The Nephrology Fellowship at Penn State Health Milton S. Hershey Medical Center is a two-year, ACGME-accredited program that admits two fellows per year.
The Penn State Health Milton S. Hershey Medical Center Nephrology Fellowship prepares the trainee for clinical or academic adult nephrology. We also train clinician-scientists to become competitive clinical researchers.
Training is conducted on the campus of Hershey Medical Center, which offers the unique colocation of basic, translational and clinical science; patient care; and a College of Medicine on one campus.
Clinical training covers a full array of experiences in dialysis, renal transplantation, hypertension, inpatient service, consultation service and outpatient consultative and long-term follow-up activities. All modalities of dialysis are available, including in-center and home hemodialysis, acute hemodialysis, chronic peritoneal dialysis and continuous renal replacement therapy (CRRT and CRRT/MARS).
Inpatient Clinical Training
The inpatient consult service sees patients with acute renal failure, electrolyte and acid-base disorders and severe hypertension, as well as following end-stage renal disease patients requiring hemo- or peritoneal dialysis. We maintain a teaching service census of approximately 20 patients, with two to five new consults per day. Critically-ill patients in our intensive care settings (MICU, SICU, heart and vascular ICU, neuro ICU, and associated intermediate care units) make up a third to a half of a typical census. Fellows supervise and teach residents and students on the service, with additional support from two physician assistants as well.
The transplant service performs 40 to 50 kidney and kidney/pancreas transplants per year. Fellows see patients in the clinic pre-transplant, present them in selection meeting, follow them in the hospital in the peritransplant period, and maintain follow-up in the post-transplant clinic setting. Fellows also see long-term follow-up transplant patients as part of the continuity clinic. The exposure to patient selection, advanced immunosuppressant therapies, post-transplant management and long-term follow-up ensures that the fellow has a superior skill set in dealing with transplant patients in in- and outpatient settings.
Outpatient Clinical Training
A cadre of 40 hemodialysis patients make up the core of the fellows’ outpatient hemodialysis experience. Fellows see approximately 15 patients in the peritoneal dialysis clinics monthly. We are proud of the amount of peritoneal dialysis training we offer our fellows, which enables them to not just be competent in that modality, but to advance the cause of peritoneal dialysis after fellowship. Fellows have the opportunity to attend a national extramural course in peritoneal dialysis as well, further expanding their abilities.
The fellows’ continuity clinic is held weekly. Fellows will see one to two new and four to six follow-up patients per clinic along with the attending. As a referral center, our outpatient patient mix includes both common (CKD, hypertension), advanced (renal transplant, CKD in other solid organ transplant patients), and unusual cases (e.g. atypical or complex glomerular disease presentations).
Fellows have the opportunity for elective rotations in critical-care nutrition (e.g. TPN management), pediatric nephrology, renal imaging and intervention and renal pathology. A stone clinic, co-managed with nephrology and urology, is available for fellow exposure to the metabolic evaluation and treatment of nephrolithiasis. Each fellow will rotate on the apheresis service, and will be able to gain qualification in therapeutic apheresis such that, post-fellowship, they would be qualified to be a medical director of an apheresis service per the American Society for Apheresis guidelines. Fellows on the apheresis service also interact with the transplant service in dealing with patients requiring plasma exchange for treatment of antibody-mediated rejection or reduction of donor-specific antibodies.
The first year of training is heavily concentrated on inpatient consult service with some exposure to transplant and outpatient dialysis. The second year brings more longitudinal exposure to chronic in-center hemodialysis and peritoneal dialysis. Research time is spread throughout the year to allow the fellow to initiate and complete a meaningful project. Depending on the interests and goals of the fellow, projects are possible in both basic and clinical science.
A goal of this activity is a peer-reviewed manuscript, or other scholarly output at that level. Our fellows have had poster and oral presentations at national meetings; submitted peer-reviewed publications; written successful IRB protocols; and obtained extramural grant funding.
While not all of our fellows plan to pursue clinical research after fellowship, motivated and skilled trainees will find challenging research work which can form the basis for further exploration.
Conferences are scheduled throughout the year, with specific sessions in July and August set aside for orientation topics. Fellows participate in planning and giving talks to the division, with additional time for this in the second year. The yearly renal medicine course for second-year medical students offers additional opportunities for small-group session teaching and facilitation.
Scheduled conferences include:
- Clinical case conference (each Tuesday, noon)
- Weekly conference (Tuesdays, 4 p.m.; topics rotate weekly)
- Basic science
- Grand rounds
- Biopsy conference
- Literature update
- Monthly departmental research conference
- Core curriculum (Thursday, noon) with emphasis on:
- Renal physiology (spans both years)
- Physiology of hemo- and peritoneal dialysis
- K/DOQI and NephSAP review
- Transplant conferences
- Kidney Transplant Selection Conference (Thursday afternoon)
- Transplant Biopsy Conference (every other Friday afternoon)
- Donor Advocacy Meeting
- HLA Meeting
- Weekly sign-out rounds and case discussion (Friday afternoons)
- Vascular access conference (third Wednesday of each month)
- ACGME Core Competencies conference (first Tuesday of each month)
- Morbidity and Mortality (M and M) Conference (third Thursday of each month)
Two fellowship openings will be available. Fellowship applications for will be accepted through ERAS starting July 1. Interviews will take place during August to October. Match result will be available in December.
Submission of complete ERAS applications by July 1 is highly recommended. We are able to support J1 visa holders.
Applicants must be in an ACGME or ACGME-I residency program, and will need to have passed all three USMLE steps before starting fellowship.
As part of the application, we require:
- Three letters of recommendation
- A personal statement describing your goals in nephrology
- USMLE transcript
- If applicable, ECFMG status report
- ERAS application
What makes a competitive applicant varies between programs, but our fellows tend to demonstrate:
- A solid breadth and depth of internal medicine knowledge
- Mature clinical decision-making
- Interest and ability in research (even if that isn’t their career goal)
- Calm professionalism
- Genuine drive to become excellent nephrologists
General Contact Information
Penn State Health also offers
- Rheumatology Fellowship
- Allergy, Asthma and Immunology Fellowship
- Infectious Disease Fellowship
- Clinical Cardiac Electrophysiology Fellowship
- Gastroenterology and Hepatology Fellowship
- Hospice and Palliative Medicine Fellowship
- Cardiovascular Disease Fellowship
- General Internal Medicine Fellowship
- Endocrinology, Diabetes and Metabolism Fellowship
- Interventional Cardiology Fellowship
- Interventional Pulmonology Fellowship
- Pulmonary and Critical Care Medicine Fellowship
- Internal Medicine Residency