Department of medicine

Nephrology General Consultation Service

Educational Purpose:

The educational goal of the rotation is to attain skills in evaluation and management of the following: acute kidney injury and failure, chronic renal failure, the renal transplant patient, glomerular disease, nephritic syndrome, placing temporary dual-lumen percutaneous hemodialysis catheters, and the management of chronic hemodialysis and peritoneal dialysis patients.

Goals and Objectives:

PGY-1:

1.  Evaluation and management of acute kidney injury.

2.  Evaluation and management of serum and urine electrolyte abnormalities.

3.  Evaluation and management of complex acid-base abnormalities.

4.  Evaluation and management of urgent/emergent hypertension.

5.  Placing temporary dual-lumen percutaneous hemodialysis catheters.

6.  Managing very ill patients on hemodialysis and continuous renal placement therapy.

7.  Analyzing urinary sediment.

8.  Writing a detailed and purposeful consultation note.

PGY-2 and 3:

1.  Evaluation and management of acute kidney injury.

2.  Evaluation and management of serum and urine electrolyte abnormalities.

3.  Evaluation and management of complex acid-base abnormalities.

4.  Evaluation and management of urgent/emergent hypertension.

5.  Placing temporary dual-lumen percutaneous hemodialysis catheters.

6.  Managing very ill patients on hemodialysis and continuous renal placement therapy.

7.  Analyzing urinary sediment.

8.  Writing a detailed and purposeful consultation note..

9. Supervising interns, as well as medical students assigned to the nephrology consult service.

10. Generating short-term as well as long term treatment plans of care, and communication with the primary team on patient care and education.


Teaching Methods:

The consultation team consists of the Nephrology fellow, with supervision from the Nephrology Division faculty member, 1-2 house officers, 1-2 medical students, and a PharmD with expertise in Nephrology.  The goal of the consultation team is quality care of patients.  Work rounds occur from 7:30-9:00 A.M. daily without the faculty member.  The entire renal consultation team meets daily from 9:00-12:00 for an additional one to two hours in the afternoon to address same-day consults.

Instruction is provided by the faculty member, whose only function for that particular month is to supervise the consultation service.  The role of the Nephrology faculty member is educational, and it is of paramount importance that the attending not usurp the duties of the fellow and residents.  Rounds cover patient management, teaching on the content of each case, and 2-3 didactic sessions per week on relevant topics.  The urinary sediment of certain patients will be reviewed by the faculty member with the entire consultation team.  The faculty member will read and critique the consultation notes of the fellow and residents.

The resident is to perform data gathering, examination or urinary sediment, data synthesis, development of differential diagnosis and treatment plan, and consultation notes.  In addition, the resident is expected to review renal ultrasounds, renal angiograms, renal CT scans, and excretory programs face-to-face with the radiologist.  The resident and fellow are expected to review renal histopathology with the renal pathologist on the biopsies that they perform within forty-eight hours of biopsy.

Mix of Diseases and Pathological Material:

Acute kidney injury, acid-base disorders, chronic kidney disease, hypertension, renal artery disease, end stage renal disease, and electrolyte disorders.

Patient Characteristics:

Residents care for a diverse patient population with respect to age, ethnicity, and gender.  The majority of the patients are older adults, but there are significant numbers of adolescent and young adult patients in some sites.  All have acute or chronic renal diseases as well as general medical conditions.

Types of Clinical Encounters:

Fifty percent of patients are in the intensive care units and fifty percent are diagnosed with acute kidney injury.  Thirty percent of patients are non-dialysis, non-ICU consults on other services.  Twenty percent of patients are chronic dialysis patients.  Ten percent of patients are diagnosed with electrolyte abnormalities, acid-base disorders, chronic kidney disease, management of hypertension and renal artery disease.  Two percent of patients are diagnosed with renal disorders in pregnancy. 

Procedures and Services:

The resident may have the opportunity to place femoral dialysis catheters, perform a urinalysis and observe the orders for hemodialysis.

Supervision:

The resident’s activities will be monitored closely by the renal fellow.  All patients will be seen and a plan of care approved by the attending physician daily.

Educational Resources to be Used and Reading Lists:

The attending physician will distribute original manuscripts or review articles and suggest readings from standard Nephrology textbooks.  These texts, which are housed either in the MUSC library, or in the offices of the faculty, are available to the residents 24 hours per day:  The Kidney, The Principles and Practice of Nephrology, Renal and Electrolyte Disorders,  Hypertension, Primer on Kidney Diseases, A Handbook of Routine Urinalysis, and Drug Prescribing in Renal Failure.

Method of Evaluation of Resident Competence:

Written evaluations are constructed with the E*Value computerized system.  Patient Care is assessed based on direct observation and chart review.  Medical Knowledge is assessed through direct questioning on rounds.  Professionalism is assessed based on observation of the resident’s demeanor and behavior on this rotation.  Interpersonal and Communication Skills are assessed by observing the resident’s interactions with consulting team, patients, families, and staff.  Systems-Based Practice is evaluated based on the resident’s ability to function in the team setting, including interactions with the consulting service.  Practice-
Based Learning
is evaluated based on the resident’s ability to learn and improve his or her skills based on feedback, study, and literature review.

 
 
 

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