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Policies and Procedures

5. Nephrology Fellow/Internal Medicine
Resident Interactions
I. Overview
Nephrology fellows will interact with residents in internal medicine and other medical
specialties throughout their fellowship. Fellows will serve as teachers, supervisors, and may
assist in the evaluation process of residents and students. Specific guidelines for the clinical
rotations are outlined in this document.
II. Consult Rotation
Internal Medicine and Family Medicine residents along with third and fourth year
medical students frequently rotate on the consult team. The fellow is expected to coordinate the
efforts of the trainees and assign them with new consults as appropriate. The fellow should
assist in consultations providing teaching and learning opportunities for the team. All patients
will be presented to the attending physician during daily teaching rounds. It is anticipated that
residents and students will present the majority of the consults on attending rounds after the
nephrology fellow has prepared them for this presentation. The attending or nephrology fellow
should supervise all procedures performed on the service by a rotating resident.
The nephrology fellows perception of the resident/students performance will be utilized
in the evaluation process performed by the attending physician. The fellow is encouraged to
provide feedback to the rotating trainees throughout the rotation so that their performance can
improve with time on service.
Nephrology fellows will also interact with residents and students on other services. To
assure quality patient care and maximize teaching and learning opportunities the nephrology
fellow should assure proper communication of recommendations to the team requesting
consultation.

III. Service Rotation
The service is composed of 3 or 4 resident trainees, 1 to 3 medical students, and a
supervising attending. On months where a fellow is assigned to the service, the fellow, with
supervision from the assigned attending, is responsible for coordinating the efforts of the trainees
with regard to patient care, education, and evaluations. All procedures performed by these
individuals should be supervised by the nephrology fellow and/or attending.
IV. Outpatient Rotation
During the outpatient rotation nephrology fellows will infrequently interact with residents
or students. Most interactions are anticipated to occur when a patient requires admission to the
hospital or transfer to the emergency room. In the event of such a patient transfer the nephrology
fellow is expected to communicate the patients condition to the inpatient admitting resident or
the emergency room physician or resident.
V. Transplant Rotation
Nephrology fellows will frequently interact with students or residents rotating on the
ECU transplant surgery service or another primary service. As consultants, the transplant fellow
is expected to follow guidelines similar to those outlined for the consult service. Nephrology
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fellows are not expected to respond to surgical complications of the transplant patient and these
questions should be routed to the surgical staff. The transplant fellow should, however, assist
with medical management of the transplant patient as guidelines of consultation dictate.
VI. Continuity Clinic
There should be little interaction between nephrology fellows and residents or students
during their continuity clinic. Any interaction would likely represent a request for consultation
or transfer for emergency or inpatient management. In these circumstances the nephrology
fellow is expected to communicate appropriately with the accepting physicians.

VII. Offsite Eastern Nephrology Associates Vascular Access Center Interventional
Nephrology Rotation (elective)
The nephrology fellow does not have any responsibility for teaching and /or supervising
other subspecialty/internal medicine residents or other specialty residents while on an
Interventional Nephrology elective.