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Clay Block, MD, MS, Koyal Jain, MD, and Liz Kotzen, MD
Clay Block, MD, MS, Koyal Jain, MD, and Liz Kotzen, MD

What should someone consider if they are interviewing for a nephrology fellowship program? How will they know if it’s the right fit? Dr. Ron Falk talks with the associate program directors for UNC’s nephrology training program, Dr. Clay Block and Dr. Koyal Jain, as well as a current nephrology fellow, Dr. Liz Kotzen. They discuss what appeals to them about nephrology, what appealed to them about UNC, and think back to their own respective interview days.

Listen to the full length recording (25 min)

 

Ron Falk, MD: Hello, this is Ron Falk for the Department of Medicine at the University of North Carolina. Welcome to the Chair’s Corner.

Today we will be talking about interviewing for a nephrology fellowship program, and we’ll take the vantage point of two current UNC faculty, both of whom have done their training here. We’ll talk about what applicants might want to think about when they’re considering different nephrology programs, and how to know if a program will be a good match for them.

Our conversation will start with two faculty from our own Division of Nephrology, and then, later, we will get to hear from a current fellow who will tell us about her experience at UNC.

We welcome Dr. Clay Block, Professor of Medicine, and Dr. Koyal Jain, Assistant Professor of Medicine. Dr. Block and Dr. Jain are co-associate Directors of our Nephrology Training Program at UNC. Welcome, Dr. Block and Dr. Jain.

Clay Block, MD, MS: Thank you.

Koyal Jain, MD: Thank you for having us.

Training in nephrology

Falk: Clay Block, you completed your nephrology fellowship, oh, way back in 1804 or 1805. At that point I think you might have been on a horse and buggy—do you remember?

Block: I do. Everything was Bright’s disease back then! I completed my training in 1995 here.

Falk: That still seems like a long time ago.

Block: Still a long time ago.

Falk: What made you choose nephrology in the first place?

Block: Definitely the mentorships. My dad was a nephrologist, and he loved every day he went to work. He never regretted a single day of going to the hospital or going to the dialysis unit. When I came here, my experience with the nephrologists was very much the same. They were all very excited about nephrology.

Falk: Nephrology. What encompasses training in nephrology? What makes it exciting to you?

Block: The breadth of patients that we encounter: everything from the intensive care unit, where you’re seeing changes in physiology minute to minute, or the dialysis patients, some of whom we may know for thirty years, even. And everything in between.

Falk: Dr. Jain, you have much more recently finished your fellowship program. What brought you into nephrology?

Jain: The reason I came into nephrology was, I feel it has the full flavor of internal medicine. Similar to what Dr. Block was saying, I also feel you can take care of the patient as a whole. You’re not focusing on one part of the body, and you can form a relationship with the patient and see them for a long time and know them.

Falk: It’s the physiology, it’s the immunology, both in transplant and glomerular disease. It’s dialysis, it’s stones and polycystic diseases of one kind or another. It’s the breadth of disease and the ability to care for people for the long haul. Is that about right?

Jain: That’s correct.

Block: Sums it up. I would add that there’s a lot of infectious disease in the field, hypertension, genetics.

Fellowship interview day

Falk: Interview days for anybody are always sort of stressful. Interview days for interns, or for residents, for fellows, or even quite frankly, for faculty can be intimidating experiences. They shouldn’t be. What do you remember about your interview moment?

Block: My interview for nephrology I think was pretty different than how it’s done today. I met with Dr. Blythe, who was your predecessor as the chief of nephrology here. He said, “So, Clay, you think you might be interested in nephrology?”I said, “Yes,”and he said, “Welcome aboard.”

Falk: Dr. Jain, what happened with you?

Jain: Mine was a little more structured than Clay’s interview day! I remember walking into the seventh floor of nephrology and had an instant connection with Rochelle and Sheri over dogs and cats.

But overall, there was just this feeling left behind that everybody was happy—the fellows were happy, the staff was happy, everybody was well-treated. You had these world-class physicians here but they were so down to earth and humble. I just loved being here. I also remember Dr. Jennette doing the nephropathology conference that day and just the awe of being in the same presence and being in the same room as him. I just felt like I would be honored to be in this place.

Falk: So, the process now is structured because there’s an organized national match for fellows. So, when you’re exploring programs now, you can’t have the program director assure you of a spot, and there’s an interesting dance between the applicant and the program. What advice would you give to the applicant so they get the most out of this day or two-day experience?

Jain: I feel that the interview day is really a day where two people are trying to evaluate each other. One is the program trying to figure out whether the candidate is right for them, but also the candidate is trying to figure out whether that’s the best place for them. I think the most they can get out of it is trying to figure out if they have a work-life balance—Will they be happy there? Will they be successful?You know, you’re going to spend two years, or maybe three or four, or maybe the rest of your time, and you want to know that you will be happy and that you want to be there for the long haul.

Dr. Block’s and Dr. Jain’s experience in nephrology at UNC

Falk: Clay Block, you’ve had a long career as a nephrologist. That career has taken you from UNC, to California, to Dartmouth in Lebanon, New Hampshire, and you’ve returned now as a faculty member at UNC. What was it about UNC that lured you back?

Block: It’s really the people here, as Dr. Jain was saying. The people who work in the nephrology office at the UNC Kidney Center are many of the same people working here when I was a fellow many years ago. There’s just great spirit. Everybody feels part of the family here, many of the colleagues I trained with in those years are now here on faculty and in other departments. It really feels like coming home to my family.

Falk: What has stayed the same, and what has changed?

Block: Well, UNC hospital I feel has a real authenticity. It functions as much as a community hospital as it does as a quaternary care hospital. The patients and their families—this is where they get their care, and that feels the same. What’s changed is it’s much bigger. It not only has Memorial Hospital, but the Cancer Hospital, the Neurosciences Hospital. The emergency room is probably five times the size it was. The technology has grown with it. But I feel the authentic feeling is still the same.

Falk: The hospital has a thousand some-odd beds, and when you were here initially it probably had four hundred. Koyal Jain, you were a fellow here more recently. Have things changed since that period of time?

Jain: I graduated fellowship three years ago, but things have just changed for the better. Structurally, not so much, but as a program, I think we’ve grown. Dr. Hladik as a program director has always addressed any needs of the fellows. He has always listened to us—any questions or concerns, he’s always addressed them. I think there have been changes in the program, yes, but only for the betterment of the fellows.

Falk: What things made your time as a fellow more interesting or more fun?

Jain: What stands out for me, as Dr. Block was saying, this is a family. It’s the culture here that stands out for me. I actually went to a lot of nephrology programs to interview. You get great education anywhere, but this is a place where you have a family atmosphere. Everybody is supportive, everybody is really approachable. It just makes me happy to look back on those few years of my life. I feel that this is a place where a large division comes together, collaborates, and we all do well.

Choosing a nephrology program

Falk: How does an applicant get that understanding? How are they going to figure that out in a course of a day?

Jain: It’s very hard. It’s not easy to figure that out, but I think there’s a gut feeling that you get at the end of the day where you know that’s the right place for you. You know people are nice to you, kind to you, they care about your success, and they’re happy to see you there.

Falk: Let’s pause for a moment, because we’re talking about how we hope applicants will feel about the UNC program. The reality is that there are more spots in nephrology across the country than there are applicants, so to a huge extent, this is a buyer’s market, not a seller’s market. How do you as program directors strive to get the best fellows, the ones that fit, but without compromising quality of trainee?

Block: Well, we want to put our best foot forward when they visit here, and we want to do things like this so that they’ll think about visiting here. I think the best way for them to experience our program would be to go on rounds with us, go on rounds with the fellows, come to biopsy conference, where we combine academics with education with patient care, and spend the day not in an artificial interview kind of environment but spending the day doing what we do.

Strengths of UNC nephrology

Falk: It’s not just the adult program that is part of the UNC Kidney Center, it’s also pediatric nephrology. How does that work?

Jain: I think that’s been a huge strength of our program, that UNC Kidney Center has not only adult nephrology but pediatric nephrology, where we work together, we learn from each other. I’ve had trouble with some genetic conditions and I can approach Dr. Gibson and ask her about those questions.

We also have transplant nephrology here and we do over 100 transplants a year. We do pancreatic transplants. We have enough experience in those fields.

But also, we have you in glomerular diseases. You discovered ANCA! So, we get to learn from you, Dr. Falk. You mentored me. I learned from you. I think that we have a huge glomerular population here where we can learn from our patients and get mentored by these amazing physicians and nephropathologists—you, Dr. Jennette..

Falk: And you, Dr. Jain, and your colleagues, since the younger crowd is now taking over, and that’s a merciful and wonderful thing.

Block: I’d like to expand on that a little bit and say that we have fantastic faculty in glomerular disease and really all of immunology, we have fantastic transplantologists, we have pediatric nephrologists, we have hypertension specialists, we have world’s leading expert on diabetic nephropathy, not to mention Dr. Flythe in dialysis research, a long-neglected part of nephrology, it’s really emphasized here. Anyone who came here would have the chance learn under her wing.

But all of those people maintain their roots in general nephrology. All of us take turns attending on the wards and the consult service and I think it makes for a better division. They have a great level of expertise but remain grounded in nephrology. They’re great role models for the fellows, residents and students.

What Dr. Block & Dr. Jain seek in an applicant

Falk: What are you looking for in an applicant?

Jain: When I look at an applicant, I’m looking for someone who is kind, caring, someone who is really hard-working, but more than that, somebody who is motivated and wants to learn and wants to be educated.

Block: I think that’s the most important thing, is that they have an attitude where they’re enthusiastic and cheerful. They like taking care of patients, they like learning. I think their knowledge base is less important—we can teach them. We just need someone with the energy and enthusiasm.

Advice for an undecided applicant

Falk: When somebody comes through the program, they’ve gone through their interview day, their interview is over, and if they are undecided about where to go, what should they do? Can they reach out, call back, what are your suggestions?

Block: If they’re in the area, they would be welcome back any time to spend more time with us, seeing how we go about our jobs as nephrologists. If they’re not in the area and they want to call or Skype or email, we’re always available.

Jain: I agree—they can come back for a second visit. We would be happy to talk with them over email, or we can talk to them over the phone. As a fellow, I remember having mentored people who had other concerns and questions regarding the visas, because there are a lot of applicants coming from international medical colleges, so we’re more than happy to answer any questions and concerns.

Falk: Now we’d like to welcome Liz Kotzen. Liz is a Medicine and Pediatric fellow in our training program. She was a Medicine and Pediatric resident as well, so we welcome Dr. Kotzen.

Liz Kotzen, MD: Thank you.

Choosing Chapel Hill

Falk: Why were you drawn to UNC?

Kotzen: I had a fantastic experience as a medical student on the wards with both the pediatric and adult nephrologists here in our division. When I started looking for a nephrology training program, UNC was a place I was very interested in. When I looked into training programs, I was particularly drawn to UNC for the excellent clinical opportunities here, but when I came to visit, what really grabbed me and made me very confident, was the people I had previously worked with and the new faculty and fellows I met when I came to visit.

Falk: Liz, the real problem is you escaped from us for four years. You went to a different color blue. Why?

Kotzen: I’ve lived in the Triangle even prior to going into medicine, and one thing I really love about this area is the wonderful array of opportunities that it’s presented for myself and my husband. We’ve both been able to pursue careers that are very rewarding to us. We have a lot of opportunities within Chapel Hill, as well as in Durham and Raleigh to do so.

Falk: It’s really an important issue, because Research Triangle Park includes UNC, North Carolina State, Duke, and all of the industry that is in the Park, so for dual-career families, this turns out to be a really good place for people to come.

Kotzen: I absolutely agree. When my husband and I looked at places where we would both have career opportunities, other places that would have allowed us to pursue our individual interests and be in the same place were large cities. We really enjoy the smaller city lifestyle that we have here.

Falk: Otherwise it’s Boston, New York, California—you’re right this is smallish. But right now, this area boasts over almost two million people at this point, if you take the whole area. It’s growing, but it’s still not the size at all of larger metropolitan area, and there are lots and lots of opportunities.

Dr. Kotzen’s interview day at UNC

Falk: Do you remember your interview day?

Kotzen: I sure do—it wasn’t that long ago. When I arrived back at UNC, I remember getting set up for my interview day ahead of time. I had been working internationallyduring an international rotation during my final year of residency, and I had some concern that it would make it difficult to arrange for interviews. However, Rochelle very warmly communicated with me about my dates and was extremely accommodating and took a lot of the stress out of preparing for interview day.

I remember arriving back to this hospital that I knew so well from four years prior, and being really excited to be back. I met with Dr. Hladik, our program director, and I can’t convey how welcoming and warm Dr. Hladik was both in that meeting, and each time I’ve interacted with him throughout this first year of clinical fellowship.

Dr. Kotzen’s experience in her first year

Falk: What would you tell us about your experiences as a fellow so far? You’re doing both medicine and pediatrics.

Kotzen: Yes, so I’m finishing up my first clinical year now. I have for the most part served in the role of a traditional first year adult clinical fellow, although I have been really pleased to maintain a pediatric continuity clinic, allowing me to maintain relationships with the pediatric faculty, and to keep up to some extent my pediatric knowledge base, although I look forward to building on that knowledge base in the coming year.

When I look back at how much I’ve learned over the past year it’s been transformative to me as a physician, and I think that I’ve had a wide array of clinical opportunities, as well as opportunities for didactic conferences that we have that I think are phenomenal. The balance of busy clinical services, with time to reflect and learn in the didactic conferences has been really beneficial to me in my learning.

Falk: What’s the difference between being a resident and being a fellow?

Kotzen: Coming into fellowship was similar to me to coming into those first weeks of intern year. The first weeks of fellowship, even though I had just come out of residency program where I had built my knowledge base, I realized how much I had to learn.

I found that I had quite a lot of support in terms of learning the basics of providing dialysis in our inpatient dialysis center. I had wonderful support not only from the faculty, but from the fellows one year ahead of me as well as from Connie, our nurse practitioner who is just a wonderful resource and has taught me an enormous amount about dialysis. Those first few weeks were very busy with me getting me up to speed on the basics of nephrology.

One of the key differences between residency and fellowship is that I am here to slowly and progressively develop expertise in one clinical area in nephrology. So, over the course of this year I’ve been able to increasingly build my knowledge base and develop increasing independence in providing care to patients with kidney disease. So, I’ve really enjoyed the opportunity to grow into that role.

Long-term nephrology career goals

Falk: What’s your long-term career plan?

Kotzen: Well, as a combined medicine and pediatrics fellow, I hope to ultimately provide care for young adults who are transitioning from pediatric care to adult care for their chronic kidney diseases. I’m interested in learning about clinical research techniques to help me to improve my provision of care to that population. One thing that drew me to UNC is the availability here of a really excellent school of Public Health where I would like to pursue a Master’s Degree during the final years of my fellowship.

Falk: There is an organized approach here to get both a fellowship in nephrology but also to get a Master’s in Public Health through the UNC School of Public Health, that’s right. Lots of fellows have availed themselves of that opportunity. Ten years from now, Dr. Kotzen, what are you going to be doing?

Kotzen: I hope to be continuing to work in academic nephrology. I would love to be providing care to the spectrum from children to adults with a focus on the transition of care.

Falk: How come people just don’t undergo a metamorphosis from caterpillar to butterfly? Do you think they need help in that metamorphosis?

Kotzen: I think that we all needed some help in our transition from adolescence into adulthood, so when I think about adolescents who are living with a challenging chronic disease such as glomerulonephritis or living with a kidney transplant, I think about myself and though I didn’t have those challenges, how much support I needed to transition to adulthood. I feel that as physicians caring for these patients, we need to be alert to the special needs of that population.

Falk: Make sure the caterpillars don’t get tramped upon in their metamorphosis.

Dr. Kotzen’s advice to applicants

Falk: What advice would you give to someone applying to this fellowship program, or any fellowship program?

Kotzen: Similarly to when you interviewed for residency programs, it’s important to find a place that offers you the educational opportunities that you’re looking for, but I think it’s also important to find a place where you feel comfortable as a part of that community or family of physicians providing care.

When I interviewed here at UNC, I immediately felt that the fellows here were interesting people. They were fascinated by kidney disease, but they also had interests outside of medicine, they enjoyed each other’s company. I felt the same way about the faculty, and I felt that the community here is a really great fit for me. So, I wouldn’t hesitate to recommend that you consider that kind of subjective feel when you interview for programs.

I also think it’s really important to find a place that has the ability to offer you training in the basics of general nephrology, and then to augment your training in any special area of interest that you may have. Here I see that some of my co-fellows have special interests in glomerulonephritis or in interventional nephrology or in transplant or in clinical research. I’ve seen that, not only in my special circumstance of being interested in dual Med-Peds training, but also in some of my co-fellows special interests that UNC has been really been able to be creative about providing us with the educational needs that we’re looking for.

Falk: Thanks, Liz Kotzen, for joining us today.

Kotzen: Thank you.

Falk:Thanks to our listeners for tuning in. As we end this episode, we’ll play some music featured in an Nephropoly created by some of our former fellows, Dr. Dorey Glenn and Akhil Hegde. They won the 2015 ASN Innovations in Kidney Education contest.