Curriculum for Internal Medicine Housestaff
Rotation: Nephrology Subspecialty Selective
Every resident will be able to demonstrate competency in the evaluation, diagnosis and treatment of common nephrologic conditions.
- Fluid and electrolytes:
The resident will be able to demonstrate competence in the evaluation and treatment of disorders of sodium balance, potassium balance, body water alterations, and disorders of calcium and magnesium balances.
- Acid-base disorders:
The resident will be able to demonstrate competence in the evaluation and treatment of simple and mixed acidosis and alkalosis, categorizing acid-base disorders as metabolic or respiratory, and determining if acid-base disorders are appropriately compensated.
- Acute renal disease
The resident will be able to demonstrate competence in diagnosing, evaluating and treating acute renal failure; in the appropriate use of dialysis for acute indications; in differentiating between acute glomerular, tubular and interstitial diseases; and in differentiating between primary and secondary acute renal diseases.
- Chronic renal disease
The resident will demonstrate competence in the diagnosis, evaluation and treatment of patients with chronic renal disease; in the management of chronic co-existent conditions complicating the course of chronic renal disease; in differentiating between chronic glomerular, tubular and interstitial diseases; in differentiating between primary and secondary chronic renal diseases, in the conservative management of patients with chronic renal disease; and in the appropriate choice for referral of patients for renal transplantation.
The resident will demonstrate competence in patients with renal disease in the appropriate selection of diagnostic imaging studies, in the appropriate selection and interpretation of blood and urine biochemistry, in the use and interpretation of microscopic urinalysis, in the use of medical microbiology in the evaluation and treatment, and in the use of anatomical histopathology in evaluation and treatment.
The resident will demonstrate competence in the diagnosis, evaluation and treatment of patients with systemic hypertension, in distinguishing between primary and secondary hypertension, and in the appropriate use of pharmacotherapy in the treatment of hypertension.
- Diabetes Mellitus
The resident will demonstrate competence in the diagnosis, evaluation and treatment of patients with diabetes mellitus, with and without renal disease, in managing the systemic complications of diabetes mellitus, in distinguishing between Type I and Type II diabetes and will demonstrate competence in the management of each, and in the diagnosis, evaluation and treatment of patients with metabolic syndrome.
Read the Nephrology section in Harrison's Textbook of Internal Medicine. At the end of the month, turn in the exact number of pages you have read. All aspects of the curriculum are covered in this textbook. This should be the primary reference source. Alternatively, each resident will be given a series of review articles, which cover the major nephrology topics. If this reading source is used in place on Harrison's, the resident should report which articles were completed during the rotation.
- Review the slide carousel which demonstrates slides of typical findings seen in urinalysis.
- Attend Nephrology Journal club, every Tuesday at 12 noon.
- Attend renal biopsy conference, first Wednesday of the month at 1 PM.
- Attend Medicine morning report and Medicine Grand Rounds.
- Attend Nephrology didactic teaching sessions: wed 11 am at 6 Dobbs conference room.
- Attend Nephrology Case Conference at fri 11am (alternates between VAMC conference room on 4G and UT 6 Dobbs conference room).
- Attend daily Nephrology attending rounds.
- Attend outpatient Nephrology clinics: (Mon am and Thurs am for VAMC assigned residents, and Tues pm Medplex clinic for residents assigned at UT Bowld/ Med service.
Additional Reference Material:
Up to Date computerized textbook of Nephrology. This is available at both the division of nephrology office at UTCHS and at the Nephrology division, VAMC. This is useful for obtaining recent literature references concerning Nephrology topics.
There is a resident notebook kept in the Division of Nephrology, UTCHS which includes key references concerning many aspects of clinical Nephrology.
Renal pathophysiology. (Burton Rose and Helmut Rennke)
You will be provided with a PC floppy disk that contains handouts and lecture notes dealing with the following topics: acid-base disorders, urinalysis, and summary of the basic renal syndromes. The disc will also include sample test questions.
- A multiple-choice examination will be given at the end of the rotation. The examination will deal with all aspects of clinical nephrology (as described in the resident curriculum). Questions will be formatted similarly to the Internal Medicine board examination (single best answer multiple-choice). The results of this examination will be included as part of your monthly evaluation.
- The ABIM standardized global assessment form will be filled out by your attending physician.
- Attendance at nephrology didactic teaching sessions and Internal Medicine Housestaff conferences should be > 75 %. Residents will provide documentation of completing the reading assignment (Harrison's text or supplemental articles).
- Medical record review: Nephrology attending will review and critique a written nephrology consult, which has been performed and entered into the patient's chart. This critique will be reflected on the global assessment form.
The educational success of our elective in nephrology will be based on two criteria:
- Nephrology subsections scores on the in-service examination of all residents who have successfully complete the elective and
- Nephrology subsections scores on the ABIM certifying examination in internal medicine taken by medical graduates. Our goal is all residents scoring at the 50th percentile or higher.