The educational purpose of the nephrology consultation rotation is to provide the internal medicine residents with clinical and didactic experience which defines the spectrum of disorders attended to by a practicing nephrologist. The composite of a month's experience should include teaching on each of the major topics (see below) and should provide insights into the pathophysiology and disease spectrum nephrologists manage.

PRINCIPLE TEACHING METHODS

Clinical

• Inpatient case management review during daily attending rounds.
• Patient specific topic review by assigned resident.

Didactic

• Weekly Clinical Conference - formal disease-specific topic of discussion.
• Weekly Journal Club - two current publications reviewed.
• Monthly Radiology Conference.
• Monthly Renal Biopsy Conference - commentary by pathologists and nephrologists.

MOST IMPORTANT EDUCATIONAL CONTENT ENCOUNTERED

1. Tubulo-interstitial renal disease including inherited diseases of transport, cystic disease and other congenital disorders.
2. Glomerular and vascular diseases including the glomerulonephritides, diabetic nephropathy, and atheroembolic renal disease.
3. Chronic renal failure including medication-induced and dye-induced ATN.
4. Acute renal failure including medication-induced and dye-induced ATN.

PRINCIPLE ANCILLARY EDUCATIONAL MATERIALS TO BE USED

Renal and Electrolyte Disorders by Robert W. Schrier, M. D.

METHODS FOR EVALUATION OF RESIDENT AND PROGRAM PERFORMANCE

Verbal feedback is given throughout the rotation and an ABIM-format Resident Performance Evaluation form is completed at the end of the month. If an attending judges that a resident is performing poorly in any area of evaluation, he or she must explicitely provide this constructive criticism sometime during the middle of the rotation.

Residents, in turn, evaluate attending physician and program performance using a standard departmental form that provides for comments.

The program's success at teaching core education content is determined by reviewing residents' consultation assessments, progress notes and presentations.

STRENGTHS AND LIMITATIONS

Trainees are exposed to and gain clinical experience managing a wide spectrum of diseases causing acute and chronic renal failure. They are also involved in the management of patients being acutely and chronically dialyzed. There is relatively less exposure to extreme electrolyte disturbances and obstructive uropathy than at the Westside VA Hospital setting.

NEPHROLOGY BIBLIOGRAPHY

• Daugirdas JT, Ing TS (eds.). Handbook of Dialysis, 2nd ed. Little Brown and Co. , 1994.
• Greenberg A (ed.). Primer on Kidney Diseases. Academic Press, 1994.
• Knochel JP (ed.). MKSAP in the Subspeciality of Nephrology and Hypertension, Book 1: Syllabus and Questions. American College of Physicians, Philadelphia , 1994.
• Mandal AK, Jennette JC (eds.). Diagnosis and Management of Renal Disease and Hypertension, 2nd ed. Carolina Academic Press, Durham , NC , 1994.
• Rose BD. Clinical Physiology of Acid-Base and Electrolyte Disorders, 3rd ed., McGraw-Hill. Rose BD, Black RM. Manual of Clinical Problems in Nephrology, Little Brown and Co.
• Schrier RW. Renal and Electrolyte Disorders.

See online reading list

Updated 7/7/04
Curriculum: Nephrology Consult Service
Site: UIH