Nephrology Curriculum
I.
Rationale
The family physician encounters a broad range of genitourinary and renal disease in the course of
outpatient, urgent/emergent, and inpatient care. These diseases range from chronic and indolent to life
threatening. Family physicians are often the first line in diagnosing such conditions and are, likewise,
often responsible for the long-term care of patients with these illnesses. Additionally, prevention and
optimal medical management of diseases commonly treated by the family practitioner (e.g., diabetes,
hypertension, SLE, etc.) can reduce the morbidity and mortality associated with renal disease.
II.
Goals
Residents will be evaluated on the following six competencies, eventually achieving the expected level of
a board certified family physician. Achievement of satisfactory performance levels for all six competencies
will be necessary for successful completion of the rotation.
III.
Objectives
Medical Knowledge/Patient Care
Residents must demonstrate knowledge about established and evolving biomedical, clinical, and cognate
(e.g. epidemiological and social-behavioral) sciences and the application of this knowledge to patient
care. Residents are expected to:
A.
B.
C.
D.
E.
F.
G.
H.
Review the principles of normal renal physiology.
Understand the diagnosis and management of:
1. Acute renal failure (including indications for various modalities of acute dialysis)
2. Chronic renal failure (including its medical complications)
3. End-stage renal disease
4. Acid-base and fluid and electrolyte abnormalities.
Learn the outpatient evaluation and treatment of hypertensive disorders, hematuria, and
proteinuria.
Become familiar with issues surrounding renal transplant and dialysis management.
Learn a nephrology directed history and physical.
Appreciate the psychosocial issues involved for patients on long-term dialysis.
Learn resources for personal education and develop a plan for ongoing education.
Learn the diagnosis, associated complications, and management of:
1. Acute renal failure
2. Chronic renal insufficiency and failure
3. End stage renal disease
a. Hemodialysis
b. Peritoneal dialysis
c. Continuous veno-venous hemo-diafiltration
4. Glomerular disease: nephrotic syndrome/glomerulonephritis
5. Acid-base disorders: particularly metabolic acidosis and metabolic
alkalosis
6. Disorders of water, sodium, potassium, calcium, phosphate and
magnesium metabolism
7. Hypertensive disorders
8. Renal transplantation:
a. Immunosuppressive therapy
Last Updated April 19, 2013
I.
J.
K.
L.
M.
b. Complications
9. Nephrolithiasis
10. Hematuria
11. Systemic disease with prominent renal involvement:
a. Diabetes mellitus
b. SLE
Become familiar with other renal conditions such as cystic diseases of the
kidney, renal cancers, and tuberculosis of the kidney.
Become familiar with common known nephrotoxic medications (e.g., NSAIDs,
gentamycin, cyclosporins, etc.).
Learn when to refer patients for long-term vascular access (e.g., vascath,
ateriovenous fistula)
Strive to perform the following procedures during this rotation and should
be able to evaluate abnormalities in the results:
1. Microscopic evaluation of urine sediment
2. Arterial blood gas sampling
Observe the following, as available:
1. Renal biopsy
2. Hemodialysis access placement (vascath)
Learning Activities
Attending Rounds
Multidisciplinary Rounds
Grand Rounds
Sub-Specialty Conference
Morning Report
X
Didactics
Other
Evaluation Methods
X
Attending Evaluation
X
Program Director
Review
360 ᵒ evaluation
Other
X
X
X
Research Conference
Ethics/Comm Conference
Specialty Conference
Noon Conference
Faculty Supervision
Procedures
X
X
Directly Supervised Procedures
In-Training Exam
X
X
Videotape Review
X
X
Outpatient Clinics
Direct Patient care
Resident Seminar
Journal Club
Readings
Morning Report
Faculty Supervision
and Feedback
Quarterly Review
Professionalism
Residents must demonstrate a commitment to carrying out professional responsibilities, adherence to
ethical principles, and sensitivity to a diverse patient population. Residents are expected to:
A. Demonstrate respect, compassion, and integrity; a responsiveness to the needs of patients
and society that supersedes self-interest; accountability to patients, society, and the
profession; and a commitment to excellence and on-going professional development.
B. Demonstrate a commitment to ethical principles pertaining to provision or withholding of
clinical care, confidentiality of patient information, informed consent, and business practices.
C. Demonstrate sensitivity and responsiveness to patients' culture, age, gender, and disabilities.
D. Arrive at the rotation in a timely fashion.
E. Work effectively as a member of a team.
F. Respect patient privacy by guarding medical records and discussion of personal information
about patients.
Last Updated April 19, 2013
G. Assist patients and their families in planning for future care needs and care decisions based
on prognosis for the disease.
H. Support the patient in their healthcare decisions.
I. Demonstrate professional, respectful demeanor when addressing team members, patients,
ancillary staff, and consultants.
J. Appear professionally dressed and well groomed.
K. Completes H&P’s, progress notes and discharge summaries in a timely fashion.
L. Attends required daily conferences and grand rounds.
M. Responds to pages in a timely fashion.
Learning Activities
Attending Rounds
Multidisciplinary Rounds
Grand Rounds
Sub-Specialty Conference
Morning Report
Didactics
Other
Evaluation Methods
X
Attending Evaluation
X
Program Director
Review
360 ᵒ evaluation
Other
X
Research Conference
Ethics/Comm Conference
Specialty Conference
Noon Conference
Faculty Supervision
Procedures
X
X
Outpatient Clinics
Direct Patient care
Resident Seminar
Journal Club
Readings
Directly Supervised Procedures
In-Training Exam
X
X
Videotape Review
X
Morning Report
Faculty Supervision
and Feedback
Quarterly Review
Practice-based Learning and Improvement
Residents must be able to investigate and evaluate their patient care practices, appraise and assimilate
scientific evidence, and improve their patient care practices. Residents are expected to:
A. Analyze practice experience and perform practice-based improvement activities using a
systematic methodology.
B. Locate, appraise, and assimilate evidence from scientific studies related to their patients'
health problems.
C. Obtain and use information about their own population of patients and the larger population
from which their patients are drawn.
D. Apply knowledge of study designs and statistical methods to the appraisal of clinical studies
and other information on diagnostic and therapeutic effectiveness.
E. Use information technology to manage information, access on-line medical information; and
support their own education.
G. Learn to incorporate health promotion and disease prevention into patient care.
H. Use evidence-based medicine, evaluation of available evidence, and use of best-available
evidence at morning report meetings and during routine clinical care.
Learning Activities
Attending Rounds
Multidisciplinary Rounds
Grand Rounds
Sub-Specialty Conference
Last Updated April 19, 2013
Research Conference
Ethics/Comm Conference
Specialty Conference
Noon Conference
X
Outpatient Clinics
Direct Patient care
Resident Seminar
Journal Club
Morning Report
Didactics
Other
X
Evaluation Methods
X
Attending Evaluation
X
Program Director
Review
360 ᵒ evaluation
Other
Faculty Supervision
Procedures
Readings
Directly Supervised Procedures
In-Training Exam
X
X
Videotape Review
X
Morning Report
Faculty Supervision
and Feedback
Quarterly Review
Interpersonal and Communication Skills
Residents must be able to demonstrate interpersonal and communication skills that result in effective
information exchange and teaming with patients, their patients families, and professional associates.
Residents are expected to:
A. Develop patient sensitive skills for interviewing that allow accurate, and complete collection of
information regarding symptoms, the family and the community that affect the patient's
health and care.
B. Develop skills in communicating results to patients, their families, other health care providers.
C. Develop skills in educating patients and their families, in dealing with sensitive issues for
patients and families, and in negotiating a plan of investigation and treatment with the patient
and family.
D. Develop professional relationships with co-workers, consultants, ancillary staff and other
professionals to enable assembling of health care teams and mobilization of community
resources to optimize care of the patient.
E. Develop an understanding of the role of the family medicine consultant, and is able to support
the patient through the process of consultation, medical evaluation, treatment, rehabilitation
and long-term care.
F. Use professional language and demeanor when communicating with other residents, with
Family Medicine attending physicians, with physicians from other services, with non-physician
clinical staff, with non-physician non-clinical staff, and with patients and their families.
G. Create and sustain a therapeutic and ethically sound relationship with patients.
H. Use effective listening skills and elicit and provide information using effective nonverbal,
explanatory, questioning, and writing skills.
I. Work effectively with others as a member or leader of a health care team or other professional
group.
K. Improve skills for providing patient education regarding prevention of renal disease associated
with other medical conditions.
Learning Activities
Attending Rounds
Multidisciplinary Rounds
Grand Rounds
Sub-Specialty Conference
Morning Report
Didactics
Other
Evaluation Methods
Last Updated April 19, 2013
X
Research Conference
Ethics/Comm Conference
Specialty Conference
Noon Conference
Faculty Supervision
Procedures
X
X
X
Outpatient Clinics
Direct Patient care
Resident Seminar
Journal Club
Readings
X
X
Attending Evaluation
Program Director
Review
360 ᵒ evaluation
Other
X
X
Directly Supervised Procedures
In-Training Exam
X
Videotape Review
X
Morning Report
Faculty Supervision
and Feedback
Quarterly Review
Systems-based Practice
Residents must demonstrate an awareness of and responsiveness to the larger context and system of
health care and the ability to effectively call on system resources to provide care that is of optimal value.
Residents are expected to:
A. Understand how their patient care and other professional practices affect other health care
professionals, the health care organization, and the larger society and how these elements of
the system affect their own practice.
B. Know how types of medical practice and delivery systems differ from one another, including
methods of controlling health care costs and allocating resources.
C. Practice cost-effective health care and resource allocation that does not compromise quality
of care.
D. Advocate for quality patient care and assist patients in dealing with system complexities.
E. Know how to partner with health care managers and health care providers to assess,
coordinate, and improve health care and know how these activities can affect system
performance.
F. Learn the appropriate documentation, coding, and billing for nephrology consults,
procedures, and patient education.
G. Thoroughly document the plan for patient care management in the medical record.
H. Learn what constitutes an appropriate nephrology consult, including the formulation of a
specific clinical question for the consultant.
I. Become knowledgeable about prevention strategies for preventing renal sequelae.
Learning Activities
Attending Rounds
X
Multidisciplinary Rounds
X
Grand Rounds
Sub-Specialty Conference
Morning Report
Didactics
Other
Evaluation Methods
X
Attending Evaluation
X
Program Dir
Review
360 ᵒ evaluation
Other
Last Updated April 19, 2013
X
X
X
X
X
Research Conference
Ethics/Comm Conference
Specialty Conference
Noon Conference
Faculty Supervision
Procedures
X
X
X
X
Directly Supervised Procedures
In-Training Exam
X
Videotape Review
X
Outpatient Clinics
Direct Patient care
Resident Seminar
Journal Club
Readings
Morning Report
Faculty Supervision
and Feedback
Quarterly Review
IV.
Instructional Strategies (see above)
This is a four-week rotation and should be attended by the resident for a minimum of 5-6 half days per
week. The other 4-5 half days per week will be spent in the resident’s continuity clinic and in didactics.
Readings can be obtained from Section VI and should also be solicited from the Nephrology attending
and team. The resident should assess and manage patients on the service and should actively participate
in case discussions. Outpatient care of renal conditions will occur longitudinally in the resident’s
continuity clinic.
V.
Evaluation Strategies (see above)
A.
B.
C.
VI.
Observation of the resident by the Nephrology attending.
Procedure/diagnosis documentation by the resident.
End of rotation evaluation.
Implementation Methods
The rotation is offered as a PGY3 medical subspecialty. The nephrology medical subspecialty rotation
offers both outpatient and inpatient experiences. The resident will further his/her rotational experience by
continuing to see his/her continuity clinic patients 3-4 half days per week and by attending Family
Practice didactics on one half day per week.
Location: Michael Braithwaite, MD
Contact: 404-815-72717 office; 404-817-0763 fax
Family Practice Center: Emory Midtown Hospital, 550 Peachtree Street, Atlanta, GA 30308
Call/Vacation: Call will be with the Family Medicine Service at Emory University Midtown Hospital.
Vacation is permitted.
Supervision: Residents will be supervised by Dr. Braithwaite. Residents should document all procedures
in their residency passport.
Conferences: The resident is expected to attend Family Medicine Conferences.
VI.
Suggested Readings/Resources
Acute Renal Failure. Am Fam Physician 2000;61:2077-88.
Thadhani R, Pascual M, Bonventre JV.
Acute renal failure. N Engl J Med 1996;334:1448-60.
Hricik DE, Chung-Park M, Sedor JR. Glomerulonephritis. N Engl J Med 1998;339:888-99.
Singer GG. Fluid and electrolyte management. In: The Washington manual of medical therapeutics. 29th
ed. New York: Lippincott-Raven, 1998:39-60.
McCarthy JT. A practical approach to the management of patients with chronic renal failure. Mayo Clin
Proc March 1999;74:269-73.
Proteinuria in Adults: A Diagnostic Approach. Am Fam Physician 2000;62:1333-40.
Last Updated April 19, 2013
McConnell KR, Bia MJ. Evaluation of proteinuria: an approach for the internist. Resident Staff Phys
1994;40:41-8.
Evaluating Proteinuria in Children. Am Fam Physician 1998;Oct 1:1145-1158.
Ettenger RB. The evaluation of the child with proteinuria. Pediatr Ann 1994;23:486- 94.
Asymptomatic Microscopic Hematuria in Adults: Summary of the AUA Best Practice Policy
Recommendations. Am Fam Physician 2001;63:1145-54.
Diagnosis and Initial Management of Kidney Stones. Am Fam Physician 2001;63:1329-38.
Last Updated April 19, 2013