Training Tomorrow's Leaders
A major purpose of the Stanford Nephrology training program is to prepare trainees for a career in academic medicine. The standard program is 3 years in duration and comprises 1 year of training in clinical general and transplant nephrology and 2 years of research. However, the program can be tailored according to individual needs. Thus, for the individual who desires more intensive clinical training, a second clinical year may be arranged. Similarly for the individual who desires more intensive research, additional training is offered. The program is ACGME accredited.
The program is divided into rotations among the 3 principal teaching hospitals, Stanford Hospital and Clinics (SHC), The Veterans Affairs Palo Alto Health Care System (VAPAHCS) and the Santa Clara Valley Medical Center (SCVMC). Weekly Nephrology clinics (9 in all) are held at each of the hospitals, and 3 transplant Nephrology clinics are held each week at Stanford. In addition, the fellow is responsible for supervising and teaching (under close supervision by a faculty member) Stanford medical residents and medical students.
A new feature of the program is a one week "intersession" to improve the education we provide fellows in the first, clinical year. During this week, first year fellows will be excused from clinical duties to attend teaching sessions with division faculty. A schedule of informal morning and afternoon didactic presentations together with assigned reading and group review of selected cases and problems is designed to help new fellows understand material (such as use of urea kinetics for dialysis prescription, acid balance in clinical medicine, and the basic statistics used in clinical reports) which is hard to pick up in busy hospital practice.
Fellows choosing the research training pathway will be paired with at least one mentor of their choice. In addition to faculty within the division, we have expanded the pool of potential mentors and co-mentors greatly and beyond the division, department, and School of Medicine. This way, we can tailor each fellow’s training to her or his specific interests and needs (e.g., economics, business, genomics, law, as they relate to nephrology).
While in training the fellow is expected to conceive, design and perform an independent research project and prepare at least one manuscript for publication. Most fellows exceed this goal and publish several articles in quality medical journals. It is also expected that each fellow write grant applications to support their research and training, under close guidance of their mentor(s). Recent fellowship classes have been extremely successful in garnering fellowship support from most prestigious and highly competitive grant programs (e.g., National Institutes of Health, Agency for Healthcare Research and Quality, American Kidney Fund, National Kidney Foundation, American Heart Association). The division also holds a coveted T32 training grant from the National Institute of Diabetes and Digestive and Kidney Diseases of the National Institutes of Health. Many fellows enroll in formal research training programs offered at Stanford and earn a Master of Science degree in Epidemiology or Health Services Research during their fellowship.
During the research years (2nd and 3rd year of the fellowship), the vast majority of time is protected for research and training. Some clinical responsibilities, however, remain during that time. The first research year includes working in an outpatient clinic for one-half day each week, which exposes the fellow to long-term management of a cohort of patients, and is required for board certification. In addition, the fellow will provide 1 to 2 months of coverage on the clinical service for first year fellows who take vacation, or board examinations, or require health-related leave.
During the third year (i.e., the second research year) the fellow will also be called upon to provide coverage for the first year clinical fellows, but usually for no more than one month.