department of internal medicine goals and...division of nephrology ... of evaluation method: fef,...

DEPARTMENT OF INTERNAL MEDICINE DIVISION OF NEPHROLOGY

PROGRAM OBJECTIVES FOR OUTPATIENT CLINICAL ROTATION

I. GOALS II. OBJECTIVES FOR POSTGRADUATE YEAR IV FELLOW III. METHODS OF EVALUATION AND FEEDBACK IV. TABLE OF ABBREVIATIONS

May 26, 2002 PGY 4 – Clinical Rotation

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I. GOALS:

The goal of outpatient clinic rotation is to learn to evaluate and treat kidney diseases on an outpatient basis. It includes history and physical examination, ordering and analyzing laboratory and radiological data, formulating treatment strategies, patient education and follow up and monitoring. During the rotations fellow should have learnt to manage wide variety of kidney disorders including primary and secondary glomerular diseases, hypertension, tubulointerstitial diseases, chronic renal failure and transition to renal replacement therapy, kidney stones, electrolyte and acid-base problems. During PGY 4 and PGY 5 years of rotation all fellows have continuity clinics on Wednesday every week. Two faculty members supervise this clinic. Social worker, dietitian and advanced nurse practitioner are also present. New referrals as well as old patients are followed up with renal problems. There are more clinics with other faculty members on the other days of the week and each fellow is assigned to one of those clinics. This clinic sees referred patients from within the university system as well as from around the state and there is a wide variety of renal problems.

II. OJBECTIVES FOR POSTGRADUATE YEAR IV FELLOW:

During this year the fellows learn to manage common outpatient kidney diseases, which include hypertension, diabetic nephropathy, proteinuria and hematuria, glomerular nephritis, acid base electrolyte, and lupus and other autoimmune disorders. At the end of the rotation, fellows should be able to:

Evaluate the referrals from other clinic, interact with patients and take routine history and physical exam which is problem oriented, come up with differential diagnosis of the disease, supervised decision making related to treatment and investigations including needle biopsy. (Competency: IC, MK, PC, PBMI Teaching Method: LS, FS, CE, OF Evaluation Method: FEF, MCQ, GR, 360).

Do urine analysis, dipstick and microscopy, and be able to identify common urine abnormalities in form of cellular casts, crystals, dysmorphic red cells and proteinuria. (Competency: MK, PC, PBMI Teaching Method: LS, FS, UTD Evaluation Method: FEF, MCQ).

PROGRAM OBJECTIVES FOR RENAL OUTPATIENT CLINICAL SERVICE

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Formulate evidence based treatment strategy based on available literature. Discussion with the patient regarding informed treatment decisions. Analytical thinking by the fellows, literature review about the problem and evidence based management of the disease. (Competency: MK, PC, P, ICS Teaching Method: JC, LS, FS Evaluation Method: FEF, MCQ, GR).

Work up hypertension in outpatient setting. Should be able to differentiate between essential and secondary forms of hypertension, order relevant tests and initiate treatment. (Competency: MK, PC, SBP Teaching Method: LS, FS Evaluation Method: FEF, MCQ).

Work up proteinuria, interpret 24 hour urine collection results and spot urine protein and creatinine values, define nephrotic syndrome, differentiate from nephritic picture, know the various primary and secondary glomerular causes of proteinuria, order appropriate serological tests. (Competency: MK, PC Teaching Method: LS, FS, UTD, JC Evaluation Method: FEF, MCQ).

Work up hematuria, differentiate between glomerular and urological causes of hematuria, recognize active glomerulonephritis, order appropriate serological tests, and know various glomerular and urological causes of hematuria. (Competency: MK, PC Teaching Method: LS, FS, UTD Evaluation Method: FEF, MCQ).

Work up elevated serum creatinine; understand the pre-renal, renal and post-renal causes and how to reach a differential diagnosis. (Competency: MK, PC Teaching Method: LS, FS, UTD Evaluation Method: FEF, MCQ).

Know the cause of progression of glomerular disease and interventions, which slow it. (Competency: MK, PC Teaching Method: LS, FS, JC, UTD Evaluation Method: FEF, MCQ).

To manage nutritional problems associated with kidney diseases like hypoalbuminemia, hypercholesterolemia, and failure to thrive. (Competency: MK, PC Teaching Method: LS, FS, JC, UTD Evaluation Method: FEF, MCQ).

Manage other complications of kidney diseases like anemia, hypercholesterolemia, calcium and phosphate disorder and opportunistic infections with immunosuppression. (Competency: MK, PC Teaching Method: LS, FS, JC, UTD Evaluation Method: FEF, MCQ).

Increase the knowledge base by patient and clinical problem based learning, review of literature, textbooks and discussion with faculty. (Competency: MK, PC, SBP Teaching Method: LS, FS, JC, UTD, RC Evaluation Method: FEF, MCQ, PF).


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Encourage scholarly pursuits including participation in ongoing clinical projects as well as design of small pilot projects by the fellows. (Competency: MK, PC, SBP Teaching Method: LS, JC, RC Evaluation Method: FEF, PF).

III. METHODS OF EVALUATION AND FEEDBACK: Methods of evaluation have been included in the body of the document with the individual objective and will not be repeated here.

Feedback will be performed semi-annually when the associate program director meets with each fellow individually to review the previous 6 months evaluations and portfolio.

During the two years of rotation there is active feedback to the fellows, which is continuous and ongoing throughout the clinic rotations by the faculty. At the end of three months each of the fellows have their rotations re-evaluated by the faculty and get appropriate feedback regarding their progress as far as learning is concerned.

Each faculty will meet with their respective fellow at the end of a rotation to discuss the performance for the month’s rotation.

A multiple choice exam (MCQ) will be performed at the start of the fellowship program, at the end of the first year and at the end of the second year as an assessment of the acquisition of medical knowledge over the course of the fellowship training.

IV. TABLE OF ABBREVIATIONS:

Abbreviations for Competencies ICS- Interpersonal & Communication Skills MK- Medical Knowledge P- Professionalism PC- patient care PBLI- Practice Based Learning & Improvement SBP- Systems Based Practice

Abbreviations for Evaluation Methods CL- Check List CSR- Chart Stimulation Recall FEF- Faculty Evaluation Form GR- Global Rating MCQ- Multiple Choice Question exam OE- Oral Exam OSCE – Objective Structured Clinical Examination PF- Portfolios PL- Procedure Log PS- Patient Survey RR- Record Review SM- Simulations & Models SP – Standardized Patient 360- 360 Evaluation GR – Global Rating

Abbreviations for Teaching Method CE- Clinical Encounters FS- Faculty Supervision JC- Journal Club LS-Lecture Series OF- Observed by Faculty RC- Research Conference RBC – Renal Biopsy Conference UTD- Up to Date


PROGRAM OBJECTIVES FOR OUTPATIENT CLINICAL ROTATION

I. GOALS II. OBJECTIVES FOR POSTGRADUATE YEAR V FELLOW III. METHODS OF EVALUATION AND FEEDBACK IV. TABLE OF ABBREVIATIONS

May 26, 2002 PGY 5 – Clinical Rotation

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I. GOALS:

The goal of outpatient clinic rotation is to learn to evaluate and treat kidney diseases on an outpatient basis. It includes history and physical examination, ordering and analyzing laboratory and radiological data, formulating treatment strategies, patient education and follow up and monitoring. During the rotations fellow should have learnt to manage wide variety of kidney disorders including primary and secondary glomerular diseases, hypertension, tubulointerstitial diseases, chronic renal failure and transition to renal replacement therapy, kidney stones, electrolyte and acid-base problems. During PGY 4 and PGY 5 years of rotation all fellows have continuity clinics on Wednesday every week. Two faculty members supervise this clinic. Social worker, dietitian and advanced nurse practitioner are also present. New referrals as well as old patients are followed up with renal problems. There are more clinics with other faculty members on the other days of the week and each fellow is assigned to one of those clinics. This clinic sees referred patients from within the university system as well as from around the state and there is a wide variety of renal problems.

II. OBJECTIVES FOR POSTGRADUATE YEAR V FELLOW:

At the end of the program the fellow should be able to:

To consolidate on PGY-4 year learning and fellows are encouraged to have more independent decision making with faculty supervision. (Competency: MK, PC Teaching Method: LS, FS Evaluation Method: FEF, MCQ).

Identify and manage acid-base, electrolyte disorders- both of acquired and congenital etiology. (Competency: MK, PC Teaching Method: LS, FS, JC, UTD Evaluation Method: FEF, MCQ).

Diagnose acute and chronic interstitial diseases, underlying etiology and treatment strategy. (Competency: MK, PC Teaching Method: LS, FS, JC, UTD Evaluation Method: FEF, MCQ).

Manage idiopathic and secondary glomerular disorders, treatment of these disorders especially with immunosuppressives and monitor it. (Competency: MK, PC Teaching Method: LS, FS, JC, UTD Evaluation Method: FEF, MCQ).


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Understand the pharmacokinetics of different drugs in the presence of renal disease. (Competency: MK, PC Teaching Method: LS, FS, JC, UTD Evaluation Method: FEF, MCQ).

Manage chronic renal insufficiency, associated metabolic derangements and prepare the patient for a transition to renal replacement therapy. Timely referral for arteriovenous fistula placement and patient education about the options available. (Competency: MK, PC Teaching Method: LS, FS, UTD Evaluation Method: FEF, MCQ, GR, CL).

There is more emphasis in this year on outpatient renal biopsy procedural skills. To review the biopsy results with pathologist and present in the pathology conference. Biopsy logbooks are checked and fellows who are lagging behind in the procedural skills are encouraged to catch up. (Competency: MK, PC, PBLI Teaching Method: FS Evaluation Method: PF, PL, RBC).

To lead group discussions about clinical problems encountered in the clinic with other fellows and faculty. (Competency: MK, ICS Teaching Method: LS, FS, JC Evaluation Method: FEF, CL, RBC, 360).

Encourage communicating with referring physicians about the management of the patients and also dictate letters to the referring physicians. (Competency: MK, ICS Teaching Method: FS Evaluation Method: FEF).

Information technology based learning including use of on-line resources like Medline, Ovid, E-journals from the university library and use of palm devices in patient management. (Competency: MK, SBP Teaching Method: FS, Evaluation Method: FEF).

To review ultrasound with the radiologist and at least identify and recognize obstructive uropathy, to look at kidney size and rule out kidney stones. (Competency: MK, PC Teaching Method: LS, FS Evaluation Method: FEF, MCQ).

Medical ethics are discussed with the fellows along with social worker including end of life care issues. (Competency: MK, PC, ICS Teaching Method: LS, FS Evaluation Method: FEF, MCQ, 360).

To learn statistical tools during formulation of clinical trials. (Competency: MK, Teaching Method: LS, FS, JC, RC Evaluation Method: FEF, MCQ).




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During the two years of rotation there is active feedback to the fellows, which is continuous and ongoing throughout the clinic rotations by the faculty. At the end of three months each of the fellows have their rotations re-evaluated by the faculty and get appropriate feedback regarding their progress as far as learning is concerned.








PROGRAM OBJECTIVES FOR RENAL CONSULTATIVE SERVICE

I. GOALS II. OBJECTIVES FOR POSTGRADUATE YEAR IV FELLOW III. METHOD OF EVALUATION AND FEEDBACK IV. TABLE OF ABBREVIATIONS

May 26, 2002 PGY 4 - Consultative Rotation

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I. GOALS:

The goal of this rotation is to provide the renal fellow with the opportunity to evaluate and follow patients with renal and related problems and to enable them to refine their knowledge, attitude and skills necessary to diagnose, manage, treat and educate patients with renal and related diseases.

II. OJBECTIVES FOR POSTGRADUATE YEAR IV FELLOW: Define the role of the primary care provider and multidisciplinary care team in the management of the renal patient (Competency: SBP, PBLI, ICS Teaching Method: LS, FS, CE Evaluation Method: 360, FEF).

Operate as the patients advocate in the area of quality care in helping the patient to deal with system complexities (Competency: SBP Teaching Method: FS, LS Evaluation Method: 360, PS).

Operate as a partner with health care managers and health care providers to assess, coordinate, and improve health care (Competency: SBP Teaching Method: FS, LS Evaluation Method: 360, GR).

GLOMERULAR DISEASE Identify the causes, clinical decision-making, and treatment of common and uncommon causes of hematuria and proteinuria (Competency: MK Teaching Method: LS, CE Evaluation Method: MCQ).

Evaluate the etiology and clinical findings of glomerular syndromes, including nephrosis, nephritis, and rapidly progressive glomerulonephritis manifesting as renal-limited processes or associated with systemic disease (Competency: MK, PC Teaching Method: JC, RC, LS, UTD, CE Evaluation Method: PF, FEF, MCQ).

Describe focal segmental glomerulosclerosis (FSGS), including its various pathological and clinical syndromes and the association with conditions or reduced renal mass, the demographics, clinical course, and outcome of the clinicopathologic syndromes of “primary” focal sclerosis, including FSGS, glomerular tip lesion, and perihilar FSGS (Competency: MK, PBLI Teaching Method: JC, RC, LS, UTD, CE Evaluation Method: PF, FEF, MCQ).


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Discuss the membranous nephropathy, including the clinical, pathological, and diagnostic features of both idiopathic membranous nephropathy and secondary membranous disease, and in-depth knowledge of the controversies regarding treatment of this disease (Competency: MK, PC, PBLI Teaching Method: JC, RC, LS, UTD, CE Evaluation Method: PF, FEF, MCQ).

Describe the IgA nephropathy, especially its clinical course, natural history, and prognostic markers (Competency: MK, PC, PBLI, ICS Teaching Method: JC, RC, LS, UTD, CE Evaluation Method: PF, FEF, MCQ).

Explain renal disease in the dysproteinemias, including multiple myeloma, amyloidosis, fibrillary glomerulopathy/immunotactoid glomerulopathy, and mixed cryoglobulinemia (Competency: MK, PC, PBLI Teaching Method: JC, RC, LS, UTD, CE Evaluation Method: PF, FEF, MCQ).

Explain the physiology, pathology, and Epidemiology of diabetic nephropathy (Competency: MK Teaching Method: LS, CE Evaluation Method: MCQ).

Discuss the pathogenesis, prevention and treatment of diabetic nephropathy (Competency: MK Teaching Method: LS, CE Evaluation Method: MCQ).

ACUTE RENAL FAILURE AND INTENSIVE CARE UNIT NEPHROLOGY Describe the differential diagnosis of acute renal failure including the pathophysiology of prerenal azotemia, the pathophysiology of intrinsic renal failure, including acute glomerular diseases, acute tubular necrosis, and acute interstitial disease, and the pathophysiology of obstructive renal failure (Competency: MK, PC, PBLI Teaching Method: JC, RC, LS, UTD, CE Evaluation Method: PF, FEF, MCQ).

Evaluate the mechanisms of acute renal failure (ARF) in the postoperative patient, in patients with hepatobiliary diseases, in patients with cancer and immunosuppression, and in patients with AIDS (Competency: PC, MK, ICS, PBLI Teaching Method: JC, RC, LS, UTD, CE Evaluation Method: PF, FEF, MCQ).

Discuss the metabolic consequences of ARF including hormonal, nutritional, electrolyte, acid-base, and volume (Competency: MK, PC, PBLI Teaching Method: JC, RC, LS, UTD, CE Evaluation Method: PF, FEF, MCQ).

Describe the hemodynamic monitoring of the critically ill patient (Competency: MK, PC, PBLI Teaching Method: JC, RC, LS, UTD, CE Evaluation Method: PF, FEF, MCQ).

Describe the role of extracorporeal therapy in the management of drug overdose, specifically ethylene glycol, methanol, lithium, theophylline, salicylate, and barbiturate (Competency: MK, PBLI Teaching Method: JC, RC, LS, UTD, CE Evaluation Method: PF, PL, FEF, MCQ).

Distinguish between acute renal failure and chronic renal failure (Competency: MK Teaching Method: LS, CE Evaluation Method: MCQ, FEF).


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CHRONIC RENAL FAILURE 1.

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Formulate strategies for the predialysis management of CRF with particular regard to diet, anemia, metabolic bone diseases, and drug dose adjustments (Competency: MK, PC, PBLI Teaching Method: JC, RC, LS, UTD Evaluation Method: PF, FEF, MCQ, CSR, RR, CL).

Discuss the role of anemia in the management of patients with CRF and the management of the anemia of chronic renal failure with the use of iron, erythropoietin and other appropriate agents (Competency: MK, ICS, PBLI, PC Teaching Method: JC, RC, LS, UTD, CE Evaluation Method: PF, PL, FEF, MCQ, CSR).

Explain the indications for initiation of ESRD therapy and placement of ESRD access in patients with CRF (Competency: MK.PC, ICS, PBLI Teaching Method: JC, RC, LS, UTD Evaluation Method: PF, PL, FEF, MCQ, 360, CSR, RR).

Formulate strategies for the appropriate use of drugs, including dose modification, for patients with progressive CRF (Competency: MK, PC, PBLI Teaching Method: JC, RC, LS, UTD Evaluation Method: PF, PL, FEF, MCQ, 360, CSR, RR).

Manage vascular access failure (Competency: MK, PBLI Teaching Method: LS, CE Evaluation Method: MCQ, RR, CSR).

Recognize and treat intradialytic hypotension (Competency: MK, PC, PBLI Teaching Method: LS, CE, OF Evaluation Method: MCQ, RR, CSR).

Discuss sepsis and infection in peritoneal dialysis patients and management of peritonitis (Competency: MK, PC Teaching Method: LS, CE, FS Evaluation Method: MCQ, RR, CSR).

HYPERTENSION Distinguish between primary (essential hypertension) and secondary forms of hypertension (Competency: MK Teaching Method: LS, CE, UTD Evaluation Method: MCQ, RR, CSR).

Discuss hypertension in patients with co-morbid disease to include diabetes mellitus, coronary artery disease, congestive heart failure and proteinuria (Competency: MK Teaching Method: LS, CE, UTD Evaluation Method: MCQ, PF).

Differentiate the mechanism of action of frequently used antihypertensive medications (Competency: MK Teaching Method: LS, CE, UTD Evaluation Method: MCQ, FEF, CSR).

Differentiate adverse effects related to antihypertensive medications (Competency: MK Teaching Method: LS, CE, UTD Evaluation Method: MCQ, CSR).

Discuss the non-pharmacological management of hypertension (Competency: MK Teaching Method: LS, CE, UTD Evaluation Method: MCQ, RR, CSR).


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Formulate strategies for appropriate management of incidentally discovered adrenal mass (Competency: MK Teaching Method: LS, CE, UTD Evaluation Method: MCQ, PF).

Discuss orthostatic hypotension in the presence of supine hypertension (Competency: MK Teaching Method: LS, CE, UTD Evaluation Method: MCQ, PF, RR).

Explain hypertension in the presence of renal artery stenosis and management of renal artery stenosis (Competency: MK Teaching Method: LS, CE, UTD Evaluation Method: MCQ, PF).

Formulate strategies for management of accelerated and malignant hypertension (Competency: MK Teaching Method: LS, CE, UTD Evaluation Method: MCQ, PF).

ACID- BASE DISORDERS Discuss clinical evaluation of acid-base disorders (Competency: MK, PC, PBLI Teaching Method: JC, RC, LS, UTD Evaluation Method: PF, FEF).

Explain renal tubular acidosis: pathogenesis, clinical features, causes, diagnosis, and management (Competency: PBLI Teaching Method: JC, RC, LS, UTD Evaluation Method: PF, PL, FEF).

Formulate strategies for treatment of uremic acidosis: acid-base homeostasis in ESRD (Competency: MK, PC, ICS, PBLI Teaching Method: JC, RC, LS, UTD Evaluation Method: PF, FEF).

Describe other types of metabolic acidosis: pathogenesis, clinical features, causes, diagnosis, and management (Competency: PC, MK, ICS, PBLI Teaching Method: JC, RC, LS, UTD Evaluation Method: PF, FEF).

Discuss metabolic alkalosis: pathogenesis, clinical features, causes, diagnosis, and management (Competency: MK, PC, ICS, PBLI Teaching Method: JC, RC, LS, UTD Evaluation Method: PF, FEF).

Identify respiratory acidosis and respiratory alkalosis: pathogenesis, clinical features, causes, diagnosis, and management. (Competency: PBLI Teaching Method: JC, RC, LS, UTD Evaluation Method: PF, PL, FEF).

Discuss the causes of hyperchloremic metabolic acidosis (Competency: MK Teaching Method: JC, RC, LS, UTD Evaluation Method: PF, FEF).

Discuss high anion gap and high osmolar gap metabolic acidosis (Competency: MK Teaching Method: JC, RC, LS, UTD Evaluation Method: PF, FEF).


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Explain hypovolemia: pathophysiology, causes, clinical features, diagnosis, and management (Competency: MK, PC, ICS Teaching Method: JC, RC, LS, UTD Evaluation Method: PF, FEF).

Describe edematous disorders: pathophysiology, causes, clinical features, diagnosis, and management (Competency: PBLI Teaching Method: JC, RC, LS, UTD Evaluation Method: PF, FEF).

Explain the clinical use and complications of diuretics (Competency: PBLI, PC, MK, ICS Teaching Method: JC, RC, LS, UTD Evaluation Method: PF, FEF).

Discuss the physiology of water balance, including tonicity sensors, effector systems, the countercurrent mechanism for urine concentration, the cellular physiology of collecting duct water reabsorption, and the regulation of water excretion by the kidney (Competency: MK Teaching Method: JC, RC, LS, UTD Evaluation Method: PF, FEF).

Describe hyponatremia: pathophysiology, causes, clinical features, diagnosis, and management (Competency: MK, PC, PBLI Teaching Method: JC, RC, LS, UTD Evaluation Method: PF, FEF).

Discuss hypernatremia: pathophysiology, causes, clinical features, diagnosis, and management (Competency: MK, ICS, PC, PBLI Teaching Method: JC, RC, LS, UTD Evaluation Method: PF, FEF).

Formulate strategies for the evaluation and management of the polyuric patient (Competency: PC, MK, ICS, PBLI Teaching Method: JC, RC, LS, UTD Evaluation Method: PF, FEF).

Discuss hypokalemia: pathophysiology, causes, clinical features, diagnosis, and management (Competency: MK, PC, ICS Teaching Method: JC, RC, LS, UTD Evaluation Method: PF, FEF).

Describe hyperkalemia: pathophysiology, causes, clinical features, diagnosis, and management (Competency: MK Teaching Method: JC, RC, LS, UTD Evaluation Method: PF, FEF).

Explain disorders of sodium, water, and potassium balance in end-stage renal disease (Competency: MK, PC, PBLI Teaching Method: JC, RC, LS, UTD Evaluation Method: PF, FEF).

TUBULOINTERSTITIAL DISEASE AND URINARY TRACT INFECTIONS Discuss structure and function of the normal renal tubules and interstitium (Competency: PC Teaching Method: JC, RC, LS, UTD Evaluation Method: PF, FEF).


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Formulate strategies for diagnostic procedures including assessment of tubular defects, evaluation of obstruction and definition of acute and chronic interstitial nephritis (Competency: MK, PC, ICS, PBLI Teaching Method: JC, RC, LS, UTD Evaluation Method: PF, FEF).

Evaluate the pathogenesis and treatment of bacterial urinary tract infections including major pathogenetic specific, routes, and course of infection, appropriate antibiotic choices, and appropriate work-up of the patient with multiple or resistance infections (Competency: MK, ICS, PBLI Teaching Method: JC, RC, LS, UTD Evaluation Method: PF, FEF).

DISORDERS OF DIVALENT CATION AND MINERAL METABOLISM Discuss the calcium and phosphorus balance in humans (Competency: MK, ICS Teaching Method: JC, RC, LS, UTD Evaluation Method: PF, PL, FEF).

Explain the physiology of calciotropic hormones, specifically parathyroid hormone, vitamin D, calcitonin, and parathyroid hormone-related peptide (Competency: MK Teaching Method: JC, RC, LS, UTD Evaluation Method: PF, FEF).

Explain an integrated view of calcitropic hormone regulation in normal situations and in the context of acute and chronic renal failure (Competency: MK Teaching Method: JC, RC, LS, UTD Evaluation Method: PF, FEF).

Discuss the pathogenesis and treatment of calcium nephrolithiasis, urate nephrolithiasis, infected stones, and cystine stones (Competency: MK Teaching Method: JC, RC, LS, UTD Evaluation Method: PF, FEF).

RENAL DISEASE IN PREGNANCY - PROGRAM BEHAVIORAL OBJECTIVES Discuss the changes in the anatomy and function of the urinary tract during pregnancy, focusing on the relevance of these changes to clinical circumstances, stressing alterations in the calyces and ureters, renal hemodynamics, and tubular function (principally potassium and glucose) (Competency: MK Teaching Method: JC, RC, LS, UTD Evaluation Method: PF, FEF).

Describe the changes in acid-base metabolism in pregnancy, focusing on normal pH, HCO3-, and PCO2 (Competency: MK, PC, PBLI Teaching Method: JC, RC, LS, UTD Evaluation Method: PF, FEF).

Explain an integrated view of volume homeostasis during pregnancy. This includes knowledge of the normal gestational changes in weight, intravascular and extracellular volume status, renal salt handling, and the production of volume-regulating hormones (Competency: MK Teaching Method: JC, RC, LS, UTD Evaluation Method: PF, FEF).

Discuss the altered osmoregulation in pregnancy, focusing on changes in plasma sodium and osmolality levels, as well as on certain disorders of water metabolism peculiar to gestation (Competency: MK Teaching Method: JC, RC, LS, UTD Evaluation Method: PF, FEF).


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Formulate strategies for the course and control of blood pressure in normal pregnancy (Competency: PBLI, MK, PC Teaching Method: JC, RC, LS, UTD Evaluation Method: PF, FEF).

Describe the tests of kidney function, including indications for renal biopsy during pregnancy (Competency: PBLI, PC, MK Teaching Method: JC, RC, LS, UTD Evaluation Method: PF, PL, FEF).

Explain the clinical spectrum and management of renal disorders in gestation including pathogenesis and treatment of urinary tract infections; acute renal failure (especially those primarily associated with gestation, i.e., septic abortion, abruption, preeclampsia, acute fatty liver, and idiopathic postpartum renal failure); and chronic glomerular and interstitial renal diseases antedating pregnancy (Competency: PBLI, MK, ICS, PC Teaching Method: JC, RC, LS, UTD Evaluation Method: PF, FEF).

Discuss the presentation of stone disease during gestation and the effect of pregnancy on patients with nephrolithiasis (Competency: MK, PBLI Teaching Method: JC, RC, LS, UTD Evaluation Method: PF, FEF).

Formulate strategies for the administration of both acute and chronic renal replacement therapy in pregnant women (Competency: PBLI,PC, MK, ICS Teaching Method: JC, RC, LS, UTD Evaluation Method: PF, PL, FEF).

Explain the effects of pregnancy on the natural history of renal allografts and of the conditions required for undertaking pregnancy in transplant recipients (Competency: PC, MK, ICS, PBLI Teaching Method: JC, RC, LS, UTD Evaluation Method: PF, FEF).

Describe the recognition and treatment of the hypertensive disorders of pregnancy, particularly preeclampsia and its variants such as HELLP syndrome. This includes the use in gravidas of antihypertensive drugs and the prevention and treatment of eclampsia, including the administration of magnesium sulfate (Competency: PBLI, PC, ICS Teaching Method: JC, RC, LS, UTD Evaluation Method: PF, FEF).

Discuss the cause of proteinuria in pregnancy (Competency: MK, PC Teaching Method: LS, JC, RC, RR Evaluation Method: MCQ, CSR).

RENAL FUNCTION TESTING Urinalysis, including dipstick and sediment (Competency: PBLI Teaching Method: JC, RC, LS, UTD Evaluation Method: PF, PL, FEF).

Measurement of renal plasma flow and GFR, including interpretation of serum creatinine concentration and calculation of its clearance rate (Competency: PBLI, PC, MK Teaching Method: JC, RC, LS, UTD Evaluation Method: PF, FEF).


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Measurement of renal concentrating and diluting capacity (Competency: PBLI Teaching Method: JC, RC, LS, UTD Evaluation Method: PF, PL, FEF).

Measurement of microalbuminuria (Competency: PBLI, MK Teaching Method: JC, RC, LS, UTD Evaluation Method: PF, FEF).

Measurement of proteinuria, using semiquantitative and quantitative methods (Competency: PBLI, PC, MK Teaching Method: JC, RC, LS, UTD Evaluation Method: PF, FEF).

Assessment of urinary acidification (Competency: MK Teaching Method: JC, RC, LS, UTD Evaluation Method: PF, FEF).

Assessment of renal sodium and potassium handling (Competency: MK Teaching Method: JC, RC, LS, UTD Evaluation Method: PF, FEF).

Renal radiology including urography, ultrasonography, radionuclide scans, computed tomography magnetic resonance imaging, and renal circulation imaging (angiography) (Competency: PBLI, MK, PC Teaching Method: LS, UTD Evaluation Method: PF, PL, FEF).

Discuss the indications and contraindications of kidney biopsy (Competency: MK, PC, ICS Teaching Method: CE, FS, LS, OF Evaluation Method: FEF, MCQ, PL).

PHARMACOLOGY OF DRUGS IN RENAL DISEASE Explain the mechanisms of drug metabolism (Competency: MK, PC Teaching Method: JC, RC, LS, UTD Evaluation Method: PF, FEF).

Formulate strategies for drug prescribing in disease states and during dialysis (Competency: PBLI, PC Teaching Method: JC, RC, LS, UTD Evaluation Method: PF, FEF).

Discuss relevant drug-drug interactions (Competency: MK, PC Teaching Method: JC, RC, LS, UTD Evaluation Method: PF, FEF).

Describe mechanisms of drug nephrotoxicity (Competency: MK, Teaching Method: JC, RC, LS, UTD Evaluation Method: PF, FEF).

Explain the management of drug-induced renal diseases (Competency: PBLI, MK, PC Teaching Method: JC, RC, LS, UTD Evaluation Method: PF, FEF).

Formulate strategies for therapeutic drug monitoring (Competency: PBLI, MK SBP Teaching Method: JC, RC, LS, UTD Evaluation Method: PF, FEF).


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PROFESSIONALISM AND ETHICAL CONDUCT 1.

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Elements of professionalism including altruism; accountability, dependability, responsibility, and prudence; excellence, but humility; continued education; commitment. Duty, justice, collegial collaboration; honor and integrity, honesty and fidelity, trustworthiness; respect for others, compassion, empathy; and common sense (Competency: PBLI Teaching Method: JC, RC, LS, UTD Evaluation Method: PF, PL, FEF).

Threats to professionalism including abuse of power and position, sexual and other harassment; arrogance, prejudice, bias; greed and selfishness; misrepresentation, clinical and scientific misconduct; impairment, including substance abuse; lack of conscientiousness; and conflicts of interest (Competency: PBLI Teaching Method: JC, RC, LS, UTD Evaluation Method: PF, PL, FEF).

Methods of evaluation of professionalism and ethical conduct in trainees including utilizing ABIM peer evaluation professional associate rating forms from multiple evaluators. Maintaining a critical events file documenting positive and constructive comments. Expanding traditional performance evaluation forms to incorporate components of professional and ethical evaluation. Providing for professionalism and ethics evaluation in research performance. When necessary, providing a mechanism for remediation of professional and ethical deficiencies (Competency: PBLI, MK, PC Teaching Method: JC, RC, LS, UTD Evaluation Method: PF, PL, FEF).

III. METHODS OF EVALUATION AND FEEDBACK Methods of evaluation have been included in the body of the document with the individual objective and will not be repeated here.

Feedback will be performed semi-annually when the associate program director meets with each fellow individually to review the previous six months evaluations and portfolio.




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IV. TABLE OF ABBREVIATIONS






I. GOALS II. OBJECTIVES FOR POSTGRADUATE YEAR V FELLOW III. METHOD OF EVALUATION AND FEEDBACK IV. TABLE OF ABBREVIATIONS

May 26, 2002 PGY 5 - Consultative Rotation

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I. GOALS:

The goal of this rotation is to provide the renal fellow with the opportunity to evaluate and follow patients with renal and related problems and to enable them to refine their knowledge, attitude and skills necessary to diagnose, manage, treat and educate patients with renal and related diseases.

II. OJBECTIVES FOR POSTGRADUATE YEAR V FELLOW: Discuss the role of the care team members with the care providers in the society to help define and outline a team approach that optimizes patient care while controlling cost of care (Competency: SBP Teaching Method: LS, FS Evaluation Method: 360, RR).

Review and understand Medicare and Medicaid rules and regulations in the area of renal related diseases to optimize the delivery of medical care while containing cost of care (Competency: SBP Teaching Method: LS, FS Evaluation Method: MCQ).

Operate as the patients advocate in the area of quality care in helping the patient to deal with system complexities (Competency: SBP Teaching Method: FS, LS Evaluation Method: 360, PS).

Operate as a partner with health care managers and health care providers to assess, coordinate, and improve health care (Competency: SBP Teaching Method: FS, LS Evaluation Method: 360, GR).

GLOMERULAR DISEASE Discuss the structure and function of the normal glomerulus and how alteration of these leads to the cardinal features of glomerular injury (proteinuria and reduced glomerular filtration rate) (Competency: MK Teaching Method: CE, JC, LS, MCQ Evaluation Method: MCQ).

Describe the principal immunologic mechanisms causing human glomerular diseases and the features that distinguish them by immunofluorescence and electron microscopy (Competency: MK Teaching Method: LS, JC, RBC Evaluation Method: MCQ).


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Explain the fundamental features of the normal immune response and have an awareness of current concepts of autoimmunity and the factors that may be responsible for and mediate immunologic glomerular injury (Competency: MK Teaching Method: LS, JC Evaluation Method: MCQ).

Identify the causes, clinical decision-making, and treatment of common and uncommon causes of hematuria and proteinuria (Competency: MK Teaching Method: LS, CE Evaluation Method: MCQ).

Evaluate the etiology and clinical findings of glomerular syndromes, including nephrosis, nephritis, and rapidly progressive glomerulonephritis manifesting as renal-limited processes or associated with systemic disease (Competency: MK, PC Teaching Method: JC, RC, LS, UTD, CE Evaluation Method: PF, FEF, MCQ).

Formulate strategies for the minimal change nephropathy of idiopathic glomerular diseases with respect to pathology, clinical features presenting in adolescents and adults, especially the response to corticosteroid treatment, the development of acute renal failure in adults, and the association with malignant tumors (Competency: MK, PC, PBLI Teaching Method: JC, RC, LS, UTD, CE Evaluation Method: PF, FEF, MCQ).

Evaluate membranoproliferative glomerulonephritis, including types I, II, and III and the clinical and pathological features of idiopathic glomerular diseases in association with hepatitis C and Cryoglobulinemia (Competency: MK, PC, PBLI, ICS Teaching Method: JC, RC, LS, UTD, CE Evaluation Method: PF, FEF, MCQ).

Describe focal segmental glomerulosclerosis (FSGS), including its various pathological and clinical syndromes and the association with conditions or reduced renal mass, the demographics, clinical course, and outcome of the clinicopathologic syndromes of “primary” focal sclerosis, including FSGS, glomerular tip lesion, and perihilar FSGS (Competency: MK, PBLI Teaching Method: JC, RC, LS, UTD, CE Evaluation Method: PF, FEF, MCQ).

Discuss the membranous nephropathy, including the clinical, pathological, and diagnostic features of both idiopathic membranous nephropathy and secondary membranous disease, and in-depth knowledge of the controversies regarding treatment of this disease (Competency: MK, PC, PBLI Teaching Method: JC, RC, LS, UTD, CE Evaluation Method: PF, FEF, MCQ).

Describe the IgA nephropathy, especially its clinical course, natural history, and prognostic markers (Competency: MK, PC, PBLI, ICS Teaching Method: JC, RC, LS, UTD, CE Evaluation Method: PF, FEF, MCQ).

Identify the postinfectious glomerulopathies, including bacterial, viral, parasitic, rickettsial, and fungal infections, and their epidemiology, clinical course, and response to therapy, especially with respect to HIV infections


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(Competency: MK, PC, ICS, PBLI Teaching Method: JC, RC, LS, UTD, CE Evaluation Method: PF, FEF, MCQ).

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Describe glomerular diseases associated with systemic diseases with respect to pathology, clinical and serological features, and response to treatment of necrotizing and crescentic glomerulonephritis, anti-glomerular basement membrane disease, immune complex diseases, including lupus nephritis, postinfectious glomerulonephritis, and Henoch-Schönlein purpura, Pauci-immune glomerulonephritis and small vessel vasculitis (Competency: MK, PC, PBLI Teaching Method: JC, RC, LS, UTD, CE Evaluation Method: PF, FEF, MCQ).

Evaluate the renal manifestations of other rheumatic disorders, including systemic sclerosis, Sjögren’s syndrome, mixed connective tissue disease, rheumatoid arthritis, Bechet’s syndrome, relapsing polychondritis, and familial Mediterranean fever (Competency: MK, PC, PBLI Teaching Method: JC, RC, LS, UTD, CE Evaluation Method: PF, FEF, MCQ).

Explain renal disease in the dysproteinemias, including multiple myeloma, amyloidosis, fibrillary glomerulopathy/immunotactoid glomerulopathy, and mixed cryoglobulinemia (Competency: MK, PC, PBLI Teaching Method: JC, RC, LS, UTD, CE Evaluation Method: PF, FEF, MCQ).

Interpret the various serological markers in the presence of kidney disease (c-ANCA, p-ANCA, C3, C4, ANA, RF, Anti-GBM, and others) (Competency: MK Teaching Method: LS, CE Evaluation Method: MCQ, FEF, PF).

Explain the physiology, pathology, and Epidemiology of diabetic nephropathy (Competency: MK Teaching Method: LS, CE Evaluation Method: MCQ).

Discuss the pathogenesis, prevention and treatment of diabetic nephropathy (Competency: MK Teaching Method: LS, CE Evaluation Method: MCQ).

ACUTE RENAL FAILURE AND INTENSIVE CARE UNIT NEPHROLOGY Discuss the normal regulation of renal and glomerular hemodynamics (Competency: MK Teaching Method: JC, RC, LS, UTD, CE Evaluation Method: PF, FEF, MCQ).

Describe the differential diagnosis of acute renal failure including the pathophysiology of prerenal azotemia, the pathophysiology of intrinsic renal failure, including acute glomerular diseases, acute tubular necrosis, and acute interstitial disease, and the pathophysiology of obstructive renal failure (Competency: MK, PC, PBLI Teaching Method: JC, RC, LS, UTD, CE Evaluation Method: PF, FEF, MCQ).

Evaluate the mechanisms of acute renal failure (ARF) in the postoperative patient, in patients with hepatobiliary diseases, in patients with cancer and immunosuppression, and in patients with AIDS (Competency: PC, MK, ICS, PBLI Teaching Method: JC, RC, LS, UTD, CE Evaluation Method: PF, FEF, MCQ).


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Discuss the metabolic consequences of ARF including hormonal, nutritional, electrolyte, acid-base, and volume (Competency: MK, PC, PBLI Teaching Method: JC, RC, LS, UTD, CE Evaluation Method: PF, FEF, MCQ).

Evaluate and manage ARF by radiologic techniques, biochemical evaluations, the role of renal biopsy, nondialytic therapy and dialytic therapies including hemodialysis, peritoneal dialysis, and continuous therapy (Competency: MK, PC, ICS, PBLI Teaching Method: JC, RC, LS, UTD Evaluation Method: PF, PL, FEF).

Describe the hemodynamic monitoring of the critically ill patient (Competency: MK, PC, PBLI Teaching Method: JC, RC, LS, UTD, CE Evaluation Method: PF, FEF, MCQ).

Formulate a plan for the management of electrolyte/acid-base disturbances, fluid management, and the use of vasoactive drugs in the critically ill patient (Competency: MK, PC, PBLI Teaching Method: JC, RC, LS, UTD, CE Evaluation Method: PF, FEF, MCQ).

Describe the role of extracorporeal therapy in the management of drug overdose, specifically ethylene glycol, methanol, lithium, theophylline, salicylate, and barbiturate (Competency: MK, PBLI Teaching Method: JC, RC, LS, UTD, CE Evaluation Method: PF, PL, FEF, MCQ).

Distinguish between acute renal failure and chronic renal failure (Competency: MK Teaching Method: LS, CE Evaluation Method: MCQ, FEF).

CHRONIC RENAL FAILURE Discuss the various etiologies of chronic renal failure (CRF) including evaluation, diagnosis, and treatment of CRF resulting from glomerular, interstitial, vascular, and obstructive processes including the diagnosis of glomerular processes, interstitial processes, prerenal processes, obstructive processes, and systemic processes that led to CRF including diabetes mellitus, hypertension or ischemic renal disease (Competency: MK, PC, PBLI Teaching Method: JC, RC, LS, UTD, CE Evaluation Method: PF, PL, FEF, MCQ).

Describe the current concepts and the results of clinical studies pertaining to the role of hypertension, dietary composition, and divalent cations on the progression of chronic renal diseases (Competency: MK, ICS, PC, PBLI Teaching Method: JC, RC, LS, UTD, CE Evaluation Method: PF, FEF, MCQ).

Formulate strategies for the predialysis management of CRF with particular regard to diet, anemia, metabolic bone diseases, and drug dose adjustments (Competency: MK, PC, PBLI Teaching Method: JC, RC, LS, UTD Evaluation Method: PF, FEF, MCQ, CSR, RR, CL).

Discuss the role of anemia in the management of patients with CRF and the management of the anemia of chronic renal failure with the use of iron,


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erythropoietin and other appropriate agents (Competency: MK, ICS, PBLI, PC Teaching Method: JC, RC, LS, UTD, CE Evaluation Method: PF, PL, FEF, MCQ, CSR).

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Explain the indications for initiation of ESRD therapy and placement of ESRD access in patients with CRF (Competency: MK.PC, ICS, PBLI Teaching Method: JC, RC, LS, UTD Evaluation Method: PF, PL, FEF, MCQ, 360, CSR, RR).

Formulate strategies for the appropriate use of drugs, including dose modification, for patients with progressive CRF (Competency: MK, PC, PBLI Teaching Method: JC, RC, LS, UTD Evaluation Method: PF, PL, FEF, MCQ, 360, CSR, RR).

Discuss interpretations of radiographic tests, including intravenous pyelography, computed tomography, ultrasound, and radionuclide scan, in patients with CRF (Competency: MK, PC, ICS, PBLI Teaching Method: JC, RC, LS, UTD, CE Evaluation Method: PF, PL, FEF, MCQ, RR, CL, CSR).

Manage vascular access failure (Competency: MK, PBLI Teaching Method: LS, CE Evaluation Method: MCQ, RR, CSR).

Recognize and treat intradialytic hypotension (Competency: MK, PC, PBLI Teaching Method: LS, CE, OF Evaluation Method: MCQ, RR, CSR).

Discuss sepsis and infection in peritoneal dialysis patients and management of peritonitis (Competency: MK, PC Teaching Method: LS, CE, FS Evaluation Method: MCQ, RR, CSR).

HYPERTENSION Distinguish between primary (essential hypertension) and secondary forms of hypertension (Competency: MK Teaching Method: LS, CE, UTD Evaluation Method: MCQ, RR, CSR).

Discuss hypertension in patients with co-morbid disease to include diabetes mellitus, coronary artery disease, congestive heart failure and proteinuria (Competency: MK Teaching Method: LS, CE, UTD Evaluation Method: MCQ, PF).

Differentiate the mechanism of action of frequently used antihypertensive medications (Competency: MK Teaching Method: LS, CE, UTD Evaluation Method: MCQ, FEF, CSR).

Differentiate adverse effects related to antihypertensive medications (Competency: MK Teaching Method: LS, CE, UTD Evaluation Method: MCQ, CSR).

Discuss Epidemiology of hypertension and hypertension in special groups (e.g. African American, Hispanics, etc.) (Competency: MK Teaching Method: LS, CE, UTD Evaluation Method: MCQ).

Evaluate endocrine causes of hypertension (Competency: MK Teaching Method: LS, CE, UTD Evaluation Method: MCQ, RR, CSR).


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Discuss the non-pharmacological management of hypertension (Competency: MK Teaching Method: LS, CE, UTD Evaluation Method: MCQ, RR, CSR).

Explain hypertension in the presence of renal artery stenosis and management of renal artery stenosis (Competency: MK Teaching Method: LS, CE, UTD Evaluation Method: MCQ, PF).

Formulate strategies for management of accelerated and malignant hypertension (Competency: MK Teaching Method: LS, CE, UTD Evaluation Method: MCQ, PF).

ACID- BASE DISORDERS Discuss acid-base chemistry and buffering (Competency: MK Teaching Method: JC, RC, LS, UTD Evaluation Method: PF, PL, FEF).

Describe determinants of arterial carbon dioxide tension and carbon dioxide balance (Competency: MK, PC, ICS, PBLI Teaching Method: JC, RC, LS, UTD Evaluation Method: PF, PL, FEF).

Explain the determinants of plasma bicarbonate concentration and hydrogen ion balance, including renal acidification processes and the physiology of bicarbonate reabsorption, titratable acid excretion, and ammonium excretion (Competency: MK, ICS, PBLI Teaching Method: JC, RC, LS, UTD Evaluation Method: PF, FEF).

Discuss clinical evaluation of acid-base disorders (Competency: MK, PC, PBLI Teaching Method: JC, RC, LS, UTD Evaluation Method: PF, FEF).

Explain renal tubular acidosis: pathogenesis, clinical features, causes, diagnosis, and management (Competency: PBLI Teaching Method: JC, RC, LS, UTD Evaluation Method: PF, PL, FEF).

Formulate strategies for treatment of uremic acidosis: acid-base homeostasis in ESRD (Competency: MK, PC, ICS, PBLI Teaching Method: JC, RC, LS, UTD Evaluation Method: PF, FEF).

Describe other types of metabolic acidosis: pathogenesis, clinical features, causes, diagnosis, and management (Competency: PC, MK, ICS, PBLI Teaching Method: JC, RC, LS, UTD Evaluation Method: PF, FEF).

Discuss metabolic alkalosis: pathogenesis, clinical features, causes, diagnosis, and management (Competency: MK, PC, ICS, PBLI Teaching Method: JC, RC, LS, UTD Evaluation Method: PF, FEF).

Explain acid-base disturbances (Competency: MK, ICS Teaching Method: JC, RC, LS, UTD Evaluation Method: PF, FEF).

Discuss the causes of hyperchloremic metabolic acidosis (Competency: MK Teaching Method: JC, RC, LS, UTD Evaluation Method: PF, FEF).


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Differentiate simple from mixed acid base disorders (Competency: MK Teaching Method: JC, RC, LS, UTD Evaluation Method: PF, FEF).

Discuss high anion gap and high osmolar gap metabolic acidosis (Competency: MK Teaching Method: JC, RC, LS, UTD Evaluation Method: PF, FEF).

FLUID AND ELECTROLYTE DISORDERS Discuss the physiology of sodium balance, including sensors of extracellular volume, effector systems, tubular sodium transport processes, and the regulation of renal sodium excretion (Competency: MK Teaching Method: JC, RC, LS, UTD Evaluation Method: PF, FEF).

Explain hypovolemia: pathophysiology, causes, clinical features, diagnosis, and management (Competency: MK, PC, ICS Teaching Method: JC, RC, LS, UTD Evaluation Method: PF, FEF).

Describe edematous disorders: pathophysiology, causes, clinical features, diagnosis, and management (Competency: PBLI Teaching Method: JC, RC, LS, UTD Evaluation Method: PF, FEF).

Explain the clinical use and complications of diuretics (Competency: PBLI, PC, MK, ICS Teaching Method: JC, RC, LS, UTD Evaluation Method: PF, FEF).

Discuss the physiology of water balance, including tonicity sensors, effector systems, the countercurrent mechanism for urine concentration, the cellular physiology of collecting duct water reabsorption, and the regulation of water excretion by the kidney (Competency: MK Teaching Method: JC, RC, LS, UTD Evaluation Method: PF, FEF).

Formulate strategies for the evaluation and management of the polyuric patient (Competency: PC, MK, ICS, PBLI Teaching Method: JC, RC, LS, UTD Evaluation Method: PF, FEF).

Explain the physiology of potassium balance, including the regulation of transcellular potassium movement, tubular transport processes for potassium reabsorption and secretion, and the regulation of potassium excretion by the kidney (Competency: MK, PC, ICS Teaching Method: JC, RC, LS, UTD Evaluation Method: PF, FEF).

Discuss hypokalemia: pathophysiology, causes, clinical features, diagnosis, and management (Competency: MK, PC, ICS Teaching Method: JC, RC, LS, UTD Evaluation Method: PF, FEF).

Describe hyperkalemia: pathophysiology, causes, clinical features, diagnosis, and management (Competency: MK Teaching Method: JC, RC, LS, UTD Evaluation Method: PF, FEF).


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Explain disorders of sodium, water, and potassium balance in end-stage renal disease (Competency: MK, PC, PBLI Teaching Method: JC, RC, LS, UTD Evaluation Method: PF, FEF).

CYSTIC AND INHERITED DISEASES OF THE KIDNEY Discuss the genetics of inherited diseases such as Mendelian genetics, gene linkage analysis, chromosomal localization and characteristics of the gene responsible for the more common inherited renal disorders (Competency: MK Teaching Method: JC, RC, LS, UTD Evaluation Method: PF, PL, FEF).

Describe the clinical, diagnostic and epidemiologic differences between simple, acquired, and inherited cystic disorders and their potential for renal malignancies (Competency: MK Teaching Method: JC, RC, LS, UTD Evaluation Method: PF, FEF).

Explain the diagnosis of inherited and cystic disease including the use of gene link analysis and mutational analysis in the screening, the role of urinalysis, renal function testing, and radiologic testing, and the possibilities of prenatal diagnosis and pretest counseling (Competency: MK Teaching Method: JC, RC, LS, UTD Evaluation Method: PF, FEF).

Discuss the approach to the symptomatic patient including familiarity with the natural history of inherited cystic and non-cystic disease, knowledge of clinical presentations, and familiarity with extrarenal manifestations (Competency: MK, ICS, PBLI Teaching Method: JC, RC, LS, UTD Evaluation Method: PF, FEF).

Formulate a treatment plan including knowledge of strategies to manage progression of renal failure, proteinuria, and hypertension in non-cystic inherited disease; knowledge of management of pain, hypertension, renal stone, hematuria, infection, and progressive renal failure in patients with cystic disease; and familiarity with management of extrarenal manifestation of ADPKD, including mitral valve prolapse diverticular disease, intracranial aneurysm, and hepatic cystic disease (Competency: PC, MK, ICS, PBLI Teaching Method: JC, RC, LS, UTD Evaluation Method: PF, PL, FEF).

TUBULOINTERSTITIAL DISEASE AND URINARY TRACT INFECTIONS Discuss structure and function of the normal renal tubules and interstitium (Competency: PC Teaching Method: JC, RC, LS, UTD Evaluation Method: PF, FEF).

Describe the pathophysiological mechanisms of acute and chronic interstitial diseases including immunologically mediated interstitial nephritides, interstitial scarring as a consequence of primary glomerular and vascular diseases, reflux nephropathy, and obstructive nephropathy (Competency: MK Teaching Method: JC, RC, LS, UTD Evaluation Method: PF).

Explain the pathophysiology of interstitial disease including immunopathogenetic and non-immune mechanisms, relationship to glomerular function, the association with major tubular defects including


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diabetes insipidus, acidification, and potassium excretion, and the effects of acute and chronic urinary obstruction (Competency: MK Teaching Method: JC, RC, LS, UTD Evaluation Method: PF).

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Formulate strategies for diagnostic procedures including assessment of tubular defects, evaluation of obstruction and definition of acute and chronic interstitial nephritis (Competency: MK, PC, ICS, PBLI Teaching Method: JC, RC, LS, UTD Evaluation Method: PF, FEF).

DISORDERS OF DIVALENT CATION AND MINERAL METABOLISM Describe the renal handling of calcium, magnesium, and phosphorus (Competency: MK Teaching Method: JC, RC, LS, UTD Evaluation Method: PF, FEF).

Explain the physiology of calciotropic hormones, specifically parathyroid hormone, vitamin D, calcitonin, and parathyroid hormone-related peptide (Competency: MK Teaching Method: JC, RC, LS, UTD Evaluation Method: PF, FEF).

Explain an integrated view of calcitropic hormone regulation in normal situations and in the context of acute and chronic renal failure (Competency: MK Teaching Method: JC, RC, LS, UTD Evaluation Method: PF, FEF).

Describe bone physiology (Competency: MK Teaching Method: JC, RC, LS, UTD Evaluation Method: PF, FEF).

Explain the methods to diagnose and treat different types of renal osteodystrophy, interpretation of bone biopsies, and an experience in the interpretation of bone biopsies in chronic renal failure (Competency: MK, PC, ICS, PBLI Teaching Method: JC, RC, LS, UTD Evaluation Method: PF, FEF).

Discuss the pathogenesis and treatment of calcium nephrolithiasis, urate nephrolithiasis, infected stones, and cystine stones (Competency: MK Teaching Method: JC, RC, LS, UTD Evaluation Method: PF, FEF).

Explain surgical procedures necessary for the treatment of stone disease (Competency: MK, PC, PBLI Teaching Method: JC, RC, LS, UTD Evaluation Method: PF, FEF).

RENAL DISEASE IN PREGNANCY - PROGRAM BEHAVIORAL OBJECTIVES Discuss the changes in the anatomy and function of the urinary tract during pregnancy, focusing on the relevance of these changes to clinical circumstances, stressing alterations in the calyces and ureters, renal hemodynamics, and tubular function (principally potassium and glucose) (Competency: MK Teaching Method: JC, RC, LS, UTD Evaluation Method: PF, FEF).

Describe the changes in acid-base metabolism in pregnancy, focusing on normal pH, HCO3-, and PCO2 (Competency: MK, PC, PBLI Teaching Method: JC, RC, LS, UTD Evaluation Method: PF, FEF).


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Explain an integrated view of volume homeostasis during pregnancy. This includes knowledge of the normal gestational changes in weight, intravascular and extracellular volume status, renal salt handling, and the production of volume-regulating hormones (Competency: MK Teaching Method: JC, RC, LS, UTD Evaluation Method: PF, FEF).

Discuss the altered osmoregulation in pregnancy, focusing on changes in plasma sodium and osmolality levels, as well as on certain disorders of water metabolism peculiar to gestation (Competency: MK Teaching Method: JC, RC, LS, UTD Evaluation Method: PF, FEF).

Explain the clinical spectrum and management of renal disorders in gestation including pathogenesis and treatment of urinary tract infections; acute renal failure (especially those primarily associated with gestation, i.e., septic abortion, abruption, preeclampsia, acute fatty liver, and idiopathic postpartum renal failure); and chronic glomerular and interstitial renal diseases antedating pregnancy (Competency: PBLI, MK, ICS, PC Teaching Method: JC, RC, LS, UTD Evaluation Method: PF, FEF).

Discuss the presentation of stone disease during gestation and the effect of pregnancy on patients with nephrolithiasis (Competency: MK, PBLI Teaching Method: JC, RC, LS, UTD Evaluation Method: PF, FEF).

Formulate strategies for the administration of both acute and chronic renal replacement therapy in pregnant women (Competency: PBLI,PC, MK, ICS Teaching Method: JC, RC, LS, UTD Evaluation Method: PF, PL, FEF).

Explain the effects of pregnancy on the natural history of renal allografts and of the conditions required for undertaking pregnancy in transplant recipients (Competency: PC, MK, ICS, PBLI Teaching Method: JC, RC, LS, UTD Evaluation Method: PF, FEF).

Perform preconception counseling pertinent for the maternal and fetal prognoses for women with chronic hypertension and/or underlying kidney disorders (Competency: PBLI, MK, PC, ICS Teaching Method: JC, RC, LS, UTD Evaluation Method: PF, FEF).

RENAL FUNCTION TESTING At the end of the program, the fellow should be able to explain the indications, contraindications, complications, interpretation of results, cost effectiveness, and application to patient care of: (Competency: MK, PC PBLI Teaching Method: JC, RC, LS, UTD Evaluation Method: PF, PL, FEF).

Measurement of renal concentrating and diluting capacity (Competency: PBLI Teaching Method: JC, RC, LS, UTD Evaluation Method: PF, PL, FEF).

Assessment of renal sodium and potassium handling (Competency: MK Teaching Method: JC, RC, LS, UTD Evaluation Method: PF, FEF).


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Renal radiology including urography, ultrasonography, radionuclide scans, computed tomography magnetic resonance imaging, and renal circulation imaging (angiography) (Competency: PBLI, MK, PC Teaching Method: LS, UTD Evaluation Method: PF, PL, FEF).

Discuss the indications and contraindications of kidney biopsy (Competency: MK, PC, ICS Teaching Method: CE, FS, LS, OF Evaluation Method: FEF, MCQ, PL).

PHARMACOLOGY OF DRUGS IN RENAL DISEASE Discuss the principles of drug pharmacokinetics (Competency: PBLI, PC, MK Teaching Method: JC, RC, LS, UTD Evaluation Method: PF, FEF).

Describe the renal handling of drugs and chemicals (Competency: MK Teaching Method: JC, RC, LS, UTD Evaluation Method: PF, FEF).

Explain the mechanisms of drug metabolism (Competency: MK, PC Teaching Method: JC, RC, LS, UTD Evaluation Method: PF, FEF).

Formulate strategies for drug prescribing in disease states and during dialysis (Competency: PBLI, PC Teaching Method: JC, RC, LS, UTD Evaluation Method: PF, FEF).

Discuss relevant drug-drug interactions (Competency: MK, PC Teaching Method: JC, RC, LS, UTD Evaluation Method: PF, FEF).

Describe mechanisms of drug nephrotoxicity (Competency: MK, Teaching Method: JC, RC, LS, UTD Evaluation Method: PF, FEF).

Explain the management of drug-induced renal diseases (Competency: PBLI, MK, PC Teaching Method: JC, RC, LS, UTD Evaluation Method: PF, FEF).

Formulate strategies for therapeutic drug monitoring (Competency: PBLI, MK SBP Teaching Method: JC, RC, LS, UTD Evaluation Method: PF, FEF).

Describe renal transplant immunosuppression (Competency: MK, PC Teaching Method: JC, RC, LS, UTD Evaluation Method: PF, FEF).

PROFESSIONALISM AND ETHICAL CONDUCT Elements of professionalism including altruism; accountability, dependability, responsibility, and prudence; excellence, but humility; continued education; commitment. Duty, justice, collegial collaboration; honor and integrity, honesty and fidelity, trustworthiness; respect for others, compassion, empathy; and common sense (Competency: PBLI Teaching Method: JC, RC, LS, UTD Evaluation Method: PF, PL, FEF).

Threats to professionalism including abuse of power and position, sexual and other harassment; arrogance, prejudice, bias; greed and selfishness; misrepresentation, clinical and scientific misconduct; impairment, including


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substance abuse; lack of conscientiousness; and conflicts of interest (Competency: PBLI Teaching Method: JC, RC, LS, UTD Evaluation Method: PF, PL, FEF).

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Methods of evaluation of professionalism and ethical conduct in trainees including utilizing ABIM peer evaluation professional associate rating forms from multiple evaluators. Maintaining a critical events file documenting positive and constructive comments. Expanding traditional performance evaluation forms to incorporate components of professional and ethical evaluation. Providing for professionalism and ethics evaluation in research performance. When necessary, providing a mechanism for remediation of professional and ethical deficiencies (Competency: PBLI, MK, PC Teaching Method: JC, RC, LS, UTD Evaluation Method: PF, PL, FEF).

III. METHODS OF EVALUATION AND FEEDBACK Methods of evaluation have been included in the body of the document with the individual objective and will not be repeated here.

Feedback will be performed semi-annually when the associate program director meets with each fellow individually to review the previous six months evaluations and portfolio.



IV. TABLE OF ABBREVIATIONS





PROGRAM OBJECTIVES FOR DIALYSIS ROTATION

I. GOALS II. OBJECTIVES FOR POSTGRADUATE YEAR IV FELLOW III. SHIFT COVERAGE IV. METHOD OF EVALUATION AND FEEDBACK V. TABLE OF ABBREVIATIONS

May 26, 2002 PGY 4 - Dialysis Rotation

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I. GOALS:

The goals of this rotation are to provide the Nephrology fellow with:

An opportunity for longitudinal follow up of both peritoneal and hemodialysis patients to enable them to refine the knowledge, attitudes and skills necessary to diagnose, manage and treat renal failure patients and develop health promotion behaviors in this population.

An understanding of the business aspects of managing a dialysis facility and the role and responsibilities of a medical director.



Describe the types, advantages, and disadvantages of acute and chronic hemodialysis access (Competency: MK, PC Teaching Method: LS, FS Evaluation Method: FEF, MCQ).

Describe the complications and management of acute and chronic hemodialysis access (Competency: MK, PC Teaching Method: LS, FS Evaluation Method: FEF, MCQ).

Discuss the most common complications of hemodialysis and their management including hypotension, cramps, arrhythmias, hemolysis and air embolism with patients, their families and other health care providers (Competency: MK, PC, ICS Teaching Method: LS, FS Evaluation Method: FEF, MCQ, RR, 360).

Discuss water treatment issues and equipment for hemodialysis (Competency: MK, PC Teaching Method: LS, FS Evaluation Method: FEF, MCQ).

Compare current hemodialyzers including advantages and disadvantages of membrane composition, biocompatibility, and solute and water flux (Competency: MK, PC Teaching Method: LS, FS Evaluation Method: FEF, MCQ).

PROGRAM OBJECTIVES FOR RENAL DIALYSIS ROTATION

2

6.

7.

8.

9.

10.

11.

12.

13.

14.

15.

16.

17.

18.

Explain the importance and the preferred methodology for determination and monitoring of adequate hemodialysis (Competency: MK, PC Teaching Method: LS, FS Evaluation Method: FEF, MCQ).

Describe the types, advantages, and disadvantages of peritoneal dialysis access (Competency: MK, PC Teaching Method: LS, FS Evaluation Method: FEF, MCQ).

Describe the complications and management of peritoneal dialysis access (Competency: MK, PC Teaching Method: LS, FS Evaluation Method: FEF, MCQ).

Discuss equipment for peritoneal dialysis systems (Competency: MK, PC Teaching Method: LS, FS Evaluation Method: FEF, MCQ).

Explain the importance and the preferred methodology for determination and monitoring of adequate peritoneal dialysis (Competency: MK, PC Teaching Method: LS, FS Evaluation Method: FEF, MCQ).

Discuss the most common complications of peritoneal dialysis and their management including peritonitis, hypotension, hernias, dialysate leaks, and inadequate dialysis (Competency: MK, PC Teaching Method: LS, FS Evaluation Method: FEF, MCQ,RR).

Explain the nutritional considerations and management of end stage renal disease patients (Competency: MK, PC Teaching Method: LS, FS Evaluation Method: FEF, MCQ, 360).

Evaluate and manage complications of end stage renal disease including anemia, renal osteodystrophy, dialysis, amyloidosis, hypertension, hyperlipidemia and acquired cystic disease (Competency: MK, PC Teaching Method: LS, FS Evaluation Method: FEF, MCQ, RR).

Participate in monthly continuous quality improvement process (Competency: PC, PBLI, SBP Teaching Method: FS Evaluation Method: FEF, MCQ, PF, 360).

Participate in patient care conferences (Competency: MK, PC, ICS, PBLI, SBP Teaching Method: LS, FS Evaluation Method: FEF, MCQ, PF, 360).

Discuss medical reimbursement for end stage renal disease care including listing services bundled under the monthly capitated payment system (Competency: PBLI, SBP Teaching Method: LS, FS Evaluation Method: MCQ).

Integrate care with other renal health care providers to maximize care provided including renal social worker, renal dietician, dialysis nursing and technical staff (Competency: PC.SBP, ICS, PBLI Teaching Method: FS Evaluation Method: FEF, 360).

Describe the role of the primary care provider in the care and management of the dialysis patient (Competency: PBLI; SBP Teaching Method: LS, FS Evaluation Method: FEF).


3

19.

20.

21.

1.

2.

3.

4.

5.

6.

Use information technology to manage information, access on-line medical information and support continuing self-education (Competency: PBLI Teaching Method: FS, Evaluation Method: PF).

Apply medical literature in the management of dialysis patients in the daily practice (Competency: PBLI Teaching Method: JC, RC, LS, UTD Evaluation Method: PF, PL, FEF).

Apply state (Network) and national (USRDS) data in the evaluation and management of patient population (Competency: PBLI Teaching Method: LS, FS Evaluation Method: FEF, MCQ).

III. SHIFT COVERAGE

Each fellow will be assigned a group of peritoneal dialysis patients and a shift of hemodialysis patients to follow for up to two years. The peritoneal dialysis clinic meets one half day a month for each fellow. Hemodialysis shifts meets three days a week with the fellows being required to round once a week on their hemodialysis shift. The faculty will attend each peritoneal dialysis clinic and will round once a month with the fellow on their assigned hemodialysis session. In addition, each fellow will have a month long rotation annually in the dialysis facility.

IV. METHODS OF EVALUATION AND FEEDBACK: Methods of evaluation have been included in the body of the document with the individual objective and will not be repeated here.




At the end of the dialysis rotation the fellow will be evaluated by:

a. Meeting with the nephrology APN.

b. Taking a multiple choice question examination.

c. Completion of 360 degree global rating.

Ongoing as dictated by patient care and job performance


4

V. TABLE OF ABBREVIATIONS:





PROGRAM OBJECTIVES FOR DIALYSIS ROTATION

I. GOALS II. OBJECTIVES FOR POSTGRADUATE YEAR V FELLOW III. SHIFT COVERAGE IV. METHOD OF EVALUATION AND FEEDBACK V. TABLE OF ABBREVIATIONS

May 26, 2002 PGY 5 – Dialysis Rotation

1.

2.

1.

2.

3.

4.

I. GOALS:

The goals of this rotation are to provide the Nephrology fellow with:

An opportunity for longitudinal follow up of both peritoneal and hemodialysis patients to enable them to refine the knowledge, attitudes and skills necessary to diagnose, manage and treat renal failure patients and develop health promotion behaviors in this population.

An understanding of the business aspects of managing a dialysis facility and the role and responsibilities of a medical director.

II. OBJECTIVES FOR POSTGRADUATE YEAR V FELLOW:


Explain issues regarding dialyzer reprocessing, available techniques, advantages, and possible drawbacks (Competency: MK, PC Teaching Method: LS, FS Evaluation Method: FEF, MCQ).

Describe the different continuous dialytic therapies, including continuous arteriovenous hemodiafiltration and venovenous hemodiafiltration (Competency: MK, PC Teaching Method: LS, FS Evaluation Method: FEF, MCQ).

Utilize the appropriate drugs, including dose modifications for dialysis patients (Competency: MK, PC Teaching Method: LS, FS Evaluation Method: FEF, MCQ).

Describe the role of Medicare, the Health Care Finance Administration, renal networks, U.S. Renal Data System, and voluntary organizations/societies, such as the National Kidney Foundation, the American Society of Nephrology, the Renal Physicians’ Association, and the American Nephrology Nurses’ Association in the delivery and financing of care for end stage renal disease patients (Competency: PBL, P, SBP Teaching Method: LS, FS Evaluation Method: FEF, MCQ).


2

5.

6.

7.

1.

2.

3.

4.

5.

6.

Compare and contrast pros and cons of cost containment measures such as dialyzer selection and patient modality selection (Competency: MK, PC, ICS, PBLI, P Teaching Method: LS, FS Evaluation Method: FEF, MCQ).

Direct patient care conferences (Competency: MK, PC, ICS, PBLI, SBP Teaching Method: LS, FS Evaluation Method: FEF, MCQ, PF, 360).

Participate in monthly continuous quality improvement process (Competency: MK, PC, ICS, PBLI, SBP Teaching Method: LS, FS Evaluation Method: FEF, MCQ, PF, 360).

III. SHIFT COVERAGE

Each fellow will be assigned a group of peritoneal dialysis patients and a shift of hemodialysis patients to follow for up to two years. The peritoneal dialysis clinic meets one half day a month for each fellow. Hemodialysis shifts meets three days a week with the fellows being required to round once a week on their hemodialysis shift. The faculty will attend each peritoneal dialysis clinic and will round once a month with the fellow on their assigned hemodialysis session. In addition, each fellow will have a month long rotation annually in the dialysis facility.

IV. METHODS OF EVALUATION AND FEEDBACK: Methods of evaluation have been included in the body of the document with the individual objective and will not be repeated here.




At the end of the dialysis rotation the fellow will be evaluated by:

a. Meeting with the nephrology APN.

b. Taking a multiple choice question examination.

c. Completion of 360 degree global rating.

Ongoing as dictated by patient care and job performance


3

V. TABLE OF ABBREVIATIONS:





PROGRAM OBJECTIVES FOR TRANSPLANTATION ROTATION


May 26, 2002 PGY 4 - Transplantation Rotation

1.

2.

3.

4.

I. GOALS:

To provide clinical Nephrology Fellows in our training program the highest level of training in clinical kidney and pancreas transplantation: including historical perspective, the pretransplant evaluation of the recipient, the pretransplant evaluation of the living donor, the pretransplant evaluation of the cadaver donor/organ procurement, the surgical technique and surgical management, the physiology of the transplanted kidney, the pathogenesis and pathology of allograft dysfunction, the post transplant care/in hospital care, the post transplant care/outpatient care – short and long term; expected clinical outcome/analysis of risk factors, special considerations in pediatric renal transplantation and special consideration for pancreas and kidney/pancreas transplantation.



Discuss with an audience of different educational backgrounds the advantages, disadvantages and potential complications of renal replacement therapy including living related, living unrelated, cadaveric kidney transplantation and the option for simultaneous kidney/pancreas transplant versus pancreas after kidney transplant (Competency: MK, PC, ICS, P, SBP Teaching Method: LS, JC, CE Method of Evaluation: CL, GR, MCQ, PS).

Compare and contrast the differences in short and long term outcomes of the optimal versus marginal cadaveric organ donors (Competency: MK, PC, ICS, SBP Teaching Method: LS, JC, CE Method of Evaluation: CL, GR, MCQ, PS).

Define the basic principles of pharmacology of immunosuppressant drugs including steroids, cyclosporine, Tacrolimus, Sirolimus, Microphenolate mofetil, azathioprine, monoclonal and polyclonal antibodies (Competency: MK, PC Teaching Method: LS, JC, CE Method of Evaluation: CL, GR, MCQ, PS).

Discuss the clinical utility of currently available immunosuppressants in preventing and treating acute rejection episodes (Competency: MK, PC, PBLI, SBP Teaching Method: LS, JC, CE Method of Evaluation: CL, GR, MCQ, PS).

PROGRAM OBJECTIVES FOR RENAL TRANSPLANTATION ROTATION

2

5.

6.

7.

8.

9.

10.

11.

12.

1.

2.

3.

Recognize the histological classifications of allograft rejection and be able to device a short and long-term management plan for treating different types of allograft rejection (Competency: MK, PC, PBLI Teaching Method: LS, JC, CE Method of Evaluation: CL, GR, MCQ, PS).

Discuss the pathogenesis of chronic allograft nephropathy and recognize the factors responsible for allograft loss and potential interventions (Competency: MK, PC, PBLI, SBP Teaching Method: LS, JC, CE Method of Evaluation: CL, GR, MCQ, PS).

Discuss the potential infectious and noninfectious complications after kidney and kidney/pancreas transplantation and identify effective prophylactic and therapeutic interventions (Competency: MK, PC Teaching Method: LS, JC, CE Method of Evaluation: CL, GR, MCQ, PS).

Explain the psychosocial, financial, ethical and legal issues in cadaveric and living donor transplantation (Competency: MK, PC, ICS, SBP Teaching Method: LS, JC, CE Method of Evaluation: CL, GR, MCQ, PS).

Describe the psychosocial impact and medical management of patients with failing allograft including when to initiate renal replacement therapy (Competency: MK, PC, SBP Teaching Method: LS, JC, CE Method of Evaluation: CL, GR, MCQ, PS).

Perform transplant renal biopsies and manage complications associated them (Competency: MK, PC Teaching Method: LS, JC, CE Method of Evaluation: CL, GR, MCQ, FEF, PS).

Manage outpatient follow up of the transplant recipients. Including monitoring immunosuppressive therapy and different regimens (Competency: MK, PC, ICS, SBP Teaching Method: LS, JC, CE Method of Evaluation: CL, GR, MCQ, FEF, PS).

Attend one or two transplant surgeries in the operating room (Competency: MK, PC, ICS Teaching Method: LS, JC, CE Method of Evaluation: CL, GR, MCQ, PS).





3

4. A multiple choice exam (MCQ) will be performed at the start of the fellowship program, at the end of the first year and at the end of the second year as an assessment of the acquisition of medical knowledge over the course of the fellowship training.






PROGRAM OBJECTIVES FOR TRANSPLANTATION ROTATION


May 26, 2002 PGY5 - Transplantation Rotation

1.

2.

3.

4.

5.

I. GOALS:

To provide clinical Nephrology Fellows in our training program the highest level of training in clinical kidney and pancreas transplantation: including historical perspective, the pretransplant evaluation of the recipient, the pretransplant evaluation of the living donor, the pretransplant evaluation of the cadaver donor/organ procurement, the surgical technique and surgical management, the physiology of the transplanted kidney, the pathogenesis and pathology of allograft dysfunction, the post transplant care/in hospital care, the post transplant care/outpatient care – short and long term; expected clinical outcome/analysis of risk factors, special considerations in pediatric renal transplantation and special consideration for pancreas and kidney/pancreas transplantation.

I. OJBECTIVES FOR POSTGRADUATE YEAR V FELLOW:


Compare and contrast the differences in short and long term outcomes of the optimal versus marginal cadaveric organ donors (Competency: MK, PC, ICS, SBP Teaching Method: LS, JC, CE Method of Evaluation: CL, GR, MCQ, PS).

Discuss allocation and organ sharing criteria and their implications for clinical practice (Competency: MK, PC, ICS, SBP Teaching Method: LS, JC, CE Method of Evaluation: CL, GR, MCQ, PS).

Explain transplantation immunobiology and the rationale and interpretation of histocompatability testing and cross matching (Competency: MK, PC, ICS Teaching Method: LS, JC, CE Method of Evaluation: CL, GR, MCQ, PS).

Discuss the cellular and humoral mechanisms of acute rejection and how immunosuppressant drugs work and interact in light of these mechanisms (Competency: MK, PC, ICS Teaching Method: LS, JC, CE Method of Evaluation: CL, GR, MCQ, PS).

Define the basic principles of pharmacology of immunosuppressant drugs including steroids, cyclosporine, Tacrolimus, Sirolimus, Microphenolate mofetil, azathioprine, monoclonal and polyclonal antibodies (Competency: MK, PC Teaching Method: LS, JC, CE Method of Evaluation: CL, GR, MCQ, PS).


2

6.

7.

8.

9.

10.

11.

12.

13.

14.

1.

2.

3.

Discuss the clinical utility of currently available immunosuppressants in preventing and treating acute rejection episodes (Competency: MK, PC, PBLI, SBP Teaching Method: LS, JC, CE Method of Evaluation: CL, GR, MCQ, PS).

Recognize the histological classifications of allograft rejection and be able to device a short and long-term management plan for treating different types of allograft rejection (Competency: MK, PC, PBLI Teaching Method: LS, JC, CE Method of Evaluation: CL, GR, MCQ, PS).

Discuss the pathogenesis of chronic allograft nephropathy and recognize the factors responsible for allograft loss and potential interventions (Competency: MK, PC, PBLI, SBP Teaching Method: LS, JC, CE Method of Evaluation: CL, GR, MCQ, PS).

Discuss the current recommendations and potential complications of pregnancy after transplantation (Competency: MK, PC, ICS Teaching Method: LS, JC, CE Method of Evaluation: CL, GR, MCQ, PS).

Explain the psychosocial, financial, ethical and legal issues in cadaveric and living donor transplantation (Competency: MK, PC, ICS, SBP Teaching Method: LS, JC, CE Method of Evaluation: CL, GR, MCQ, PS).

Perform transplant renal biopsies and manage complications associated them (Competency: MK, PC Teaching Method: LS, JC, CE Method of Evaluation: CL, GR, MCQ, FEF, PS).

Manage outpatient follow up of the transplant recipients. Including monitoring immunosuppressive therapy and different regimens (Competency: MK, PC, ICS, SBP Teaching Method: LS, JC, CE Method of Evaluation: CL, GR, MCQ, FEF, PS).

Manage the care of new transplant recipients in the hospital including antibody induction protocols and drug regimens (Competency: MK, PC Teaching Method: LS, JC, CE Method of Evaluation: CL, GR, MCQ, FEF, PS).

Attend one or two transplant surgeries in the operating room (Competency: MK, PC, ICS Teaching Method: LS, JC, CE Method of Evaluation: CL, GR, MCQ, PS).





3







PROGRAM OBJECTIVES FOR RESEARCH ROTATION


May 26, 2002 PGY 4 - Research Rotation

1.

2.

3.

4.

5.

6.

I. GOALS:

The trainees are expected to acquire research experience in various areas including, but not limited to renal physiology, molecular biology, biochemistry, pharmacology, pathology or clinical research. This can be accomplished through weekly journal clubs and monthly research seminars that critically review clinical and basic science articles. Trainees should become familiar with the methods and problems inherent in performing and interpreting clinical and basic research. This would be best accomplished by their participation in the design, performance and interpretation of a particular research project. The training program should provide a teaching environment that focuses on these components of research. At the end of the fellowship the trainees must acquire knowledge and understanding of the following areas.

II. OJBECTIVES FOR POSTGRADUATE YEAR IV FELLOW: Develop hypothesis for clinical or basic research projects (Competency: MK, PBLI, ICS, P Teaching Method: FS, JC, LS, RC Evaluation Method: FEF, PF).

Discuss experimental design of human, animal or other research projects (Competency: MK, PBLI, ICS, P Teaching Method: FS, JC, LS, RC Evaluation Method: FEF, PF, GR).

Perform elementary statistical analysis (Competency: MK, PBLI, ICS Teaching Method: FS, JC, LS, RC Evaluation Method: FEF, PF).

Participate in the development of protocols to be submitted to the institutional review board (IRB) (Competency: MK, PBLI, ICS, P Teaching Method: FS, JC, LS, RC Evaluation Method: FEF, PF, GR).

Submit data for publication (Competency: MK, PBLI, ICS, P Teaching Method: FS, JC, LS, RC Evaluation Method: FEF, PF).

Demonstrates scientific integrity and responsible conduct in the area of clinical and basic research i.e. (Competency: PC, MK, PBLI, ICS, P Teaching Method: FS, JC, LS, RC Evaluation Method: FEF, PF, GR, MCQ)

. Protection of animal and human subjects

PROGRAM OBJECTIVES FOR RENAL RESEARCH ROTATION

2

. Integrity in the collection and recording of data.

. Integrity in the interpretation of data.

. Integrity in the authorship and publication.

. Discuss the Nuremberg code, Helsinki declaration and Belmont report.

7.

8.

9.

10.

11.

1.

2.

3.

Describe scientific misconduct and fraud i.e. (Competency: MK, PBLI Teaching Method: FS, JC, LS, RC Evaluation Method: FEF, PF, MCQ)

. Self-deception.

. Fabrication, falsification and plagiarism.

. Conflicts of interest

. Scientist-scientist relationship

. Scientist-industry relationship.

Develop familiarity with and a working knowledge of techniques and assays relevant to their project (Competency: MK, PBLI, ICS Teaching Method: FS, JC, LS, RC Evaluation Method: FEF, PF, GR).

Admit study subjects to the clinical research center, participate in obtaining informed consent, and play an active role in the study (Competency: PC, MK, PBLI, ICS, P Teaching Method: FS, JC, LS, RC Evaluation Method: FEF, PF, GR).

Acquire data and should participate in a meaningful way in the analysis of such information (Competency: MK, PBLI, ICS, P Teaching Method: FS, JC, LS, RC Evaluation Method: FEF, PF, GR).

Prepare abstracts, manuscripts, or reports that originate as a result of the studies (Competency: MK, PBLI, ICS, P Teaching Method: FS, JC, LS, RC Evaluation Method: FEF, PF, GR).





3


I. TABLE OF ABBREVIATIONS:





PROGRAM OBJECTIVES FOR RESEARCH ROTATION


May 26, 2002 PGY 5 - Research Rotation

1.

2.

3.

4.

5.

6.

I. GOALS:

The trainees are expected to acquire research experience in various areas including, but not limited to renal physiology, molecular biology, biochemistry, pharmacology, pathology or clinical research. This can be accomplished through weekly journal clubs and monthly research seminars that critically review clinical and basic science articles. Trainees should become familiar with the methods and problems inherent in performing and interpreting clinical and basic research. This would be best accomplished by their participation in the design, performance and interpretation of a particular research project. The training program should provide a teaching environment that focuses on these components of research. At the end of the fellowship the trainees must acquire knowledge and understanding of the following areas.

II. OJBECTIVES FOR POSTGRADUATE YEAR IV FELLOW: Develop hypothesis for clinical or basic research projects (Competency: MK, PBLI, ICS, P Teaching Method: FS, JC, LS, RC Evaluation Method: FEF, PF).

Discuss experimental design of human, animal or other research projects (Competency: MK, PBLI, ICS, P Teaching Method: FS, JC, LS, RC Evaluation Method: FEF, PF, GR).

Perform elementary statistical analysis (Competency: MK, PBLI, ICS Teaching Method: FS, JC, LS, RC Evaluation Method: FEF, PF).

Participate in the development of protocols to be submitted to the institutional review board (IRB) (Competency: MK, PBLI, ICS, P Teaching Method: FS, JC, LS, RC Evaluation Method: FEF, PF, GR).

Submit data for publication (Competency: MK, PBLI, ICS, P Teaching Method: FS, JC, LS, RC Evaluation Method: FEF, PF).

Demonstrates scientific integrity and responsible conduct in the area of clinical and basic research i.e. (Competency: PC, MK, PBLI, ICS, P Teaching Method: FS, JC, LS, RC Evaluation Method: FEF, PF, GR, MCQ)

. Protection of animal and human subjects


2

. Integrity in the collection and recording of data.

. Integrity in the interpretation of data.

. Integrity in the authorship and publication.

. Discuss the Nuremberg code, Helsinki declaration and Belmont report.

7.

8.

9.

10.

11.

1.

2.

3.

Describe scientific misconduct and fraud i.e. (Competency: MK, PBLI Teaching Method: FS, JC, LS, RC Evaluation Method: FEF, PF, MCQ)

. Self-deception.

. Fabrication, falsification and plagiarism.

. Conflicts of interest

. Scientist-scientist relationship

. Scientist-industry relationship.

Develop familiarity with and a working knowledge of techniques and assays relevant to their project (Competency: MK, PBLI, ICS Teaching Method: FS, JC, LS, RC Evaluation Method: FEF, PF, GR).

Admit study subjects to the clinical research center, participate in obtaining informed consent, and play an active role in the study (Competency: PC, MK, PBLI, ICS, P Teaching Method: FS, JC, LS, RC Evaluation Method: FEF, PF, GR).

Acquire data and should participate in a meaningful way in the analysis of such information (Competency: MK, PBLI, ICS, P Teaching Method: FS, JC, LS, RC Evaluation Method: FEF, PF, GR).

Prepare abstracts, manuscripts, or reports that originate as a result of the studies (Competency: MK, PBLI, ICS, P Teaching Method: FS, JC, LS, RC Evaluation Method: FEF, PF, GR).





3


I. TABLE OF ABBREVIATIONS:




Structure for the Month: Timing is variable but the fellow is expected to: 1. Participate in monthly Dialysis CQI meeting. 2. Participate in monthly Care Plan meeting. 3. Participate in CKD anemia management CQI (usually 2nd week of month). 4. Participate in Hemodialysis Adequacy CQI (usually 3rd week of month). 5. Participate in Hemodialysis anemia management (usually Thursday & Friday 2nd &

4th weeks of month). 6. Assess and treat acute patient problems in both the peritoneal and hemodialysis

clinics. 7. Round for any fellow who is on vacation. 8. Complete chart audits for documentation of MCP covered services. 9. Complete readings in syllabus. 10. Tour water system and assist with cultures and testing. 11. Complete test on water system. 12. Precept with RN (acute or chronic) for hands on experience with hemodialysis. 13. Precept with Peritoneal Dialysis nurse for hands on experience with CAPD and

CCPD. 14. Participate in CKD Education classes 15. Arrange with Dr Barone (688-6377) to scrub on vascular access cases. 16. Arrange with Interventional radiology scheduler (395-9100) to scrub for thrombolysis

or venography studies. 17. Attend Peritoneal Dialysis clinic with Dr. Bienvenue (Tues, 10-12 am) twice during

month (optional). 18. Study reuse module and tour Midtown Dialysis unit for hands on experience with

reuse. 19. Complete observational surveys at both Freeway and Midtown Hemodialysis units. 20. Review records and write orders for transient patients. 21. Review records and write orders for new dialysis patients. 22. Be graded on Medical Director Duties Report Card by unit director and review results

with her. 23. Review, with renal dietitian, her role in the unit, assessment requirements, subjective

global assessment and parameters of a renal diet for both hemo and peritoneal dialysis patients.

24. Review, with the renal social worker, her role in the unit and paperwork required by CMS and Network 13.

25. Participate in any patient or family conferences that occur (intermittent, usually for problems in the unit or withdrawal from dialysis)

26. Participate in CKD screenings (last Friday morning of each month) 2/06 AE

department of internal medicine goals and...division of nephrology ... of evaluation method: fef,...

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