Revised June 26, 2008
GOALS AND OBJECTIVES
RESIDENT CURRICULUM FOR NEPHROLOGY ROTATION
Rotation Coordinator: Marwan A. Takieddine
Kantor Nephrology Consultants, Ltd.
1750 E. Desert Inn Road, Suite 200
Las Vegas, NV 89169
(702) 732-2438
Educational Purpose
Nephrology involves the assessment and management of patients with known or
suspected kidney disease. The general internist should have a substantial understanding
and wide range of competencies in the evaluation and management of renal disorders.
The General Internist must be able to do the following:
1. Identify and manage, with the supervision of the nephrology attending, acute
renal failure in hospitalized patients including critically ill patient.
2. Understand the risks and benefits of various renal imaging tests including
ultrasound, nuclear, CT and MRI.
3. Understand risk for contrast nephropathy and fibrosing dermopathy and take
appropriate preventive measures.
4. Demonstrate competency in the interpretation of renal tests including acid base
disorders, FeNa, and creatinine clearance.
5. Competency in assessing complications associated with dialysis including fluid
overload, infections, and other co-morbidities.
6.
Competency in identifying glomerulonephritis, nephrotic syndrome, diabetic
nephropathy, renal vascular disease, and other common renal disorders and
understanding indications for consultation with a nephrologist.
7. Competency in assessment and management of hypertension, electrolytes
disturbance and acid-base states.
Teaching Methods
The rotation will be under the supervision of the attending nephrologist. The resident
will see consultations and patients as assigned by the attending nephrologist. The
resident will obtain the initial data, write a consultation note, and present the patient to
the attending physician. The attending will confirm the findings, teach about the case,
and with the resident, craft the final recommendations. The resident will see the patient
daily, write the follow up consult notes, and review them with the attending nephrologist.
Daily rounds will occur with the attending physician at which time instruction in the
unique aspects of the consultative process will be provided. Residents will be required to
continue their regular morning report and noon conference core curriculum. The resident
and attending will review and discuss any required reading.
Mix of Diseases
Patients present with a wide variety of acute and chronic renal problems that a
nephrology consultant may be requested to evaluate. These include end-stage renal
disease, acute renal failure of uncertain etiology, rhabdomyolysis, renal vasculitis,
glomerulonephritis, tubulointerstitial disease, drug toxicity, urinary obstruction, and fluid
and electrolyte abnormalities.
Patient Characteristics
The patient population is diverse, male and female, of all ages from adolescent to
geriatric, representing most ethnic and racial backgrounds, from all social and economic
strata. The hospital serves primarily the indigent population of the city of Las Vegas.
Types of Clinical Encounters
All patient encounters are in the inpatient setting on a consultative basis from other
clinical services. Many of the patients with acute renal failure are seen in an intensive
care setting.
Close interaction with various other healthcare team members including care managers,
discharge planners, home health agencies, inpatient nurses, respiratory therapists,
physical therapists, dialysis technicians, and patient care technicians occurs daily.
Resident Supervision
Residents have constant on site supervision as well as daily personal supervision in their
patient care. Vascular access procedures are supervised.
Procedures and Services
The resident will participate in dialysis and filtration modalities, and may establish
vascular access. The resident will observe procedures including renal biopsy and
placement of nephrostomy tubes.
Didactic Teaching
Morning Report
Residents required to maintain greater than 60 % attendance at morning report.
Morning Report begins at 8 a.m. on Monday through Thursday and at 8:30 a.m.
on Friday.
Noon Conference
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Residents are required to maintain greater than 60 % attendance at noon
conference. Noon conference occurs daily, Monday through Friday. These
sessions cover the basic core curriculum, and other curriculum topics such as
ethical issues, geriatrics, computer systems and informatics, health care systems,
occupational and environmental health issues, and other topics of concern. A
renal topic is presented at least once during each month.
Attending Rounds
Didactic discussions will be held regarding all patients seen in consultation during
the month. Each resident and medical student will be required prepare and
discuss during teaching rounds one article or nephrology topic each week.
Teaching rounds by the attending physician will occur every day for 45 - 60
minutes after regular management rounds. Each resident is required to review
common infectious disease topics.
Core Reading Materials
Harrison’s Principle’s of Internal Medicine, 16th ed., Kasper DL, ed. McGraw
Hill
Brenner and Rector's The Kidney, 8th ed. Brenner BM, ed. W. B. Saunders
The Washington Manual of Medical Therapeutics, 32nd ed.
The Washington Manual Nephrology Subspecialty Consult, Agha I, ed.
Lippincott Williams & Wilkins
Ancillary Educational Materials
Subspecialty Texts of Neurology, Pulmonary Medicine, Nephrology,
Endocrinology, Infectious Diseases, Rheumatology as well as General Medical
References (Harrison’s Principles of Internal Medicine, Cecil’s Textbook of
Medicine) are available 24 hours a day, seven days a week in the resident lounge.
Savitt Medical Library On-Line
Residents have access to the on-line services of Savitt Library (the main library of
the University of Nevada - Reno) via their computer in the resident room, Suite
300 of the 2040 W. Charleston Building. Access to this room is available 24
hours a day, seven days a week.
Full text is available for many peer-review journals including, but no limited to:
ACP Journal Club
Annals of Internal Medicine
British Medical Journal
Cancer
Circulation
Journal of the American College of Cardiology
The Lancet
New England Journal of Medicine
Stroke
Also available on-line:
Harrison’s Principle’s of Internal Medicine, 14th ed.
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Merck Manual, 17th ed.
Guide to Clinical Preventive Services, 2nd ed.
The Cochrane Library
Medline and Grateful Med Databases
Pathological Material and Other Educational Resources
Residents are encouraged to review the pathological reports on patients for whom they
have consulted and to follow the hospital care of those patients. If a patient with whom
the resident has consulted should die and have an autopsy, the resident is encouraged to
attend the post-mortem session.
Training Sites
University Medical Center
All of the inpatient nephrology consultation experience occurs at University
Medical Center (UMC) under the supervision of one of the full-time endocrine
faculty.
Competency-based Goals and Objectives
Nephrology Rotation
Learning Venues
Evaluation Methods
1. Direct patient care/consultations
2. Attending Rounds
3. Residency core lecture series
4. Self study
5. Morning Reports
Competency: Patient Care
Level Specificity
A. Attending evaluation
B. Direct Observation
C. Nurse/Ancillary staff
evaluations
D. Written Examination
E. Self Evaluation
F. Patient Evaluation
Learning
Venues
Obtain an accurate history regarding prior 1 , 2, 4, 5
and current renal status, risk factors for
renal disease and symptoms of
dysfunction.
Perform a thorough physical exam on
1, 2
patient with known or suspected renal
disease.
Perform specific analysis of diagnostic
1, 2, 3, 4
studies serum creatinine, creatinine,
clearance, urinalysis, FeNa.
Demonstrate ability to generate
1, 2, 4, 5
differential diagnosis; define therapeutic
R-1 = 1
R-2 = 2
R-3 = 3
Evaluation
Methods
A, B, C, E
Level
1, 2, 3
A, B, C
1, 2, 3
A, D, E
1, 2, 3
A, B, D, E
1, 2, 3
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plan and consultant recommendations to
primary team.
Recognize adverse effects of medications
on renal function.
Recognize and identify pre-renal, renal,
and post renal failure and distinguish
etiology.
Provide initial consultation and direct the
management of patient with renal
disorders.
Recognize and initiate appropriate
treatment for specific nephrologic
emergencies.
Monitor patients’ response to treatment
recommendation.
Identify common electrolyte disturbance
associated with renal disease and initiate
corrective action.
Describe indications for acute
hemodialysis.
Adjust medication dosing based on renal
function.
Demonstrate competency in management
of hypertensive emergency, hypertensive
urgency, secondary hypertension and
difficult hypertension.
Demonstrate knowledge of indications,
contraindications and preventative
measures in assessing renal function
biochemically and with imaging studies.
Demonstrate knowledge of cost effect
and evidence based evaluation and
treatment.
Demonstrate knowledge of comorbidities
associated with renal diseases.
Competencies: Medical Knowledge
1, 2, 3, 4, 5
A, B, C, D, E
1, 2, 3
1, 2, 3, 4, 5
A, B, C, D, E
1, 2, 3
1, 2, 4
A, B, C, E
2, 3
1, 2, 4
A, E
2, 3
1, 2
A, B, C, E
1, 2, 3
1, 2, 3, 4, 5
A, B, C, D, E
1, 2, 3
1, 2, 3, 4, 5
A, B, C, D, E
1, 2, 3
1, 2, 3, 4, 5
A, B, D
1, 2, 3
1, 2, 3, 4, 5
A, B, D, E
1, 2, 3
1, 2, 4, 5
A, B, C, D, E
1, 2, 3
1, 2, 3, 4, 5
A, B, D
2, 3
1, 2, 3, 4, 5
A, B, D
2, 3
Learning
Venues
Evaluation
Methods
1, 2, 3, 4
1, 2, 3, 4
1, 2, 3, 4
1, 2, 3, 4
B, D
B, D
B, D
B, D
Level
Demonstrate knowledge of the following
renal disorder or syndrome:
a.
b.
c.
d.
Glomerulonephritis
Tubular disorders
Tubulo interstitial disease
Vascular injury
1, 2, 3
2, 3
2, 3
2, 3
5
e. Nephrolithiasis
f. UTIs and pyelonephritis
g. Urinary obstruction
h. Renal transplant including medication
management/assessment
Competency: Interpersonal and
Communication Skills
Interact in an effective way with
physicians, residents and medical
students requesting consultations, and
with medical support staff.
Demonstrate understanding of patient
preferences in diagnostic evaluation and
management of renal disorder.
Maintain accurate medical records.
Serve as a patient advocate.
Ensure adequate transfer of information
when transferring patient to care of
another physician.
Communicate efficiently and effectively
with referring physician, regarding
diagnosis, treatment and follow-up.
Communicate effectively to patient and
medical support staff
Communicate patients problems clearly
with patients family
Treat patients and families with
respect/empathy
Treat colleagues with respect
Respect patient confidentiality
1, 2, 3, 4
1, 2, 3, 4
1, 2, 3, 4
1, 2, 3, 4
B, D
B, D
B, D
B, D
2, 3
1, 2, 3
1, 2, 3
3
Learning
Venues
1, 2
Evaluation
Methods
A, B, C, E
1, 2, 3
1, 2
A, B, C, E, F
1, 2, 3
1, 2
1, 2
1, 2
A, B, C
A, B, C, E, F
A, B, C, E
1, 2, 3
1, 2, 3
1, 2, 3
1, 2
A, B, C, E
1, 2, 3
1, 2
A, B, C, E, F
1, 2, 3
1, 2
A, B, C, E, F
1, 2, 3
1, 2
A, B, C, E, F
1, 2, 3
1, 2,
1, 2
A, B, C, E, F
A, B, C, E, F
1, 2, 3
1, 2, 3
Level
Learning
Venues
Evaluation
Methods
Treat team members, primary
care-givers, and patients with
respect and empathy
Understand, practice and adhere
to a code of medical ethics
1,2,3,4,5
A, B, C, E, F
1,2,3,4,5
A,B,C, E
1, 2, 3
Participate actively in
consultations and on rounds
1,2,3,4,5
A,B,C,E
1, 2, 3
Attend and participate in all
scheduled conferences
2,3
attendance, A
Competency: Professionalism
Level
1, 2, 3
1, 2, 3
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Competency: Practice-Based
Learning
Incorporate renal case studies
with EB care
Review out comes of care and
apply to core delivery
Identify limitation of knowledge
in geriatric area and take
corrective action via the
medical/geriatric literature
1. Direct patient
care/consultations
2. Attending Rounds
3. Residency core lecture series
4. Self study
5. Morning Reports
Competency: Systems-Based
Practice
Develop understanding of the
multi-disciplinary approach to
end-stage renal disease care and
outpatient dialysis
Demonstrate ability to access
available support systems
including home nursing, home
intravenous therapy, social
services
Learning
Venues
1, 2, 4,5
Evaluation
Methods
A,E
1, 2, 3
1, 2
A, E
1, 2, 3
1, 2, 3, 4,5
A, E
1, 2, 3
A. Attending
evaluation
B. Direct
Observation
C.
Nurse/Ancillary
staff
evaluations
D. Written
Examination
E. Self
Evaluation
1. Direct patient
care/consultations
2. Attending
Rounds
3. Residency
core lecture series
A. Attending
evaluation
B. Direct
Observation
C.
Nurse/Ancillary
staff
evaluations
D. Written
Examination
E. Self
Evaluation
Learning
Venues
1, 2, 3, 4, 5
Evaluation
Methods
A,B,C,E
Level
1,2,5
A,B,C,E
1, 2, 3
4. Self study
5. Morning
Reports
Level
1, 2, 3
EVALUATION
A. Of Residents
At the completion of each rotation, all clinical faculty are required to complete the
standard ABIM resident evaluation form. All clinical faculty are encouraged to
provide face-to-face feedback with the residents. The night-float resident is
evaluated by one of the three service attendings. In addition, residents may
receive interim feedback utilizing the ABIM’s Praise and Early Warning cards.
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B. Of Rotation and Preceptor
All residents are encouraged to evaluate the rotation, and the clinical faculty
member, at the completion of the rotation. This evaluation form is included at the
end of this document. These evaluations are then converted to type and shared
anonymously with the clinical faculty.
The program director also discusses the rotation with the residents to ensure
rotation quality and satisfaction.
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Renal Rotation Resident Check List
1. Evaluation reviewed at mid-month and end of rotation by the supervising faculty
member and resident.
2. Completed assigned readings
3. Attended all assigned activities (excluding scheduled time away, required clinics and
emergencies).
4. Completed required case report abstracts and/or posters if assigned by the supervising
faculty member.
5. Demonstrated understanding of the basic principals of renal medicine.
6. Received verbal feedback from attending at end of rotation.
Intern/Resident Signature_________________________
Date___________________
Supervising Attending Signature ___________________
Date___________________
All items must be completed for rotation credit and checklist returned to the
Department of Medicine by the rotation’s end.
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