Curricula
Geriatric Nephrology
Overview and Goals
The number of people age 65 years and older will triple over the period of your career in nephrology. Because the incidence of chronic kidney disease increases with age, nephrologists will increasingly be called upon to evaluate and manage geriatric patients. To prepare you for this role as a nephrologist, we have created a Geriatric Nephrology rotation based at the UofL affiliated Robley Rex VA Medical Center. This four week rotation will focus on education of fellows in the unique requirements of caring for a geriatric population with acute kidney injury, chronic kidney disease and End-Stage Renal Disease.
Site(s): Robley Rex VA Medical Center
Duration: 1months/year, additional elective time depending on interest
Educational Objectives
Medical Knowledge
Understand changes in kidney function and physiology as part of normal aging
Understand the limitations in applying current measures of kidney function in the geriatric population
Learn the main causes of acute and chronic kidney failure in the geriatric population
Learn the benefits and risks of renal replacement therapy in this population
Learn differences in pharmacokinetics in the elderly
Learn differences in clinical guideline applications for the geriatric population
Understand clinical scenarios associated with high risk for acute kidney injury or electrolyte disturbances in the elderly
Patient Care
Learn when and how to apply principles of conservative supportive care for ESRD
Learn how to identify and avoid iatrogenic causes of AKI and electrolyte disturbances
Learn how to be part of a multidisciplinary team including palliative and geriatric providers
Communication
Learn how to explain the risk/benefit ratio for RRT modalities to patients and their support systems in the acute and chronic settings
Learn how to explain the distinction between quality and quantity of life in the context of kidney failure
Professionalism
Understand the importance of timely response to patient and family concerns
Learn how to identify and incorporate the values articulated by older patients and their families in planning diagnostic testing and therapies
Become proficient in the timely recording of inpatient and outpatient visits and encounters and in the transmission of these data to other providers
Practice based learning and improvement
Become familiar with resources necessary for the delivery of optimal geriatric nephrology care including journals, websites, curricula, and specialized databases
Understand and perform self-evaluations for guideline adherence
Systems based practice
Become acquainted with transitions of care.
Become familiar with multidisciplinary aspects of geriatric nephrology care
Understand barriers to geriatric nephrology care
Specific Educational Components
Inpatient rounding on the nephrology service at the Robley Rex VA Medical Center, including the care of acute and chronic kidney disease patients
Participation in outpatient general nephrology clinics at the Robley Rex VA Medical Center
Inpatient rounding on the Geriatric, Palliative, and Hospice services at the Robley Rex VA Medical Center
Attendance at and participation in multidisciplinary evaluation and quality improvement conferences for the Geriatrics service
Participation in end of life discussions with patients and families in the inpatient and outpatient settings
Participation in the multidisciplinary ICU rounds
Educational Methods and Materials
Supervised patient care: Experiential learning through management of geriatric inpatients and outpatients. Fellows will be encouraged to have initial patient interactions to allow for independent development of clinical assessments and care plans. Cases will then be presented to faculty supervisors at which time the supervising physicians will work with the fellow to finalize care plans. Fellows are under the full supervision of a faculty nephrologist in each inpatient and outpatient venue.
Structured Didactics and Small Group Learning
Fellows Curriculum Lecture 12noon – 1pm Tuesdays
Nephrology Combined Conference 12noon-1PM Fridays
Multidisciplinary geriatric conferences
Independent Study (including core reading and other education resources)
Texts
Primer on Kidney Diseases
Feehally Comprehensive Clinical Nephrology
NephSAP
- Geriatric Nephrology. NephSAP Vol 10, 2011.
Core Journals
Clinical Journal of American Society of Nephrology (CJASN)
Nature Nephrology Review
Kidney International
American Journal of Kidney Diseases (AJKD)
American Journal of Transplantation
Transplantation
Curricula
- ASN Geriatric Nephrology Curriculum modules
Outpatient Dialysis
Overview and Rotation Goals
The Dialysis Rotation blocks are 8-week educational blocks completed in both first and second years of fellowship, for a total of four months of training. Core clinical teaching venues include: Home Dialysis Clinic (hemodialysis and peritoneal dialysis), Incenter Hemodialysis rounds, monthly Total Quality Management meetings, and Multidisciplinary Care Plan meetings. The dialysis curriculum includes management and complications of various dialysis therapies, economic considerations of dialysis, technical aspects of dialysis machine function, water purification and management, patient quality of life indicators, and understanding the role of dialysis unit medical directorship. Opportunities for scholarly activities include: designing and implementing a Quality Improvement Project concerning an area of clinical dialysis. Suggested topics include but are not limited to interdialytic weight gain, protein-calorie malnutrition, hypertension on dialysis, quality of life parameters, reduction of cardiovascular risk factors, bone mineral metabolism on dialysis, access to kidney transplantation, and anemia management.
Site(s): UKC Outpatient Hemodialysis Units; Home Training Dialysis Clinics
Duration: 2 months each years 1 and 2
Educational Objectives
Medical Knowledge
Learn the scientific principles supporting the application of dialysis therapies to end stage renal disease
Learn how to evaluate a patient for suitability for the different dialysis modalities
Become knowledgeable in the complications of dialysis
Gain experience and expertise in the dialysis prescription
Learn the goals of dialysis therapy
Understand the components of dialysis therapy: water supply, dialysis filters, PD cycling machines, PD fluid
Patient Care
Gain experience in the acute and long term follow up issues for dialysis patients
Learn how to achieve the required goals for delivery of dialysis therapy to patients
Communication
Learn how to explain the process, risks and benefits of the different dialysis modalities to patients and families
Learn how to review monthly labwork with members of the dialysis team and with patients
Gain experience in interactions with key members of the dialysis team including nurses, social workers, clinic managers, and dietitians.
Professionalism
Understand the importance of timely response to patient concerns
Accept the responsibility for primary adjustment of the dialysis prescription
Become proficient in the timely recording of outpatient visits and encounters
Treat all members of the healthcare delivery team, patients and families with respect and dignity
Practice based learning and improvement
Become familiar with resources necessary for the delivery of optimal dialysis care including journals, websites, curricula, and specialized databases such as the Renal Network
Understand and perform self-evaluations for guideline adherence
Systems based practice
Become acquainted with transitions of care from dialysis to transplantation; transplantation to dialysis; inpatient to outpatient care; and vice versa.
Become familiar with multidisciplinary aspects of dialysis care
Understand barriers to the delivery of adequate dialysis
Understand the regulatory components of dialysis care – the responsibilities of the medical director, the quality of care reporting requirements
Specific Educational Components
Outpatient rounding in the dialysis units on assigned shifts of dialysis patients. This rotation also includes multidisciplinary rounds with the dialysis team
Attendance at and participation in multidisciplinary evaluation and quality improvement conferences
Attendance during vascular access puncture and needle withdrawal
Rounding with the engineering staff to understand the water system, the maintenance of dialysis machines, and the monthly testing
Rounding with the dietitian
Rounding with the social worker
Independent study
Educational Methods and Materials
Supervised patient care: Experiential learning through management of inpatients and outpatients with solid organ transplants. Fellows will be encouraged to have initial patient interactions to allow for independent development of clinical assessments and care plans. Cases will then be presented to faculty supervisors at which time the supervising physicians will work with the fellow to finalize care plans. Fellows are under the full supervision of a faculty nephrologist in each outpatient venue.
Structured Didactics and Small Group Learning
Fellows Curriculum Lecture 12noon – 1pm Tuesdays
Nephrology Combined Conference 12noon-1PM Fridays
Multidisciplinary dialysis conferences
Specialized one on one experiences with the social workers, dietitians
Independent Study (including core reading and other education resources)
Texts
Primer on Kidney Diseases
Feehally Comprehensive Clinical Nephrology
NephSAP
- Endstage Renal Disease and Dialysis NephSAP 13:5, Nov 2014
Core Journals
Clinical Journal of American Society of Nephrology (CJASN)
Nature Nephrology Review
Kidney International
American Journal of Kidney Diseases (AJKD)
Curricula
ASN Dialysis Curriculum modules
RPA Business of Nephrology modules
Outpatient Subspecialty Nephrology
Glomerulonephritis, Nephrolithiasis and Tubulointerstitial Disease, Resistant and Secondary Hypertension
Overview and Rotation Goals
The fellow will rotate through outpatient Nephrology subspecialty clinics including General Chronic Kidney Disease Clinics, Glomerulonephritis Clinic, Interdisciplinary Lupus Clinic, Nephrolithiasis Clinic, and Hypertension Clinic. Additional outpatient clinic opportunities in other specialties including Rheumatology, Endocrinology, and Cardiology to enhance a multi-disciplinary approach to complex medical cases will also be provided. The purpose of this rotation is to gain expertise on the workup and treatment of primary and secondary glomerulonephritis, idiopathic and secondary nephrolithiasis, and resistant and secondary hypertension.
Site(s): ULP Outpatient Center
Duration: 2-3 months
Rotation Competency Objectives
The following provide an overview of the knowledge, skills, and conduct promoted in this rotation.
Patient Care and Medical Knowledge - Upon completion of this rotation, fellows will demonstrate
Knowledge of the pathophysiology, clinical presentations, laboratory and radiological diagnosis and therapeutic modalities for treatment of complex kidney diseases in the outpatient setting including the following conditions:
Primary and Secondary Glomerulonephritis
Lupus Nephritis
Idiopathic and Secondary Nephrolithiasis
Tubulointerstitial Diseases
Resistant and Secondary Hypertension
Primary and Secondary Chronic Kidney Diseases
History taking and physical exam skills including a renal focused history and physical exam including recognition of assessment of volume status and identification of systemic complaints associated with renal pathology.
Appropriate ordering and interpretation of urinalysis, serum chemistries, 24 hour urine studies, urine protein to creatinine ratio, serologic testing, endocrine testing in the work up of secondary hypertension and nephrolithiasis, 24 hour urine testing for nephrolithiasis, radiographic studies, and when to order a kidney biopsy
Interpersonal and Communication Skills:
Fellows will recognize the importance of patient education in renal dietary and drug compliance.
Demonstrate communication skills that support respectful patient-centered care.
Generate written documentation consistent with a hypothesis-generating approach to renal conditions.
Professionalism: Throughout the rotation Fellows will:
Respectfully and compassionately respond to patients with a multitude of renal disorders.
Compassionately respond to socio-behavioral and psychiatric complexities of common renal conditions including the unique aspects of care for patients with chronic disease.
Practice-Based Learning and Improvement:
- Demonstrate willingness to learn from error, use it to support self-education and facilitate the learning of others
Systems-Based Practices:
Fellows will participate in various quality improvement project meetings in the outpatient dialysis setting and learn the dynamics of advancing patient care.
Strive to provide cost-effective care incorporating awareness of available ancillary services.
Educational Components
Hypertension Clinic staffed by Dr. Nina Vasavada
Nephrolithiasis Clinic staffed by Dr. Eleanor Lederer
Genetic Renal Disease Clinic staffed by Dr. Eleanor Lederer
Glomerular Disease Clinic staffed by Drs. Dawn Caster, Liliane Hobeika, and Kenneth McLeish
Interdisciplinary Lupus Clinic staffed by Drs. Dawn Caster, Liliane Hobeika, Kenneth McLeish, and W. Neal Roberts
Refugee/Global Health Clinic staffed by Drs. Julio Ramirez, Rahel Bosson, and Paula Peyronie
HIV Clinic staffed by Drs. Julio Ramirez, Paula Peyronie, and Raul Nakamatsu
Chronic Kidney Disease Clinics staffed by Drs. Fred Arndt, Alfred Jacobs, Liliane Hobeika, Jon Klein
Teaching Methods
Supervised patient care: The emphasis of the rotation is on experiential learning through management of outpatients with specific renal diseases. A variety of outpatient faculty supervised patient care activities will be provided in this rotation. Fellows will be encouraged to have initial patient interactions to allow for independent development of clinical assessments and care plans. Cases will then be presented to faculty supervisors at which time the supervising physicians will work with the fellow to finalize care plans. Fellows are under the full supervision of a faculty nephrologist in each outpatient venue.
Structured Didactics and Small Group Learning- fellows are expected to attend each of the following.
Fellows Curriculum Lecture 12noon – 1pm Tuesdays
Nephrology Combined Conference 12noon-1PM Fridays
Independent Study (including core reading and other education resources)
Textbooks and Manuals
Primer on Kidney Diseases
Clinical Physiology of Acid-Base and Electrolyte Disorders
KDIGO Clinical Practice Guideline for Glomerulonephritis 2012
KDIGO Clinical Practice Guideline for the Management of Blood Pressure in Chronic Kidney Disease 2012
NephSAP
Primary and Secondary Glomerular Diseases July 2016
Hypertension March 2016
Renal Bone Disease, Disorders of Divalent Ions, and Nephrolithiasis September 2016
Chronic Kidney Disease
Core Journals
Clinical Journal of American Society of Nephrology (CJASN)
Nature Nephrology Review
Kidney International
American Journal of Kidney Diseases (AJKD)
Continuity Clinic: General Nephrology continuity clinic continues, ½ day weekly
Transplant Nephrology
Overview and Goals
Organ transplantation is a standard, albeit highly specialized and evolving, modality for the treatment of multiple organ failures including kidney, heart, lung, pancreas, and liver. This rotation will provide the trainee with experience in the evaluation, treatment, and follow up of kidney transplant recipients and in the renal complications of non-renal transplants.
Site(s): Jewish Hospital, Renal Tissue Typing Laboratory, KODA
Duration: 2-3 months depending on interest and activity level, minimum 2 months
Educational Objectives
Medical Knowledge
Identify qualifications for becoming a transplant candidate
Learn how to evaluate a patient for suitability for immediate kidney transplantation
Become knowledgeable in the complications of transplantation, immediate and long term, medical and surgical
Gain experience and expertise in the use of immunosuppressive medications
Learn the science and application of tissue typing
Patient Care
Gain experience in the acute and long term follow up issues for kidney transplant recipients
Learn how to balance immunosuppressive regimens against long term complications for recipients
Gain experience in both inpatient and outpatient specific issues
Learn the indications, techniques, and pathology of kidney transplant biopsies
Communication
Learn how to explain the process, risks and benefits of transplantation to patients and families
Understand the critical aspects of the transplant experience that should be recorded in follow up notes
Gain experience in interactions with key members of the transplant team including surgeons, referring physicians, primary care physicians, coordinators, nurses.
Professionalism
Understand the importance of timely response to patient concerns
Accept the responsibility for primary adjustment of immunosuppressive medications
Become proficient in the timely recording of inpatient and outpatient visits and encounters
Practice based learning and improvement
Become familiar with resources necessary for the delivery of optimal transplant care including journals, websites, curricula, and specialized databases such as UNOS databases, pregnancy in transplantation registry, and tumor registries
Understand and perform self-evaluations for guideline adherence
Systems based practice
Become acquainted with transitions of care from dialysis to transplantation; transplantation to dialysis; inpatient to outpatient care; and vice versa.
Become familiar with multidisciplinary aspects of transplant care
Understand barriers to transplantation and post-transplant care
Specific Educational Components
Inpatient rounding on the transplant service at Jewish Hospital, including the care of new and established kidney transplant recipients as well as non-renal solid organ transplant recipients who have developed renal-related issues. This rotation also includes multidisciplinary rounds with the organ transplant team
Participation in outpatient transplant clinics
Attendance at and participation in multidisciplinary evaluation and quality improvement conferences
Attendance at kidney transplant surgery
Participation in the process of potential organ transplant donor identification and evaluation
Educational Methods and Materials
Supervised patient care: Experiential learning through management of inpatients and outpatients with solid organ transplants. Fellows will be encouraged to have initial patient interactions to allow for independent development of clinical assessments and care plans. Cases will then be presented to faculty supervisors at which time the supervising physicians will work with the fellow to finalize care plans. Fellows are under the full supervision of a faculty nephrologist in each outpatient venue.
Structured Didactics and Small Group Learning
Fellows Curriculum Lecture 12noon – 1pm Tuesdays
Nephrology Combined Conference 12noon-1PM Fridays
Multidisciplinary transplant conferences
Specialized one on one experiences at KODA, the tissue typing laboratory, organ donor evaluation and management events, and kidney transplantation surgery
Independent Study (including core reading and other education resources)
Texts
Primer on Kidney Diseases
Feehally Comprehensive Clinical Nephrology
NephSAP
Core Journals
Clinical Journal of American Society of Nephrology (CJASN)
Nature Nephrology Review
Kidney International
American Journal of Kidney Diseases (AJKD)
American Journal of Transplantation
Transplantation
Curricula
- AST Curriculum modules
Acute Inpatient Nephrology Trauma/Public Hospital
Description: On this rotation, the fellow will have the opportunity to see and assume care for inpatients at the University Hospital which is a Level I Trauma Center and referral center for high risk pregnancy. This is exclusively a consult service. The educational focus of this rotation is to develop skills in the realms of inpatient consult service in a high acuity public hospital setting and in the inpatient management of medical complications seen in ESRD patients such as vascular access failure, infection, and acute cardiovascular events.
Site(s): University of Louisville Hospital
Duration: 2 months first year, 1-2 months second year
Educational Objectives
Medical Knowledge
Learn the diagnostic and therapeutic strategies for acute kidney injury in the hospital setting
Learn how to evaluate a patient for the need for acute hemodialysis
Learn the science and application of dialysis pheresis therapies
Understand the acute and long term complications of acute kidney injury
Learn the common complications of chronic kidney disease that result in hospitalization
Learn the presentation and renal complications of high risk pregnancy
Learn the application of acute dialysis therapies to drug overdose
Patient Care
Learn how to determine the optimal form of acute renal replacement therapy for the individual patient
Gain experience and expertise in the prescription of acute intermittent and continuous dialysis therapies
Understand and recognizes the complications of acute dialysis in the hospital setting
Understand how to adjust medications in the face of changing kidney function or advanced kidney failure
Communication
Learn how to explain the process, risks and benefits of acute hemodialysis to patients and families
Understand the critical aspects of writing an inpatient consult note
Gain experience in interactions with key members of the inpatient health care delivery team including referring physicians, primary care physicians, other consulting physicians, primary and dialysis nurses, other health providers.
Professionalism
Understand the importance of timely response to patient concerns
Accept the responsibility for primary evaluation of patient for renal replacement needs, medication adjustments
Become proficient in the timely response to consultation and documentation of inpatient visits and encounters
Practice based learning and improvement
Become familiar with resources necessary for the delivery of optimal inpatient nephrology care including journals, websites, curricula
Understand and perform self-evaluations for guideline adherence such as those applicable to delivery of acute dialysis therapies
Systems based practice
Become acquainted with transitions of care from inpatient to outpatient care and vice versa and inpatient initiation of dialysis to outpatient establishment of chronic dialysis.
Become familiar with multidisciplinary aspects of inpatient acute nephrology care
Understand barriers to post-discharge care
Specific Educational Components
Inpatient rounding on the general nephrology service at University of Louisville Hospital, including the care of acute and chronic kidney failure patients on wards and the ICUs.
Participation in outpatient hospital follow up clinics
Attendance at and participation in multidisciplinary evaluation and quality improvement conferences for acute dialysis
Educational Methods and Materials
Supervised patient care: Experiential learning through management of inpatients with acute kidney failure and subsequent outpatient follow up after hospitalization. Fellows will be encouraged to have initial patient interactions to allow for independent development of clinical assessments and care plans. Cases will then be presented to faculty supervisors at which time the supervising physicians will work with the fellow to finalize care plans. Fellows are under the full supervision of a faculty nephrologist in each outpatient venue.
Structured Didactics and Small Group Learning
Fellows Curriculum Lecture 12noon – 1pm Tuesdays
Nephrology Combined Conference 12noon-1PM Fridays
Independent Study (including core reading and other education resources)
Texts
Primer on Kidney Diseases
Feehally Comprehensive Clinical Nephrology
NephSAP
Core Journals
Clinical Journal of American Society of Nephrology (CJASN)
Nature Nephrology Review
Kidney International
American Journal of Kidney Diseases (AJKD)
Curricula
Acute Inpatient Nephrology Private Hospital
Description: On this rotation, the fellow will have the opportunity to see and assume care for inpatients at the affiliated private hospitals. This will be predominantly but not exclusively a consult service. The educational focus of this rotation is to develop skills in the realms of inpatient consult service in a private practice setting and in the inpatient management of medical complications seen in ESRD patients such as vascular access failure, infection, and acute cardiovascular events.
Site(s): Jewish Hospital, Norton Hospital
Duration: 2 months first year, 1-2 months second year
Educational Objectives
Medical Knowledge
Learn the diagnostic and therapeutic strategies for acute kidney injury in the hospital setting
Learn how to evaluate a patient for the need for acute hemodialysis
Learn the science and application of dialysis pheresis therapies
Understand the acute and long term complications of acute kidney injury
Learn the common complications of chronic kidney disease that result in hospitalization
Patient Care
Learn how to determine the optimal form of acute renal replacement therapy for the individual patient
Gain experience and expertise in the prescription of acute intermittent and continuous dialysis therapies
Understand and recognizes the complications of acute dialysis in the hospital setting
Understand how to adjust medications in the face of changing kidney function or advanced kidney failure
Communication
Learn how to explain the process, risks and benefits of acute hemodialysis to patients and families
Understand the critical aspects of writing an inpatient consult note
Gain experience in interactions with key members of the inpatient health care delivery team including referring physicians, primary care physicians, other consulting physicians, primary and dialysis nurses.
Professionalism
Understand the importance of timely response to patient concerns
Accept the responsibility for primary evaluation of patient for renal replacement needs, medication adjustments
Become proficient in the timely response to consultation and documentation of inpatient visits and encounters
Practice based learning and improvement
Become familiar with resources necessary for the delivery of optimal inpatient nephrology care including journals, websites, curricula
Understand and perform self-evaluations for guideline adherence such as those applicable to delivery of acute dialysis therapies
Systems based practice
Become acquainted with transitions of care from inpatient to outpatient care and vice versa and inpatient initiation of dialysis to outpatient establishment of chronic dialysis.
Become familiar with multidisciplinary aspects of inpatient acute nephrology care
Understand barriers to post-discharge care
Specific Educational Components
Inpatient rounding on the general nephrology service at Jewish Hospital (and/or Norton Hospital depending on patient census and pathology), including the care of acute and chronic kidney failure patients on wards and the ICUs.
Participation in outpatient hospital follow up clinics
Attendance at and participation in multidisciplinary evaluation and quality improvement conferences for acute dialysis
Educational Methods and Materials
Supervised patient care: Experiential learning through management of inpatients with acute and chronic kidney disease and subsequent outpatient evaluation of those patients. Fellows will be encouraged to have initial patient interactions to allow for independent development of clinical assessments and care plans. Cases will then be presented to faculty supervisors at which time the supervising physicians will work with the fellow to finalize care plans. Fellows are under the full supervision of a faculty nephrologist in each outpatient venue.
Structured Didactics and Small Group Learning
Fellows Curriculum Lecture 12noon – 1pm Tuesdays
Nephrology Combined Conference 12noon-1PM Fridays
Independent Study (including core reading and other education resources)
Texts
Primer on Kidney Diseases
Feehally Comprehensive Clinical Nephrology
NephSAP
Core Journals
Clinical Journal of American Society of Nephrology (CJASN)
Nature Nephrology Review
Kidney International
American Journal of Kidney Diseases (AJKD)
Curricula