During the first year of training the residents have six mandatory rotations in order to acquire the core knowledge and skills needed to practice nephrology.

1. In-Centre Hemodialysis: The largest Dialysis Unit in our Program is the Adam Linton Dialysis Unit at Victoria Hospital, where 156 patients receive treatment. This is where the trainees are located for their Hemodialysis Rotation. The Trainees are expected to function as the Junior Consultant assisting the Nurse Practitioners in the care of the dialysis patients. The Trainees independently follow 45 additional Hemodialysis Patients at the London Satellite Hemodialysis Unit, under the supervision of the Nephrology Consultant on call for Hemodialysis. This unit is in walking distance from Victoria Hospital. The Trainee not only rounds regularly on these patients, but also leads a Clinic for these patients once a week, with appropriate supervision. The trainee also attends multidisciplinary review meetings for the Hemodialysis Patients at the Adam Linton Dialysis Unit twice a week, where they get exposure to urea kinetic modeling, dialysis prescription, transonics for evaluation of access and anemia management, etc. The trainee is responsible for temporary dialysis catheter placements, when necessary, for the hemodialysis patients, and also has the opportunity to learn how to place tunnelled dialysis catheters, although this is not mandatory. This rotation teaches the Trainee about the importance of the team approach in the care of patients on hemodialysis. The trainee meets with the Nephrology Consultant once a week for didactic teaching around important hemodialysis topics. It is mandatory that the following 8 topics be covered during the two month Hemodialysis Block. These teaching sessions are in addition to the Academic Half Day.
   
   
   1. Urea Kinetic Modeling in Hemodialysis: Principles and Clinical Application
   2. Vascular Access for Hemodialysis:
         Temporary Access
         Permanent Access:
              i) AV Fistula
             ii) AV Graft
            iii) Perm-Cath
      
            A) Advantages and disadvantages of each
            B) When to place access
            C) How to monitor patency of access
            D) Management of access stenosis/thrombosis/recirculation
      
   3. Management of Hypotension/Hypertension in the Hemodialysis Patient:
   4. Management of Anemia in the Hemodialysis Patient.
   5. Management of Calcium/Phosphate/PTH Disorders in the Hemodialysis Patient
   6. Appropriate Management of Line Sepsis -- Exploring Controversies
   7. Dialyzer Reactions -- Presentation and Management:
   8. Water Treatment in the Dialysis Unit
   
   
2. Home Dialysis: The Home Dialysis Rotation is situated at South Street Hospital. During this rotation, the Trainees are expected to learn about all forms of Home Dialysis, including: peritoneal dialysis, conventional home hemodialysis and home quotidian hemodialysis. We currently have 123 patients on peritoneal dialysis, 4 patients on conventional home hemodialysis and 20 patients on the home quotidian hemodialysis. The Trainees attend peritoneal dialysis and home hemodialysis clinics and meetings. During this rotation, the Trainees are also expected to attend regular satellite hemodialysis clinics where 230 patients are treated under the supervision of one of the Consultants. The patients also have the opportunity to learn how to percutaneously place peritoneal dialysis catheters during this rotation.
   
   
3. Transplantation: This is a combined in-patient/out-patient rotation at University Hospital. The Trainees work under the supervision of the Transplant Team, which includes Transplant Nephrologists and Transplant Surgeons. Over the last few years, 60-100 kidney transplants have been performed each year; this includes, deceased donor, living-related and living non-related transplants. The Trainees are expected to look after the transplant patients in the perioperative period and during their hospital stay. They are also expected to attend two transplant follow-up clinics, a transplant donor assessment clinic and a transplant recipient assessment clinic each week. The trainees also attend a monthly Renal Transplantation Journal Club. The trainee also attends all combined medical and surgical transplant rounds to review program policies and review complex patients for the wait list. The trainee is also responsible for performing all transplant kidney biopsies under appropriate supervision.
   
   
4. Ambulatory Clinics at University Hospital and Victoria Hospital: The Trainees are expected to attend General Nephrology ambulatory clinics under the supervision of the Nephrology Consultant. A clinic schedule is prepared for them prior to beginning their rotation. These clinics include both General Nephrology and Progressive Renal Insufficiency Clinics. The Trainee is expected to dictate clear and concise clinic notes on the patients they assess. The Trainee is also expected to follow up on laboratory investigations and imaging tests, and, if necessary, communicate the results to the referring physician or to the patient.
   
   
5. Consultation at Victoria Hospital: Victoria Hospital has a large Oncology and Internal Medicine service, as well as the Regional Trauma Centre. Therefore, it provides a busy consultation service with a high incidence of acute renal failure. The Trainees act as Consultants, under the supervision of the Consultant On Call. The Trainees are responsible for the management of all forms of renal replacement therapy in the ICU and on the wards, including: continuous renal replacement therapy (CRRT), conventional hemodialysis and peritoneal dialysis. The trainee is also responsible for performing native kidney biopsies and all temporary hemodialysis catheter placements on these patients. Victoria Hospital also has an in-patient Nephrology Service that is staffed by Internal Medicine Residents. The Nephrology trainee is available as a resource for them when it comes to managing acutely ill patients and establishing dialysis access.
   
   
6. Consultation at University Hospital: University Hospital has a very large Multi-organ Transplant Program and Cardiovascular Surgery Division. The flavour of patients seen at University Hospital is, therefore, vastly different from that of Victoria Hospital. The trainee is responsible for managing a busy consultative service at this hospital, with supervision from the attending Nephrologist. The trainee also supervises more junior Internal Medicine Residents who are rotating on the Consult Service. This gives the trainee opportunities to further their leadership skills. The Trainee leads meetings twice a week with Allied Health Staff to review current patient issues. The Trainee is also responsible for all Nephrology consultations in the Medical and Surgical ICU and manages all forms of renal replacement therapy, including continuous venovenous hemodiafiltration, conventional hemodialysis and peritoneal dialysis. The Trainee is also responsible for all temporary dialysis catheter placements and native kidney biopsies.