It is understood that the first-year renal fellow has to complete a full residency in Internal Medicine before she/he can begin their renal fellowship. Thus each fellow comes to the start of their fellowship trained in Internal Medicine and board admissible in Internal Medicine. Thus, first year privileges for the fellow are based on that accumulated knowledge and skill. Thus the fellow is able to do all the basic IM practice: this includes doing an unsupervised H&P; assessment of vital signs and labs and the ordering of routine tests. Basic IM procedures include venipuncture, joint aspiration, blood gas drawing, thoracentesis and paracentesis. The first year renal fellow cannot initiate dialysis or RRT without discussion with the attending and review of orders. The first year fellow cannot place femoral dialysis lines until evaluations by attendings deem them competent to do so independently. The first year renal fellow cannot make independent out-patient referrals for patients without review of the case by the attending.The first year renal fellow cannot do a renal biopsy without an attending being present.
It is understood that the second-year renal fellow will meet all of the above requirements and that by faculty evaluation of their competence in the above procedures will then be able to begin to function more independently. The second year fellow will see and evaluate patients in clinic and be able to make independent plans for referral and care, with supervision of the attending. The second year fellow will be able to make decisions to initiate dialysis or CRRT with the supervision of the attending. The second year fellow cannot do a renal biopsy without an attending being present, but is expected to be able to perform the procedure in a competent and independent manner.