nephrology fellowship guide...

1

General Nephrology

1) GoalFellows will become competent in caring for patients with general nephrology problems.

2) Objectives Detailed objectives for general nephrology are described in the General Nephrology table. There are 4 separate tables that address objectives for each rotation on general nephrology. A rotation is defined as a 6-month period, so there are separate objectives for the 1st, 2nd, 3rd and 4th 6-month rotations. These objectives reflect a progressive increase in expectations for fellows' competency achievement. While these are discussed in detail in the table, the essence of the objectives for each 6-month rotation are as follows: 1. Months 1-6 - Fellows function at least a the level of accurate reporting of the history, physical and

other data, i.e., they correctly recall and state the relevant facts. Fellows begin to understand orcomprehend this information, reviewing and reporting the relevant facts in an organized andefficient manner. Fellows begin to describe how to apply this information to make diagnostic andtherapeutic decision.

2. Months 7-12 - Fellows are able to accurately interpret the history, physical examination and data.The information is analyzed and an accurate differential diagnosis is formulated. Fellows are able toperform urinalysis accurately. Fellows continue in their abilities to design a diagnostic plan andtherapeutic interventions.

3. Months 13-18 - Fellows are able to correctly manage general nephrology patient care. This extendsprevious expectations to formulating a correct diagnostic plan, making the correct diagnosis. Theyshould be beginning to critically analyze literature relevant to the care issues.

4. Months 19-24 - Fellows are competent in all six core competencies. They function as self-educators, reading and analyzing the literature, and adjusting their care based on this analysis.They also function as educators in a larger context, using their clinical experience and informationthey have obtained from the literature to teach their colleagues, staff and faculty.

3) Types of clinical encounters and supervision1. Inpatient general nephrology encounters – Fellows spend 6 months/year on the inpatient general

nephrology service, 3 months at the UH and 3 months at the VAMC. The Fellows have directpatient care responsibilities for all Nephrology Service inpatients at the UH and VA, includingtransplant and dialysis patients. The Fellow is the first person from the Nephrology Service toevaluate a new inpatient, including a history, physical examination, and urinalysis (the latter faculty-supervised). The Fellow follows all nephrology inpatients with daily history and examinations and,after discussion with faculty, charts recommendations or writes orders. The Attending conductsdidactic sessions each day on material relevant to the in-house cases. The Fellow is responsible forarranging outpatient renal follow-up and for providing a dictated discharge summary for use in renalclinic. The Attending is on-call with the Fellow 24 hours a day.

2. Outpatient encountersa. UH General Nephrology Clinic - Each Thursday or Monday morning (Fellows are assigned to

specific days for the duration of their training) from 8:30 AM - noon, all Fellows, regardless ofrotation, attend a general nephrology clinic at the University covering all aspects of nephrologyexcept transplantation and dialysis. Patients are assigned to Fellows and followed on acontinuity basis throughout their fellowship (2 years for clinical fellows and three years forresearch fellows). The clinics are staffed by Drs. Kohan and Raphael on Mondays and by Drs.Gregory and Abraham on Thursdays who are there solely to supervise and train the Fellows.Each Fellow is given 1/2 hour for follow-up visits and 1 hour for new patients.

b. VA General Nephrology Clinic – Each Tuesday afternoon from 12:30-4:30 PM, the Fellow basedat the VA and internal medicine resident assigned to the Nephrology services at UH attend ageneral nephrology clinic at the VA covering all aspects of nephrology except transplantation anddialysis. Typically, other residents or interns on VA outpatient rotations attend this clinic. The

2

patients are followed on a non-continuity basis. All patients are presented to the VA Nephrology Attending who is in the clinic solely to supervise and teach.

4) Patient characteristics (number, demographics)1. Inpatients - The average inpatient General Nephrology census is 15-25 patients at UH and 6-8

patients at the VA (these numbers include dialysis patients). Approximately 30% of inpatients are inthe intensive care units at both hospitals. Ninety percent of VA patients are male (mean age – 58years) and 10% are female (mean age – 49 years); the SLVAMC has the widest geographic referralarea of any VA in the nation and sees a broad spectrum of general nephrology problems.Approximately 50% of UH patients are male; ages for both sexes range from 20-90 years. BecauseSalt Lake City is situated over 400 miles from any other city with a major medical center, it receivesa wide variety of referrals with an extremely broad range of renal disorders covering all aspects ofgeneral nephrology. In addition, genetic diseases are prevalent in this region providing atremendous learning opportunity..

2. Outpatientsa. UH General Nephrology - Over the course of two years, each Fellow will follow a total of

approximately 150 general nephrology patients on a continuity basis. These patients come fromIdaho, Utah, Nevada, Wyoming, Colorado, and Montana. All aspects of general nephrology arerepresented with equal numbers of male:female patients and ages ranging from 20-90 years.The majority of patients are Caucasian, however there are significant numbers of Hispanic,Native American, and South Pacific (Tonga and Samoa) patients. African American patients areseen although they represent the smallest minority. The General Nephrology clinic see about 6-7 patients per clinic.

b. VA General Nephrology Clinic – An average of 15 patients are seen in each clinic on a non-continuity basis. Demographics are similar to those for SLVAMC inpatients. A broad range ofrenal disorders are seen with particular emphasis on diabetes, hypertension, renal vasculardisease, urinary tract obstruction, drug toxicity, primary glomerulopathies, and collagen vasculardiseases.

5) Procedural training (see General Nephrology Table)1. Percutaneous biopsy of native kidneys – Performed by the Fellow on inpatients on their inpatient

service at UH, outpatients they follow on a continuity basis, and VA outpatients when the Fellow isbased at the VA. Fellows perform about 10-20 native renal biopsies yearly.

2. Urinalysis – Performed by the Fellow on most new inpatients and outpatients, and on follow-upevaluation as necessary.

3. Renal ultrasound – Fellows observe these during all renal biopsies.4. Lithotripsy – Performed by the Urologists. Fellows are given didactic instruction in its use,

indications, complications and outcomes.5. Therapeutic plasmapheresis – Fellows are trained in its indications, contraindications and

outcomes, and are supervised by Nephrology faculty.

6) Teaching methods (see General Nephrology Table)1. Educational training

a. Handouts - At the beginning of the Fellowship, Fellows are given several books and access toUpToDate. The books include: Clinical Nephrology (Johnson and Feehally), NKF Primer onKidney Diseases, and Urinalysis (Sister Laurine Graff). Recent articles may be provided at thebeginning of the Fellowship on interpretation of urine electrolytes and osmolality, management ofthe nephrotic syndrome, diagnostic strategies in disorders of fluid, electrolyte and acid-basehomeostasis, clinical disorders of water metabolism, nondialytic management of acute renalfailure, hypokalemic and hyperkalemic states, clinical findings and therapy of glomerulonephritis,hyponatremia and hypernatremia, pathogenesis and treatment of kidney stones, prevention ofprogression in chronic renal disease, pathophysiology of chronic renal failure, diagnosis of acuteglomerulonephritis, management of urinary tract infections in adults, and medical management ofdiabetic nephropathy, and other areas.

3

2. Didactic sessionsa. Weekly didactic conference – General nephrology issues are covered in detail in the didactic

conference held each Friday from 11:30-12:30 PM for 2 years. This conference is based onClinical Nephrology (Johnson and Feehally) and other sources. The Fellows are responsible forreading the assigned material in advance - a yearly schedule is provided. During the session, afaculty member facilitates discussion of the assigned material. A total of 85-90 sessions are heldcovering dialysis, renal transplantation, renal physiology, fluid and electrolyte disorders,glomerulopathies, interstitial nephritis, renal diseases of pregnancy, congenital urinary tractmalformations, acute and chronic renal failure, inherited renal diseases, primary and secondaryhypertension, nephrolithiasis, radiologic imaging of the kidney, surgical and radiologic issuesrelevant to vascular access, ESRD economics, epidemiology, statistics, study design, informedconsent, psychosocial aspects of ESRD, special issues of the elderly and others. In addition,fellows receive a series of 4 lectures on biostatistics. Finally, 4 sessions each year are devotedto NephSap review. Fellows and the assigned faculty review the questions in NephSAP(Nephrology Self-Assessment Program) distributed by the American Society of Nephrology. Inadvance of this meeting, the Fellows meet with a designated faculty who is expert in theparticular topic to review the text (typically around 50 pages of NephSAP text on which thequestions are based).

b. Primer Course: At the beginning of the Fellowship, a course (held over several days for a fewhours each day) is given to provide trainees with a basic level of instruction regarding severalissues in Nephrology. While it is geared primarily towards a basic level of instruction regardingtopics in Nephrology that the fellow is unlikely to have covered during residency and will need tounderstand at the outset of their fellowship (mechanics of dialysis and transplant protocols),some general nephrology issues are discussed.

3. Conferences – Fellows must attend the following conferences:a. Nephrology Clinical Conference – held every other Wednesday from 4-5 PM. The conference is

divided into cycles of 4 weeks each:1) Journal club (1 week out of the cycle) - This consists of a journal club in which fellows and

faculty briefly present an article of interest from the current literature. Fellows review assignedjournals, identify and read important articles, and discuss these with faculty. All majornephrology journals are covered as well as some general research and clinical journals.

2) Case presentations (2 weeks out of the cycle) - Fellows and residents on the NephrologyService prepare a 25 minute presentation including 5-10 minutes of case presentationfollowed by 15-20 minutes for review of relevant literature. Discussants pick the topic at leastone week in advance and review their selection with their Attending. The discussant handsout one good review or original article, however their discussion should be based, at least inpart, on review of original literature. The goal is to cover in-depth one, focused area pertinentto the case. In doing so, Fellows are closely critiqued and advised on interpretation of originalarticles, including study design, methods and data interpretation. Each Fellow presents oncea month and keeps a log of cases they presented.

3) Board review/NephSap (every three months) – the latest American Society of NephrologyNephrology self-assessment module is reviewed.

4) Transplant grand rounds (every other month) – Transplant cases are presented followed by adiscussion by the transplant nephrologists.

5) Morbidity and Mortality conference (every three months) - Fellows and faculty present M&Mcases that were encountered over the past 2 months. Correctable problems are identified andaction plans initiated as appropriate. Fellows send potential M&M cases to the TrainingProgram Director, Dr. Kohan, in advance of the meeting so that appropriate cases can beidentified, including those that require more immediate attention. This conference is heldevery other month. Fellows keep a log of cases they presented.

b. 5 PM Nephrology Conference – held each Wednesday from 5-6 PM. About 70% of theconferences are based on local or visiting faculty research, while the remaining 30% are an in-depth review of clinical topics by the faculty.

4

c. Renal Pathology Conference - held each Friday from 12:30-1:30 PM during the two years. Allbiopsies performed at University Hospital are reviewed as well as interesting historical cases.The conference is led by the Renal Pathologist using a multi-headed microscope and is attendedby all Fellows. Renal biopsies performed at the VA are reviewed by the Fellow, Attending andVA Renal Pathologist independent of this conference.

4. Inpatient attending rounds – See under Types of Clinical Encounters above.

7) Assessment and evaluation of Fellows (see General Nephrology Table)1. Clinical encounters – A variety of instruments are used to assess Fellow performance. The specific

evaluation utilized is indicated in the General Nephrology Table. These include:a. Checklist

1) Fellows are evaluated at the end of each 2-week block with a given attending. The attendinguses a scale from 1-9 to assess patient care knowledge, skills, attitudes and behaviors.Fellows review these orally with the attending and both individuals sign the review form. Ifthere is any significant issue, the attending immediately communicates this to the ProgramDirector who meets with the attending and fellow to develop an action plan to address theissue. The Fellow’s performance in this area is then reassessed, by Checklist by the inpatientattendings, in one month and reviewed with the Program Director. During the first 6 months offellowship, all scores must be "5" (satisfactory) or higher; scores under this will be reviewedwith the Program Director, specific problem areas identified, and the appropriate correctiveaction taken. The problem areas are re-evaluated in one month. During the second 6 months(7-12 months of training), scores must average "6" or over; during the third 6 months (13-18months of training), scores must average "7" or over; and during the fourth and final 6 months(19-24 months), scores must average "8" or above. If these ratings are not obtained, the samesteps are taken as discussed above.

2) Fellows are evaluated by the Program Director every 6 months. First, the goals and objectivesof the upcoming 6-month general nephrology rotation are reviewed. The Director uses a scalefrom 1-9 to evaluate the Fellow’s patient care, medical knowledge, professionalism,interpersonal and communication skills, practice-based learning and improvement, andsystems-based practice as it pertains to general nephrology. Fellows review this with theProgram Director. The evaluation is based on review of the attending checklists, 360 degreeevaluations (see below), and any other pertinent information. If any significant issues exist, anaction plan is developed and the fellow re-evaluated by the Program Director in 6 monthsusing the same evaluation measurements as above. Importantly, this evaluation is also basedon semi-annual discussions between all the clinical faculty and the Program Director. Inaddition, even if no significant issues are identified, goals are established for the fellow to workon over the next 6 months. These goals typically do not reflect needed attention to sub-parperformance, but instead are intended to help the Fellow focus efforts. For example, facultymay note that the fellow did relatively few native kidney biopsies or that attending commentsreflected a need to increased general nephrology knowledge base – appropriaterecommendations to work on these areas would be made, and progress evaluated at the nextsemi-annual Program Director review.

b. Multi-source evaluation – this evaluation is completed by administrative assistants, secretaries,renal social workers, renal dieticians, nurses, pharmacists, technicians, nurse practitioners,physician assistants, and residents on the renal rotation in order to give a broad sense of howthe Fellow delivers patient care and interacts with members of the general nephrology healthcare interdisciplinary team. It is completed every 6 months. Fellows review this with the ProgramDirector. Problem areas (scores under "5") are identified and an action plan developed. Fellowsare reassessed in 6 months with particular attention to these problem areas.

c. Patient surveys – Over the course of the year, all patients in continuity clinic are asked tocomplete a form rating Fellow’s general nephrology clinic patient interaction. These are reviewedsemi-annually with the Program Director. Areas in need of improvement (defined as greater than5% of patients responding negatively) are identified and reassessed, by patient survey, within 3months.

5

d. Written exam – In the spring of first year, Fellows take the American Society of Nephrology In-Training Examination. Their performance is reviewed with the Program Director. Generalnephrology areas in need of improvement (defined as missing more than 2 questions in thatarea) are identified and an action plan is developed to address these. Fellow’s fund of knowledgein these areas is reassessed in 6 months by performance on the relevant NephSAP, if available,or by questioning by the Program Director.

e. Resident portfolio – This is partly intended to evaluate Fellow’s practice-based learning andimprovement. Several approaches are utilized:

1) Faculty or fellow-initiated CQI project. The Fellow catalogues over time questions andissues that arose during patient care activities and identifies, with a faculty mentor, andissue to address. Once identified, an action plan is developed, the rationale expound(including identifying data sources used), actions taken, and the effect of suchinterventions assessed. This is reviewed every 6 months with the Program Director andthe faculty mentor.

2) Morbidity and mortality conference. Identification of practice and/or system-basedproblems contributing to morbidity and mortality is an important aspect of meeting thesecore competencies. Fellows attendance at these conferences, and identification of theissues discussed and actions taken, is documented and included in the portfolio.

3) Case-based presentations. Each fellow does approximately 8 case-based presentationsyearly. These presentations assist in improving the fellow's practice, detailing how theyresearched a topic and how such research impacted their care, or plan for subsequentcare. The topics covered are listed in the portfolio and the presentation itself is added tothe reference database in the web-based "Fellows Lounge" on the Nephrology Divisionwebsite. This latter activity helps improve the practice of all fellows and faculty.

4) Journal club. Each fellow does approximately 8 journal club presentations yearly. Thearticle that they presented is listed in the portfolio. This helps document the fellow'scommitment to improving their analysis of the literature relevant to care of their patients.

5) Log of adverse events and actions taken. Fellows keep a computer log of this,independent of their M&M presentations.

6) Summative evaluations. All summative fellow evaluations are included in the portfolio toenable the fellow to review their progress and facilitate making any necessary changes.While this information can largely be obtained by each fellow using their unique logonaccess to the web-based evaluation system (MyEvaluations.com), having a written listfacilitates discussion with, and review by, the Program Director.

7) Procedures. All procedures completed are listed here - see details in following section.8) Self-evaluation. Fellows complete a self-assessment every 6 months that is reviewed with

them by the Program Director.f. Mini-clinical examination (Mini-CEX) – These are given about 4 times during the first year, in the

inpatient and outpatient setting, to provide formative input on the fellow’s progression towardsobtaining clinical competence relevant to general nephrology patient care.

2. Procedures – Fellows are required to keep a log of all native kidney biopsies, indicating date,attending, patient identifier, indication and complications. Fellows are required to perform at least 5native biopsies per year. These biopsies are always done in the presence of an attending,regardless of fellow competency and experience. Fellows are not required to keep a log ofurinalyses, but must be certified as competent in these by the Program Director, based on facultyinput, prior to being able to conduct these unsupervised.

3. Conferences – Fellows attendance at conferences is documented as described above. Participationin journal clubs, M&M, case-based presentations, and Landmark articles review, as they relate togeneral nephrology, is discussed with the Program Director during the 6-month evaluation.

4. Final (summative) evaluation - This evaluation includes a review of the Fellow’s performance duringthe final period of education, and verifies that the Fellow demonstrated sufficient professional abilityto practice competently and independently

8) Assessment and evaluation of attendings by Fellows - discussed in section below devoted to this topic.

6

General Nephrology Table - Months 1-6

Competency category

Competency objectives General Nephrology objectives relevant to competency Teaching Methods Evaluation Methods

Acceptable Performance

Patient care Exhibit caring and respectful behaviors

Exhibit caring and respectful behaviors towards general nephrology patients

Attending teaching Conferences Orientation Core lectures

Patient surveys 360 evaluation Checklist Mini-CEX

≤10% unacceptable ≥ 5 ≥ 5 Formative

Gather essential and accurate information about their patients

Gather essential information about fellow’s general nephrology patient

Attending teaching Conferences Core lectures

Checklist 360 evaluation Mini-CEX

≥ 5 ≥ 5 Formative

Make informed decisions about diagnostic and therapeutic interventions

Begin to understand the basics of making informed decisions about diagnostic and therapeutic interventions in general nephrology patients


Checklist ≥ 5

Develop and carry out patient management plans

Begin to develop general nephrology patient management plans


Checklist 360 evaluation

≥ 5 ≥ 5

Counsel and educate patients and families

Counsel and educate, with direct attending supervision, general nephrology patients and families with regard to their disease, socioeconomics, support systems, diet, lifestyle, medications




Use information technology

Use information technology to assist caring for general nephrology patients, including UpToDate, NIH information and databases, NephSAP, electronic medical records, PubMed, and other sources

Attending teaching Orientation Conferences

Checklist ≥ 5

Perform: Physical exam

Examine the general nephrology patient, particularly with regard to the renal examination and organ systems affected by renal dysfunction


Checklist Mini-CEX

≥ 5 Formative

Perform: Procedures

Understand the principles of informed consent, indications, contraindications, alternative procedures, and the risks and benefits, and understand the correct procedural techniques for: 1. Percutaneous native renal biopsyUnderstand interpretation and the correct technique for: 2. Urinalysis


Checklist ≥ 5

Provide preventative health care services

Understand preventative health care services relevant to general nephrology patients

Conferences Attending teaching

Checklist ≥ 5

Work within a team of health care professionals

Work within the general nephrology health care team, including attendings, nurses, dieticians, social workers, physician extenders, pharmacists and administrative assistants

Conferences Attending teaching Orientation


≥ 5 ≥ 5

7

Medical knowledge

Demonstrate investigatory and analytic thinking about clinical situations

Begin to demonstrate investigatory and analytic thinking about clinical general nephrology situations

Attending teaching Core lectures Conferences Journal club Clinical meetings Orientation

Checklist Mini-CEX

≥ 5 Formative

Know and apply the basic and clinically supportive sciences

Fellows will gather the data and begin to develop the fund of knowledge necessary for prevention, evaluation, and management of general nephrologic disorders in: a. Acute renal failureb. Chronic renal failurec. Fluid, electrolyte, and acid-base disordersd. Disorders of mineral metabolism including nephrolithiasis and renal

osteodystrophy (including use of lithotripsy)e. Urinary tract infections and pyelonephritisf. Hypertensive disordersg. Renal disorders related to pregnancyh. Primary and secondary glomerulopathies, including understanding of

immunologic mechanisms of renal disease and the laboratory testsnecessary for their diagnosis

i. Diabetic nephropathyj. Tubulointerstitial nephritis including papillary necrosisk. Genetic and developmental renal diseases including renal cystic

diseases, hereditary glomerulopathies and interstitial nephritis,phakomatoses, systemic diseases with renal involvement, congenitalmalformations of the urinary tract, maternally inherited mitochondrialdiseases, and renal cell carcinoma

l. Vascular diseases including atheroembolic diseasem. Disorders of drug metabolism and renal drug toxicity, including in

geriatric patientsn. Renal disorders associated with geriatric patientso. Renal cystic diseases without a recognized genetic basisUnderstand nutritional management of general nephrologic disorders Understand indications and interpretation of renal imaging, including

ultrasound, CT, IVP, MRI, angiography, nuclear medicine studies Understand indications, complications and outcomes in therapeutic

plasmapheresis

Attending teaching Core lectures Conferences Journal club Clinical meetings Orientation

Checklist Mini-CEX

≥ 5 Formative

8

Practice-based learning and improvement

Analyze own practice and perform practice-based improvement using a systematic methodology

Fellow will hold up a mirror to themselves to document, assess, and improve their practice. This will involve: a. Monitoring their practiceb. Reflecting on or analyzing their practice to identify learning

or improvement needsc. Begin a learning or improvement plan

Attending teaching Case-based presentations

on fellow’s own pts. Journal club Participation in CQI activities Exit rounds on patient

discharge M&M on fellow’s own

patients Conferences Log of significant events and

plan to address Assigned faculty mentor PIM

Resident portfolio (Fellow catalogues over time questions and issues that arose during patient care activities along with copies of the data sources used, and actions taken, to address the specific question or issue).

6 case-based talks* 6 journal clubs* 1 M&M* ≥ 5 on checklists Log of 1 significant event and how addressed CQI project started

*Conferenceperformance evaluated by TPD

Use evidence from scientific studies related to patients’ health problems

Use evidence from scientific studies related to general nephrology patients’ health problems


on fellow’s own pts. Journal club

Checklist ≥ 5 Formative

Apply knowledge of study designs and statistical methods to appraising clinical studies and other information

Begin to understand study designs and statistical methods to appraising clinical studies and other information

Statistics and epidemiology course

Conferences Journal club Assigned faculty mentor



Use information technology as itemized in Patient Care above Attending teaching Orientation Conferences

Checklist Resident portfolio

≥ 5 See “Analyze own practice…” above

Facilitate the learning of others

Facilitate the learning of others, including, residents, fellows, physician extenders, nurses and dialysis technicians. Initially, this is based on assigned literature review.

Role models Attending teaching Conferences


≥ 5 ≥ 5

Interpersonal & communication skills

Maintain a therapeutic and ethical relationship with patients

Maintain a therapeutic and ethical relationship with general nephrology patients

Role models Attending teaching Conferences Core lectures

Checklist 360 evaluation Patient surveys

≥ 5 ≥ 5 ≤10% unacceptable

Demonstrate effective listening and writing skills

Demonstrate effective listening and writing skills Role models Attending teaching



9

Professionalism Demonstrate respect, compassion, and integrity

Demonstrate respect, compassion, and integrity Role models Attending teaching

Checklist 360 evaluation Patient surveys Mini-CEX

≥ 5 ≥ 5 ≤10% unacceptable Formative

Demonstrate an ethically sound practice

Demonstrate an ethically sound practice Role models Attending teaching Conferences


≥ 5 ≥ 5

Demonstrate sensitivity to patients’ culture, age, gender, and disabilities





Systems-based practice

Understand interaction of their practices with the larger system

Begin to understand interaction between fellow’s practice and the hospital and clinic staff, administration, surgical service, radiology, and medical consult services


360 evaluation ≥ 5

Understand types of medical practice and delivery systems

Begin to understand how types of general nephrology practice and providers deliver care


Checklist ≥ 5

Practice cost-effective health care

Begin to understand how to practice cost-effective general nephrology patient care

Conferences Core lectures Attending teaching


≥ 5 ≥ 5

Advocate for quality patient care

Begin to understand how to advocate for general nephrology patient quality care

Attending teaching Participation in CQI Conferences


≥ 5 ≥ 5

10


Competency category






Patient surveys 360 evaluation Checklist Mini-CEX

≤10% unacceptable ≥ 6 ≥ 6 Formative







Synthesize data to begin to make informed decisions about diagnostic and therapeutic interventions in general nephrology patients




Develop general nephrology patient management plans. Understand how to carry out such plans.





Counsel and educate general nephrology patients and families with regard to their disease, socioeconomics, support systems, diet, lifestyle, medications






Attending teaching Conferences

Checklist ≥ 6




Checklist Mini-CEX

≥ 6 Formative

Perform: Procedures

Understand the principles of informed consent, indications, contraindications, alternative procedures, and the risks and benefits, and demonstrate the correct procedural techniques for: 1. Percutaneous native renal biopsyUnderstand interpretation and demonstrate the correct technique for: 2. Urinalysis


Checklist ≥ 6 Perform at least 5 native renal biopsies by end of year 1


Provide preventative health care services relevant to general nephrology patients







≥ 6 ≥ 6

11

Medical knowledge


Demonstrate investigatory and analytic thinking about clinical general nephrology situations

Attending teaching Core lectures Conferences Journal club Clinical meetings

Checklist ASN In-training

examination

≥ 6 Formative

Formative


Fellows will continue to acquire the fund of knowledge necessary for prevention, evaluation, and management of the general nephrologic disorders below. They will begin to apply this information. a. Acute renal failureb. Chronic renal failurec. Fluid, electrolyte, and acid-base disordersd. Disorders of mineral metabolism including nephrolithiasis and renal








plasmapheresis


Written exam

Mini-CEX

≤4 incorrect in each general nephrology Area Formative

12




or improvement needsc. Engaging in a learning or plan improvement







12 case-base talks* 12 journal clubs* 2 M&M* ≥ 6 on checklists Log of 2 significant events and how addressed CQI project data analyzed and improvement plan developed






ASN In-training examination

Formative






Formative






Facilitate the learning of others, including faculty, residents, fellows, physician extenders, nurses and dialysis technicians



≥ 6 ≥ 6











13








≥ 6 ≥ 6








Understand interaction between fellow’s practice and the hospital and clinic staff, administration, surgical service, radiology, and medical consult services




Understand how types of general nephrology practice and providers deliver care



Formative


Understand cost-effective general nephrology patient care and begin to apply these principles

Conferences Core lectures Attending teaching


≥ 6 ≥ 6


Advocate for general nephrology patient quality care by demonstrating proactive efforts towards general nephrology patient care



≥ 6 ≥ 6

14


Competency category






Patient surveys 360 evaluation Checklist

≤10% unacceptable ≥ 7 ≥ 7





≥ 7 ≥ 7


Make informed decisions about diagnostic and therapeutic interventions in general nephrology patients


Checklist ≥ 7


Develop and carry out general nephrology patient management plans



≥ 7 ≥ 7





≥ 7 ≥ 7




Checklist ≥ 7




Checklist ≥ 7

Perform: Procedures



Checklist ≥ 7




Checklist ≥ 7





≥ 7

15

Medical knowledge




Checklist ≥ 7


Fellows will acquire the fund of knowledge necessary for prevention, evaluation, and management of general nephrologic disorders in: a. Acute renal failureb. Chronic renal failurec. Fluid, electrolyte, and acid-base disordersd. Disorders of mineral metabolism including nephrolithiasis and renal








plasmapheresis


Checklist ≥ 7

16




or improvement needsc. Engaging in a learning or plan improvementd. Applying the new learning or improvement







18 case-base talks* 18 journal clubs* 3 M&M* ≥ 7 on checklists Log of 3 significant events and how addressed CQI project - intervention/begin data analysis






Checklist ≥ 7





Checklist ≥ 7






Facilitate the learning of others, including faculty, residents, fellows, physician extenders, nurses and dialysis technicians



≥ 7 ≥ 7










≥ 7 ≥ 7

17








≥ 7 ≥ 7














Checklist ≥ 7


Practice cost-effective general nephrology patient care Conferences Core lectures Attending teaching


≥ 7 ≥ 7


Advocate for general nephrology patient quality care by demonstrating proactive efforts towards dialysis CQI



≥ 7 ≥ 7

18


Competency category






Patient surveys 360 evaluation Checklist

≤10% unacceptable ≥ 8 ≥ 8





≥ 8 ≥ 8


Make informed decisions about diagnostic and therapeutic interventions in general nephrology patients


Checklist ≥ 8


Develop and carry out general nephrology patient management plans



≥ 8 ≥ 8





≥ 8 ≥ 8




Checklist ≥ 8




Checklist ≥ 8

Perform: Procedures



Checklist ≥ 8 Perform at least 10

native renal biopsies by end of year 2




Checklist ≥ 8





≥ 8

19

Medical knowledge




Checklist ≥ 8


Fellows will acquire the fund of knowledge necessary for prevention, evaluation, and management of general nephrologic disorders in the areas below. They will serve as educators for other fellows, faculty and staff in these areas, whenever possible. a. Acute renal failureb. Chronic renal failurec. Fluid, electrolyte, and acid-base disordersd. Disorders of mineral metabolism including nephrolithiasis and renal








plasmapheresis


Checklist ≥ 8

20



Fellow will hold up a mirror to themselves to document, assess, and improve their practice. This will involve: a. Monitoring their practiceb. Reflecting on or analyzing their practice to identify learning or

improvement needsc. Engaging in a learning or plan improvementd. Applying the new learning or improvemente. Monitoring the impact of the learning or improvement







24 case-base talks* 24 journal clubs* 4 M&M* ≥ 8 on checklists Log of ≥4 significant events and how addressed CQI project - analysis & reporting






Checklist ≥ 8





Checklist ≥ 8


Use information technology as itemized in Patient Care above Attending teaching Conferences




Facilitate the learning of others, including faculty, residents, fellows, physician extenders, nurses and dialysis technicians. The degree of such education is one of the main differences from the preceding six months.



≥ 8 ≥ 8










≥ 8 ≥ 8

21








≥ 8 ≥ 8











≥ 8 ≥ 8




Checklist ≥ 8


Practice cost-effective general nephrology patient care Conferences Core lectures Attending teaching


≥ 8 ≥ 8


Advocate for general nephrology patient quality care by demonstrating proactive efforts towards dialysis CQI



≥ 8 ≥ 8

nephrology fellowship guide...

Documents