internal medicine specific requirements for nephrology

AOA/ACOI

SPECIFIC REQUIREMENTS FOR OSTEOPATHIC SUBSPECIALTY TRAINING

IN NEPHROLOGY

Adopted, BOT – 2/2005 Revised, BOT 2/2007, Effective 7/2007

Table of Contents

I. Educational Program Duration…………………………………………....1

II. Facilities and Resources………………………………………………..…1 III. Specific Program Content…………………………………………………2 IV. Specific Faculty Requirements……………………………………………5

Specific Requirements for Osteopathic Subspecialty Training in Nephrology Revised, BOT 2/2007, Effective, 7/2007

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Specific Requirements

for Osteopathic Subspecialty Training in Nephrology

This is an amendment to the Basic Standards for Fellowship Training in Internal Medicine Subspecialties, which govern and define training in the subspecialties. The Basic Standards are incorporated into this document by reference.

I. Educational Program Duration A. The fellowship training program is a full-time training program of a

minimum of 24 months in duration after satisfactory completion of a residency in General Internal Medicine. A minimum of 12 months must be devoted to clinical experiences.

II. Facilities and Resources A. Equipment: There must be equipment, modern and in good condition to

assure attainment of the stated objectives at the primary training site. Specifically these must be facilities for acute and chronic hemodialysis, continuous renal replacement therapy, acute and chronic peritoneal dialysis and renal biopsy.

B. Research Space: The training institution must provide, either directly or by arrangement, suitable laboratory space and assistance for the fellows to conduct research.

C. Resources: There must be an organized and cooperative Department of Pathology that can provide modern biochemistry, serologic and renal pathologic services. Renal biopsy processing by light, electron microscopy and immunofluorescence must be made available. There must be a radiology service that can provide up-to-date renal-related procedures including ultrasound, computerized tomography and diagnostic radionuclide laboratory. There must be a renal nutrition service and social service support. A meaningful working relationship must exist with surgery, vascular surgery, urology, obstetrics, gynecology, pediatrics, psychiatry and osteopathic medicine. The primary training site must be approved to perform renal transplantation or have a formal written agreement with such an institution ensuring that nephrology fellows receive the requisite experience with renal transplantation. The fellows must spend a minimum of eight (8) weeks as a full-time fellow on the renal transplant service with longitudinal follow-up of patients with transplants in an ambulatory setting. The training program must be of sufficient size to ensure adequate exposure of fellows to patients with acute renal failure, adequate training in long-term dialysis and intensive care nephrology training.


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III. Specific Program Content A. Clinical Requirements: 1. Fellows must have formal instruction, clinical experience and

opportunities to acquire expertise in the prevention, evaluation and management of the following disorders:

a. Acute renal failure b. All stages of chronic kidney disease and its complications c. Hypertensive disorders d. Disorders of fluid and electrolyte regulation e. Disorders of mineral metabolism including metabolic bone disease f. Disorders of acid-base regulation g. Glomerular and vascular diseases h. Tubulointerstitial and cystic renal diseases i. Genetic and inherited disease of the kidney and urinary tract and

inherited disorders of transport j. Urolithiasis k. Urinary tract infections l. Renal disorders of pregnancy m. Geriatric aspects of nephrology

n. Disorders of drug metabolism, renal drug toxicity and management of drug overdose

2. Fellows must have special experiences in renal transplantation and dialysis and extracorporeal therapy

a. Renal transplantation including evaluation and selection of transplant candidates, preoperative evaluation and preparation of transplant requirements and donors, immediate postoperative management, clinical diagnosis of rejection, medical management of rejection, recognition and medical management of surgical and nonsurgical complications of transplantation and long-term follow-up of recipients.

b. Dialysis and extracorporeal therapy including evaluation and selection of patients for acute hemodialysis, continuous renal replacement and chronic hemodialysis; evaluation and management of medical complications of hemodialysis; long-term follow-up of patients including dialysis prescription and assessment of adequacy of dialysis; understanding of principles and practice of peritoneal dialysis, how to write a peritoneal dialysis prescription and how to assess peritoneal dialysis adequacy; an understanding of the complications of peritoneal dialysis; and an understanding of the nutritional requirements of patients undergoing hemodialysis and peritoneal dialysis.


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3. Integration of Osteopathic Principles and Practice appropriate to

Nephrology. B. Technical Skills Requirements 1. Fellows must be given sufficiency experience to gain expertise in the

performance of procedural skills, including the knowledge of indications and complications, and interpretation of the results of the following:

a. Urinalysis b. Percutaneous biopsy of autologous and transplanted kidneys c. Placement of temporary vascular access for hemodialysis d. Peritoneal dialysis e. Acute and long-term hemodialysis f. Continuous renal replacement therapy 2. Fellows must have the necessary knowledge and are familiar with the

following procedures including indications, contraindications, complications and interpretations of results:

a. Radiology of vascular access b. Balloon angioplasty of vascular access c. Plasmapheresis d. Bone biopsy e. Placement of peritoneal catheters f. Renal ultrasound g. Lithotripsy C. Ambulatory Requirements

Fellows must have sufficient exposure to the long-term continuity care of patients with chronic kidney disease, hypertensive disorders and other medical renal-related disorders. Fellows must attend a continuity clinic for a minimum of four hours per week 46 weeks per year. There must be a minimum of two new patients and three follow-up patients per week. The fellow is required to maintain a log of all outpatient cases.

D. Specific Program Content for Knowledge Areas

Clinical teaching conferences must be conducted at least once weekly. The fellows must engage actively in the teaching program for other residents, interns and students. There must be a monthly basic science conference, journal club, renal biopsy conference and research conference. The fellow must present a minimum of four clinical lecture conferences under the guidance of a faculty member each year. The following specific content areas must be included in the formal program:


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Specific Program Content for Knowledge Areas (cont,d) 1.. Renal physiology, anatomy and pathology 2. Disorders of fluids, electrolytes and acid-base balance 3. Pathogenesis and management of acute renal failure

4. Tests of glomerular filtration rate, renal blood flow, urinary dilution and concentration, urinary acidification and various Kt/V calculations

5. Imaging diagnostic studies of the kidney and urinary tract that include intravenous urography, angiography, retrograde studies, voiding cystourethrograms, radionuclide scans, ultrasonography, computerized tomography, MRI, renal venography and renal vein sampling

6. Pathogenesis, natural history and management of congenital and acquired diseases of the kidney and urinary tract and renal diseases associated with systemic disorders such as diabetes, collagen-vascular diseases and pregnancy

7. Normal mineral metabolism and its alteration in renal diseases, metabolic bone disease and nephrolithiasis and principles of lithotripsy

8. Normal and abnormal blood pressure regulation 9. Clinical pharmacology, including drug metabolism and

pharmacokinetics and the effects of drugs on renal structure and function

10. Nutritional aspects of renal disorders 11. Immunology including basic principles, immunologic mechanisms of

renal disease and basic aspects of diagnostic laboratory immunology relevant to renal diseases

12. Renal transplantation which must include biology of transplant rejection, indications for and contraindications to transplantation, principles of recipient evaluation and selection, principles of donor evaluation, histocompatibility testing, principles of organ harvesting, preservation and sharing and psychosocial aspects of organ donation and transplantation.

13. Dialysis and extracorporeal therapy including kinetic principles of hemodialysis and peritoneal dialysis, dialysis indications, complications and management of each mode of dialysis, principles of dialysis access, urea kinetics and protein catabolic rate, nutritional management of dialysis patients, reuse of artificial kidneys, artificial membranes used in hemodialysis and biocompatibility, and psychosocial and ethical issues of dialysis.

14. Geriatric renal medicine including physiology and pathology of aging kidney and drug dosing and renal toxicity in elderly patients.

15. Principles of staging of chronic kidney disease and DOQI guidelines. 16. The regulations and guidelines set forth by agencies regarding end-

stage renal disease and the utilization of dialysis and transplant services.


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IV. Specific Faculty Requirements

There must be a minimum of two faculty members one of which must be certified in nephrology by the AOA through the American Osteopathic Board of Internal Medicine and the other eligible for examination in nephrology by the AOA or ABMS. A minimum of two faculty members must be actively engaged in the teaching program, have the majority of their clinical practice at the primary training institution and be members in good standing of the medical staff. The minimum faculty/fellow ratio must be one faculty to one fellow. The faculty must adhere to the Code of Ethics of the AOA. The Chairman of the Department of Internal Medicine must assure that the nephrology Program Director is adequately overseeing the program and seeing that the stated goals and objectives are being met. The Program Director must have sufficient dedicated time to administer the training program and must be compensated in some form.

internal medicine specific requirements for nephrology

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