Mission

• To provide the necessary opportunities to acquire the clinical competencies, teaching, and research skills of a nephrology sub-specialist as determined by the ACGME, and to ensure that trainees qualify for the ABIM Nephrology certifying examination.
• To train U.S. Army, Navy, and Air Force Nephrologists in accordance with ACGME requirements, as above, and to support DoD nephrology needs in both war and peacetime. Military requirements may interrupt or delay training, and military curriculum components are added. Methods to compensate for delays are in place. ABIM and ACGME are the civilian arbiters of training integrity.

Vision

• To meet and exceed ACGME and ABIM nephrology subspecialty training requirements, while providing additional nephrology military-unique curriculum, while serving military beneficiaries.

Aims

• To fully meet the requirements for Nephrology fellowship training per the ACGME and ABIM.
• To ensure training in nephrology-specific military topics, with the input of program graduates.
• To serve military beneficiaries in need of nephrology care (active duty, retired, and their dependents).

Topics and types of conferences follow those required by the ACGME. We sponsor one hour of didactic training four times weekly, broadcast online on Teams to military and federal nephrologists throughout the U.S. Please contact the program if you’d like to participate.

First Year Fellows

• Rotate between inpatient and outpatient nephrology, with longitudinal experiences in chronic dialysis (including home dialysis) and transplantation. A one-month block is spent at the Washington D.C. Veterans Affairs hospital, concentrating on POCUS training and chronic outpatient dialysis (in-center and peritoneal dialysis). Late in the year, a one-month block is spent developing the research topic to be pursued during the second year.
• At the end of the first year, fellows may apply for a one-year critical care fellowship, and if accepted, pursue a 1-month elective during their second year focused on procedural and ICU nephrology.

Second Year Fellows 

• Primarily pursue research and special projects, a multi-disciplinary performance improvement project, as well as rotations in home dialysis, experience with Pediatric Nephrology, additional CRRT and ECMO experience at Washington Hospital Center (a 1-month block), and onconephrology/experience with rare nephrologic diseases at the NIH Clinical Center (a 1-month block).

Second year fellows may arrange with interventional radiology for training in native and transplant kidney biopsy, to achieve sufficient numbers and experience to demonstrate competence in the procedure.

One week of home call in every 4-6 weeks. 

The WRNNMC Nephrology Training Program military curriculum is presented in specific lectures, experiences, and clinical rotations throughout fellowship training. Active duty nephrologists must be able to rapidly establish infrastructure for dialysis/RRT capability in forward deployed settings or OCONUS, to include coordination in a multidisciplinary and multi-institutional fashion. The results of recent curriculum surveys of military nephrologists (2019, 2021, 2022, 2023) by the program have been used to focus on topics that were deemed important by greater that 50% of respondents, to include POCUS, specific CRRT and austere dialysis training, and placement of temporary dialysis catheters.

Fellows attend the Columbia Renal Biopsy Course (online) and the University of Alabama CRRT and Home Dialysis Courses during their second year.

Simulation is used for training and assessing competence in placement of temporary dialysis catheters, counseling patients for nephrology procedures, and writing appropriate dialysis prescriptions for acute and chronic hemo- and peritoneal dialysis.

Second year fellows are required to complete a research project and obtain IRB approval if needed. They must present a poster or podium talk locally, regionally, or nationally, as a graduation requirement. Many publish original, peer-reviewed research in the year or two following fellowship training.

Second year fellows are required to develop and implement a multidisciplinary, nephrology-specific Quality Improvement Project. Recent projects include development of a home hemodialysis curriculum, and an outreach project to local military primary care providers regarding the hazards of high-dose NSAIDs.

Nephrology fellows have opportunities to serve on hospital committees, including the housestaff and wellness committees. Fellows participate in teaching of medical students and residents, providing formal and informal lectures on nephrology topics.

• Washington D.C. VA Medical Center
• National Institutes of Health Clinical Center
• Washington Hospital Center

WRNMMC internal medicine residents are encouraged to rotate on Nephrology, either on the inpatient or outpatient service.

Please contact us in June or July the year before training would begin to arrange for an interview. Interviews may be done in person or virtually.

Program graduates take the American Board of Internal Medicine (ABIM) Nephrology Specialty Board examination. This exam is offered annually in the autumn. To become fully board certified, applicants are eligible to take board certification exam during the year after graduation. Please see the ABIM policies regarding board certification examinations.

• Fellows participate in medical student teaching (pre-clinical and clinical) on selected topics (dysnatremia, acid-base disorders, acute kidney injury) during their second year.
• Fellows will be assigned journal club, critical reading, and grand rounds topics as part of the Nephrology SVC didactic schedule. Second year fellows present a “Capstone” patient management conference at the end of the year, describing the evidence-based management of a patient with a nephrology disease of interest to them.

• All fellows are assigned a research mentor, responsible for assisting the fellow in developing the research protocol, navigating the Institutional Review Board process, completing the research plan, and reporting/publishing the results.
• Fellows are assigned a faculty mentor to assist them in preparation of didactic conferences.

We participate in institutional (WRNMMC and NCC) wellness training and projects.