What I Wish I’d Known Before I Started Fellowship

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We have all experienced those moments when we wonder what we have gotten ourselves into. Nephrology fellowship is one of these life-altering events, so we asked a sampling of current fellows the one thing they wish they had known before starting training.

Some answers focused on the practical. Deepti Torri, of North Shore Long Island Jewish Medical Center in New Hyde Park, N.Y., said better understanding of renal physiology would have helped. “Taking Texbook of Medical Physiology by Arthur Guyton out of the dusty bookshelf and reading the renal physiology chapters from beginning to end would have been time well spent,” Torri said.

Ruba Nijmeh, fellow at Ohio State University Medical Center in Columbus, remembers the first overwhelming days of fellowship when the pager went off for the acute dialysis room. “You answer your page, and the nurse on the other end of the phone is asking you for orders: what type of bath you want, how many hours, what anticoagulation, etc.,” Nijmeh said. “Of course, as you don’t happen to know the right answer, you go with what the nurse says. Most of the time, the nurse is experienced and helps you make the right decision.” Any of the basic building blocks of inpatient nephrology would have been helpful, she added.

Rajiv Vij of the North Shore University Hospital did not realize how many choices there were within nephrology. These include private practice, clinical investigation, and basic science research. “For candidates who are uncertain, I support application to either clinical fellowship programs with an option to do a third year of research, or to programs that have an open-mindedness with respect to the new niches in nephrology,” he said.

One interesting answer focused on the transition from resident to specialty fellow. As a resident, “your goal was more of a facilitator and making sure all of your patients’ bases were covered,” according to Josh Bitter of the Ohio State University Medical Center. Transitioning from the big-picture, coordination of care view to an organ system view presented challenges. “Once I realized my role as a consultant was to provide the best, most focused input in my area of expertise, primary services were much more appreciative.”

Finally, Nathan Hellman of Massachusetts General Hospital focused on more personal aspects. Hellman is a new member of the ASN Kidney News editorial board.

“Try and think beyond the two to three years of fellowship to what you will be doing in your post-educational life.” Changes in personal status, like marriage and children, alter one’s perspective. “I find myself having to incorporate into my professional desires a whole new series of variables: affordability of day care options, employability options for my wife, and proximity to relatives are just a few examples,” Hellman said. “I am not suggesting that the academic aspects of a nephrology program be overlooked—they are still probably the most important factor to consider—but rather that the decision-making process becomes more complex with increasing life responsibilities.

“Even though things have generally worked out for me despite my ignorance of these family-related variables at the time of my fellowship interviews, it now seems silly to have not taken these factors into account at the time of my decision,” Hellman said. “I do not think that my situation is that unique, as the fellowship period is very often a time of rapid change: new relationships, marriage, children; even the transition from everyday clinical work to the different pace of a research project can be profound. It may be impossible to predict exactly how things will change, but keep in mind that they certainly will.”

Change is almost universal, but one thing will remain constant: new fellows will always find something they wish they had known before their journey to become nephrologists.

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