Clinical Training

Clinical Training Photo 1

Clinical Training Photo 2

Our program offers robust and extensive clinical training across three major training sites to equip trainees with the expertise and skillset for excellence in clinical nephrology. The combination of a VA hospital, county hospital, and university hospital prepares fellows to practice in varied environments with diverse patients.

Training Sites

All fellows rotate through the main clinical training sites: UCSF Medical Center, Zuckerberg San Francisco General Hospital (ZSFG), and the San Francisco Veterans Administration Health Care System (SFVAHCS), and together these sites cater to a unique and diverse patient population in the Bay Area.

At UCSF Health (Parnassus/Mount Zion/Mission Bay), fellows are exposed to a quaternary-care patient population. Conditions include acute kidney injury; end stage kidney disease; oncologic emergencies and onconephrology; pregnancy-related kidney diseases; organ transplants including heart, lung, liver, kidney, and pancreas; critical care nephrology. UCSF Health at Parnassus is a 600-bed hospital and the main site for the Kidney Transplant Unit (KTU), one of the largest programs in the United States performing roughly 375-400 kidney transplants per year. UCSF Health is also the main training site for continuous renal replacement therapy (CRRT).

The Zuckerberg San Francisco General Hospital (ZSFG) is a safety-net, 397-bed hospital that provides care for underserved populations in the Bay Area, in addition to being the only Level 1 Trauma center in San Francisco. An outpatient dialysis unit, Ward 17, is located on campus and provides hemodialysis and peritoneal dialysis. Fellows at ZSFG will care for patients with advanced presentations of kidney diseases that were previously undiagnosed and untreated, affording fellows the opportunity to provide a fresh diagnostic evaluation and initial management. ZSFG and the San Francisco VA Health Care System are the main training sites for in-center hemodialysis and peritoneal dialysis.

The San Francisco Veterans Administration Health Care System (SFVAHCS) is a 112-bed hospital providing care for veterans from the San Francisco Bay Area and the Western U.S. An outpatient dialysis unit located on campus provides hemodialysis and peritoneal dialysis to veterans. The hospital is associated with a 120-bed community living center. The SFVAHCS is a National Center of Excellence in the areas of: nephrology/dialysis, epilepsy treatment, cardiac surgery, post-traumatic stress disorder and HIV care.

UCSF Medical Center (square)

University of California, San Francisco Medical Center
505 Parnassus

ZSFGH (square)

Zuckerberg San Francisco General Hospital
1001 Potrero Avenue

SFVA Medical Center (square)

San Francisco VA Medical Center
4150 Clement Street

Clinical Rotations

Our clinical rotations include nephrology consultative services, outpatient chronic dialysis (hemodialysis and peritoneal dialysis), and kidney transplantation. Consultative services encompass dialysis care, continuous renal replacement therapy (CRRT) for ICU patients, acute and chronic kidney disease, hypertension management, glomerulonephritis, and electrolyte/acid-base disorders. Throughout the first year, fellows alternate monthly between higher intensity "systole" rotations, such as inpatient consults at UCSF Health, and lower intensity "diastole" rotations, such as outpatient chronic dialysis at ZSFG and SFVAHCS.

Nephrology faculty and fellows at the three sites supervise in-center and home hemodialysis and peritoneal dialysis for over 300 end-stage kidney disease patients in the San Francisco Bay Area. The Kidney Transplant Unit (KTU) at UCSF performs approximately 375-400 kidney transplants per year, including simultaneous pancreas-kidney and liver-kidney transplants, expanded criteria donors, and high-risk patients.

Year 1 Year 2 (Clinical Track)
Inpatient Consult Service at UCSF Medical Center (12-16 weeks) Inpatient Consult Service at UCSF Medical Center (4-8 weeks)
Inpatient Consult Services at ZSFGH (4 weeks) Inpatient Consult Service at ZSFGH (8 weeks)
ZSFGH Chronic Service (8 weeks) VA Elective (14 weeks)
VA Acute Consult Service (4 weeks) VA Acute Consult Service (6-8 weeks)
VA Chronic Service (8 weeks) Night Float (5 weeks)
Kidney Transplant Service (8 weeks)  
Night Float (4 weeks)  
Vacation: 4 weeks of scheduled vacation time off per year. Additionally fellows get two 5 day holiday blocks (Thanksgiving, Christmas or New Year's) and ASN Kidney Week coverage for 2nd year fellows, along with coverage to attend other educational conferences if requested in advance including Home Dialysis University, Nephrology Business Leadership University.

Rotation Descriptions

Fellows benefit from diverse clinical experiences by rotating on the nephrology services at UCSF Health, ZSFG, and the SFVAHCS.

UCSF Health: Fellows are based at the UCSF Parnassus campus.

  • Nephrology Consult Service: The consult service is split between two fellows, each working one-on-one with a faculty attending nephrologist. We do not separate ICU vs. non-ICU or chronic dialysis vs. non-dialysis consults.
  • Kidney Transplant Unit: Staffed by a transplant nephrology attending and general nephrology fellow. One of the busiest kidney transplant centers in the nation, the UCSF Kidney Transplant Unit (KTU) performs approximately 375-400 kidney transplants each year. General nephrology fellows on the KTU rotation will serve on the KTU primary service and the KTU consult service, seeing patients with functional kidney allografts on other services or patients with other solid-organ transplants who need nephrology consultation. Fellows will also see patients in the KTU outpatient clinic, attend weekly kidney transplant lectures, and go to daily biopsy review sessions with our renal pathologists.

Zuckerberg San Francisco General Hospital:

  • Acute Consult Service: The ZSFG consult service is split between a ZSFG acute fellow, who sees the majority of the consults, and the ZSFG outpatient fellow (see below), who follows any admitted Ward 17 patients for continuity (up to a maximum of 5).
  • Chronic Outpatient Service: The ZSFG outpatient fellow rounds on hemodialysis and peritoneal dialysis outpatients at Ward 17. The focus is on learning the management of stable chronic dialysis patients in a multidisciplinary team. The outpatient fellow also sees patients in the weekly low GFR clinic, where patients with advanced kidney disease are followed closely for medical management as well as kidney failure education, including dialysis options and planning depending on goals of care.

San Francisco Veterans Affairs Health Care System:

  • Acute Consult Service: The VA consult service is staffed by one fellow and attending. The fellow takes care of inpatient consults and also participates in the general nephrology clinic on Thursdays.
  • Chronic Outpatient Service: The outpatient fellow follows chronic hemodialysis and peritoneal dialysis patients and participates in the weekly general nephrology and low GFR clinic.
  • Elective: Clinical track fellows have approximately 4 months of elective time during their second year. Fellows choose a scholarly/research project with a VA faculty mentor (e.g. QI projects, book chapters/review articles, research project, teaching modules). During this time, fellows also have the opportunity to attend conferences, such as National Kidney Foundation Conference, Mount Desert Island Physiology Course in Maine, Nephrology Business Leadership University, or Home Dialysis University.
Continuity Clinics

Fellows are assigned to half-day weekly continuity clinics across the three main training sites. Fellows attend continuity clinics throughout the first two years of fellowship training. Assignments to the 3 clinic sites are rotated on an annual basis to offer a diverse outpatient training experience.

Night Float

Fellows on clinical rotation during the daytime do NOT take night call Monday to Friday for the majority of the year (exceptions include times of limited fellow availability, such as holidays and ASN Kidney Week). The night float system mitigates fatigue for the fellows who are working during the daytime on weekdays. The night float fellow takes home call and provides coverage from 6 PM to 7 AM, Monday to Friday. First year fellows are not assigned to the night float rotation until the second half of the year, once they are familiar with the main clinical sites and basic nephrology.

Procedural Training

Fellows will receive training in procedures including:

  • Hemodialysis
  • Peritoneal Dialysis
  • Continuous Renal Replacement Therapy
  • Urine Sediment Microscopy
  • Temporary Hemodialysis Catheter Insertion (with real time ultrasound guidance)
  • Ultrasound-Guided Percutaneous Kidney Biopsies

Fellows will also receive training in renal pathology through the renal pathology conference, Fellows' Lecture Series, weekly case conference, and kidney transplant biopsy rounds.

Vacation and Holiday Schedule

All fellows have 4 weeks of scheduled vacation time off per year.

The Thanksgiving, Christmas, and New Year holidays are divided into 5-day blocks. Fellows get 2 out of the 3 holiday blocks off, working one holiday block (preferences are taken into consideration).

In addition, all second year fellows are off service to allow attendance during ASN Kidney Week, with coverage provided by first year fellows.

Fellows Coaching Program

Each first and second year fellow is assigned a faculty coach to discuss career advancement, individual academic interests, and success in fellowship. Each fellow and coach pair meets throughout the year to advance these interests.