Getting Started

Introduction:

The RUMC Section of Nephrology uses a 12-month calendar for their schedule: Attending Service Schedule 2024-25.pdf  and Fellows Service Schedule 2024-25.pdf.  The RUMC Department of Medicine runs on twenty six 2-week rotations schedule. Therefore you may work with several Attendings and  Fellows during your two 2-week rotations, although you will usually spend the majority of your time with a single Attending and Fellow who will be responsible for your evaluation at the end of your rotation.

The weekends are rotated for Attendings and Fellows as well so you may interact with most if not all of the Fellows and Attendings during your rotation: Fellows Weekend Call 2024-25.pdf. In addition, it is not unusual to have Residents from other hospital’s Internal Medicine residency program rotating with us. They are often on a different rotation schedule. Residents from outside hospitals will have to get a name badge and fulfill other “red-tape” requirements their first day prior to starting rounds. They may also need a “Crash Course” in EPIC, Rush’s Electronic Health Record. This is pre-arranged by the Department of Medicine. We often also have first year Urology Residents, Medical Students, PA Students rotating with us.

Depending on the month and what IM program you are from, you may start your rotation any day of the week. The Rush Residents typically all start and leave the rotation at the same time. Therefore, those Residents leaving the rotation need to coordinate (with the Fellow) patient hand-offs to the incoming Residents. The Fellow will either meet with you the morning of your first day of the rotation to help distribute the patients or communicate through a “WhatsApp” group chat. You will then round on your patients. We will meet as a team to round (walk around or meet in a conference room) to discuss patients. If there are any new consults, they may be seen in the morning prior to rounds, during rounds or after rounds that day; the Fellow will help guide the timing of rounds and consults every day. New consults are typically seen and worked-up by the Resident before presenting to the Attending, but this is flexible depending on the time of day and the acuity of the consult. Whenever a new consult is called during the day, it is important to let the renal Fellow know ASAP, as dialysis may need to be scheduled.

M-F there are two Fellows on the Consult Service. How the patients are split up will vary depending on the patient load but generally there is a Primary Fellow (called “General Nephrology I”) on the Fellows Service Schedule 2024 that is responsible for the ICU patients and the Tower patients, and a second Fellow (called “General Nephrology II”) that is responsible for the Atrium patients. The service will round with both Fellows.

Make sure you review the Resident Learning Objectives for the rotation.

Here are the Medical Student M4 Elective Objectives for the rotation.

DAILY ROUNDS:

Group (Students, PA students, Residents, Fellows, Attending) rounds typically begin at 9:30-10:00 AM (Attending dependent) Monday through Friday and are over by noon to allow you to go to any Internal Medicine noon conferences. You are expected to round on your patients prior to group rounds.  Daily EPIC notes are to be written on each patient and should focus on nephrologic issues. These notes can be written anytime but are best completed only after morning rounds in which the Attending, Fellow and Resident have made the necessary decisions and recommendations. Epic renal note templates are available and encouraged. Residents also round on weekends, but the weekend schedule must be within the constraints of duty hour limitations. Medical students do not typically come in on weekends.

Again, new consults may be seen in the morning, during rounds, or after rounds (and after Residents’ noon conference) and are typically seen and worked-up by the Resident before presenting to the Attending, but this is flexible depending on the time of day and the acuity of the consult. Consults may be “called in” to the Fellow or the Resident, and each should inform the other of all consultation requests.

This is a MUST READ document: In-Pt Rotation Pointers a survival guide to help you understand the daily routine of the service as well as to help you focus your patient management on Renal Issues.

RESIDENT CALL:

There is a Renal Call Pager that the resident on-call takes during the day. Thus, a call schedule needs to be made the first day of the rotation. New consults are assigned first to that resident and the team works together after that to do the rest. That pager is handed over to the Renal Fellow for the evening and night. Thus, the renal resident does not take night call.

CONFERENCES/TEACHING:
In addition to the teaching that occurs on rounds and during the presentation of consults, there are Nephrology conferences that residents may attend, although the Internal Medicine conferences should always take precedence. Nephrology Clinical Conferences and the Core Curriculum lectures are typically ZOOMed on M-W at noon. Renal biopsy conferences are also ZOOMed on Thursdays from 1-2:00 PM.