GCRMC Nephrology

Nephrology Eval

Faculty Chair:

Leandrita Ortega ,MD

Contacts:

Shahid Mansoor, MD

Required Experiences:

Gerald Champion Regional Medical Center

Optional Experience:

Elective rotations

Weekly Schedule PGY3:

Sunday Monday Tuesday Wed Thursday Friday Saturday
Clinic Nephro Nephro Clinic Nephro
Clinic Nephro Didactics Clinic

Requirements:

AOA

Internal Medicine

The program must provide at least thirty-two weeks of clinical training in internal medicine disciplines, including at least eight weeks of general internal medicine experiences during the OGME-1 year. This requirement can be met by either inpatient internal medicine or inpatient family medicine service.

At a minimum internal medicine training must include:

  • Twenty-four weeks of inpatient experience.
  • Four weeks of training in critical care medicine.
  • Didactic and clinical training.

Internal medicine training shall include exposure to the following disciplines, in either inpatient or outpatient settings:

  • Allergy and immunology.
  • Cardiology.
  • Dermatology.
  • Endocrinology.
  • Gastroenterology.
  • Hematology.
  • Infectious diseases.
  • Nephrology.
  • Neurology.
  • Oncology.
  • Pulmonology.
  • Rheumatology.

ACGME

There must be specific subspecialty curricula to address the breadth of patients seen in family medicine. (Core)

The program must ensure that every resident has exposure to a variety of medical and surgical subspecialties throughout the educational program. (Detail)

Description of Rotation or Educational Experience:

The family physician encounters a broad range of genitourinary and renal disease in the course of outpatient, urgent/emergent, and inpatient care. These diseases range from chronic and indolent to life threatening. Family physicians are often the first line in diagnosing such conditions and are, likewise, often responsible for the long-term care of patients with these illnesses. Additionally, prevention and optimal medical management of diseases commonly treated by the family practitioner (e.g., diabetes, hypertension, SLE, etc.) can reduce the morbidity and mortality associated with renal disease.

The resident will gain knowledge and skills necessary to evaluate and manage issues involving patients with special problems related to the kidney and to use preventative measures to maximize renal health. The resident will understand community, state, national resources and systems for patients with renal disease.

Expectations:

Residents

Residents are expected to arrive to nephrology and continuity clinics on time and to dress and act in a professional manner. They are expected to contact the nephrology preceptors’ office prior to their first day on the rotation in order to arrange the initial meeting time and location of the rotation. It is expected that while at the preceptors’ office the residents will be respectful of the office space and personnel. The resident is responsible for maintaining a procedure log as well as completing assigned readings.

Faculty:

Family medicine faculty will provide precepting of nephrology cases and procedures as seen in resident continuity clinics. Dr. Mansoor will provide precepting during the focused Nephrology rotation. The faculty and preceptors are expected to allow the resident to participate in active patient care and procedures when appropriate. The preceptors should also provide time and allowance for explanation and teaching of nephrologic conditions and their treatments.

Call:

There is no call specific to this rotation.

Patient Care

Goal

Residents must be able to provide patient care that is compassionate, appropriate, and effective for the treatment of health problems and the promotion of health. Residents are expected to:

Competencies

  • Be able to perform standardized comprehensive nephrology assessments, obtain necessary further investigation and develop acute and long-term comprehensive treatment plans based on the basis of presenting and progressively deteriorating nephrologic processes.

Objectives

In the appropriate setting, the resident should demonstrate the ability to independently

perform or appropriately refer:

  • Evaluation skills
    • Learn a nephrology directed history and physical
    • Strive to perform the following procedures during this rotation and should be able to evaluate abnormalities in the results:
      • Microscopic evaluation of urine sediment
      • Arterial blood gas sampling
    • Observe the following, as available:
      • Renal biopsy
      • Hemodialysis access placement (vascular catheter)
    • Appreciate the psychosocial issues involved for patients on long-term dialysis
  • Management skills
    • Support the patient in their healthcare decisions
    • Assist patients and their families in planning for future care needs and care decisions based on prognosis for the disease
    • Learn when to refer patients for long-term vascular access (e.g., vascular catheter, arterio-venous fistula)

Medical Knowledge

Goal

Residents must demonstrate knowledge of established and evolving biomedical, clinical, epidemiological, and social-behavioral sciences, as well as the application of this knowledge to patient care. Residents are expected to:

Competencies

  • Be able to understand normal nephrologic development, anatomy and physiology.

Objectives

In the appropriate setting, the resident should demonstrate the ability to apply

knowledge of:

  • Review the principles of normal renal physiology.
  • Understand the diagnosis and management of:
    • Acute renal failure (including indications for various modalities of acute dialysis)
    • Chronic renal failure (including its medical complications)
    • End-stage renal disease
    • Acid-base and fluid and electrolyte abnormalities.
  • Learn the outpatient evaluation and treatment of hypertensive disorders, hematuria, and proteinuria.
  • Become familiar with issues surrounding renal transplant and dialysis management.
  • Appreciate the psychosocial issues involved for patients on long-term dialysis.
  • Learn resources for personal education and develop a plan for ongoing education.
  • Learn the diagnosis, associated complications, and management of:
    • Acute renal failure
    • Chronic renal insufficiency and failure
    • End stage renal disease
    • Hemodialysis
    • Peritoneal dialysis
    • Continuous veno-venous hemo-diafiltration
    • Glomerular disease: nephrotic syndrome/glomerulonephritis
    • Acid-base disorders: particularly metabolic acidosis and metabolic alkalosis
    • Disorders of water, sodium, potassium, calcium, phosphate and magnesium metabolism
    • Hypertensive disorders
    • Renal transplantation:
      • Immunosuppressive therapy
      • Complications
    • Nephrolithiasis
    • Hematuria
    • Systemic disease with prominent renal involvement:
      • Diabetes mellitus
      • SLE
  • Become familiar with other renal conditions such as cystic diseases of the kidney, renal cancers, and tuberculosis of the kidney.
  • Become familiar with common known nephrotoxic medications (e.g., NSAIDs, gentamycin, cyclosporins, etc.).
  • Learn when to refer patients for long-term vascular access (e.g., vascath, ateriovenous fistula)
  • Strive to perform the following procedures during this rotation and should be able to evaluate abnormalities in the results:
    • Microscopic evaluation of urine sediment
    • Arterial blood gas sampling
  • Observe the following, as available:
    • Renal biopsy
    • Hemodialysis access placement (vascath)

Practice Based Learning and Improvement

Goal

Residents must demonstrate the ability to investigate and evaluate their care of patients, to appraise and assimilate scientific evidence, and to continuously improve patient care based on constant self-evaluation and life long learning. Residents are expected to develop skills and habits to be able to:

Competencies

  • Be able to recognize his or her own practice limitations and seek consultation with other health care providers to provide optimal care.

Objectives

  • Complete assigned reading topics and apply learned material in the clinical setting
  • Demonstrate ability to identify limitations in own knowledge and take steps to fill these gaps.

System Based Practice

Goal

Residents must demonstrate an awareness of and responsiveness to the larger context and system of health care, as well as the ability to call effectively on other resources in the system to provide optimal health care. Residents are expected to:

Competencies

  • Be able to optimize treatment plans based on knowledge of local resources that include local, state and federal agencies.
  • Coordinate ambulatory, in-patient and institutional care across health care providers, institutions and governmental agencies.

Objectives

  • Make appropriate referrals to and coordinate care with neurologists for those conditions that fall out of the scope of family medicine or do not respond to that treatment which family physicians can provide
  • Demonstrate cost effective care and diagnostic testing

Professionalism

Goal

Residents must demonstrate a commitment to carrying out professional responsibilities and an adherence to ethical principles. Residents are expected to demonstrate:

Competencies

The list below reflects competencies that fall under Professionalism. Which of the following competencies are relevant for the rotation or educational experience you have chosen? (Pick one or two)

  • Compassion, integrity, and respect for others
  • Responsiveness to patient needs that supersedes self-interest
  • Respect for patient privacy and autonomy

Objectives

  • Display sensitivity for patient privacy and autonomy during exams and procedures
  • Engage in interviewing techniques which demonstrate cultural and social sensitivity

Interpersonal and Communication Skills

Goal

Residents must demonstrate interpersonal and communication skills that result in the effective exchange of information and teaming with patients, their families, and professional associates. Residents are expected to:

Competencies

The list below reflects competencies that fall under Interpersonal and Communication Skills. Which of the following competencies are relevant for the rotation or educational experience you have chosen? (Pick one or two)

  • Communicate effectively with patients and families across a broad range of socioeconomic and cultural backgrounds
  • Act in a consultative role to other physicians and health professionals

Objectives

Communicate with patients and their families in a respectful, and concise manner that facilitates understanding with minimal jargon.

Teaching Methods

Residents will provide medical care to patients under the direct supervision of the attending physician. They will be supervised on all procedures performed. They will participate in weekly conferences. Residents will be assigned specific reading topics to be completed by the end of their month on the service.

Assessment Method (residents)

Direct observation with a ongoing global assessment based on the REDI system. All procedures will be recorded on New Innovations and independence for each procedure assessed using the REDI system. Evaluation from each of the community preceptors to be completed at the end of the rotation. Review of documentation by family medicine preceptors as part of continuity clinic supervision.

Assessment Method (Program Evaluation)

Residents will be provided with an evaluation of their experiences and given the opportunity to provide feedback of the rotation during their quarterly IEP assessments.

Level of Supervision

The resident is directly supervised by the attending physician during all procedures performed. An Attending will be available the entire time the resident is on the rotation. An Attending will be available at all times during continuity clinic visits.

Educational Resources

Acute Renal Failure. Am Fam Physician 2000;61:2077-88.

Thadhani R, Pascual M, Bonventre JV.

Acute renal failure. N Engl J Med 1996;334:1448-60.

Hricik DE, Chung-Park M, Sedor JR. Glomerulonephritis. N Engl J Med 1998;339:888-99.

Singer GG. Fluid and electrolyte management. In: The Washington manual of medical therapeutics. 29th ed. New York: Lippincott-Raven, 1998:39-60.

McCarthy JT. A practical approach to the management of patients with chronic renal failure. Mayo Clin Proc March 1999;74:269-73.

Proteinuria in Adults: A Diagnostic Approach. Am Fam Physician 2000;62:1333-40.

McConnell KR, Bia MJ. Evaluation of proteinuria: an approach for the internist. Resident Staff Phys 1994;40:41-8.

Evaluating Proteinuria in Children. Am Fam Physician 1998;Oct 1:1145-1158.

Ettenger RB. The evaluation of the child with proteinuria. Pediatr Ann 1994;23:486- 94.

Asymptomatic Microscopic Hematuria in Adults: Summary of the AUA Best Practice Policy Recommendations. Am Fam Physician 2001;63:1145-54.

Diagnosis and Initial Management of Kidney Stones. Am Fam Physician 2001;63:1329-38.

Location 2450 S. Telshor Blvd. Phone 575-521-5378 E-mail john.andazola@lpnt.net
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