rush university medical center fellowship in nephrology

Rush University Medical CenterFellowship in Nephrology

Policy ManualTraining Program Description

& Curriculum

Roger A. Rodby, M.D.Nephrology Fellowship Program Director1426 W. Washington Blvd.Chicago, IL 60607

312-850-8434312-850-8431 (fax)

[email protected]

Updated: June 8, 2004

2Table Of Contents: Page

General Fellowship Description 4

Faculty 5

Basic Policies 6-9

• Recruitment and applications 6• Promotion 6• Work environment 6• Meetings 6-7• Books 7• Supervision 7• Job Descriptions by level 7• Duty hours and On-call 7• Moonlighting 7• Absence 7-8• Preceptors 8• Evaluations 8• Vacations and new child leave 8-9• Gifts to physicians from industry 9

Detailed Description of Fellowship

• Hemodialysis 10-11• Peritoneal dialysis 11-12• Clinical Service 12• Pediatric Nephrology 12-13• Transplantation 13-14• Renal Pathology 14• Out-Patient General Nephrology Clinic 14-15• Conferences

o Clinical Conference 15o Journal Club 16o Biopsy Conference 16o Renal Radiology 16

• Lectures 16-17• Research 17• Procedures 17

Curriculum 18-19

Core Curriculum 20

3Appendices

A: Resident Duty Hours and Working Environment 21-22

B: Job/Procedure Descriptions 23

C: Research Proposal Form 24

D: Procedure Log 25

E: Goals and Objectives of Clinical Service 26-27

F: Goals and Objectives of Transplantation Rotation 28

G: Goals and Objectives of Chronic Hemodialysis Rotation 29H: Goals and Objectives of Peritoneal Dialysis Rotation 30

I: Goals and Objectives of Pediatric Nephrology Rotation 31

J: Goals and Objectives of Renal Pathology Rotation 32

K: Policy on Gifts to Physicians from Industry 33-34

L: Maternity/Paternity/Family Leave Policy 35-36

M: Policy on Expenses for Fellows attending Meetings 37

Evaluation Forms

Rotation Evaluation of Nephrology Fellows 38-39

Fellows Annual Evaluation of Attending Physicians 40-41

Fellows Annual Evaluation of Nephrology Fellowship Program 42-43

4General Fellowship Description

The Rush University Medical Center (RUMC) Nephrology Fellowship Training Program is an

ACGME accredited 2-year program designed to train Fellows for the practice of Clinical Nephrology

and Clinical Nephrology Research. On average, three Fellows are recruited each year with the total

program consisting of 6 Fellows.The Fellowship program has in-patient rotations at RUMC (the major teaching hospital for Rush

Medical College). The Fellowship has out-patient rotations at 1426 W. Washington Blvd, located about

1/4 of a mile from the RUMC complex. This address houses the Section of Nephrology’s Academic

offices and is the site of 1) Circle Medical Management (CMM), the dialysis facility affiliated with

RUMC, and 2) Edmund J. Lewis & Associates (EJL & Assoc) the practice offices of the Section of

Nephrology’s Attending Staff. A number of out-patient rotations occur at 1426 W. Washington

including chronic hemodialysis, chronic peritoneal dialysis clinic, and the general nephrology

consulation clinics. Out-patient transplant clinics occur at the offices of the Department of Surgery’s

Section of Transplantation at RUMC.

There are adjunctive (non-patient visiting) offices on the 5th floor of the Rawson Building of the

RUMC complex.

5Faculty

RUMC Nephrology

Roger A. Rodby, M.D.: Fellowship Program Director, Associate Professor of Medicine, Attending

Physician, and Medical Director for Circle Medical Management’s acute dialysis program

Edmund J. Lewis, M.D.: Nephrology Section Director, Professor of Medicine and Attending Physician

Stephen M. Korbet, M.D.: Associate Section Director, Professor of Medicine, Attending Physician, and

Medical Director Circle Medical Management’s chronic dialysis program

Marvin Sinsakul, M.D.: Assistant Professor of Medicine, Attending Physician

William Whittier, M.D.: Assistant Professor of Medicine, Attending Physician

Samuel Saltzberg, M.D.: Assistant Professor of Medicine, Attending Physician, and Transplant

Nephrologist

RUMC Pediatric NephrologyFrank Assadi, M.D.: Professor of Pediatrics, Pediatric Attending Physician

and Medical Director RUMC Pediatric chronic and acute dialysis program

RUMC Renal PathologyMelvin Schwartz, M.D.: Professor of Pathology, Renal Pathologist

6Basic Policies

Recruitment and Applications: The Section of Nephrology accepts Fellowship applications only from

candidates that are presently in or have graduated from an American, university based, and 3-year

accredited Internal Medicine residency program. Residencies that are affiliates of a university but are

themselves not the main university residency program, do not qualify. Exceptions to this rule may be

made if the resident has 1) rotated as an elective on the RUMC Nephrology Consult Service, or 2)

rotated with a Nephrologist (from an outside program) that the Program Director knows professionally.

Candidates should be eligible to take the Board Examination in Internal Medicine at the time of starting

Fellowship in Nephrology.

Applications are available two years in advance of the proposed starting date of the Fellowship.

The program has a rolling admissions policy. Candidates can be offered positions as soon as theirapplications and personal interviews with the RUMC Nephrology Attending staff have been completed.

Applications are closed as soon as all the positions for a given year are filled.

Promotion: First year Fellows are promoted to the second year after satisfactory completion of the first

year. Non-renewal of a Fellow’s contract for the second year can only occur in accordance with the steps

required by the RUMC House Officer’s Agreement (contract) and must include failure to improve

during a probationary period of 60 days that has defined goals. Fellows that will not be offered contract

renewal for the second year must be given 120 days notice before the expiration of present contract.

Work Environment: The Fellowship complies with the RRC’s “Common Requirements for all Core

and Subspecialty Programs” for resident duty hours and the working environment (see Appendix A). In

addition: The Fellows are provided offices and desks at both the 5th floor of the Rawson building at

RUMC, and at the Offices of CMM and EJL & Assoc. at 1426 W. Washington. Both sites have

computers with high-speed internet access, Powerpoint software, and printers . The Section of

Nephrology provides the Fellows with dictaphones and a dictation transcription service. Beepers areprovided by the RUMC Department of Medicine.

Meetings: First year Fellows may attend a Nephrology Review Course e.g. “The Cleveland Clinic

Course” or one of the national Nephrology Board Review courses as determined by the Program

Director. The second year Fellows may attend the American Society of Nephrology (ASN) meeting. If

7the Fellow has an abstract accepted at a meeting other than the ASN, the Section may pay the expenses

to attend such meeting. See Appendix M for policy regarding expenses.

Books: At the beginning of the Fellowship, first year Fellows are provided copies of the following three

textbooks: “Handbook of Dialysis”, the “Handbook of Transplantation”, and “Clinical Physiology of

Acid-base and Electrolyte Disorders”.

Supervision: Supervision of the Fellows’ activities and procedures by Attending physicians is outlinedin each of the specific sections detailed below.

Job Description by Level: The complete job description by level is found in the document entitled

“Detailed job descriptions” (see Appendix B). As a rule, procedures are not performed without direct

participation with an Attending physician, until approved by an Attending.

Duty Hours and On-call: The Fellowship complies with the RRC’s “Common Requirements for all

Core and Subspecialty Programs” for resident duty hours and the working environment (see Appendix

A). The Fellow on the RUMC Clinical Service (see below) is on call for the entire month, except for

weekends which start 3:00 PM Fridays and last until 9:00 AM Mondays. Call is never “In-house” but

Fellows are expected to return to the hospital to see appropriate consults and admissions. The on-call

schedule including holidays is made by the Fellows and rotates with equal amounts of call among first

and second year Fellows.

Moonlighting: Moonlighting is allowed but must be approved by the program director (covered within

Appendix A).

Absence: Fellows need to arrange coverage if they are gone or unavailable during the time they are on

active rotations including Transplantation, Out-pt. Hemodialysis, Out-pt. peritoneal dialysis, or the

RUMC Clinical service. Any pre-arranged Fellow absences should be cleared with the appropriate

Attending for trainees absent from the Clinical and Transplantation services, or the Program Director for

Fellows absent from the Out-pt. Hemodialysis (HD) or Out-pt. Peritoneal dialysis (PD) services. A

memo or email with the dates and covering Fellow must be circulated. The Fellow needs to make sure

that the designated person is available and on-site. For instance, The Out-pt. PD Fellow can cover the

Out-pt. HD Fellow, but should be at the out-patient office site during the coverage time. The Fellow

8covering the unavailable Fellow should let the other service’s “charge” nurse know that they are

covering and available. Absence from Pediatric Nephrology and Renal Pathology should be cleared only

with the Program Director and Drs. Assadi or Schwartz. Fellows do not need to arrange coverage for

these two services.

Preceptors: Fellows are assigned a RUMC Attending physician who serves as a “preceptor” for a six-

month period. Over the course of the two-year Fellowship, the Fellow will have four different

preceptors. The Fellow has out-patient general nephrology clinic (see below) at the same time as his orher preceptor. Many Fellow based conferences (see below) are overseen by the Fellow’s preceptor.

Evaluations: After each monthly “service” rotation, the Fellow is evaluated by the Attending by filling

out a form based on the standardized ABIM evaluation form entitled “Evaluation of Subspecialty

Trainees” (pages 39-40). These monthly Fellow evaluations are reviewed by the Attending with the

Fellow and the Fellow’s signature is required. This should be done in a timely manner following the

rotation.

Fellows are evaluated by the Program Director every 6 months. A written report of this

evaluation is made, which is provided to and discussed with the Fellow. All evaluations are maintained

in the Fellow’s file and are made available to the Fellow by request.

Evaluations of the Attendings by the Fellows are done annually by filling out a form based on

the standardized ABIM evaluation form entitled “Evaluation of Attending Physician” (pages 41-42).

Each Fellow will evaluate each Attending. These forms are collected and reviewed by the Program

Director who will prepare a summary statement for each Attending which is distributed to the respectiveAttending. The goal is to maintain as much anonymity as possible, so that the Fellow feels comfortable

and will be frank with the process.

The Fellows evaluate the program yearly through the use of a form based on the standardized

ABIM form entitled “Fellow’s Annual Evaluation of a Subspecialty Training Program” (pages 43-44).

The Program Director meets with the “Chief Fellow” once a year to review and evaluate the

entire program and curriculum. Prior to this meeting, the Senior Fellow will have met with the other

Fellows to discuss and therefore represent their opinions on the curriculum. The Program Director then

meets with the Attending Staff to discuss potential curriculum changes.

Vacations and New Child leave: Each Fellow may take up to 4 weeks of vacation each academic year.

Fellows must make arrangements for coverage by another Fellow if they are away from the hospital

9during days that fall during a rotation when they have clinical responsibilities (see above paragraph

entitled “Absence”). See Appendix L for RUMC housestaff maternity and paternity/family leave policy.

Gifts to Physicians From Industry: It is the policy of the Section of Nephrology to teach the Fellows

the relevant issues related to interaction with industry in regards to gifts and meals etc. as can be offered

by representatives of the pharmaceutical as well as other medical provider industries that the trainee may

come in contact with (see Appendix K).

10Detailed Description of the Fellowship

The Fellowship program will prepare the trainee to practice all major areas of Nephrology. Thisis done through a number of mechanisms: In-patient and out-patient Clinical Service Rotations and

Clinics, Conferences and Lectures, and Clinical Research. The Section of Nephrology performs

approximately 1,500 new in-patient consults a year and oversees the delivery of approximately 4,500 in-

patient dialysis treatments a year.

HemodialysisTraining in hemodialysis is centered in both the in-patient (RUMC) and out-patient (CMM)

setting.

Out-patient hemodialysis: Fellows will spend 2-3 one-month blocks each year on the “Out-patient Hemodialysis Rotation” managing hemodialysis patients at CMM, the hemodialysis unit

affiliated with RUMC. All out-patient hemodialysis activities are supervised by Nephrology Attending

Physicians assigned to patients by shifts. Except for conferences and lectures, the Fellow will be present

at the HD unit from approximately 8:30 AM -5:00 PM, 5 days a week. Fellow responsibilities include,

writing and updating hemodialysis orders, evaluation and management of patients’ hemodialysisaccesses, dry weights, blood pressures and extracellular fluid balances, hemodialysis prescriptions,

nutritional status, osteodystrophy status, anemia status; and will review monthly and other non-routine

labs and cultures. The Fellow will also address and triage patient medical complaints. These issues are

identified and dealt with through daily rounds. Rounds may be made with or without the Attending

present. As a result of these patient evaluations, a monthly note is written on each patient by the Fellow,

which addresses blood pressure, osteodystrophy status, dialysis adequacy, nutrition, dialysis access, and

anemia. These notes are reviewed by the Attending with the Fellow. The Fellow will also meet with the

hemodialysis staff to review the water treatment facilities, the set-up and running of a dialysis machine.

The average size of the out-patient hemodialysis program is 120 patients.

Fellows on Out-pt. HD will also attend the monthly patient-care conferences. These are

multidisciplinary conferences attended by the head HD nurse, the on-site Social Worker, and the on-site

Dietician. An Attending physician runs the meeting. The purpose of this conference is to review all

medical, social and dietary issues that pertain to a patient on chronic hemodialysis. This review is done

twice yearly for each patient.

11In-patient hemodialysis: Fellows learn in-patient hemodialysis while on the Clinical and

Transplantation Services (see below). The Fellow learns to write orders for in-patients requiring

hemodialysis, determines the proper dialysate bath, anticoagulation protocol, fluid removal amount, time

on hemodialysis, blood flow rate, and the need for sodium modeling. The Fellow also manages the

accesses of these patients, either placing hemodialysis access or arranging placement when necessary.

The Fellow deals with all hemodialysis related problems that develop while a patient receives

hemodialysis. These include hemodynamic instability and poor access function.

Peritoneal DialysisTraining in peritoneal dialysis is centered in both the in-patient (RUMC) and out-patient (Circle

Medical Management, or CMM) setting.

Out-patient peritoneal dialysis: Fellows will spend 2-3 one-month blocks each year on the

“Peritoneal Dialysis Rotation” managing peritoneal dialysis patients at CMM. This is done through

formal Peritoneal Dialysis Clinics, in which peritoneal dialysis patients make out-patient visits on a

monthly basis. Patients are initially seen and examined by the Fellow who reports to an Attending

Physician and the case is discussed. Both the Fellow and the Attending Physician then see the patients

and appropriate changes are made in dialysis prescription to affect ultrafiltration or clearance. The

patient’s anemia and osteodystrophy management are reviewed and the treatment of a patient’s

peritonitis or exit site infection if applicable are reviewed. When new patients start peritoneal dialysis,

the Fellow will, in conjunction with the Attending, write orders for the patient that will be tailored to a

patient’s medical and lifestyle requirements. The Fellows on this service will observe peritoneal dialysis

staff based patient training for both CAPD and CCPD, and will become well versed in “connectology”.They will also learn about the diagnosis and out-patient treatment of peritonitis, the out-patient

evaluation of peritoneal transport, and peritoneal dialysis adequacy. They will review all labs and

cultures. The average size of the out-patient peritoneal dialysis program is 35 patients. The Fellows’

hours on this Service are 8:30 AM - 5:00 PM, 5 days a week.

Fellows on Out-pt. PD service will also attend the monthly patient-care conferences. These are

multidisciplinary conferences attended by the head PD nurse, the on-site Social Worker, and the on-site

Dietician. An Attending physician runs the meeting. The purpose of this conference is to review all

medical, social and dietary issues that pertain to a patient on chronic peritoneal dialysis. This review is

done twice yearly for each patient.

In-patient peritoneal dialysis: While on the Clinical service, the Fellow in conjunction with the

Attending on the Clinical Service will manage all peritoneal dialysis in the hospital. The issues related to

12the management of these patients may or may not be similar to those seen in the out-patient setting. This

Fellow/Attending team will make daily decisions that are required to manage these patients’ dialysis

prescriptions, as well as manage infectious and mechanical complications of the therapy. The average

number of peritoneal dialysis in-patients is 2.

In-patient Consultation and ManagementRUMC: Fellows will spend 2 one month blocks each year on the “Clinical Service” managing

all in-patients in which a patient is either admitted to a Nephrology Attending, or the Nephrology servicehas been consulted (excluding those patients whose Attending is a kidney or liver transplant surgeon, see

Transplant Service, below). Similar to all other in-patient services, there is a single Attending Physician

that works with the Fellow and is assigned to that service for the entire month. Rounds are made

together on all patients on a daily basis and start in the morning. New Consults or Admissions are

usually seen first by the Fellow and a Resident and are subsequently presented to the Attending. The

cases are then discussed with appropriate recommendations made. The team may also meet at 4:00 PM

on weekdays to discuss follow-up on issues identified during morning rounds, as well as to discuss new

consults that may have been seen.

This is a busy service with the average number of patients being followed by this service being

35, and the average number of new patients (either admissions or consults) being 5/day. Fellows on this

service are expected to return to the hospital to evaluate most Admissions and Consults that may

develop after normal working hours. There is no in-hospital “call”. The hour requirements of this service

depend solely on the patient load but have never exceeded that defined by the RRC’s duty hour limits.

The Fellow will be exposed to most aspects of in-patient Nephrology while on this Service. Thisincludes management of all electrolyte disorders, all forms and complications of acute and chronic renal

failure, all forms of renal replacement therapies including hemodialysis, peritoneal dialysis, and

continuous renal replacement, acute and chronic glomerulopathies, hypertension, pregnancy and renal

disease, and may perform any number of procedures (see below).

Pediatric NephrologyFellows will spend one month during their 2-year Fellowship rotating on the “Pediatric

Nephrology Service”, with Dr. Assadi, a full-time Pediatric Nephrologist in the Department of

Pediatrics. During that time they will become familiar with the differences between pediatric and adult

ESRD replacement therapies. They will attend the Pediatric Nephrology clinics at RUMC and learn the

evaluation of the pediatric patient with proteinuria and hematuria, congenital electrolyte abnormalities.

13They may also see in-patient pediatric patients with an array of acute and chronic renal diseases.

Dialysis of the newborn may also be observed. The out-patient Pediatric hemodialysis unit is located on

the RUMC premises and Fellows will make rounds in that facility with Dr. Assadi.

Renal TransplantationTraining in the management of patients with a renal transplant is centered in both the in-patient

(RUMC) and out-patient (Transplant Offices at the Section of Transplantation located at RUMC)

settings. Dr. Saltzberg is the head of Transplant Nephrology and will be responsible for the majority of a

Fellow’s training in renal transplant medicine.

Fellows will spend two months a year rotating with Dr. Saltzberg on the “Transplant Service”.

During the month the Fellow will attend all of Dr. Saltzberg’s transplant clinics and round with Dr.

Saltzberg on all in-patient renal transplant recipients and liver transplant patients in which a renalconsult has been requested. The average size of this service is 16 patients. It is expected that the Fellow

evaluate patients as they get admitted for renal transplantation, and follow their post-transplant course.

The Fellow will become familiar with various induction and maintenance immunosuppression protocols.

The Fellow will become aware of the differential diagnosis of immediate post-surgery, early and late

transplant dysfunction. The fellow will learn the short and long-term consequences of

immunosuppression including general steroid toxicity in addition to infections and malignancies. The

Fellow will perform and interpret renal transplant biopsies when appropriate. There are over 120 renal

transplants performed yearly at RUMC, the Transplant Service fellow will follow most of these patients.

The Fellow will manage any post-transplant in-patient hemodialysis needs that these patients may have.

There is no night call for the Fellow on this service.

The Transplant Clinics see patients with established renal transplants as well as those undergoing

work-up for receiving or donating a renal transplant. The goals of this out-patient clinic’s aspect of the

rotation are: to learn to evaluate ESRD patients to determine if they are potential and acceptable

candidates, to learn the appropriate work-up of ESRD patients for either living donor transplantation or

placement on the cadaver list, to learn the appropriate work-up of individuals as potential living relatedand living non-related donors, to learn about immunosuppressive drugs and regimens used in the

management of renal transplants, to learn the side effects, complications and drug interactions of

immunosuppressive drugs, to learn to evaluate and treat post-transplant complications including

infection, hypertension, malignancy, de novo glomerular disease and recurrent glomerular disease, to

learn to recognize and treat acute rejection, to learn to recognize and treat chronic rejection, and finally,

14to learn the fundamentals of HLA matching and histocompatibility testing. These transplant clinics

follow several hundred renal transplant patients, with as many as 20 patients seen on any clinic day.

Renal PathologyFellows spend one month their first year working with Dr. Melvin Schwartz, Professor of

Pathology and renal Pathologist on the “Renal Pathology Rotation”. During that month they learn the

fundamentals of renal histopathology through a combination of one-on-one teaching and slide review

that the Fellow performs on his/her own. First year Fellows may attend a series of didactic lectures onrenal pathology given by Dr. Schwartz early in the academic year that he provides the Pathology

Residents.

Training in interpretation of renal biopsies is also provided through our weekly BiopsyConference, a CME approved joint conference between the Section of Nephrology and the Department

of Pathology that takes place in the conference room of the Department of Pathology. Two cases are

presented each week. All cases, in which a biopsy of a native kidney was performed at RUMC, in

addition to selected cases of transplant biopsies, are written up as a protocol by the Fellow involved in

the case. This protocol is handed out to conference participants and is orally presented by that Fellow.

Both Attendings and Fellows then discuss the case as they are called upon by a conference mediator.

After a differential diagnosis has been generated, the pathology is presented onto a screen. A Fellow is

randomly chosen to read these slides (first year Fellows do not read cases in this conference until they

have completed their Pathology rotation). When the slide review has been completed, the Fellow is

asked to give a histologic diagnosis. The treatment is then discussed by Attendings and Fellows as they

are called upon. The active process of reading biopsies in an intellectually stimulating and supportivesetting is the most effective teaching tool. Dr. Schwartz is an integral part of the Nephrology Section

with a commitment to the education of our Fellows.

Fellows are encouraged to perform as many renal biopsies as they can that are medically

indicated during their Fellowship. Fellows perform on average 10 biopsies a year during their

Fellowship. Biopsies may be done on native kidneys as well as on renal transplants.

Out-Patient Nephrology ClinicFellows see patients one half day a week in their out-patient clinic at the offices of EJL & Assoc.

Fellows have out-patient clinic at the same time as their preceptor (see above). This clinic sees new out-

patient consultations, and continues follow-up of established patients. All patients assigned to the Fellow

are seen first by the Fellow with the case then being presented to the Attending and the case then

15subsequently discussed together. This team then sees the patient together and decides and relays further

work-up and therapy. All aspects of acute and chronic renal disease may be seen in this clinic. The

Fellow dictates all letters and progress notes on his patients, which are reviewed with the Fellow, by the

Attending, prior to being sent out. A special emphasis is made on preparing patients for ESRD;

considering nutritional, socioeconomic, and access concerns as well as requiring the patient to be an

active participant in the ESRD modality choice. A Fellow follows his patients throughout the 6-month

period. A Fellow sees an average of 1 new and 3 established patients/clinic day.

ConferencesThere are usually three conferences each week. Once a week at noon, there is either a Clinical

Conference (thrice monthly), or a Journal Club or Research Conference (once monthly). The Research

Conferences are provided by RUMC Nephrology faculty or by a visiting professor. These conferences

are usually multifaceted and because of the nature of the topics under discussion, cover a combination of

tasks and topics including but not limited to literature review, discussion of clinical cases, evaluation

and presentation of research, and concepts of Nephrology basic science. The Section of Transplantation

of the Department of Surgery has a Transplantation conference approximately every other month,usually with a visiting professor. There is a weekly Renal Biopsy Conference. There are weekly

Wednesday AM teaching conferences where an Attending meets with the Fellows to teach curriculum

topics in either a lecture or workshop format (see Curriculum below). Renal Radiology conferences are

provided every other month.

Clinical ConferenceClinical Conference is a weekly conference that takes place at noon in a conference room at

RUMC. It is a case-based discussion of a case or topic that the Fellow and an Attending (usually the

Fellow’s preceptor) find relevant or interesting. That Attending oversees and reviews the presentation

prior to the conference. The Fellow prepares a written case as a handout. The case is read and then the

Fellow presents the topic. This is usually done as a Powerpoint presentation. Schedules for Clinical

Conferences are made 6 months in advance. Clinical Conferences are attended by RUMC Nephrology

faculty and RUMC Nephrology Fellows, and RUMC residents and Medical Students rotating on the

renal clinical service.

16Journal Club

An article of the Fellow’s and preceptor’s choice is presented at Journal Club, which occurs once

a month during a noon conference that takes place at noon in a conference room at RUMC. The Fellow

chooses the article with his or her preceptor. The Fellow is expected to critically review the article, read

background material, and present the article to the group, using handouts, overheads or Powerpoint. The

Fellow’s presentation is discussed with the Fellow’s preceptor (who must be present at the Conference)

prior to the presentation. As part of the evaluation of an article the Fellow and the preceptor will focus

on the design as well as interpretation of the data and results including the use of statistical methods, theresponsible use of informed consent, and research methodology. This exercise is considered an

important part of a Fellow’s Research training. Schedules for Journal Club are made 6 months in

advance. Journal Club is attended by RUMC Nephrology Faculty and RUMC Nephrology Fellows.

Renal Biopsy ConferenceRenal Biopsy Conference is a weekly conference held on Thursday afternoons and usually lasts

90 minutes with two cases typically being presented. It is attended by RUMC Nephrology Faculty,

RUMC Nephrology Fellows, RUMC Residents and Medical Students presently rotating on the Renal

Service, in addition to Nephrology Faculty from Cook County Hospital and Mount Sinai Hospital and

University of Illinois Nephrology Fellows. See Renal Pathology (above) for a detailed description.

Renal Radiology ConferenceBesides the routine review of relevant cases that may appear on any of the services, radiology of

the urologic system is taught in a Renal Radiology Conference. This conference will be given onceevery other month and will follow biopsy conference on Thursday afternoons. It is a joint conference

with Nephrology Attendings and Fellows and Urology Attendings and Residents.

LecturesAttendings give weekly lectures/workshops for the Fellows on Wednesday mornings from 8-

9:00 AM. The goal of these lectures is to cover all Nephrology core concepts but not limited to acid-

base disorders, normal and abnormal basic science related renal physiology, disorders of salt and water

and other electrolytes, acute renal failure, chronic renal failure, hemodialysis, peritoneal dialysis,

continuous renal replacement therapies, nephrolithiasis, renal disease of pregnancy, basic transplantation

topics (see ‘Transplantation” above), primary and secondary glomerular diseases, renal osteodystrophy,

dialysis adequacy, access recirculation, hypertensive disorders, urinary tract infections, tubulointerstitial

17disorders, disorders of drug metabolism and renal drug toxicity, genetic and inherited disorders, and

geriatric aspects of Nephrology. The schedule is provided 12 months in advance.

ResearchFellows are given two one-month blocks each year in their schedule designated for research. It is

the intent of the Fellowship that every Fellow partakes in some type of “research” project. This may

include a case report with critical literature review, a retrospective analysis of clinical material, or

involvement in a short-term prospective clinical trial. Projects may be provided by Attendings, or may

be developed by the Fellow. All projects will be supervised by an Attending, which may or may not be

the Fellow’s preceptor. All projects need to be approved by the Program Director through a formal

application form (see Appendix C) before a project is to be embarked upon. It is expected that all

Fellows submit their work as a manuscript for publication (for case reports) or as an abstract (for

research projects) to one of the national meetings. If an abstract is accepted for oral or poster

presentation, the Section of Nephrology will cover expenses for the Fellow to attend that meeting.

Fellows are expected to present important research articles at Journal Club (see above). This

exercise requires extensive preparation and review of pertinent literature and is felt to represent an

important part of a Fellow’s “Research” training.

ProceduresFellows will be trained by Attendings to be competent to perform the following procedures:

percutaneous renal biopsy, hemodialysis access line placement, placement of access for continuous renal

replacement therapies, and not universally, temporary peritoneal dialysis catheter placement. A Faculty

member is present at all procedures until the Fellow has demonstrated competence. The complete

procedure description by level is found in the document entitled “Detailed job descriptions” (Appendix

B, available upon request). It is the Fellow’s responsibility to keep a log of all procedures. An optional

Log is available (see Appendix D).

18Curriculum

The curriculum is based on multiple venues and experiences as outlined above. The Fellowship

program has in effect many diverse means by which all program requirements as defined by the

ACGME for training in Nephrology are fulfilled. It is not expected that any single experience will fulfill

all Goals and Objectives. Monthly rotations differ in exposures, responsibilities, and experiences and

there is considerable overlap by rotation and experience.

Still, there are goals and objectives for each rotation that the Attending and the Fellows must focus on.

These are outlined by rotation and distributed to Fellows and Attending at the start of each rotation. The

specific rotation documents and appendices (attached) are

a) Clinical Service, Appendix Eb) Transplantation, Appendix F

c) Chronic Hemodialysis, Appendix G

d) Peritoneal Dialysis/Renal Transplantation, Appendix H

e) Pediatric Nephrology, Appendix I

f) Renal Pathology, Appendix J

The Program Director meets with one of the senior fellows once a year to review and evaluate the

curriculum, with changes made as deemed appropriate.

The weekly lecture series is meant to cover many of the goals and objectives as defined in Appendices

E-J. The majority of Nephrology Basic Science training occurs through this series of lectures and

workshops. The lecture topics are presented in the following table:

19

Renal BiopsyRecirculation: All types and how to measure/KT/V HDPET test and membrane failureBasic Science: Na, Volume, Fluid compartmentsWater treatmentBasic Science: Renal water handling 1Basic Science: Renal water handling 2Basic Science: HLA system & role in renal TxHD acute complications/emergenciesHD chronic complicationsW/U of transplant donor and recipientHypo Na and polyuria problemsContinuous hemofiltrationTx immunosuppression: induction/pheresis/ALG/ATG/OKT3PeritonitisTx immunosuppression: CSA, FK, steroids, rapamycin, CellceptLRRT vs CRT vs Pediatric vs elderly vs “dead” donorsBasic Science: Acid Base 1Basic Science: Acid Base 2KT/V PDBasic Science: GFRBasic Science: HyperkalemiaBasic Science: HypokalemiaPregnancy: normal physiology, Na, H2O, acid base etc.NephrolithiasisBasic Science: Renal Ca, PO4 and Mg handlingNephrotic syndromes: FSGS, Min. change, MGN etcNephritic syndromes: Vasculitis, PSGN, MPGN etc.Pregnancy: effect in renal disease: HTN, pre-eclampsia and HUS etcPregnancy in ESRD, dialysis and transplantationOther uses for HD, hypothermia, overdoses etcBasic Science: Metabolic alkalosisRenovascular HTNPrimary non-function/acute rejection/ARF in renal TxChronic rejection/recurrent DzParaproteinemias, ITG, amyloidosis etc.Renal osteodystrophyBasic Science: ATNTubulointerstitial diseasesInherited renal diseasesInfections in renal Tx recipientsObstructive uropathyPlasmapheresisBasic Science: Urine Anion GapBasic Science: UrinalysisEpidemiology of ESRD

20

Core Curriculum

The ACGME has identified six general competencies, applicable to all physicians in training, that nowrequire specific education and documentation of completion. The six general competencies are:

1) Patient Care2) Medical Knowledge3) Professionalism4) Systems-based Practice5) Practice-based Learning and Improvement6) Interpersonal and Communication Skills

The Fellowship uses a program developed by the University of Illinois at Chicago for assisting with thisrequirement. This Core Curriculum Program is web-based and is thus available through any internetconnection 24/7. The program has 13 modules that can be completed at the desired pace of the Fellow.The on-line program is broken down into the following modules:

1) GME 101: The nature and scope of professionalism in medical practice2) GME 102: Evolution, organization, and financing of the U.S. health system3) GME 103: The physician’s role in management of the health care team4) GME 104: Quality, cost, and resource management in medical practice5) GME 105: Life long learning and evidence based medicine6) GME 107: teaching and learning skills for the physician educator7) GME 108: Managing a successful medical practice8) GME 109: Medical and health care information systems9) GME 110: Topics in research for medical residents10) GME 111: Communications skill for physicians11) GME 112: Medical and clinical ethics12) GME 113: Cultural competency for health care delivery

21Appendix A: Resident Duty Hours and the Working Environment

1. Supervision of Residentsa. All patient care must be supervised by qualified faculty. The program director mustensure, direct, and document adequate supervision of residents at all times. Residentsmust be provided with rapid, reliable systems for communicating with supervisingfaculty.b. Faculty schedules must be structured to provide residents with continuous supervisionand consultation.c. Faculty and residents must be educated to recognize the signs of fatigue and adopt andapply policies to prevent and counteract the potential negative effects.

2. Duty Hoursa. Duty hours are defined as all clinical and academic activities related to the residencyprogram, i.e., patient care (both inpatient and out-patient), administrative duties related topatient care, the provision for transfer of patient care, time spent in-house during callactivities, and scheduled academic activities such as conferences. Duty hours do notinclude reading and preparation time spent away from the duty site.b. Duty hours must be limited to 80 hours per week, averaged over a four-week period,inclusive of all in-house call activities.c. Residents must be provided with 1 day in 7 free from all educational and clinicalresponsibilities, averaged over a four week period, inclusive of call. One day is defined asone continuous 24- hour period free from all clinical, educational, and administrativeactivities.d. A-10 hour time period for rest and personal activities must be provided between alldaily duty periods, and after in-house call.

3. On-Call ActivitiesThe objective of on-call activities is to provide residents with continuity of patient careexperiences throughout a 24 hour period. In-house call is defined as those duty hoursbeyond the normal work day when residents are required to be immediately available inthe assigned institution.a. In-house call must occur no more frequently than every third night, averaged over afour-week period.b. Continuous on-site duty, including in-house call, must not exceed 24 consecutivehours. Residents may remain on duty for up to 6 additional hours to participate in didacticactivities, maintain continuity of medical and surgical care, transfer care of patients, orconduct out-patient continuity clinics.c. No new patients may be accepted after 24 hours of continuous duty except in out-patient continuity clinics. A new patient is defined as any patient for whom the residenthas not previously provided care.d. At-home call (pager call) is defined as call taken from outside the assigned institution.

1.) The frequency of at-home call is not subject to the every third night limitation.However, at-home call must not be so frequent as to preclude rest and reasonablepersonal time for each resident. Residents taking at-home call must be providedwith 1 day in 7 completely free from all educational and clinical responsibilities,averaged over a 4-week period.2.) When residents are called into the hospital from home, the hours residentsspend in-house are counted toward the 80-hour limit.

223.) The program director and the faculty must monitor the demands of at-homecall in their programs and make scheduling adjustments as necessary to mitigateexcessive service demands and/or fatigue.

4. Moonlightinga. Because residency education is a full-time endeavor, the program director must ensurethat moonlighting does not interfere with the ability of the resident to achieve the goalsand objectives of the educational program.b. The program director must comply with the sponsoring institution’s written policiesand procedures regarding moonlighting, in compliance with the InstitutionalRequirements III. D.1.k.c. Moonlighting that occurs within the residency program and/or the sponsoringinstitution or the non-hospital sponsor’s primary clinical site(s), i.e., internalmoonlighting, must be counted toward the 80-hour weekly limit on duty hours.

5. Oversighta. Each program must have written policies and procedures consistent with theInstitutional and Program Requirements for resident duty hours and the workingenvironment. These policies must be distributed to the residents and the faculty.Monitoring of duty hours is required with frequency sufficient to ensure an appropriatebalance between education and service.b. Back-up support systems must be provided when patient care responsibilities areunusually difficult or prolonged, or if unexpected circumstances create resident fatiguesufficient to jeopardize patient care.

6. Duty Hours ExceptionAn RRC may grant exceptions for up to 10 % of the 80-hour limit, to individualprograms based on a sound educational rationale. However, prior permission of theinstitution’s GMEC is required.

23Appendix B: RUMC Section of Nephrology Fellow Job/Procedures Descriptions

1) The Nephrology Fellowship consists of Fellows at each of two levels of training, first yearFellows (PGY 4) and second year fellows (PGY 5). All Nephrology Fellows have completedtraining in an ACGME approved Internal Medicine program prior to commencing training inthe Fellowship.

2) The ultimate responsibility for care rendered by the Nephrology Fellow is via a NephrologyAttending.

3) Supervision can be provided by an Attending Physician through direct observation of theFellow performing the procedure, or for some procedures, a second year fellow forprocedures performed by first year Fellows (see below).

4) All Nephrology fellows are permitted to perform routine care procedures such as historiesand physical examinations, order writing, and documentation of same, without directobservation by a supervisory person.

5) Certain technical procedures are necessary for training:a. Percutaneous renal biopsy: All renal biopsy procedures are performed under direct

supervision of an Attending Physician. i. Native kidney under ultrasound guidance ii. Transplant kidney under ultrasound guidance

b. Placement of temporary vascular access for hemodialysis and related procedures:Placement of vascular access lines is performed by the Fellow on the Clinical Service.These lines are placed under direct supervision by an Attending physician or a secondyear Nephrology Fellow for the Fellow’s first month of rotation on that service.

c. Acute peritoneal dialysis: Orders for acute peritoneal dialysis are written by the Fellowon the Clinical service. These orders are written under direct supervision of an Attendingphysician for the Fellow’s first month on that Service.

d. Chronic peritoneal dialysis: Orders for chronic peritoneal dialysis are written by theFellow on the out-patient Peritoneal Dialysis rotation. These orders are written underdirect supervision of an Attending physician for the Fellow’s first month on that service.

e. Acute hemodialysis: Orders for acute peritoneal dialysis are written by the Fellow on theClinical Service. These orders are written under direct supervision of an Attendingphysician for the Fellow’s first month on that service.

f. Chronic hemodialysis: Orders for chronic hemodialysis are written by the Fellow on theout-patient Hemodialysis service. These orders are written under direct supervision of anAttending physician for the Fellow’s first month on that service.

g. Continuous renal replacement therapy: Orders for continuous renal replacement therapiesare written by the Fellow on the Clinical service. These orders are written under directsupervision of an Attending physician for the Fellow’s first month on that Service.

Expertise acquired by the end of the first year of Nephrology Fellowship training includes b-g above (placement of temporary vascular access for hemodialysis and related proceduresacute peritoneal dialysis, chronic peritoneal dialysis, acute hemodialysis, chronichemodialysis, and continuous renal replacement therapy).

Expertise acquired by the end of the second year of Nephrology Fellowship training:percutaneous renal biopsy.

It is the Fellow’s responsibility to keep track of above procedures a and b in a procedure logbook or other reproducible system.

24Appendix C: Nephrology Fellow Research Proposal

Participating Fellow(s): _____________________________________________

Supervising Attending(s): _____________________________________________

Project description:

Hypothesis to be tested:

Proposed Statistical analysis:

Funding (if applicable):

Fellow(s) Date ____________

Attending(s) Date ____________

Approval _______________ _____ ____________________ Roger A. Rodby, M.D. Edmund J. Lewis, M.D.

25Appendix D: RUMC Nephrology Fellowship Procedure Log

Name: ____________________________

Venous HD orCVVH CatheterAcute PDcatheterRenal biopsynativeRenal BiopsyTx




26Appendix E: Goals and Objectives of the Rotation “Clinical Service”

To learn the evaluation and management of:

1) Disorders of mineral metabolism, including nephrolithiasis and renal osteodystrophy2) Disorders of fluid, electrolyte, and acid-base regulation3) Acute renal failure4) Chronic renal failure and its management by conservative methods, including nutritional

management of uremia5) End-stage renal disease6) Hypertensive disorders7) Renal disorders of pregnancy8) Urinary tract infections9) Tubulointerstitial renal diseases, including inherited diseases of transport, cystic diseases,

and other congenital disorders10) Glomerular and vascular diseases, including the glomerulonephritides, diabetic

nephropathy, and atheroembolic renal disease11) Disorders of drug metabolism and renal drug handling12) Genetic and inherited renal disorders13) Geriatric aspects of nephrology, including disorders of the aging kidney and urinary tract,

including physiology and pathology of the aging kidney and drug dosing and renaltoxicity in elderly patients

14) Indications for and interpretations of radiologic tests of the kidney and urinary tract

In addition, it is expected that the Fellow will learn the, or develop an

1) Evaluation and selection of patients for acute hemodialysis or continuous renalreplacement therapies

2) Evaluation of end-stage renal disease patients for various forms of therapy and theirinstruction regarding treatment options

3) Drug dosage modification during dialysis and other extracorporeal therapies4) Evaluation and management of medical complications in patients during and between

dialyses and other extracorporeal therapies, including dialysis access, and anunderstanding of the pathogenesis and prevention of such complications

5) Long-term follow-up of patients undergoing long-term dialysis, including their dialysisprescription and modification and assessment of adequacy of dialysis

6) Understanding of the principles and practice of peritoneal dialysis, including theestablishment of peritoneal access, the principles of dialysis catheters, and how to chooseappropriate catheters

7) Understanding of the technology of peritoneal dialysis, including the use of automatedcyclers

8) Assessment of peritoneal dialysis efficiency, using peritoneal equilibration testing and theprinciples of peritoneal biopsy

9) An understanding of how to write a peritoneal dialysis prescription and how to assessperitoneal dialysis adequacy

10) An understanding of the complications of peritoneal dialysis, including peritonitis and itstreatment, exit site and tunnel infections and their management, hernias, plural effusions,and other less common complications and their management

2711) An understanding of the special nutritional requirements of patients undergoing

hemodialysis and peritoneal dialysis12) The pharmacology of commonly used medications and their kinetic and dosage alteration

with peritoneal dialysis

The Fellow will also learn the:

1) Evaluation and selection of patients for acute hemodialysis or continuous renalreplacement therapies

2) Writing of acute hemodialysis orders including decisions related to anticoagulation,potassium, calcium, sodium and bicarbonate dialysate concentrations as well asappropriate fluid removal with ultrafiltration

3) Evaluation and management of medical complications in patients during acutehemodialysis and other extracorporeal therapies including dialyzer reactions, air emboli,hemolytic reactions, and hemorrhage.

4) Complications of vascular access and how to evaluate for recirculation5) Evaluation and treatment of poor vascular access blood flow6) Utilization of thrombolytics for poor access function7) Drug dosage modification during dialysis and other extracorporeal therapies

The Fellow should gain expertise in the following procedures:

1) Placement of temporary vascular access for hemodialysis and related procedures2) Urinalysis3) Percutaneous biopsy of both autologous and transplanted kidneys4) Peritoneal dialysis5) Acute and long-term hemodialysis6) Continuous renal replacement therapy

28 Appendix F: Goals and Objectives of the Rotation “Renal Transplantation”

The Fellow should also learn the:

1) Evaluation and selection of transplant candidates2) Preoperative evaluation and preparation of transplant recipients and donors3) Immediate postoperative management of transplant recipients, including administration

of immunosuppressants, evaluation of primary nonfunction4) Clinical diagnosis of all forms of rejection including laboratory, histopathologic, and

imaging techniques5) Medical management of rejection, including use of immunosuppressant drugs and other

agents6) Recognition and medical management of the surgical and nonsurgical complications of

transplantations7) Long-term follow-up of transplant recipients in the ambulatory setting8) Interpretation of histopathology of the renal transplant9) Biology of transplantation rejection10) Indications for and contraindications to renal transplantation11) Principles of transplant recipient evaluation and selection12) Principles of evaluation of transplant donors, both live and cadaveric, including

histocompatibility testing13) Principles of organ harvesting, preservation, and sharing14) Psychosocial aspects of organ donation and transplantation15) The pathogenesis and management of urinary tract infections16) The pathogenesis and management of acute renal failure17) Indications for and interpretations of radiologic tests of the kidney and urinary tract18) Disorders of fluids and electrolytes and acid-base balance in the renal transplant patient19) The HLA immunologic system

Technical Skills:

1) Percutaneous biopsy of transplanted kidneys

29Appendix G: Goals and Objectives of the Rotation “Chronic Hemodialysis”

The Fellow will learn the, or develop an

1) Writing of chronic hemodialysis orders including time on dialysis, blood flow rate,determination of dry weight, dialysate flow rate, dialysate electrolyte composition

2) The pharmacology of commonly used medications and their kinetic and dosage alterationwith hemodialysis

3) Evaluation and management of medical complications in patients during acutehemodialysis and other extracorporeal therapies including dialyzer reactions, air emboli,hemolytic reactions, and hemorrhage.

4) Long-term follow-up of patients undergoing long-term hemodialysis, including theirdialysis prescription and modification and assessment of adequacy of dialysis,management of anemia, osteodystrophy, and blood pressure

5) Understanding of the special nutritional requirements of patients undergoinghemodialysis

6) Understanding of the special social services requirements of patients undergoinghemodialysis

7) Understanding of the hemodialysis machine and each of the pumps, pressure monitorsand other data measured throughout the treatment

8) Complications of vascular access and how to evaluate for recirculation9) Utilization of thrombolytics for poor access function10) Drug dosage modification during dialysis and other extracorporeal therapies11) Evaluation and treatment of poor vascular access blood flow12) Dialysis water treatment, delivery systems, and reuse of artificial kidneys13) The artificial membranes used in hemodialysis and biocompatibility14) The psychosocial and ethical issues of dialysis

30Appendix H: Goals and Objectives of the Rotation “Peritoneal Dialysis”

The Fellow will learn the, or develop an:

1) Understanding of the principles and practice of peritoneal dialysis, including theestablishment of peritoneal access, the principles of dialysis catheters, and how to chooseappropriate catheters

2) Understanding of the technology of peritoneal dialysis, including the use of automatedcyclers

3) Assessment of peritoneal dialysis efficiency, using peritoneal equilibration testing and theprinciples of peritoneal biopsy

4) An understanding of how to write a peritoneal dialysis orders5) An understanding of the complications of peritoneal dialysis, including peritonitis and its

treatment, exit site and tunnel infections and their management, hernias, plural effusions,sclerosing encapsulating peritonitis, leaks, and other less common complications andtheir management

6) An understanding of the special nutritional requirements of patients peritoneal dialysis7) An understanding of the special social services requirements of patients peritoneal

dialysis8) The pharmacology of commonly used medications and their kinetic and dosage alteration

with peritoneal dialysis9) Long-term follow-up of patients undergoing long-term peritoneal dialysis, including their

dialysis prescription and modification and assessment of adequacy of dialysis,management of anemia, osteodystrophy, and blood pressure

31Appendix I: Goals and Objectives of the Rotation “Pediatric Nephrology”

To learn the evaluation and management of:

3) Congenital and acquired disorders of fluid, electrolyte, and acid-base regulation2) Acute renal failure in the neonate, infant and adolescent3) End-stage renal disease management in the pediatric population and the use of growth

hormone4) Secondary hypertensive disorders seen in the pediatric population5) Urinary tract infections and reflux nephropathy6) Tubulointerstitial renal diseases, including inherited diseases of transport, cystic diseases,

and other congenital disorders7) Glomerular diseases common to the pediatric population8) Drug dosing in pediatric patients9) Indications for and interpretations of radiologic tests of the urinary tract

The Fellow should gain expertise in the following procedures:

7) Percutaneous biopsy of autologous kidneys in infants and adolescents8) Acute and long-term hemodialysis in infants and adolescents9) Continuous renal replacement therapy in neonates, infants and adolescents

32Appendix J: Goals and Objectives of the Rotation “Renal Pathology”

To learn:1) Normal renal histology including the recognition of different normal and abnormal cells

within the glomerulus and interstitium2) The handling and processing of renal biopsy specimens3) The normal staining characteristics of the trichrome, PAS, H&E, and silver stains4) A systematic approach to reading renal histopathologic slides5) A systematic approach to reading renal immunofluorescence slides6) A systematic approach to reading renal electron micrographs7) The renal histopathologic features of the major nephrotic, nephritic, microvascular, and

tubulointerstitial diseases including an understanding of the criteria of acute rejection inthe renal transplant

33Appendix K: Gifts to Physicians From Industry

Many gifts given to physicians by companies in the pharmaceutical, device, and medicalequipment industries serve an important and socially beneficial function. For example, companies havelong provided funds for educational seminars and conferences. However, there has been growingconcern about certain gifts from industry to physicians. Some gifts that reflect customary practices ofindustry may not be consistent with the Principles of Medical Ethics. To avoid the acceptance ofinappropriate gifts, physicians should observe the following guidelines:

1. Any gifts accepted by physicians individually should primarily entail a benefit to patients andshould not be of substantial value. Accordingly, textbooks, modest meals, and other gifts are appropriateif they serve a genuine educational function. Cash payments should not be accepted. The use of drugsamples for personal or family use is permissible as long as these practices do not interfere with patientaccess to drug samples. It would not be acceptable for non-retired physicians to request freepharmaceuticals for personal use or use by family members.

2. Individual gifts of minimal value are permissible as long as the gifts are related to the physician’swork (e.g., pens and notepads).

3. The Council on Ethical and Judicial Affairs defines a legitimate “conference” or “meeting” asany activity, held at an appropriate location, where (a) the gathering is primarily dedicated, in both timeand effort, to promoting objective scientific and educational activities and discourse (one or moreeducational presentation(s) should be the highlight of the gathering), and (b) the main incentive forbringing attendees together is to further their knowledge on the topic(s) being presented. An appropriatedisclosure of financial support or conflict of interest should be made.

4. Subsidies to underwrite the costs of continuing medical education conferences or professionalmeetings can contribute to the improvement of patient care and therefore are permissible. Since thegiving of a subsidy directly to a physician by a company’s representative may create a relationship thatcould influence the use of the company’s products, any subsidy should be accepted by the conference’ssponsor who in turn can use the money to reduce the conference’s registration fee. Payments to defraythe costs of a conference should not be accepted directly from the company by the physicians attendingthe conference.

5. Subsidies from industry should not be accepted directly or indirectly to pay for the costs oftravel, lodging, or other personal expenses of physicians attending conferences or meetings, nor shouldsubsidies be accepted to compensate for the physicians’ time. Subsidies for hospitality should not beaccepted outside of modest meals or social events held as a part of a conference or meeting. It isappropriate for faculty at conferences or meetings to accept reasonable honoraria and to acceptreimbursement for reasonable travel, lodging, and meal expenses. It is also appropriate for consultantswho provide genuine services to receive reasonable compensation and to accept reimbursement forreasonable travel, lodging, and meal expenses. Token consulting or advisory arrangements cannot beused to justify the compensation of physicians for their time or their travel, lodging, and other out-of-pocket expenses.

34

6. Scholarship or other special funds to permit medical students, residents, and fellows to attendcarefully selected educational conferences may be permissible as long as the selection of students,residents, or fellows who will receive the funds is made by the academic or training institution.Carefully selected educational conferences are generally defined as the major educational, scientific orpolicy-making meetings of national, regional or specialty medical associations.

7. No gifts should be accepted if there are strings attached. For example, physicians should notaccept gifts if they are given in relation to the physician’s prescribing practices. In addition, whencompanies underwrite medical conferences or lectures other than their own, responsibility for andcontrol over the selection of content, faculty, educational methods, and materials should belong to theorganizers of the conferences or lectures. (II) Issued June 1992 based on the report, "Gifts to Physiciansfrom Industry," adopted December 1990; (JAMA. 1991; 265: 501 and Food and Drug LawJournal.1992; 47: 445-458); Updated June 1996 and June 1998.

35Appendix L: Maternity/Paternity/Family Leave

HOUSESTAFF MATERNITY/ PATERNITY/FAMILY LEAVE

“Maternity/Paternity Leave – Two weeks of leave shall be paid with benefits for the care of newlyborn or adopted child. The House Officer must provide 30 days notice (or as much notice as practicableif the leave is not foreseeable) to the Department of Graduate Medical Education and the DepartmentChairperson of the request for leave and complete the necessary forms.

Family Leave - Up to three months of leave in total to care for a spouse, parent, or child with a serioushealth condition, two weeks of which shall be paid. The House Officer must provide 30 days notice (oras much notice as practicable if the leave is not foreseeable) to the Department of Graduate MedicalEducation and Department Chairperson of the request of leave and complete the necessary forms.

Vacation and Special Education leave – the equivalent of four work weeks with pay, one of whichmay be taken as an educational leave. Vacation and/or educational leave must be scheduled by mutualagreement with the Department Chairperson or his/her designee.”

Date ____/____/0____

House Officer ________________________________PGY/ FEL level __________

Department _________________________ Program (if different) _____________

Dates of anticipated maternity/paternity leave: ___/____/0____ to ___/____/0____

Number of vacation days to apply toward leave _____________ (20 maximum=4 weeks) Plus 2 weeks paid leave + 10 (10 work days=2 weeks) _________________________________________ Total # days to be paid

Unpaid leave ___________________________ (additional days/weeks)

Department Chair/Program Director’s approval _________________________

It is essential that your Program Director and GME be notified of your exact leave dates as soon as theyare finalized. Please do so in writing.

Best wishes to you and your family!

REMEMBER: You must bring your child’s birth certificate to GME within 31 days of birth inorder to be added to your health insurance plan!

Return this form to GME (527 Ac Fac) with your Department Chair or Program Director’s signatureapproval as soon as possible. Thank you.

GME Use OnlyDate received ___/____/0____ by _______

36Actual start date ___/____/0____ Actual Return date ___/____/0____

Payroll entered ___/____/0____ by _______

# Vacation days _______+ 10 = # Paid days ________ # Unpaid days ________

37Appendix M: Policy on Expenses for Fellows Attending Meetings

The Section will cover expenses for Fellows attending meetings under the followingguidelines:

1. Expenses will only be covered during the time period of the meeting.

2. No expense will be reimbursed without proper receipt and documentation.

3. Air reservations must be made at least 30 days in advance and through our travel agency,Pleasure Travel. The lowest cost direct flight will be selected. See Evelyn Wheelock for help inthis regard.

4. Same gender Fellows should room together unless otherwise approved.

5. Hotel expenses covered are room rate and applicable taxes, one call home/day and callsto work.

6. Transportation costs covered are transportation to and from airport from home and hotel,and to meeting events.

7. Meal allowance is $50.00/day.

8. Other expenses may be covered but must be pre-approved.

9. Meeting registration is covered. Pre-meeting Courses should be approved with theFellowship Director.

38

Rotation Evaluation of Nephrology Fellow

Fellow’s Name Rotation NameEvaluator’s Name Rotation Period Evaluation date

In evaluating the Fellow’s performance, use as your standard the level of knowledge, skills, and attitudes expected from theclearly satisfactory Fellow at this stage of training. For any component that needs attention or is rates a 4 or less, pleaseprovide specific comments and recommendations on the back of the form. Be as specific as possible, including reports ofcritical incidents and/or outstanding performance. Global adjectives or remarks such as “good Fellow” do not providemeaningful feedback to the Fellow.

Unsatisfactory Satisfactory Superior

Patient Care 1 2 3 4 5 6 7 8 9

X Performance needs attention

Medical Knowledge 1 2 3 4 5 6 7 8 9


Practice-Based Learning/Improvement 1 2 3 4 5 6 7 8 9


Interpersonal & Communication Skills 1 2 3 4 5 6 7 8 9


Incomplete, inaccurate medical interviews,physical examinations, and review of otherdata; incompetent performance of essentialprocedures; fails to analyze clinical dataand consider patient preferences whenmaking medical decisions

X Insufficient contact to judge

Superb, accurate comprehensive medicalinterviews, physical examinations, review ofdata, and procedural skills; always makesdiagnostic and therapeutic decisions based onavailable evidence, sound judgment, andpatient preferences

Limited, knowledge of basic and clinicalsciences; minimal interest in learning; doesnot understand complex relations,mechanisms of disease


Exceptional knowledge of basic and clinicalsciences; highly resourceful development ofknowledge; comprehensive understanding ofcomplex relationships, mechanisms ofdisease

Fails to perform self-evaluation; lacksinsight, initiative; resists or ignores feedback;fails to use information technology toenhance patient care or pursue self-improvement


Constantly evaluates own performance,incorporates feedback into improvementactivities; effectively uses technology tomanage information for patient care and self-improvement

Does not establish even minimally effectivelytherapeutic relationships with patients andfamilies; does not demonstrate ability to buildrelationships through listening, narrative ornonverbal skills; does not provide educationor counseling to patients, families orcolleagues


Establishes a highly effective therapeuticrelationship with patients and families;demonstrates excellent relationship buildingthrough listening, narrative and nonverbalskills; excellent education and counseling ofpatients, families, and colleagues; always“interpersonally” engaged

39

Rotation Evaluation of Nephrology Fellow (cont.)

Unsatisfactory Satisfactory Superior

Professionalism 1 2 3 4 5 6 7 8 9


System-Based Learning 1 2 3 4 5 6 7 8 9


Fellow’s Overall ClinicalCompetence in Nephrology 1 2 3 4 5 6 7 8 9

Attending’s Comments___________________________________________________________________________________________________

___________________________________________________________________________________________________

___________________________________________________________________________________________________

___________________________________________________________________________________________________

___________________________________________________________________________________________________

Signatures: Fellow_________________________ Attending ___________________________

Lacks respect, compassion, integrity,honesty; disregards need for self-assessment;fails to acknowledge errors; does not considerneeds of patients, families, colleagues; doesnot display responsible behavior


Always demonstrates respect, compassion,integrity, honesty; teaches/role modelsresponsible behavior; total commitment toself-assessment; willingly acknowledgeserrors; always considers needs of patients,families, colleagues

Unable to access/mobilize outside resources;actively resists efforts to improve systems ofcare; does not use systematic approaches toreduce errors and improve patient care


Effectively accesses/utilizes outsideresources; effectively uses systematicapproaches to reduce errors and improvepatient care; enthusiastically assists indeveloping systems’ improvement

40Fellow’s Annual Evaluation of Attending Physician

Attending Physician: ________________________________ Time period evaluated: ______________________Evaluator: _________________________________________

For each of the following criteria, please rate the Attending Physician

Availability:

Comments: ________________________________________________________________________________________

__________________________________________________________________________________________________

Teaching:

Comments: ________________________________________________________________________________________

__________________________________________________________________________________________________

Patient Care and Professionalism:

Comments: ________________________________________________________________________________________

__________________________________________________________________________________________________

Not Observed Marginal Satisfactory Very Good ExcellentWas Prompt X X X X XAdhered to rounds and consult service X X X X XKept interruptions to a minimum X X X X XSpent enough time on rounds; was unhurried X X X X XEncouraged active housestaff participation X X X X X

Not Observed Marginal Satisfactory Very Good ExcellentStated goals clearly and concisely X X X X XKept discussions focused on case or topic X X X X XAsked questions in non-threatening way X X X X XUsed bedside teaching to demonstrate history-taking and physical examination skills X X X X X

Emphasized problem-solving (thought processesleading to decisions) X X X X X

Integrated social/ethical aspects of medicine X X X X XStimulated team members to read, research, andreview pertinent topics X X X X X

Accommodated teaching to actively incorporateall members of team X X X X X

Provided special help as needed to team members X X X X X

Not Observed Marginal Satisfactory Very Good ExcellentPlaced the patient’s interests first X X X X XDisplayed sensitive, caring, respectful attitudetoward patients X X X X X

Established rapport with team members X X X X XShowed respect for housestaff and students X X X X XServed as a role model X X X X XWas enthusiastic and stimulating X X X X XDemonstrated gender sensitivity X X X X XRecognized own limitations; was appropriatelyself-critical X X X X X

Encouraged housestaff to bring up problems X X X X X

41Fellow’s Annual Evaluation of Attending Physician (cont.)

Medical Knowledge:

Comments: ________________________________________________________________________________________

__________________________________________________________________________________________________

Practice-Based Learning and Improvement:

Comments: ________________________________________________________________________________________

__________________________________________________________________________________________________

System-Based Practice:

Comments: ________________________________________________________________________________________

__________________________________________________________________________________________________

Recommendations:

Overall Comments: ___________________________________________________________________________________

____________________________________________________________________________________________________

____________________________________________________________________________________________________

____________________________________________________________________________________________________

Not Observed Marginal Satisfactory Very Good ExcellentDemonstrated broad based knowledge ofNephrology X X X X X

Was up-to-date X X X X XIdentified important elements in case analysis X X X X XUsed relevant medical/scientific literature insupporting clinical advice X X X X X

Discussed pertinent aspects of population andevidence-based medicine X X X X X

Not Observed Marginal Satisfactory Very Good ExcellentExplicitly encouraged further learning X X X X XMotivated Fellows to self-learn X X X X XEvaluated Fellow’s ability to analyze orsynthesize knowledge X X X X X

Not Observed Marginal Satisfactory Very Good ExcellentReviewed expectations of each team member atbeginning of rotation X X X X X

Provided useful feedback including constructivecriticism to team members X X X X X

Balanced service responsibilities and teachingfunctions X X X X X

Yes NoWould you recommend that this faculty member continue to serve as an attending physician forthe training program? X X

To further enhance professional development, would you recommend that this faculty memberreceive formal training in teaching and faculty development? X X

42

Fellow’s Annual Evaluation of Nephrology Fellowship Training Program

Please evaluate your training program based on your experiences during this past year

Poor (1) ---> Excellent (5)TRAINING ENVIRONMENTQuality and diversity of pathology 1 2 3 4 5Learning value of attending rounds 1 2 3 4 5Adequacy of attending supervision 1 2 3 4 5Quality of attending supervision 1 2 3 4 5Quality and timeliness of feedback from attending 1 2 3 4 5Opportunity to perform required procedures 1 2 3 4 5Opportunity to perform research 1 2 3 4 5Quality of research environment 1 2 3 4 5Interdisciplinary support

• Nursing• Social work• Dietary• Pharmacy

1111

2222

3333

4444

5555

Availability of consultations• Internal Medicine and IM subspecialties• Transplantation• Other Surgical specialties

111

222

333

444

555

Ancillary Services• Laboratory data retrieval• Radiology data film retrieval• Procedure form report retrieval• Intravenous and phlebotomy services• Messenger/transport services• Secretarial/clerical services

111111

222222

333333

444444

555555

Appropriateness of workload 1 2 3 4 5Overall quality of rotations 1 2 3 4 5

43

Fellow’s Annual Evaluation of Nephrology Fellowship Training Program (cont.)

Poor (1) ---> Excellent (5)TEACHING CONFERENCESPlease rate the quality of the teaching conferences listed below

• Clinical conference• Research/Visiting professor conference• Journal club• Renal biopsy conference• Lecture series conferences• ESRD Patient care conferences• Radiology conferences

1111111

2222222

3333333

4444444

5555555

TEACHING FACULTY• Availability• Commitment to teaching• Quality• Promote scientific/discovery literacy

1111

2222

3333

4444

5555

OVERALL QUALITY OF TRAINING 1 2 3 4 5GENERAL QUESTIONS

• My colleagues (Fellows) behave in a reliable manner• My colleagues are reliable• In time of conflict or trouble, I turn to my colleagues for

support• I would have members of my class as partners in my practice• My attending physicians behave in an appropriate manner• My attending physicians are reliable• In times of conflict or trouble, I turn to my attending

physicians for support• The educational atmosphere encourages excellence• The educational atmosphere recognizes excellence• I wish someone would have motivated me more to expand and

strengthen my knowledge base

YesYesYes

YesYesYesYes

YesYesYes

XXX

XXXX

XXX

NoNoNo

NoNoNoNo

NoNoNo

XXX

XXXX

XXX

Identify the core strengths and weaknesses of the program

Core Strengths:

Areas needing improvement:

rush university medical center fellowship in nephrology

Documents

nephrology section director

year program

outside program

total program

fellowship applications

clinical nephrology

pediatric attending

rumc complex