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Nephrology Outpatient

Renal Outpatient Elective

I. Goals and Objectives:

A. Overview:

The Renal Outpatient Elective is designed to provide the house officer the knowledge and skills necessary for the diagnostic evaluation and management of patients with kidney disease.  It will allow the house officer to interact with nephrologists and others in multidisciplinary settings in which patient with renal disease are cared for such as ambulatory nephrology clinics, pre and post-transplant clinics, and outpatienthemodialysis centers.

The renal elective consists of one or two block(s) of two weeks and is available to all internal medicine PG-Y2’s and PG-Y 3's.  The elective includes participation in the in-patient dialysis and transplant service but will primarily be an out-patient experience involving the multidisciplinary clinics as delineated above, based at both the Weiler and Moses campuses.  In renal clinic the resident will participate in the care of patients with glomerular diseases, hypertension, electrolyte disorders, and all stages and varied etiologies of chronic kidney disease (CKD).  Residents will be exposed to the full spectrum of care for patients with CKD as they will also round in the outpatient dialysis unit and observe the care of patients with End Stage Renal Disease (ESRD) on hemo and peritoneal dialysis.  In addition, residents will attend transplant clinics and thus be exposed to the complex medical management of patients preparing for and living with a solid organ transplant on immunosuppressant medications.The composite of patients thelearner will encounter are very diverse ethnically and socioeconomically, and their demographics and renal diseases are representative of those in the neighboring Montefiore communities.

 

B. Level based Rotation Goals and Objectives:

PGY2/PGY3:

 

Patient Care:  Recognize the relative significance of problems in patients with renal disease; recognize renal emergencies;explain the indications and complications of treatments used in various renal diseases.


Medical Knowledge:  Review literature and reference sources to increase knowledge base in nephrology; demonstrate basic knowledge in the areas of underlying physiology, pathophysiology and the clinical aspects of renal diseases; apply evidence-based data in the treatment of patients. 


Professionalism:  Establish trust with patients and staff; exhibit honesty, reliability and responsibility in patient care; demonstrate respect for patients and staff; work to fulfill the needs of patients; accept assignments graciously; attend conferences.


Interpersonal and Communication Skills:  Write understandable notes and consultation reports;listen to patients and staff; communicate verbally and nonverbally in a productive manner; work effectively as a member of the health care team.


Practice Based Learning and Improvement:  Recognize one’s limitations of knowledge; use references and literature to improve practice patterns; accept feedback and change behavior; ask for help when needed.


System Based PracticeAdvocate for patients with renal disease; accept and apply necessary devised guidelines; develop an understanding of the health care systems/structure and how it relates to patients with renal disease including those who require renal replacement therapy.

II. Areas Covered During Renal Outpatient Elective

1) Principles, Physiology and Basic Sciences:

a)     Physiology of normal kidney function

b)    Epidemiology of CKD and ESRD

c)     Underlying physics of dialysis

d)    Principles and pharmacology of immune suppression for kidney transplant patients

 

2)  Practical skills unique to Nephrology:

a) Performa history and physical examination in a patient with chronic kidney disease with attention to assessment of uremic symptoms, specific chronic kidney disease complications, and volume status

    b) List the differential diagnosis of nephrotic and nephritic diseases and state the appropriate serologic tests included in the work up

   c) Explain the indications for a renal biopsy with insight into the risks, benefits, and alternatives

    d) Gain insight into the structure of care and funding for patients with ESRD in the United Statesas delineated by the Centers for Medicare and Medicaid Services (CMS)
    e) Participate in multidisciplinary team management of ESRD and kidney transplant patients

    f)  Critically appraise and analyze the Nephrology literature

3) Approach to clinical problems in renal patients:

     a) Describe the stages of CKD and list the symptoms and specific complications that may occur

     b)Explain modalities of renal replacement therapy including hemodialysis, peritoneal dialysis, and kidney transplant

4) Specific Diagnoses in Nephrology:
a) Nephrotic syndrome
b) Nephritic syndrome
c) Acute kidney injury (AKI)
d) CKD
e) ESRD
f)  Diabetic nephropathy
g) Hypertension
h) Anemia of CKD
i)  Mineral and Bone Disorders in CKD(CKD - MBD)
j) Hyperkalemia
k) Dialysis access complications
l)Renal transplant complications


5) Treatment Modalities in Nephrology:
       a) Non-dialysis medical management
       b) Hemodialysis
       c) Peritoneal dialysis
       d) Kidney transplant


6) Technical Skills specific to Nephrology:
       a) Residents may observe a renal biopsy during the course of the elective


7) Emergenciesencountered in renal patients:
        a) Hyperkalemia
        b) Acidosis

       c) Pulmonary edema

       d) Sepsis

       e) Severe acute hypertension

 



III. Schedule of Activities

The following lists the scheduled activities available during the elective.  The outpatient settingwill be the venue for the majority of time spent on this rotation.Ambulatory nephrology experience will be in general nephrology, pre transplant, and post- transplant clinic settings; as well as hemodialysis facilities.

1)  Hemodialysis Outpatient Rounds:Tuesday 2-5 and Wednesday 9-12 on Morris Park Ave

2)  General Nephrology Clinic sessions:Tuesday 8:30 -12WeilerCFCC and Wednesday 1-5 Moses MAP

       3) CKD Clinic sessions:alternate Thursdays 9 -12 Moses MAP

4)  Renal Post Transplant Clinic sessions:alternateThursdays 9-12 Rosenthal Pavilion Moses

5)  Renal Pre Transplant Clinic sessions:Mondays 9-12 Rosenthal Pavilion Moses

6)  Hemodialysis Inpatient Rounds:  Mondays 1-5 Weiler

       7)  Transplant Inpatient Rounds:  Thursdays 7:15-9 Moses Silver Zone

6)  Weekly Core Curriculum:Journal Club, CoreConference, Noon Conference, etc. (see separate weekly schedule for times and locations)

7)  Nephrology Grand Rounds:  Thursdays 5-6

 

Residents will have a chance for career mentoring built into the elective.  They will meet with the Division head, Dr. Folkert for outpatient HD rounds on Wednesday mornings.  They will meet with the Fellowship Director Dr. Melamed after CFCC renal clinic on Tuesday mornings.  They will meet with the Associate Fellowship Director Dr. Sharma after noon conference on Friday.

 

Residents will be expected to give a 15 minute presentation on an outpatient renal topic of their choice at the culmination of the elective.  Residents will meet with Dr. Sharma the first week of the elective and receive guidance on the format of the presentation which will be given during the noon conference time slot to the fellows and faculty on the final Friday of the elective.

 

Prior to starting the elective the resident should contact Olivia Migenes omigenes@montefiore.org to let her know the start date of the elective so she can alert the various faculty to expect the resident.

 

 

All absences must be cleared through the Chief residents.

 

 

 

 

 

 

 

Weekly Schedule

Week One:

Monday

Tuesday

Wednesday

Thursday

Friday

9 am - 12 pm

Moses: Pre -TXN clinic

Rosenthal Pavilion Red Zone 2nd Floor

Supervisor: Dr. Akalin

8:30 am - 12 pm

Weiler: CFCC Renal Clinic 1515 Blondell

Supervisor: Dr. Melamed

 

9 - 12 pm

Weiler: Outpatient HD

1325 Morris Park Avenue

Supervisor: Dr. Folkert

7:15 am - 9 am

Moses: Inpatient TXN rounds Silver Zone 7th floor Conference room - page the TXN fellow

Supervisor: Dr. Akalin

 

 

9 am - 12 pm

Moses: Post -TXN clinic

Rosenthal Pavilion Red Zone 2nd Floor

Supervisor: Dr. Akalin

8 - 9 am

Moses: Renal Journal club

Tischman Learning Center Conference Room 5

1 - 5 pm

Weiler: Inpatient HD

Service; Weiler HD unit second floor - page the dialysis fellow

Supervisor: Weiler Attending Service Attending

2 - 5 pm

Weiler: Outpatient HD

1325 Morris Park Avenue

Supervisor: Dr. Raff

1 - 5 pm

Moses Renal Clinic

3400 Bainbridge second floor

Supervisor: Dr. Sharma

 

 

Location will vary

4 - 5 pm

Core Conference

5 - 6 Renal Grand Rounds

12 - 1 pm

Moses: Renal noon conference

Silver Zone 4th floor conference room across the hall from the HD unit

Supervisor: Dr. Sharma

WeekTwo:

Monday

Tuesday

Wednesday

Thursday

Friday

9 am - 12 pm

Moses: Pre -TXN clinic

Rosenthal Pavilion Red Zone 2nd Floor

Supervisor: Dr. Akalin

8:30 am - 12 pm

Weiler: CFCC Renal Clinic 1515 Blondell

Supervisor: Dr. Melamed

 

9 - 12 pm

Weiler: Outpatient HD

1325 Morris Park Avenue

Supervisor: Dr. Folkert

7:15 am - 9 am

Moses: Inpatient TXN rounds Silver Zone 7th floor Conference room - page the TXN fellow

Supervisor: Dr. Akalin

 

9 am - 12 pm

Moses: Kidney Care Program

3400 Bainbridge second floor

Supervisor: Dr. Johns

8 - 9 am

Moses: Renal Journal club

Tischman Learning Center Conference Room 5

1 - 5 pm

Weiler: Inpatient HD ;Weiler HD unit second floor - page the dialysis fellow

Supervisor: Weiler Attending Service Attending

2 - 5 pm

Weiler: Outpatient HD

1325 Morris Park Avenue

Supervisor: Dr. Raff

1 - 5 pm

Moses Renal Clinic

3400 Bainbridge second floor

Supervisor: Dr. Sharma

Location will vary

4 - 5 pm

Core Conference

5 - 6 Renal Grand Rounds

12 - 1 pm

Moses: Renal conference

Silver Zone 4th floor conference room across the hall from the HD unit

Supervisor: Dr. Sharma

IV. Methods ofEvaluation and Assessment

The house officer is evaluated continuously during their time on service on the Renal Outpatient elective. Importantly, formative feedback is given to the house officer throughout the rotation experience. The final evaluation is entered through www.new-innov.com and a summary performance assessment is discussed in a meeting with the house officer. This evaluationwill assess overall clinical competence as reflected by the following subcategories: patient care, medical knowledge, professionalism, practice-based learning and improvement, systems-based practice, and interpersonal and communication skills.

 

The final evaluation will be prepared by Dr. Sharma with input from all the faculty the resident works with.

 

House officers will have the opportunity to evaluate both the rotation and the specific faculty with whom they worked via .evaluations in New Innovations (www.new-innov.com).

Subpages (1): Goals and Objectives
ĉ
Kevin Hauck,
Dec 11, 2014, 7:02 PM
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