Cancer Center (Public) – One fellow rounds at MDACC each month. This rotation offers exposure to inpatient onco-nephrology. 

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Outpatient Rounding Responsibilities

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Most nephrology clinics occur in the afternoon, which allows our fellows on inpatient rotations to complete patient care tasks in the morning. There are no clinics on Wednesday afternoon; this time is reserved for didactics and grand rounds.

Harris Health General Nephrology Clinic - This multi-disciplinary clinic is at the Smith Clinic on Friday afternoons. It includes faculty, fellows, residents and students, as well as a dedicated renal dietician and social worker. Fellows rounding in the county hospital are assigned to this clinic 

MEDVAMC General Nephrology Clinic - This clinic is at the VA Hospital on Monday or Friday afternoon. Fellows rounding on the critical care and general nephrology services are assigned to this clinic. Faculty and fellows are paired to provide care for a panel of patients. 

Houston Methodist Transplant Clinic - This clinic is at the Methodist Outpatient Center on Tuesday afternoons. The clinic is staffed by Baylor faculty and several dedicated transplant coordinators. It is a wonderful clinic to learn about the management of post-transplant patients. Fellows rounding at Baylor St. Luke’s and Methodist are assigned to this clinic.

Miscellaneous Outpatient Clinics - The miscellaneous clinics include: Baylor Medicine Private Practice (Baylor College of Medicine), Pediatric Nephrology (Texas Children's Hospital), Peritoneal Dialysis (DaVita Home at the Museum), VA Transplant Clinic (MEDVAMC), Hemodialysis (Riverside Dialysis Center, US Renal), Vascular Access (Orbis Access Center), Harris Health Outpatient Kidney Biopsy Clinic (Ben Taub), Harris Health Glomerulonephritis Clinic (Smith Clinic) and BSLMC Transplant Clinic (Baylor Clinic). Fellows are assigned to attend these clinics only during specific rotations, some are optional.

Medical Directorship: Continuous Quality Improvement (CQI) - Our faculty manage more than 500 dialysis patients and hold medical directorships at numerous outpatient clinics. Each fellow will be assigned four CQI meetings per year to learn how patient care is delivered at a large dialysis clinic.