Division of Nephrology: Fellowship Orientation Manual

NEPHROLOGY DIVISION

FELLOWSHIP INFORMATION

The following is some general information you will find helpful to begin your fellowship.

Change of Address or Telephone

If you change your address or telephone number, notify Dede Copeland as soon as possible. This information must be updated regularly in the UT Southwestern Human Resources database.

Change of Name

All house staff officers who marry and wish to have their name changed must let Dede Copeland know so this information can be updated in the UT Southwestern Human Resources database.

Evaluations

Fellow Evaluations:

The Division of Nephrology uses an online fellowship management system called New Innovations (new-innov.com). You will have access to the system in order to sign/approve and/or obtain your evaluations. Emails are automatically sent out to your attendings periodically as a reminder to complete the evaluations on the fellows. At the end of your fellowship, all evaluations must be completed, signed, and approved, as required by the Accreditation Council for Graduate Medical Education.

Training of the administrative staff be held the second week of July. After that time, you will receive detailed information about access.

Attending Evaluations:

Fellows are also required to evaluate attendings each month. These evaluations are anonymous – an attending will not be able to view evaluations until at least five have been completed (regardless of the time necessary to obtain the minimum number). Emails are automatically sent out to you as a reminder to complete these evaluations.

Program Evaluations:

Twice each year, fellows will meet with the Clinical Director and the Division Chief to evaluate the program. Evaluations are done as a group and a composite of comments is maintained in the Division. Individual faculty members are also evaluated. Faculty members are notified of the composite evaluations by the fellows. Comments by individual fellows are kept in strict confidence to maintain integrity of the evaluation process.

Procedure Logs

The compilation of all your procedures during your fellowship can be done through New Innovations. You need to submit each procedure that you did through that database, and have your attending sign off on each of them. These completed records of procedures are required for graduation from the program, as well as accreditation by the Accreditation Council for Graduate Medical Education.

Risk Management

All new fellows must complete 15 hours of risk management education at the beginning of their appointment. After successful completion of the Risk Management Education Program, you will have three years in which to complete an additional 15 hour course. If a new fellow completed his/her initial 15 hours as a resident while at UT but then left for a year, he/she will need to complete another 15 hours, but the hours can all be “elective” hours. You are not required to take the quiz again unless you want to.

The initial course consists of 10 core hours and 5 elective hours. Current specifics of how to take the quiz and what types of courses/conferences/reading constitute elective hours and the deadline for meeting the requirements is in Section 9 of this manual. This information is also accessible on the Nephrology Division’s O Drive.

Rotations

St. Paul

Before you rotate at St. Paul, you must have the following:

• Completed physician profile and confidentiality form

• Completed parking form

• Ut Southwestern ID Badge (you can have one made at the Visitor Information Center/ Parking Services office in the plaza at UT Southwestern.

Your computer access from Parkland should give you access to the St. Paul University Hospital (SPUH) clinical repositories. If you have difficulty, contact Dede in the Nephrology Office.

The designated area for residents to park is on the Lower Level of the SPUH Professional Office Building I Parking Garage. If you have a UTSW badge/parking card, but have not had it activated, you should park on the 4^th or 5^th level of the parking garage on the first day of your rotation.

Fellows will be issued a DEA number, as needed, to use during their SPUH rotations. You will also be asked to sign a Pharmacy Card so the Pharmacy Department can maintain a copy of your DEA number and your signature on file.

Methodist

The Methodist rotation is always on the Transplant Service. Fellows rotating at Methodist Central Hospital should call Jan Leaf before beginning the rotation to obtain the name and pager number of the attending on service that month (214-947-1730). Park in parking garage (the card is passed from fellow to fellow).

Veteran’s Affairs (VA) Medical Center

For both consult and dialysis rotations, report to the Dialysis Unit (3^rd Floor – Clinical Addition) at 7:30 AM. Parking is free at the VA, but the earlier you get to work, the better your parking. On the first day, your attending can direct you to the best parking.

Rotation Switches

On occasion, it is necessary for fellows to switch rotations. Such changes must be approved by Dr. Biff Palmer. A revised schedule will then be prepared and distributed.

Vacation Schedule

To make each rotation a meaningful experience, only one week of vacation may be taken on any rotation. If you would like to take off two weeks in a row, this can be done by taking the last and first weeks of consecutive rotations. Vacations should not be requested during Parkland transplant, Parkland dialysis, or VA dialysis rotations.

Vacations must be requested in advance by contacting the Chief Fellow, Vishal Patel. He will then request permission from your attending via memo. You will be notified of approval or disapproval, but in most cases requests will be approved. If you cancel your vacation plans, you should also notify Dr. Patel as soon as possible in writing.

Fellows are allowed three weeks (15 working days) of vacation time each year.

Nephrology Conferences

The purpose of the Monday Clinical Conference, Tuesday Research Conference and Thursday Physiology Lecture is to provide a broad range of educational lectures to faculty and fellows. Attendance at these conferences is required for all fellows. While clinical emergencies will occasionally prevent a fellow from attending a conference, this should not be a common occurrence. To track attendance, sign-in sheets will be available for each conference. This information will become a part of each fellow’s file and will be part of his/her evaluation.

• Two Lab coats: Mary Lou Swann will order lab coats at the beginning of each year. Please give her your size and correct spelling of your name. Allow about four weeks for delivery.

• Copy cards: You will be issued a copy card which allows you to make copies in the UT Southwestern library. Copies are charged to the Nephrology Division account. (Note: when possible, copies should be made on the copier in the division office. This reduces the cost of copying.)

• Library cards: To obtain a library card, you must first have a UT Southwestern ID badge made. To make an appointment, call Dee Hampton in the Human Resources Department (x80821). Once you have your ID badge, take it to the Information Desk in the Library. They will attach a barcode to the back of your card, which acts as your library card.

• Forced Authorization Code (FAC) for Long Distance Calling: You will be issued a FAC for making long distance calls from the division offices. At the end of each month, you will receive a list of all long distance calls you have made. Indicate on the list any personal calls and attach payment for the total amount. Business calls are charged to the division.

• GroupWise Email Address: Each fellow will be issued an email address as soon as he/she is appointed. It is very important that you check your email consistently as this is the communication line between you, Parkland, and UT Southwestern, including information regarding insurance changes, policy/procedure changes, conference date/time changes, etc. Often, they include very important deadlines. The house staff at Parkland and the Internal Medicine Department will use your PMH or UTSW email address for all correspondence.

If you wish to forward your Parkland GroupWise email account to your private account, that may be done in the following steps:

1) Access GroupWise from the PHHS Network either from within or from the Internet. To access from the Internet, type webmail, pmg.org in address field, and click on Parkland Health & Hospital System Web Access.

4) Under the Define Conditions, place a check next to Mail. (Or, you can leave them all unchecked to use the default setting of forwarding all items, mail, appt., etc.)

7) Type in a Subject and a Message that will be included in all forwarded messages.

9) In the future, to disable the rule, just click Tools, select Rules and then uncheck the rule or delete it.

Standard computer access for all required functions will be requested by Elizabeth Ponce at the time of appointment. Other standard accesses will be obtained by the Nephrology Administration. For questions, contact Dede Copeland.

The Internal Medicine Residency Program uses the website amion.com for rotation and call schedules. You can login to the system from any location using the password utswim3. To page a resident, simply click on the pager number and complete the information blocks. They will be paged via the Arch Wireless paging system. Specific instructions are:

• To view the block rotations, select “block” at the top left of the screen. This will show the R1 block. To view the R2 block, use the drop-down menu at the top center of the screen.

• To view the Renal rotations, return to the current day call list and use the drop-down menu to select the appropriate rotation (PMH Renal = Consult, RT = Renal Transplant; VA Renal = VA renal consult)

All three-year research fellows (whether clinical research or basic science) are required to have a Texas Medical license by the end of the second year of training. For information on application, contact the Fellowship Coordinator.

All fellows have a mailbox in the division mail closet (the door to the right of the Administrative Office entrance). The code for the door is 1029.

Fellows should check their mailboxes frequently as the staff often put important information in the boxes.

The Nephrology Division will take care of dry-cleaning lab coats. Please leave the coat in the basket in the hall outside of H5.122.

Fellows are automatically covered by the UT System. You will receive a certificate stating that you are covered, but there will be now policy number listed.

Nephrology fellows may moonlight at other institutions provided the following conditions are met:

1. Fellows must request and obtain written permission from the Director of Clinical Nephrology.

4. Moonlighting activities must not interfere with the normal workload of your fellowship.

5. If you plan to moonlight at an institution not covered by the malpractice insurance provided by UT Southwestern, you must purchase your own insurance.

The lines of responsibility for fellows are identical at all teaching hospitals:

A. The ultimate legal responsibility for the training program is vested in (a) the Chief of Nephrology and (b) the Program Director.

B. On each rotation, the fellow is under the direction and reports to the attending Physician assigned to that rotation. The Attending Physician is responsible for all medical care and teaching. The Fellow is directly responsible to the Attending Physician, whose decisions on medical care are final.

C. In outpatient clinics, the Fellow is responsible to and directed by the Attending Physician.

D. The Fellows, teaching faculty, and Program Director interact with the hospital CEO and administration of each teaching hospital according to the bylaws of that hospital. At PHHS, this interaction occurs through the Medical Advisory Council. At VANTHC and ZLUH, these interactions occur through the Executive Committee of the medical staff. The administrations of the teaching hospitals have no authority over the teaching programs.

1. The Fellow is responsible for the care of all patients assigned by the Attending Physician. The Fellow is expected to demonstrate independent thought in devising a clinical plan and writing orders, but he/she should discuss these with the Attending Physician.

2. The Fellow must know in detail and follow all patients on the service. She/he must guide the residents and students who may be on the service as well as teach both theory and practice. Organization of work on teaching rounds is the responsibility of the Fellow, who reports directly to the Attending Physician. The Attending Physician should write daily notes, which should be reviewed by the Fellow.

In the outpatient clinics, especially continuity clinics, the Fellow will manage her/his patients independently. Prior to the patient’s discharge from the clinic, a brief summary should be presented to the Attending Physician(s). With more complicated patients, or those with whom questions arise regarding further workup and management, the Attending Physician should be involved earlier.

Scheduling of clinical rotations is under the direction of the Chief Fellow, along with the Program Director. All Fellows are expected to follow these assignments. The Chief Fellow also assigns vacations, education leaves and absences required because of emergencies, such as family illness or death, with final approval by the Program Director.

A. The day to day operation of the Fellowship Program is vested in the office of the Program Director. The Program Director executes the policies of the Department of Internal Medicine and the Division of Nephrology and is responsible for conformity to the bylaws of the teaching hospitals.

B. The Attending is the first source of counseling should a Fellow have difficulty or if disputes arise during a rotation. If problems cannot be solved by the Attending, they may be referred to Dr. Biff Palmer (Program Director).

V. Interactions with House Staff in Internal Medicine and with Consultants for Other Departments

House Staff and other consultants should be treated with dignity and respect, and their recommendations should be carefully considered.

Over the past year, several members of our faculty and house staff, among them Robert Goldsteen, Guna Raj, and next year’s Chief Residents, have worked extensively to modify and enhance our residents’ ambulatory experience. Beginning in July, each resident will have his/her Continuity Clinic at only one site (Parkland, VA, or St. Paul) throughout his/her 3 years of residency. We believe this will improve our residents’ ambulatory experience.

Over the past few years, our residents sometimes have had difficulty obtaining prompt assistance from certain subspecialty consulting services in the care of a clinic patient. When the residents contact a subspecialty service and ask for assistance, they are often told simply to send the patient to the subspecialty clinic in the coming weeks or (if the patient seems to be sicker) to the Emergency Room for immediate assistance. The bottom line: the potential learning experience for the residents in Continuity Clinic is diminished or absent.

In an attempt to improve the learning experience in Continuity Clinic, we ask that the subspecialty services, if at all possible, respond to requests for consultation by sending a fellow or Attending Physician to the Clinic, thereby providing prompt consultation and, in the process, maximizing the residents’ learning experience in the Clinic. At times, of course, this will be impossible, but at other times it might take only a few minutes. Both the patient and the resident will benefit.

The time demands of most settings, including Continuity Clinic, are intense. As a result, it is mandatory that we make a special effort to maintain the educational value of all our teaching venues, including the Clinic. Prompt consultation is one way to enhance the educational quality of the Continuity Clinic.

UTSW Nephrology Fellows on the acute dialysis service will be required to contact the attending Nephrologist on all such patients at the time of admission and discharge from PMH.

- The nephrology fellow on the acute dialysis service will contact the attending Nephrologist on all such patients at the time of admission and discharge from PMH.

- The attending Nephrologist should be contacted by pager first, then office voice mail with the information, unless otherwise noted on the phone list.

- The nephrology fellow should anticipate an average of 2 more calls per patient, and should work this into their schedule accordingly.

- For new initiations, the nephrology fellow needs to only make a call at the time of discharge to the attending.

Each Nephrology Fellow is required to complete two hours of billing compliance education annually. The Fellowship Coordinator will make you aware of the options available to satisfy this requirement.