Harborview Medical Center

Nephrology Service

Faculty Contact

Michael Ryan, MD
Assistant Professor, Medicine
Acting Section Head, Nephrology
Harborview Medical Center

Box 359764
325 9th Avenue
Seattle, WA 98104

(206) 744-3948
mjryan@uw.edu

Overall Educational Purpose

To provide exposure to a broad range of acute and chronic nephrologic 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, Continuous renal replacement therapy.

To understand the pathophysiology of disorders of renal salt and water metabolism and renal diseases and their treatments.

Team Structure

  • Attending
  • Renal fellow
  • Medical Resident
  • Medical Student

Principle Teaching Methods

Case Discussion 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.
  • Medicine topics.

Educational Content

Mix of Diseases

Patients encountered include those with: acute renal failure in the intensive care unit setting, chronic dialysis patients with acute medical problems, recipients of kidney and kidney-pancreas transplants 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.

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
  • Outpatient dialysis center

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.

Rotation Specific Schedule

Monday

8:00-12:00 Work Rounds
1:00-3:30 Attending Rounds

Tuesday

8:00-12:00 Renal Clinic
2:00-3:00 Attending Rounds

Wednesday

8:00-12:00 Work Rounds
3:00-4:00 Attending Rounds

Thursday

8:00-10:00 Conferences at UW
3:00-4:30 Professor Rounds

Friday

8:00-12:00 Renal Clinic
2:00-4:00 Attending Rounds

Call and Weekend Responsibilities

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

Principle Educational Materials Used

Recommended Readings

Library of nephrologic textbooks, journals and periodicals (Scribner Library).
Computer programs (Up-To-Date) with computer access to internet and medical literature searches.

Pathologic Materials

Three hundred renal biopsies reviewed annually.

Methods Used in Evaluating Resident and Program Performance

At the end of the rotation, the resident 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 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 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 or renal transplant 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, nephrology residents report to renal fellow and attending. Students report to the 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 and kidney-pancreas transplant services.

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 make 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 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.