UWMC Nephrology Service Curriculum
Eric Anderson, MD
Clinical Associate Professor of Medicine
1959 NE Pacific Street
Box 356521, Room EE405
Seattle, WA 98195
OVERALL GOALS & OBJECTIVES
- To provide exposure to a broad range of acute and chronic nephrology problems in adults.
- To 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, slow extended dialysis, and plasmapheresis.
- To understand the pathophysiology of disorders of electrolyte and water metabolism, acid base patho-physiology and their management.
- To develop a broad understanding of glomerular and tubular disorders including acute tubular necrosis and their management.
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.
Direct supervision of patient care by attending physician on daily patient care rounds seven days per week and in outpatient clinic.
Didactic teaching conferences and lectures by attendings and by clinical
Weekly Renal Grand Rounds.
Monthly HMC Nephrology Journal Club.
Monthly nephrology Professor's Rounds.
Monthly renal biopsy conferences.
Mix of Diseases
Includes patients with acute renal failure in the intensive care unit setting, chronic dialysis patients with acute medical problems, recipients of kidney and kidney-pancreas, liver, heart, lungs and bone marrow transplants with kidney disease and a variety of acute and chronic diseases of the kidney referred for tertiary care and management. Consultative services are provided to patients with a variety of disorders of fluid and electrolyte metabolism on multiple different hospital services.
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
Intensive care unit consultation and management
Outpatient renal clinic
Emergent outpatient consultations
Acute hemodialysis, chronic hemodialysis, acute peritoneal dialysis, chronic peritoneal dialysis (CAPD), ultrafiltration, slow continuous hemodialysis, plasma exchange, vascular access placement and renal biopsy.
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. (Residents and Students are not expected to attend regular outpatient clinics but are encouraged to see individual patients with the attending and fellow).
Call and Weekend Responsibilities
PRINCIPLE EDUCATIONAL MATERIALS USED
Computer programs (Up-To-Date) with computer access to Internet and medical literature searches.
Pathologic materialsThree 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/student 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 SERVICEDirect 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.
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.
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, 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.
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.