Curriculum‎ > ‎Electives‎ > ‎Nephrology‎ > ‎

Goals and Objectives

Written by: Sharon Silbiger, M.D.
Updated for 2014 academic year


ALBERT
EINSTEIN COLLEGE OF MEDICINE

MONTEFIORE MEDICAL CENTER

INTERNAL MEDICINE RESIDENCY PROGRAM: CURRICULUM

ROTATION: Nephrology

I.                   Overview:

A. Goals:

The program in Nephrology is designed to provide the house officer with the knowledge and skills needed to diagnose and treat diseases of the kidney and urinary system, systemic hemodynamics, acid-base and electrolyte abnormalities and balance.

Patients are very diverse ethnically and socioeconomically, and are representative of the neighboring Montefiore communities.

The Nephrology rotation/elective consists of one block of two or four weeks, with a 24/7 coverage by the Nephrology fellow (pgy4 or5) and attending.  The Nephrology rotation/elective is available to all Internal Medicine PGY 1/2/3. 

Residents work in teams under the supervision of the Nephrology fellow and the subspecialty Attending.  The Attending physician is responsible for supervision of all patient care. 

B.  Level based Rotation Objectives:

PGY1:

-          Patient Care:  Recognize the daily patient workload and  prioritize; recognize the significance of a patient’s renal conditions; differentiate the acuity level of illness, to establish patient focused care.

-          Medical Knowledge: Use discussions during daily rounds; use literature and reference sources to increase knowledge base, to learn guidelines apply for patient management; acquire basic knowledge in the areas of underlying pathophysiology and the clinical aspects of cardiac disease states.

-          Professionalism:  Learn to establish trust with critically ill renal patients and family; to participate in teamwork.  Exhibit honesty, reliability, and responsibility in patient care; demonstrate respect for patients and staff; attend conferences.

-          Interpersonal and Communication Skills:  Write understandable and timely notes; listen to patients and staff and communicate; work effectively as a member of the health care team.

-          Practice Based Learning and Improvement:  Recognize limitations of knowledge; use literature to improve your practice patterns; accept feedback and change behavior; ask for help when needed; learn from the outcomes of cardiac patients to improve outcomes in the future.

-          System Based Practice:  Be an advocate for renal patients; accept and try to apply necessary devised guidelines; to develop understanding about the health care systems/structure and how it relates to patients requiring cardiac procedures. 

PGY2: 

-          Patient Care:  Prioritize the daily tasks; recognize the relative significance

of a given renal patient’s list of renal related conditions; begin to recognize the acuity levels of illness; understand the indications, contraindications and risks of cardiac procedures; work with all providers to provide patient focused care. 

-          Medical Knowledge: Use literature and reference sources to increase knowledge base in nephrology; demonstrate basic knowledge in the areas of underlying pathophysiology and the clinical aspects of renal disease states; apply knowledge 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 and timely notes and consultation reports; listen to patients and staff and communicate verbally and nonverbally in a productive manner; work effectively as a member of the health care team.

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

-          System Based Practice:  Advocate for renal patients; apply necessary devised guidelines; develop understanding about the health care systems/structure and how it relates to patients requiring cardiac procedures.

 

PGY3:

-          Patient Care:  Prioritize the daily work load of renal patients and supervise the junior house staff appropriately; recognize the relative significance of a given patients list of renal related conditions; recognize the acuity levels of illness; recite the indications, contraindications and risks of common and uncommon procedures; discuss risks/benefits native of patient’s with specialists.

-          Medical Knowledge: Use literature and reference sources to increase knowledge base and share knowledge with junior house staff; demonstrate sophisticated knowledge in the areas of underlying pathophysiology an the clinical aspects of simple and complicated disease states; apply knowledge 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 and junior house staff who you are supervising; work with team to fulfill the needs of patients; lead health care team in patient care; understand limitations and ask supervisors for help when indicated; accept assignments graciously; attend conferences.

-          Interpersonal and Communication Skills:  Write understandable and timely notes and consultation reports; actively listen to patients and staff and communicate verbally and nonverbally in a productive manner; work effectively as a member of the health care team, and be an example for your junior house officers.

-          Practice Based Learning and Improvement:  recognize limitations of knowledge; use references and literature to improve practice patterns; accept feedback and change behavior; ask for help when needed; learn from the outcomes of cardiac patients under your care and alter practice patterns to improve outcomes in the future; aid junior house staff in evaluating their practice patterns.

-          System Based Practice:  Advocate for patients; develop a sophisticated understanding about the health care system/structure and develop mechanisms to utilize ancillary services to benefit patients.

  

II.AREAS COVERED DURING NEPHROLOGY ROTATION

1.      Principles, Physiology and Basic Sciences: Develop an understanding of:

a)      Glomerular and tubular function

b)      Sodium, water and electrolyte handling in various nephron segments

c)      Acid-base physiology

d)     Osmoregulation

                  2.   Practice skills unique to Nephrology:

e)      History and physical examination: with attention to BP, cardiac exam, abdominal exam with attention to kidney palpation and renal artery bruits, assessment of functional AV fistulas and grafts

f)       Specific tests and procedures: use and interpretation: urinanalysis/Uosm, sonography, CT/MRI, nuclear scans, renal biopsy

g)      Preventive care: microalbuminuria in dm, monitoring renal lab tests

h)      Patient education: diet, adherence to uremia, pre-dialysis counseling

i)        Attitudes/values: understand the psychosocial issues surrounding chronic illness, dialysis and withdrawal of dialysis

 

3.      Approach to presenting complaints/problems in Nephrology:

                                a)    Dysuria

                                b)   Hematuria

c)        Edema/anasarca

d)       Changes in urine volume

e)        Proteinuria/nephrotic syndrome

f)         Glomerulonephritis

g)        Use of nephrotoxic agents

h)        Dosage modification in renal failure

i)          Hypertension

      

4.      Specific Diagnoses in Nephrology:

            a)    Infections of the kidney

            b)    Acute renal failure, including dialysis

c)        Chronic renal failure, including dialysis and transplantation

d)       Hereditary kidney diseases (PKD)

e)        Electrolyte abnormalities:

                                           i)         Hypo/Hypernatremia (SIADH, DI)

ii)                  Hypo/Hypercalcemia

iii)                Hypo/Hyperphosphatemia

iv)                Hypo/Hypermagnesemia

v)                  Hypo/Hyperkalemia

f)         Acid-base abnormalities:

            i)         Acidoses (metabolic/respiratory)

ii)                  Alkaloses (metabolic/respiratory)

g)        Renal complications of systemic diseases

h)        Nephrolithiasis

i)          Hypertension

j)          Renal tumors

k)        Preeclampsia

l)          Glomerular diseases (nephrosis/nephritis)

m)      Vasculitis

                 5.  Emergencies/Therapeutic Interventions:

a)      Acute hyperkalemia

b)      Anuria

c)      Acute renal obstruction/ de-obstruction

d)     Hypertensive crisis

e)      Uremia/Acute indications for dialysis

f)       Conservation of renal function

                                            i)       ACEI, ARB, BP control, protein restriction

                                 g)   Erythropoietin therapy

                 6)   Technical Skills:

a)      Familiarity with renal biopsy

b)      Urinalysis

c)      Fundoscopic exam

d)     Familiarity with renal sonography

III. REFERENCES: See reading list. PDF’s of articles available on the Medicine House Staff site on the Intranet


IV     METHODS OF TEACHING COMPENCY ASSESSMENT

            The house officers are evaluated continuously during their Nephrology rotation.  Importantly, there is continuous feedback to the house officers.  The final evaluation is done through www.new-innov.com and the results are discussed in a meeting with the house officers.  They are evaluated in terms of their overall clinical competence with the following categories: clinical judgment, medical knowledge, clinical skills, humanistic qualities, professionalism, medical care and continuing scholarships.

 

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