curriculum development to promote the ongoing innovation, creative problem-solving, and resilient leadership we have witnessed since the advent of COVID-19. Review We reviewed the previous objectives of specific rotations and then collaboratively developed a flexible curriculum, based on key principles which enabled each of the clinical and scholarly activities to continue in modified formats (Table 1). These strategies were fully employed during the initial peak and can be titrated according to local caseload and hospital policies, which is crucial as many provinces enter a second wave. Using this as a framework, each fellow created a personalized schedule to address specific learning goals by incorporating mandatory weekly meetings, teaching sessions, and clinical activities, as well as unscheduled time reserved for completion of personal academic objectives (Figure 1). Clinical Rotations Trainees continued with the in-patient nephrology consult service, though solid organ transplantation was on hold, so kidney transplant rotations were postponed. Community rotations were also rescheduled to ensure a sufficient group of trainees to provide service at the main hospital sites, especially given the possibility of quarantine or illness. The daily experience on consult or ward service varied with the absence of medical students and rotating residents, as well as a fluctuating hospital census. On-call shifts were maintained at the usual frequency, with measures in place to reduce potential exposures. For instance, only attending nephrologists did evening rounds in the hemodialysis unit. There has not been an official position on trainee interaction with COVID-positive patients or persons under investigation (PUIs), and accordingly, this was left to the discretion of each team. During the peak, in-hospital consulting and ward services were staffed by Nephrology fellows and faculty exclusively, given that medical students and residents had been redistributed. Therefore, our trainees minimized contact with potential cases as much as possible if they were being examined daily by the attending service. Consults in the “hot zone” were completed by chart review without direct physical examination. Now that the team has a more typical complement of learners, staff nephrologists are primarily seeing potential cases. This necessitates clear communication among all team members to reduce risk and eliminate redundancy. Outpatient activities such as home dialysis and longitudinal fellows’ clinics were transitioned to telehealth platforms such as Zoom or Doxy.me, with some visits conducted by telephone. At times when case numbers are lower, select patients are brought in for assessment, including new consults and unwell or unstable individuals. We did not arrange any simulation option for procedures, given that dialysis line insertion and removal still proceeded as usual, with adequate personal protective equipment. This has been resumed as of the new academic year. Our renal pathologists developed a virtual curriculum delivered weekly over Zoom, which provided the opportunity to discuss general nephrology and transplant cases while viewing online slides, as well as broadcasting “Biopsy Rounds” regularly via Zoom, which has continued since the onset of the pandemic with extremely positive feedback from trainees. Cunningham et al 3 We evaluated the appropriateness of resuming these rotations in their more typical format on an individual basis. For instance, fellows were rescheduled for transplant blocks once surgeries were occurring with enough frequency to provide adequate volume for achieving learning objectives. There were no formal criteria for expanding clinical service with respect to decline in provincial or local caseload, but rather these decisions were made in discussion with the program director. Currently, there is no indication that these changes will extend fellowship duration, given that graduating trainees had already completed mandatory rotations by Spring 2020, and first-year trainees had ample time left to compensate with substitutions in the schedule. Scholarly Activities Many major nephrology conferences have been canceled, though some are beginning to modify their schedule to an online format, such as the ERA-EDTA Virtual Congress and ASN Kidney Week. There are ongoing efforts to develop existing platforms for online lectures, which may be livestreamed or recorded for later viewing, including our Expanded Province-Wide Rounds, focusing initially on the collective response of BC Renal to COVID-19; which will continue to include all topics in nephrology. With regard to involvement in research, trainees can be redirected to projects suitable for completion via technologybased methods, and works-in-progress should be adjusted to Table 1. Adaptations to Existing Objectives and Rotations. Curriculum structure Previous methods New methods—peak periods Clinical rotations • Consults Team-based rotation with multiple learners and focus on both bedside and classroom teaching Resident and medical student allocation variable; more fellow autonomy and staff-to-fellow teaching. Widespread efforts to minimize potential exposures. • Hemodialysis Rounding on daytime shifts with bloodwork review and prescription adjustment. Where possible, one designated nephrologist to round in unit. Learning