Block INephrology

INTERNAL MEDICINE RESIDENCY PROGRAM

 

Faculty: Abdel-Moniem Attia, MD; H. Fahmy, MD; J. Timothy Sehy, MD; Ponniah Sivanesan, MD

Sites: Dialysis Unit Provena Covenant Medical Center, Carle Clinic Association, Carle Foundation Hospital, Veterans Administration Illiana Health Care System (VAIHCS)

Duration: 4 week block Rotation

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Description:

4 week block rotation under the supervision of Dr. Abdel-Moniem Attia, Dr. Hanan Fahmy, Dr. Timothy Sehy, and Dr. Ponniah Sivanesan in the direct experience in progressive responsibility for patient treatment and competent care management.

Additional Nephrology training takes place longitudinally throughout all 3 years. Block rotations in Ambulatory Medicine, Adult Medicine, Critical Care, Continuity Clinic and weekly conferences may also include a Nephrology component.

I. GOALS
Demonstrate attitudes, skills and knowledge for diagnosis, treatment and competent care management of patients with renal disorders, including competency in the performance of nephrologic examination.  In addition, the resident will gain experience in evaluating the patient as a whole by participating in multi-disciplinary conferences dealing with nephrology problems.

II. OBJECTIVES

A. PATIENT CARE

Objective 1: Demonstrate clinical skills of comprehensive medical interview, history and physical examination, including functional assessment and renal status as needed.

Objective 2: Make informed recommendations regarding preventive, diagnostic, and therapeutic options and interventions based on clinical judgement, scientific evidence, and patient preference.

 B. MEDICAL KNOWLEDGE

Objective 1: Demonstrate knowledge of the natural history, pathophysiology, clinical presentation, diagnosis through differential diagnosis and management of clinical problems as listed.

Acute Renal Failure

Nephrotic Syndrome

Chronic Renal Failure

Outpatient Dialysis

Hypertension

Renal Stone Disease

Interstitial Nephropathies

Acute Fluid Electrolyte and Acid-Based Disorders

Pharmacologic Agents and Renal Failure

Urinary Tract Infections

Renal Transplantation

Objective 2: Describe and evaluate a pharmacotherapeutic approach which includes definition of therapeutic objectives and options, selections of dose and parameters to be monitored, and measurement of therapeutic response and outcome.

C. PRACTICE-BASED LEARNING AND IMPROVEMENT

Objective 1: Demonstrate evidenced based practice through appraisal and assimilation of scientific information, e.g. scientific journals, related to patient care

Objective 2: Demonstrate ability in medical decision making, which incorporates medical assessment and patient values and preferences.

D. INTERPERSONAL AND COMMUNICATION SKILLS

Objective 1: Create an atmosphere of positive regard for the patient and family to promote the best medical outcome through accessibility, affability and continuity.

Objective 2: Incorporate psychosocial and ethical concerns of the patient and family in the development of the care management plan.

E. PROFESSIONALISM

Objective 1: Recognize the legal requirements of advanced directives and describe the process of assessing a patient’s advance directives, including the patient’s perspective.

Objective 2: Model appropriate professional attitudes and behaviors of time management and punctuality, reliability, and ethical behavior.

F. SYSTEM-BASED PRACTICE

Objective 1:  Recognize financial issues of health care, with emphasis on understanding acute and chronic care, and medication coverage and the role of the Centers for Medicare and Medicaid Services (CMS), and other third party payers.

Objective 2: Actively participate in the multidisciplinary approach to caring for patients, including appropriate recognition of other health professional and paraprofessionals’ roles and demonstrate competence in team interactions.

III. METHODS

The Nephrology rotation is a PGY 2 or PGY3 four-week training inpatient and ambulatory experience at all three training sites. Responsibilities are to the education rotation, excluding one half day per week at Continuity Clinic, and one half day per week at core conference. Patient care responsibilities are Monday through Friday, 0730 to 1700; and weekend, holiday, and on-call responsibilities are scheduled. Residents are on call as assigned by the program. A nephrology pager call for opportunity to assess new nephrology cases after hours may be arranged by attending and resident.

Inpatient: Residents train with direct supervision of an assigned nephrology physician in the care of 5 inpatients.  The residents perform the initial history and physical examination, and present findings and available laboratory data.  After review of patient data and pertinent teaching points, the resident and attending complete the patient encounter together.  Selected components of the examination may be repeated and demonstrated to the resident.  Residents are responsible for documenting the patient encounter with a written or dictated note.

Consultations: Residents will see consultations requested of the Nephrology Division. Residents perform a complete history and physical examination and make recommendations for the consultant based on current medical references. Each case is staffed by the attending physician on service for approximately 30 minutes, at a time to be arranged by the resident.

Ambulatory/Dialysis Center: The resident evaluates new patients and staffs with the attending physician in the ambulatory setting. Residents must attend the chronic hemodialysis center at Provena-Covenant and the acute hemodialysis center at Carle Clinic Association at least once in the rotation.

IV. EVALUATION

ACGME Competencies

According to Accreditation Council of Graduate Medical Education (ACGME), training and evaluation must include the following competencies: Patient Care, Medical Knowledge, Practice-Based Learning and Improvement, Interpersonal and Communication Skills, Professionalism, and System-Based Practice.

Patient Care will be evaluated by assessment of the attending physician.  Procedures performed will be documented electronically.

Medical Knowledge will be evaluated by assessment of the attending physician.

Practice-Based Learning and Improvement will be evaluated by assessment of the attending physician.

Interpersonal and Communication Skills will be evaluated by assessment of the attending physician.

Professionalism will be evaluated by assessment of the attending physician.

System-Based Practice will be evaluated by assessment of the attending physician.

The evaluation method is primarily accomplished electronically.  Residents’ performance in Nephrology is evaluated by the attending physician.  Evaluations are reviewed with the residents for formal feedback.  In addition, ongoing feedback is provided related to residents’ patient care responsibilities and activities.

Residents will document the Nephrology rotation in portfolios, e.g. procedures performed.  This tool will provide individual learning, reflection and assessment.  Additionally, residents will evaluate the Nephrology rotation.

Residents provide input on the Nephrology core lecture series, which is used in scheduling future topics and speakers.  Topics include: acid base disorders, chronic renal failure, diabetic nephropathy, dialysis, glomerulonephritis, hematuria, hyponatremia, potassium metabolism, and proteniuria.

V. REFERENCES

The Official American Society of Nephrology (ASN) 10th Annual Board Review Course and Update

SAMPLE SCHEDULE

 
MONDAY
TUESDAY
WEDNESDAY
THURSDAY
FRIDAY
0730
Subspecialty Conference
Subspecialty Conference Subspecialty Conference Subspecialty Conference Subspecialty Conference

0830

1200

Clinics Dr. Sehy

Clinics Dr. Attia
Clinics Dr. Sehy

 

Clinics Dr. Sehy

1300

1700

Clinics Dr. Attia
Continuity Clinic
Core Conference
Dialysis Unit Provena

 

7/25/00 Rev 4/06, 7/1/06, 7/1/07