Goals and Objectives
Nephrology Elective
Goals:
The educational goals of the rotation in Nephrology for the house officer are to 1)develop the ability to independently evaluate, treat, and monitor common renal conditions, 2)to acquire the knowledge of the underlying processes that contribute to the pathophysiology of the different renal diseases, and 3)to describe the research tools for studying the underlying mechanisms of different renal disorders.
Objectives:
A. Medical knowledge and patient care
Renal disorders are commonly evaluated by general internists. Disorders may be primarily renal in origin or systemic diseases that have profound secondary effects on the kidney, such as diabetes, vasculitides and atherosclerosis. General internists must be able to recognize, evaluate and initiate treatment for common renal disorders as well as understand the relationship between systemic processes and the kidney. Prevention of renal disease assumes paramount importance in decreasing the burden of chronic renal failure and hemadialysis.
Occupational exposures in the dialysis unit to blood born pathogens such as Hepatitis B and C and HIV are discussed. Caring for chronic renal patients involves occupational risks to the practitioner.
The socioeconomic aspect of chronic renal disease on overall health care spending is important for the resident to understand. Environmental, nosocomial iatrogenic causes of renal disease are considered including the use of contrast dye, drug induced renal disease and medication induced changes in initiating renal hemodynamics and drug disposition.
The difficult ethical issues of withholding dialytic therapy and discontinuing dialytic therapy are encountered.
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Disease Mix
During the one-month nephrology rotation, important topics and disorders reviewed and
encountered include:
1. Glomerulonephritis
2. Interstitial nephritis
3. Hereditary and congenital renal diseases-systemic diseases
4. Systemic diseases such as diabetes, lupus, and verculitides and their effect on the kidney
5. Preventive renal dysfunction by optimal treatment of systemic disorders
6. Acute renal failure
7. Chronic renal failure
8. Kidney stones
9. Renal transplantation
10. Electrolyte and body fluid disorders
11. Acid base disorders
12. Hypertension and associated renal complications including their prevention
13. Hematuria
14. Proteinura and the nephrotic syndrome
B. Other competencies
1. Demonstrate practice-based learning and improvement, interpersonal and communication skills, professionalism, and systems based practice through interaction with patients, attendings, and other health care personnel and through delivery of appropriate subspecialty care in a variety of venues.
Learning venues:
Patient Characteristics
Renal disorders are evaluated in a wide range of clinical severity as well as stages of illness. Renal disease can affect patients at all ages of life, although the incidence increases as the patient ages.
Types of Clinical Encounters
The resident will evaluate inpatients admitted to the renal service as well as those seen in
consultation having both acute and chronic disorders, many of which are emergent and part of catastrophic, life threatening illnesses. Patients are also seen in the outpatient setting in the renal clinic as well as in the private nephrologist’s office. Residents are supervised in all locations, both in the hospital and office setting, by faculty nephrologists. The critical role of collaboration by other members of the health care teams such as dieticians, dialytic technicians, and nursing is emphasized.
In the outpatient setting, residents have the opportunity to evaluate and participate in the
management of patients ranging from those with early stages of renal dysfunction to those with advanced renal insufficiency. The treatment strategies proven to slow the progression of and decrease the complications from chronic renal insufficiency are emphasized.
Procedures and services
The resident might assist and/or observe placement of vascular access for dialysis or kidney biopsy.
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Reading List
MKSAP (Medical Knowledge Self-Assessment Program XIII – Nephrology section including question and answer section.)
Pathological Material
Residents will be expected to review the pathology of those biopsies obtained for patients for whom they have consulted or participated in management.
Competency evaluation
Because of the close working relationship between the nephrologist and the resident, the faculty physician constantly reviews the performance of the resident. Residents are required to complete the required readings, attend all assigned clinic sessions, and complete the renal section of the MKSAP 13 including questions and answers. The attending will complete a written evaluation
at the conclusion of the rotation, which is reviewed with the resident and entered in the resident’s file.
To complete the nephrology rotation, the resident must:
A. Receive satisfactory end of rotation evaluation by the supervising faculty member.
B. Complete assigned readings.
C. Attend all outpatient clinical activities (excluding scheduled times away, required clinics and emergencies).
D. Complete the MKSAP XIII nephrology section.
Outcomes Assessment:
The educational success of our elective in nephrology will be based upon two criteria: 1)nephrology subsection scores on the in-service examination of all residents who have completed the elective and 2)nephrology subsections on the ABIM certifying examination in internal medicine taken by medical graduates. Our goal is for all residents scoring at the 50th percentile or higher.