Nephrology Curriculum

  1. 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:

  1. Review the principles of normal renal physiology.
  2. Understand the diagnosis and management of:
  3. Acute renal failure (including indications for various modalities of acute dialysis)
  4. Chronic renal failure (including its medical complications)
  5. End-stage renal disease
  6. Acid-base and fluid and electrolyte abnormalities.
  7. Learn the outpatient evaluation and treatment of hypertensive disorders, hematuria, and proteinuria.
  8. Become familiar with issues surrounding renal transplant and dialysis management.
  9. Learn a nephrology directed history and physical.
  10. Appreciate the psychosocial issues involved for patients on long-term dialysis.
  11. Learn resources for personal education and develop a plan for ongoing education.

H. Learn the diagnosis, associated complications, and management of:

  1. Acute renal failure
  2. Chronic renal insufficiency and failure
  3. End stage renal disease
  1. Hemodialysis
  2. Peritoneal dialysis
  3. 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:

  1. Immunosuppressive therapy
  2. Complications

9. Nephrolithiasis

10. Hematuria

11. Systemic disease with prominent renal involvement:

  1. Diabetes mellitus
  2. SLE

I.Become familiar with other renal conditions such as cystic diseases of the

kidney, renal cancers, and tuberculosis of the kidney.

J. Become familiar with common known nephrotoxic medications (e.g., NSAIDs,

gentamycin, cyclosporins, etc.).

K. Learn when to refer patients for long-term vascular access (e.g., vascath,

ateriovenous fistula)

L. 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

M. Observe the following, as available:

1.Renal biopsy

  1. Hemodialysis access placement (vascath)

Learning Activities
Attending Rounds / Research Conference / X / Outpatient Clinics
Multidisciplinary Rounds / Ethics/Comm Conference / X / Direct Patient care
Grand Rounds / Specialty Conference / Resident Seminar
Sub-Specialty Conference / Noon Conference / Journal Club
Morning Report / X / Faculty Supervision / X / Readings
X / Didactics / Procedures
Other
Evaluation Methods
X / Attending Evaluation / X / Directly Supervised Procedures / X / Morning Report
X / Program Director
Review / X / In-Training Exam / X / Faculty Supervision and Feedback
360 ᵒ evaluation / Videotape Review / X / Quarterly Review
Other

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:

  1. 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.
  2. Demonstrate a commitment to ethical principles pertaining to provision or withholding of clinical care, confidentiality of patient information, informed consent, and business practices.
  3. Demonstrate sensitivity and responsiveness to patients' culture, age, gender, and disabilities.

D. Arriveat 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

aboutpatients.

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 / Research Conference / X / Outpatient Clinics
Multidisciplinary Rounds / Ethics/Comm Conference / X / Direct Patient care
Grand Rounds / Specialty Conference / Resident Seminar
Sub-Specialty Conference / Noon Conference / Journal Club
Morning Report / X / Faculty Supervision / Readings
Didactics / Procedures
Other
Evaluation Methods
X / Attending Evaluation / Directly Supervised Procedures / X / Morning Report
X / Program Director
Review / In-Training Exam / X / Faculty Supervision and Feedback
360 ᵒ evaluation / Videotape Review / X / Quarterly Review
Other

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:

  1. Analyze practice experience and perform practice-based improvement activities using a systematic methodology.
  2. Locate, appraise, and assimilate evidence from scientific studies related to their patients' health problems.
  3. Obtain and use information about their own population of patients and the larger population from which their patients are drawn.
  4. Apply knowledge of study designs and statistical methods to the appraisal of clinical studies and other information on diagnostic and therapeutic effectiveness.
  5. Use information technology to manage information, access on-line medical information; and support theirown 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 / Research Conference / Outpatient Clinics
Multidisciplinary Rounds / Ethics/Comm Conference / X / Direct Patient care
Grand Rounds / Specialty Conference / Resident Seminar
Sub-Specialty Conference / Noon Conference / Journal Club
Morning Report / X / Faculty Supervision / Readings
Didactics / Procedures
Other
Evaluation Methods
X / Attending Evaluation / Directly Supervised Procedures / X / Morning Report
X / Program Director
Review / In-Training Exam / X / Faculty Supervision and Feedback
360 ᵒ evaluation / Videotape Review / X / Quarterly Review
Other

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 collectionof

information regarding symptoms, the family and the community that affect thepatient's healthand care.

B. Develop skills in communicating results to patients, their families, other health careproviders.

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 thepatient

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 tooptimize care of the patient.

E. Develop an understanding of the role of the family medicine consultant, and is able to support

thepatient 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

FamilyMedicine 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 / Research Conference / X / Outpatient Clinics
Multidisciplinary Rounds / Ethics/Comm Conference / X / Direct Patient care
Grand Rounds / Specialty Conference / Resident Seminar
Sub-Specialty Conference / Noon Conference / X / Journal Club
Morning Report / X / Faculty Supervision / Readings
Didactics / Procedures
Other
Evaluation Methods
X / Attending Evaluation / X / Directly Supervised Procedures / Morning Report
X / Program Director
Review / X / In-Training Exam / X / Faculty Supervision and Feedback
360 ᵒ evaluation / Videotape Review / X / Quarterly Review
Other

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:

  1. 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.
  2. Know how types of medical practice and delivery systems differ from one another, including methods of controlling health care costs and allocating resources.
  3. Practice cost-effective health care and resource allocation that does not compromise quality of care.
  4. Advocate for quality patient care and assist patients in dealing with system complexities.
  5. 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.
  6. Learn the appropriate documentation, coding, and billing for nephrology consults, procedures, and patient education.
  7. Thoroughly document the plan for patient care management in the medical record.
  8. Learn what constitutes an appropriate nephrology consult, including the formulation of a specific clinical question for the consultant.
  9. Become knowledgeable about prevention strategies for preventing renal sequelae.

Learning Activities
Attending Rounds / Research Conference / X / Outpatient Clinics
X / Multidisciplinary Rounds / X / Ethics/Comm Conference / X / Direct Patient care
X / Grand Rounds / X / Specialty Conference / Resident Seminar
Sub-Specialty Conference / Noon Conference / X / Journal Club
Morning Report / X / Faculty Supervision / X / Readings
Didactics / Procedures
Other
Evaluation Methods
X / Attending Evaluation / X / Directly Supervised Procedures / Morning Report
X / Program Dir
Review / X / In-Training Exam / X / Faculty Supervision and Feedback
360 ᵒ evaluation / Videotape Review / X / Quarterly Review
Other

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)

  1. Observation of the resident by the Nephrology attending.
  2. Procedure/diagnosis documentation by the resident.
  3. End of rotation evaluation.

VI.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.

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