HMC Nephrology Service Curriculum

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FACULTY CONTACT:

Michael Kelly, MD
Clinical Professor of Medicine
Acting Section Head, Nephrology
Harborview Medical Center

Address:
Box 359764
325 9th Avenue
Seattle, WA 98104
Phone:  206-744-4933
Email: mrkmd@uw.edu

OVERALL GOALS & OBJECTIVES

  • To provide exposure to a broad range of adult patients with acute and chronic nephrologic problems.
  • To further understanding of the diagnosis and treatment of electrolyte derangements, salt and water imbalances, and renal diseases and their treatments.
  • To help develop familiarity with principles, clinical indications, complications and performance of nephrologic procedures including acute and chronic hemo and peritoneal dialysis, renal biopsy, vascular access placement, and continuous renal replacement therapy.

DESCRIPTION

This is a busy rotation where residents and medical students play a key role in the care of the patients on the consult service. Residents and medical students will see 1-2 new patients per day, on average, and follow serveral patients throughout their course. They will also see new and follow up patients in the outpatient clinic.

TEAM STRUCTURE

Attending
Renal Fellow
Mid-level Provider
Medical Resident
Medical Student

PRINCIPAL TEACHING METHODS

Case discussions and review

Case-based discussions and review conferences weekly including nephrology clinical conference, clinic conference and nephrology professor's rounds.

Rounds

Direct supervision of patient care by attending physician on daily patient care rounds seven days per week and in outpatient clinic.

Didactics

Didactic teaching conferences and lectures by attendings and by clinical fellows.
Weekly fellow orientation sessions six months each year.
Dialysis teaching curriculum one week at the beginning of the year.
Monthly nephrology research conferences.
Monthly renal biopsy conferences.
Monthly nephrology journal clubs.

EDUCATIONAL CONTENT

Mix of Diseases

Patients encountered include those with: acute kidney injury in the intensive care unit setting, patients with hypo- and hyperkalemia, hypo-and hypernatremia and patients severe acid base disorders. There are also patients with end stage renal disease (ESRD), recipients of kidney and kidney-pancreas transplants and a variety of acute and chronic diseases. There are often patients with acute overdoses requiring urgent management.
Consultative services are provided to patients with a variety of disorders on multiple different hospital services. Outpatients with proteinuria, chronic kidney disease, HTN, ESRD , bone disease, etc will be seen.

Patient Characteristics

Patients seen encompass a broad social economic spectrum including Medicaid, Medicare, prepaid managed care and privately insured patients. The ethnic mix reflects that of the city of Seattle. Patients with end-stage renal disease and renal transplantation are covered by Medicare.

Types of Clinical Encounters

Inpatient consultation
Intensive care unit consultation and management
Outpatient renal and transplant clinic

Procedures

Acute hemodialysis, chronic hemodialysis, acute peritoneal dialysis, chronic peritoneal dialysis (CAPD), continuous veno-venous hemofiltration (CVVH), CVVH with dialysis (CAVHD) ultrafiltration, plasma exchange, vascular access placement and renal biopsy.

Services

A full range of consultative and clinical services covering all aspects of nephrologic care are provided. This includes outpatient renal and transplant clinic, emergency room, intensive care unit, hypertension clinic, and access to all procedures listed above.

Typical Rotation Schedule

Monday

Tuesday

Wednesday

Thursday

Friday

AM

Work rounds

Renal clinic

Work rounds

Conferences at UW

8:00-10:00
Renal conf

PM

1:00-3:30
Attending rounds

2:00-3:00
Attending rounds

3:00-4:00
Attending rounds

12:30-2:00
Professor rounds
Journal Club

2:00-4:00
Attending rounds

Call and Weekend Responsibilities

Medical Residents

The renal fellows and renal residents share responsibilities for weekends and weeknights. In general, the HMC renal resident is on call one weekend per month.

Medical Students

None

PRINCIPLE EDUCATIONAL MATERIALS USED

Recommended Readings

Library of nephrologic textbooks, journals and periodicals are available through the Program Coordinator in the UW Nephrology Office (BB1271).

Pathologic materials


Three hundred renal biopsies reviewed annually.

METHODS USED IN EVALUATING RESIDENT AND PROGRAM PERFORMANCE

At the end of the rotation, the resident/student is evaluated in writing and their performance reviewed with them verbally by every attending and fellow he or she has interacted with for a significant amount of time. The evaluator rates the resident/student on a nine-point scale in each component of clinical competence (i.e. patient care, medical knowledge, practice based learning improvement, interpersonal and communication skills, professionalism, system based learning, educational attitudes, leadership, overall clinical competence).

The resident/student is given the opportunity to evaluate in writing the quality of the curriculum and the extent to which the educational goals and objectives of the rotation have been met. The resident also evaluates the teaching competence of each attending and fellow with whom s/he has interacted for a significant amount of time.

EXPLICIT LINES OF RESPONSIBILITY FOR CARE OF PATIENTS ON THIS SERVICE

Direct supervision of patient care by attending physician on daily patient care rounds seven days per week and in outpatient clinic.

Final responsibility for patient care rests with the faculty attending on the renal consult service. Faculty attendings are available by digital pager 7days/week/24hrs/day and make rounds 7 days/week at the bedside. Renal fellows report directly to the faculty attending and the nephrology resident/student report to renal fellow and attending.

Attending

Decisions regarding the overall plan of management for renal patients are primarily the responsibility of the attending physician. The attending will also provide didactic and interactive formal teaching rounds on a daily basis. Separate attendings will cover the renal consult service.

Fellow

The fellow on the renal consult service is responsible for the renal care of all patients referred for consultation or undergoing renal dialysis. In conjunction with the attending, the fellow will plan the evaluation and management of patients including orders for renal procedures such as dialysis, CVVH, plasma-pheresis and renal biopsy. The fellow will attend work rounds every morning with his/her team. While providing direction in renal management, the fellow allows the medical resident and student to provide direction and regular medical care. The fellow supervises the resident/student in renal procedures. When appropriate, the fellow provides references and articles relevant to particular patient problems. Fellows are also responsible for a group of outpatients with chronic renal failure and for responding to renal-related emergency calls from outpatients, area dialysis facilities and the emergency room.

Resident/Student

The resident/student on the renal consult service shares responsibility for patient evaluation with the fellow. While the fellow and attending will provide the primary direction of the patient’s renal care, the resident/student directs the often-complicated medical management of these patients.

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