2008-2009

Nephrology Training Program UCLA Division of Nephrology

ACGME Program (1480511110)

2008-2009 CURRICULUM

Page I. Overall Goals and Objectives 3

II. Inpatient General Nephrology Rotation (PGY4) 4 A. Goals & Objectives B. Core Competencies C. Methods of Teaching and Implementation D. Reading Material E. Evaluations

III. Transplant Nephrology Rotation (PGY4) 11

A. Goals & Objectives B. Core Competencies C. Methods of Teaching and Implementation D. Reading Material E. Evaluations

IV. Outpatient Dialysis Rotation (PGY4) 18


V. Continuity Clinics (PGY4) 25 A. Goals & Objectives B. Core Competencies C. Methods of Teaching and Implementation D. Reading Material E. Evaluations

VI. Inpatient General Nephrology Rotation (PGY5) 32


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VII. Transplant Nephrology Rotation (PGY5) 40 A. Goals & Objectives B. Core Competencies C. Methods of Teaching and Implementation D. Reading Material E. Evaluations

VIII. Continuity Clinics (PGY5) 47


IX. Syllabus 54

X. Principal Teaching Method 60

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I. Goals and Objectives

The Nephrology Training Program of UCLA is dedicated to provide advanced training and experience for

residents to acquire expertise expected of consultants in nephrology. The duration of training is 2 years with an optional third year of dedicated research

The goals and objectives of the training program include: • To educate and train residents in cognitive knowledge, procedural skills, interpersonal skills, professional

attitudes, humanistic qualities and clinical experience expected of a consultant nephrologist. • To provide a research-oriented environment for developing critical analysis of new information, problem-

solving skills and rational decision-making. To ensure each resident has some hands-on experience in basic research methodology.

• To emphasize scholarship and continued self-instruction and to provide opportunity for acquiring leadership and management skills.

• To provide faculty mentors for adequate and appropriate supervision and as role-models throughout the training period.

• To acquire knowledge and experience in: occupational safety and health, critical assessment and decision sciences, evaluation of medical literature, clinical epidemiology, clinical study design, relative and absolute risks of disease, medical statistics and medical decision-making, psychosocial, economic and ethical issues in nephrology, cultural, social, family, behavioral and economic issues, educational and counseling skills, and research and critical assessment of new therapies and of the medical literature.

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II. Inpatient General Nephrology (PGY4) A. Goals & Objectives Residents are expected to see new consults and follow up on previous consults in this inpatient rotation. During this rotation they always have a precepting attending who overlooks the management and care of the patient but provides adequate independence to the residents to formulate their own plan. PGY4 fellows have senior fellows (PGY5) as back up if needed. The goals and objectives of the training program include: • To educate and train residents in cognitive knowledge, procedural skills, interpersonal skills, professional






B. Core Competencies

1. Patient Care Residents are trained and educated to provide patient care that is compassionate, appropriate, and effective for the treatment of health problems and the promotion of health. Residents are expected to:

• communicate effectively and demonstrate caring and respectful behaviors when interacting with patients and their families

• gather essential and accurate information about their patients from various resources including consulting physician/team, computer database, other subspecialties and nursing and ancillary staff

• make informed decisions about diagnostic and therapeutic interventions based on patient information and preferences, up-to-date scientific evidence, and clinical judgment

• develop and carry out patient management plans in accordance to the accepted guidelines • counsel and educate patients and their families about renal failure, electrolyte abnormalities,

hypertension and dialysis modalities • use information technology to support patient care decisions and patient education • perform competently all medical and invasive procedures considered essential for the area of practice

including temporary dialysis access placement, renal biopsy and urine analysis

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• provide health care services aimed at preventing health problems or maintaining health including prevention of renal and cardiovascular disease progression

• work with health care professionals, including those from other disciplines, to provide patient-focused care

2. Medical Knowledge

By the end of this rotation the residents are expected to be well versed with

• Diagnosis, work up and management of acute kidney injury and its various causes • Acid base physiology with sound understanding of pathophysiology and management • Evaluation and selection of patients for acute hemodialysis including continuous renal replacement

therapy • Various complications of dialysis including access issues • Drug dosage in patients on dialysis • Various procedures including emergent vascular access placement for hemodialysis and renal biopsy • Work up and management of various electrolyte abnormalities in hospitalized patients • Management of hypertensive urgencies and emergencies • Residents are expected to take care of patients with different level of complexities eg floor, step down

and intensive critical care units • Residents are also expected to teach other healthcare professionals regarding various renal, acid-base,

electrolyte abnormalities and hypertension • Addressing renal issues in non-renal transplant patients both pre and post operative

3. Practice-Based Learning and Improvement

Residents must be able to investigate and evaluate their patient care practices, appraise and assimilate scientific evidence, and improve their patient care practices. Residents are expected to:

• analyze practice experience and perform practice-based improvement activities using a systematic methodology

• locate, appraise, and assimilate evidence from scientific studies related to their patients’ health problems • obtain and use information about their own population of patients and the larger population from which

their patients are drawn • apply knowledge of study designs and statistical methods to the appraisal of clinical studies and other

information on diagnostic and therapeutic effectiveness • use information technology to manage information, access on-line medical information; and support

their own education • facilitate the learning of students and other health care professionals 4. Interpersonal and Communication Skills

Residents must be able to demonstrate interpersonal and communication skills that result in effective information exchange and teaming with patients, their patients families, and professional associates. Residents are expected to:

• create and sustain a therapeutic and ethically sound relationship with patients

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• use effective listening skills and elicit and provide information using effective nonverbal, explanatory, questioning, and writing skills

• work effectively with others as a member or leader of a health care team or other professional group 5. Professionalism

Residents must demonstrate a commitment to carrying out professional responsibilities, adherence to ethical principles, and sensitivity to a diverse patient population. Residents are expected to:

• demonstrate respect, compassion, and integrity; a responsiveness to the needs of patients and society that supersedes self-interest; accountability to patients, society, and the profession; and a commitment to excellence and on-going professional development

• demonstrate a commitment to ethical principles pertaining to provision or withholding of clinical care, confidentiality of patient information, informed consent, and business practices

• demonstrate sensitivity and responsiveness to patients’ culture, age, gender, and disabilities 6. Systems-Based Practice

Residents must demonstrate an awareness of and responsiveness to the larger context and system of health care and the ability to effectively call on system resources to provide care that is of optimal value. Residents are expected to:

• understand how their patient care and other professional practices affect other health care professionals, the health care organization, and the larger society and how these elements of the system affect their own practice

• know how types of medical practice and delivery systems differ from one another, including methods of controlling health care costs and allocating resources

• practice cost-effective health care and resource allocation that does not compromise quality of care • advocate for quality patient care and assist patients in dealing with system complexities • know how to partner with health care managers and health care providers to assess, coordinate, and

improve health care and know how these activities can affect system performance C. Methods of Teaching and Implementation

1. Clinical Experience A. Total of 16 weeks will be devoted to inpatient nephrology training. During this time, the fellow is expected to manage:

• ~500-600 new and 250 follow-up in-patients per rotation.

B. Patient- mix includes diversity in • Age and sex: 21 years and older to geriatric age group of both sexes. On occasion 18-21 years old will

also be seen. • Social economic status • Racial, ethnic & cultural background

C. Formal instruction and clinical experience in the prevention, evaluation and management of the entire spectrum of nephrological disorders (see Syllabus)

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2. Technical and Other Skills A. Indications, contraindications, complications and interpretation of results in:

• Urinalysis • Percutaneous biopsy of native • Peritoneal dialysis • Placement of temporary vascular access for hemodialysis and other extracorporeal therapies • Acute and chronic hemodialysis • Renal imaging • Continuous renal replacement therapy

B. Familiarity with the principle, utility, complications and cost effectiveness of:

• Radiology of vascular access • Balloon angioplasty of vascular access • Therapeutic plasmapheresis • Bone biopsy • Placement of peritoneal catheters

3. Research Experience A. Throughout the 24 months of fellowship training faculty members (all are involved in active research) inculcates a research culture into the thinking and clinical practice of the trainees. In addition, specific instruction on topics including the design and interpretation of research studies; the essentials of informed consent and the critical assessment of new therapies and the biomedical literature are taught and discussed during the:

• Journal Club on both clinical and basic science research papers • Basic Science Conference by local and visiting research professors • Research Conference given by trainees, local and visiting research professors • Attendance at national and ocal nephrology meetings with heavy emphasis on clinical and basic

research • Basic science and research topics are covered in the Pathophysiology course

B. Hands on experience in the conduct of medical research: All fellows with no previous experience in direct research are encouraged to complete a minimum of a 1-month research in the first year and 7-8 months of research in the second year of training. Fellows who have worked and published research papers have the choice of using the research rotation for an, in-depth rotation, focusing on a topic in consultative nephrology, dialysis or transplantation. C. Research requirements for nephrology fellows with no formal research training: One-month of research experience is required for Nephrology in the first year. In the second year, at least six months of research experience is required. A Nephrology fellow will first have the opportunity to get familiarized with the ongoing research activities of the faculty members of the Program and thereafter select a research project. Under the mentorship of the selected faculty member, the fellow will acquire knowledge in the design and interpretation of research studies, research ethics and responsible use of informed consent, research methodology and interpretation of data, and training in writing and presenting the outcome of the studies.

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D. Research requirements for nephrology fellow with prior research training: Nephrology fellows are selected, in part, because of their strength and track-record in clinical and basic research. This is usually reflected by their letters of recommendation and publications reflecting intensive training in research methods and skills. For fellows that are interested, the STAR program offers them the opportunity to obtain advanced degrees in clinical or basic research. These fellows are required to spend 80% of their time in research in the second year. Fellows in the STAR program can either continue after their second year to get a Masters in clinical science or a PhD in health outcome research or in basic science. Instruction in basic sciences as they relate to Nephrology is given at a Pathophysiology Course, a Basic Science Course, Research Conference, Journal Club meetings, a ESRD conference and, Renal Grand Rounds. Each fellow attends local/regional and national and international scientific conferences or training sessions each year. Nationally and internationally recognized Nephrologists visit the program each year, approximately half of these visiting professors work in basic sciences related to Nephrology. 4. Conference and Scholarly Activities

Renal Conferences • Renal Grand Rounds • Nephrology Noon Conference (includes Basic Science & Research) • Consult Service Teaching Seminar/Journal club • Pathophysiology Course • Transplant Conference Multidisciplinary Conference • Renal-Pathology Conference • Medical Grand Rounds • Noon-Conference • Morning Report Visiting Professorships • National and international professors visit each year. They represent authorities in a wide spectrum of

basic research and clinical expertise in the field of nephrology and related disciplines. Special Courses • Introduction to Renal Pathology • Advances in Renal Transplantation Attendance at Scholarly Conferences • Annual Scientific Symposium on the National Kidney Foundation of Southern California • UCLA Society of Nephrology Conferences • Either the National Meeting of the American Society of Nephrology or the National Meeting of the

National Kidney Foundation Internet Facilities • Up-to-Date: A quarterly up-dated nephrology reference. • HDCN: A web-site providing all important references and advanced on nephrology and related subjects

including complete lectures from all national and international conferences. • NEPHROL: An international web-site where practicing nephrologists exchange views and experience Special Courses Special courses lasting days to weeks are spaced through the two year training include:

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• Introduction to Renal Pathology • Advances in Renal Transplantation • Comprehensive Course on Elements of Dialytic Therapy • STAR program. Selected fellows are accepted as candidates for a masters or PhD program Other Scholarly Conferences Each year the fellow is given the opportunity to attend: • Annual Scientific Symposium of the National Kidney Foundation of Sourthern California • UCLA Society of Nephrology Conferences • Either the National Meeting of the American Society of Nephrology or the National Meeting of the

National Kidney Foundation Journal, Video and Audio Material Every resident can receive journal subscriptions and video-tapes on lectures if available.

5. Teaching and Communication Experience Fellows are given daily opportunity to learn from and model after the attending nephrologists in teaching, communication and leadership skills. These skills are specifically developed in the following activities: • Weekly lectures to residents, interns and medical students taking nephrology elective. • Opportunities to teach at the weekly "Nephrology Core Curriculum for Residents." • Presentations and participation as active discussants at the weekly UCLA Nephrology Grand Rounds. • Presentation of research papers and participation as active discussants at Journal Clubs.

6. Training in Self-Instruction and Informatics Fellows are provided with educational and informatics facilities and trained to utilize them on a daily basis to effectively search and gather information for critical analysis of clinical problems and the resource and ability to make appropriate decisions. This is expected to be a life-long culture the fellows will carry with them upon graduation. Specifically, the following sources and facilities are available: • Up-To-Date: Our program subscribes to this well known electronic clinical reference in nephrology and

hypertension. Included also are continuously undated information on an adult primary care and internal medicine; cardovascular medicine; endocrinolgoy and diabetes; gastroenterology and hepatology; infectious diseases; pulmonary disease; critical care and rheumatology

• HDCN: Abbreviation for Hypertension, Dialysis and Clinical Nephrology, an electronic journal and an official education program of the American Society of Nephrology and the Renal Physician Association. Our program encourages trainees to subscribe and pays for the subscription

• NEPHROL: Trainees are encouraged to participate in the discussion of this cyber-forum. Over 1,400 national and international nephrologists exchange their views on the management of patients with nephrological and hypertensive disorders.

• MD Consult: Our program subscribes to MD Consult, a premier online medical information it also provides all standard nephrological and other medical text books on-line.

• OVID: We also subscribe to Ovid, a powerful , high-end information retrieval solution for researchers and professional sin academic and medical settings.

• Teton Data Systems: We subscribe to this site which provides medical and drug information designed exclusively for physicians. Provides facility for cross-searching more that 31 medical texts including Medline, Stedman's Medical Dictionary and other standard medical texts.

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• PubMed: PubMed is the National Library of Medicine's search service that provides access to over 11 million citations in MEDLINE, PreMEDLINE, and other related databases, with links to participating online journals. Trainees are actively encouraged to access to this resource.

• GratefulMed: Internet Grateful Med (IGM) searches MEDLINE® using the retrieval engine of NLM's PubMed system. Trainees are actively encouraged to access this resource.

D. Reading Material PGY4 are strongly encouraged to stay current with literature by reading the following journals (JASN, AJKD, Kidney International, American Journal of Nephrology, Clinical & Experimental Nephrology, Current Opinion in Nephrology and Hypertension, New England Journal of Medicine, JAMA, Lancet, Nature, Science).

GENERAL NEPHROLOGY

1. Brenner and Rector The Kidney, Saunders 2. Massry and Glassock Textbook of Nephrology, Williams & Williams. 3. Nissenson, Fine and Gentile Clinical Dialysis, Appleton & Lange.

ACID-BASE AND ELECTROLYTE DISORDERS 1. Ira Kurtz, Acid – Base Handbook, Trafford Publishing, 2004.

2. Burton David Rose Clinical physiology of acid-base and electrolyte disorders, McGraw-Hill. 3. Robert W. Schrier Renal and electrolyte disorders, Little & Brown Co. 4. Brenner, Rector, Coe Renal physiology in health and disease, Saunders.

CLINICAL NEPHROLOGY, HYPERTENSION

1. Brenner, Coe, Rector Clinical Nephrology, Saunders. 2. Burton David Rose Pathophysiology of renal disease, McGraw-Hill. 3. Robert W. Schrier Renal and electrolyte disorders, Little & Brown Co.

RENAL PATHOLOGY

1. Columbia Pathology Review Course slides 2. AJKD website - www.ajkd.org 3. Up-to-Date program

E. Evaluations 1. The program director meets all residents informally on a weekly basis and formally on a quarterly basis and

at the end of each year. 2. After each rotation, a resident is evaluated by the attending nephrologist using the standard American Board

of Internal Medicine (ABIM) format: "Evaluation of Subspecialty Trainees". PGY4s have 2 written tests per year to evaluate their knowledge of the syllabus and an in-service test. Evaluation include assessment of: • Clinical judgment • Medical knowledge • Clinical skills: medical interviewing, physical examination, procedural skills • Humanistic qualities • Professionalism

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• Medical care • Continuing Scholarship • Overall clinical competence as a nephrologist

3. Procedure records of each resident are maintained using the standard forms provided in the ABIM Guidelines on Evaluation of Clinical Competence and Other Information: "Trainee's Log of Supervised Procedures."

4. The program director or his designate meets with each resident quarterly for performance review and counseling. Evaluation includes residents' technical proficiency, teaching skills, communication, humanistic qualities, professional attitudes and behavior and commitment to scholarship. A written summary is filed for each such encounter.

5. The program director or his/her designate completes written American Board of Internal Medicine (ABIM) tracking form on clinical competence of each resident annually and at the conclusion of the fellow's training.

In case of adverse evaluations, special programs are instituted for remedial education and training. In case of persistent documented deficiency unresponsive to corrective actions, the resident is discontinued from the program. III. Transplant Nephrology Rotation (PGY4) A. Goals & Objectives Renal Transplantation

Each fellow must complete 1- month of rotation on the renal transplant service. Additional elective transplant rotation can be arranged. Clinical experience consists of active involvement, under supervision, in the management of pre- and immediate post-transplant and long-term care of donors and recipients and include: a) Evaluation and selection of transplant candidates b) Preoperative evaluation and preparation of transplant recipients c) Immediate postoperative management of transplant recipients, including administration of

immunosuppressants d) Clinical diagnosis of all forms of rejections including laboratory, histopathologic and imaging

techniques e) Medical management of rejection, including use of immunosuppresssant drugs and other agents f) Recognition and medical management of surgical and nonsurgical complications of transplantaions g) Long-term follow-up of transplant recipients in the ambulatory setting.

Each fellow does a month rotation of inpatient transplant nephrology. During this rotation they always have a precepting attending who overlooks the management and care of the patient but provides adequate independence to the residents to formulate their own plan. The goals and objectives of the training program include: • To educate and train residents in cognitive knowledge, procedural skills, interpersonal skills, professional

attitudes, humanistic qualities and clinical experience expected of a consultant nephrologist.

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• To provide a research-oriented environment for developing critical analysis of new information, problem-solving skills and rational decision-making. To ensure each resident has some hands-on experience in basic research methodology.





1. Patient Care Residents must be able to provide patient care that is compassionate, appropriate, and effective for the treatment of health problems and the promotion of health. Residents are expected to:


• gather essential and accurate information about their patients • make informed decisions about diagnostic and therapeutic interventions based on patient information

and preferences, up-to-date scientific evidence, and clinical judgment • develop and carry out patient management plans • counsel and educate patients and their families • use information technology to support patient care decisions and patient education • perform competently all medical and invasive procedures considered essential for the area of practice • provide health care services aimed at preventing health problems or maintaining health • work with health care professionals, including those from other disciplines, to provide patient-focused

care 2. Medical Knowledge

By the end of the rotation, the residents are expected to be well versed with the following

• Evaluation and selection of renal transplant candidates • Preoperative evaluation and preparation of renal transplant recipients • Immediate postoperative management of transplant recipients including administration of

immunosuppresants • Clinical diagnosis of all forms of rejection including laboratory, histopathological and imaging

techniques • Medical management of rejection, including use of immunosuppresants • Recognition and medical management of surgical and nonsurgical complications of renal transplantation • Long term follow-up of renal transplant recipients in ambulatory setting • demonstrate an investigatory and analytic thinking approach to clinical situations

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• know and apply the basic and clinically supportive sciences towards evaluation of patients for cadaveric and living donor transplant, follow patients immediate pre, peri and post transplant, evaluate renal failure for rejection, recurrence of original disease, calcineurin inhibitor toxicity, surgical complications

• Residents are expected to take care of patients with different level of complexities eg floor, step down and intensive critical care units

• Residents are also expected to teach other healthcare professionals regarding various renal transplant issues









• create and sustain a therapeutic and ethically sound relationship with patients • use effective listening skills and elicit and provide information using effective nonverbal, explanatory,

questioning, and writing skills • work effectively with others as a member or leader of a health care team or other professional group 5. Professionalism




• demonstrate sensitivity and responsiveness to patients’ culture, age, gender, and disabilities

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6. Systems-Based Practice Residents must demonstrate an awareness of and responsiveness to the larger context and system of health care and the ability to effectively call on system resources to provide care that is of optimal value. Residents are expected to:

• understand how their patient care and other professional practices affect other health care professionals, the health care organization, and the larger society and how these elements of the system affect their own practice know how types of medical practice and delivery systems differ from one another, including methods of controlling health care costs and allocating resources

• practice cost-effective health care and resource allocation that does not compromise quality of care • advocate for quality patient care and assist patients in dealing with system complexities

know how to partner with health care managers and health care providers to assess, coordinate, and improve health care and know how these activities can affect system performance

C. Method of Teaching & Implementation

1. Clinical Experience A. 4 weeks will be devoted to clinical training. It is estimated that you will manage:

• During your transplant rotation you will manage at least 30 new patients and 45 follow-up patients. • Longitudinal follow-up of transplant patients are also seen throughout the year, in the in-patient and

outpatient nephrology rotations.

B. Patient- mix includes diversity in • Age and sex: adolescent to geriatric age group of both sexes • Social economic status • Racial-cultural background


2. Technical and Other Skills B. Indications, contraindications, complications and interpretation of results in:

• Urinalysis • Percutaneous biopsy of native and transplant kidneys • Peritoneal dialysis • Placement of temporary vascular access for hemodialysis and other extracorporeal therapies • Acute and chronic hemodialysis • Renal imaging • Continuous renal replacement therapy


• Radiology of vascular access • Balloon angioplasty of vascular access • Therapeutic plasmapheresis

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• Bone biopsy • Placement of peritoneal catheters

C. Research Experience

A. Throughout the 24 months of fellowship training faculty members (all are involved in active research) inculcates a research culture into the thinking and clinical practice of the trainees. In addition, specific instruction on topics including the design and interpretation of research studies; the essentials of informed consent and the critical assessment of new therapies and the biomedical literature are taught and discussed during the:

• Journal Club on both clinical and basic science research papers • Basic Science Conferences by local and visiting research professors • Research Conference given by trainees, local and visiting research professors • Attendance at nephrology meetings with heavy emphasis on clinical and basic research • Basic science and research topics are covered in the Pathophysiology course

B. Hands on experience in the conduct of medical research: All fellows with no previous experience in direct research are required to complete a minimum of a 1-month research in the first year and 7-8 months of research in the second year of training. Fellows who have worked and published research papers have the choice of using the research rotation for an, in-depth rotation, focusing on a topic in consultative nephrology, dialysis or transplantation. C. Research requirements for nephrology fellows with no formal research training: One-month of research experience is required for Nephrology in the first year. In the second year, at least six months of research experience is required. A Nephrology fellow will first have the opportunity to get familiarized with the ongoing research activities of the faculty members of the Program and thereafter select a research project. Under the mentorship of the selected faculty member, the fellow will acquire knowledge in the design and interpretation of research studies, research ethics and responsible use of informed consent, research methodology and interpretation of data, and training in writing and presenting the outcome of the studies. D. Research requirements for nephrology fellow with prior research training: Nephrology fellows are selected, in part, because of their strength and track-record in clinical and basic research. This is usually reflected by their letters of recommendation and publications reflecting intensive training in research methods and skills. For fellows that are interested, the STAR program offers them the opportunity to obtain advanced degrees in clinical or basic research. These fellows are required to spend 80% of their time in research in the second year. Fellows in the STAR program can either continue after their second year to get a Masters in clinical science or a PhD in health outcome research or in basic science. Instruction in basic sciences as they relate to Nephrology is given at a Pathophysiology Course, a Basic Science Course, Research Conference, Journal Club meetings, a ESRD conference and, Renal Grand Rounds. Each fellow attends local/regional and national and international scientific conferences or training sessions each year. Nationally and internationally recognized Nephrologists visit the program each year, approximately half of these visiting professors work in basic sciences related to Nephrology. D. Conference and Scholarly Activities

Renal Conferences • Renal Grand Rounds

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• ESRD Conference • Pathophysiology Course • Transplant Conference/Journal Club • Basic Science and research conferences Multidisciplinary Conference • Renal-Pathology Conference • Medical Grand Rounds • Noon-Conference • Morning Report Visiting Professorships • The Program is visited by national and international professors each year. They represent authorities in

a wide spectrum of basic research and clinical expertise in the field of nephrology and related disciplines.

Special Courses • Introduction to Renal Pathology • Advances in Renal Transplantation Attendance at Scholarly Conferences • Annual Scientific Symposium on the National Kidney Foundation of Southern California • UCLA Society of Nephrology Conferences • Either the National Meeting of the American Society of Nephrology or the National Meeting of the


including complete lectures from all national and international conferences. • NEPHROL: An international web-site where practicing nephrologists exchange views and experience Special Courses Special courses lasting days to weeks are spaced through the two year training include: • Introduction to Renal Pathology • Advances in Renal Transplantation • Comprehensive Course on Elements of Dialytic Therapy • STAR program. Selected fellows are accepted as candidates for a masters or PhD program Other Scholarly Conferences Each year the fellow is given the opportunity to attend: • Annual Scientific Symposium of the National Kidney Foundation of Sourthern California • UCLA Society of Nephrology Conferences • Either the National Meeting of the American Society of Nephrology or the National Meeting of the

National Kidney Foundation Journal, Video and Audio Material Every resident is given journal subscriptions and video-tapes on lectures if available.

E. Teaching and Communication Experience

Fellows are give daily opportunity to learn from and model after the attending nephrologists in teaching, communication and leadership skills. These skills are specifically developed in the following activities:

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• Lectures to residents, interns and medical students taking nephrology elective. • Opportunities to teach at rounds and transplant conferences • Presentation/participation as active discussants at the Nephrology Grand Rounds. • Presentation/participation of research papers as active discussants at the transplant Journal Club

F. Training in Self-Instruction and Informatics

Fellows are provided with educational and informatics facilities and trained to utilize them on a daily basis to effectively search and gather information for critical analysis of clinical problems and the resource and ability to make appropriate decisions. This is expected to be a life-long culture the fellows will carry with them upon graduation. Specifically, the following sources and facilities are available: • Up-To-Date: Our program subscribes to this well known electronic clinical reference in nephrology and









D. Reading material

• Danovitch G. M. Handbook of Kidney Transplantation, Little & Brown Co. E. Evaluations

1. The program director meets all residents informally on a weekly basis and formally on a quarterly basis and at the end of each year. 2. After each rotation, a resident is evaluated by the attending nephrologist using the standard American Board of Internal Medicine (ABIM) format: "Evaluation of Subspecialty Trainees". Fellows have 2 written tests per year to evaluate their knowledge of the syllabus. Evaluation include assessmnet of: • Clinical judgment • Medical knowledge

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• Clinical skills: medical interviewing, physical examination, procedural skills • Humanistic qualities • Professionalism • Medical care • Continuing Scholarship • Overall clinical competence as a nephrologist 3. Procedure records of each resident are maintained using the standard forms provided in the ABIM Guidelines on Evaluation of Clinical Competence and Other Information: "Trainee's Log of Supervised Procedures." 4. The program director or his designate meets with each resident quarterly for performance review and counseling. Evaluation includes residents' technical proficiency, teaching skills, communication, humanistic qualities, professional attitudes and behavior and commitment to scholarship.A written summary is filed for each such encounter.

5. The program director or his designate completes written American Board of Internal Medicine (ABIM) tracking form on clinical competence of each resident annually and at the conclusion of the fellow's training. In case of adverse evaluations, special programs are instituted for remedial education and

training. 6. In case of persistent documented deficiency unresponsive to corrective actions, the resident is discontinued from the program.

IV. Outpatient Dialysis (PGY4) A. Goals and Objectives

Dialysis and extracorporeal therapy

Each resident must complete 16 weeks on the dialysis rotation. Additional elective rotations can be arranged. Clinical experience must entail supervised involvement in decision making for patients undergoing these therapies. This experience must include: a) Evaluation and selection of patients for acute hemodialysis or continuous renal replacement

therapies b) Evaluation of end-stage renal disease patients for various forms of therapy and their instruction

regarding treatment options. c) Drug dosage and modification during dialysis and other extracorporeal therapies d) Evaluation and management of medical complications in patients during and between dialyses and

other extracorporeal therapies, including dialysis access, and an understanding of their pathogenesis and prevention.

e) Long-term follow-up of patients undergoing chronic dialysis, including their dialysis prescription and modification and assessment of adequacy of dialysis.

f) An understanding of the principles and practice of peritoneal dialysis, including the establishment of peritoneal access, the principles of dialysis catheters, and how to choose appropriate catheters.

g) An understanding of the technology of peritoneal dialysis, including the use of automated cyclers h) Assessment of peritoneal dialysis efficiency, using peritoneal equilibration testing and the principles

of peritoneal biopsy. i) An understanding of how to write a peritoneal dialysis prescription and how to assess peritoneal

dialysis adequacy.

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j) The pharmacology of commonly used medications and their kinetic and dosage alteration with peritoneal dialysis.

k) An understanding of the complications of peritoneal dialysis, including peritonitis and its treatment, exit site and tunnel infections and their management, hernias, pleural effusions, and other less common complications and their management.

l) An understanding of the special nutritional requirements of the hemodialysis and peritoneal dialysis patient.

Residents are expected to see and evaluate patients new to dialysis and follow chronic patients in the dialysis unit. During this rotation they always have a precepting attending who overlooks the management and care of the patient but provides adequate independence to the residents to formulate their own plan. The goals and objectives of the training program include: • To educate and train residents in cognitive knowledge, procedural skills, interpersonal skills, professional









• gather essential and accurate information about their patients from various resources including primary care physician, nurses, dietician, social worker and other subspecialists and health care professionals.


• develop and carry out patient management plans developed after discussing with the attending nephrologist, nurse, dietician and social worker

• counsel and educate patients and their families regarding various dislysis modalities, vascular access issues, importance of preventive medicine and the option of transplant.

• use information technology to support patient care decisions and patient education

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• perform competently all medical and invasive procedures considered essential for the area of practice including emergent dialysis (both hemo and peritoneal), vascular access placement and renal biopsy

• provide health care services aimed at preventing health problems or maintaining health • work with health care professionals, including nurses, dietician, social worker and those from other

disciplines, to provide patient-focused care 2. Medical Knowledge


• Evaluation and selection of patients with end stage renal disease for various modalities of renal replacement therapy including hemodialysis and peritoneal dialysis

• Writing prescription for different dialysis modalities and assessing adequacy of dialysis • Drug dosage and modification during dialysis • Evaluation and management of various complications of dialysis including access issues • Long term follow up of patients undergoing chronic dialysis • Understanding the principals and technical aspects of dialysis • Understanding of special nutritional requirements of patients on dialysis










questioning, and writing skills • work effectively with others as a member or leader of a health care team or other professional group

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5. Professionalism Residents must demonstrate a commitment to carrying out professional responsibilities, adherence to ethical principles, and sensitivity to a diverse patient population. Residents are expected to:









C. Methods of Teaching and Implementation


• Continued care of 8-10 out-patients per week and 1-2 new out-patients each month during the dialysis

rotation. In addition the fellow will follow 50-60 ESRD patients in the chronic dialysis unit. • Longitudinal follow-up dialysis patients are also seen throughout the year in in-patient and outpatient

nephrology rotations.

B. Patient- mix includes diversity in • Age and sex: adolescent to geriatric age group of both sexes • Social economic status • Racial-cultural background


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2. Technical and Other Skills 1. Indications, contraindications, complications and interpretation of results in:




3. Research Experience A. Throughout the 24 months of fellowship training faculty members (involved in active research) inculcate a research culture into the thinking and clinical practice of the trainees. In addition, specific instruction on topics including the design and interpretation of research studies; the essentials of informed consent and the critical assessment of new therapies and the biomedical literature are taught and discussed during the:

• Journal Club on both clinical and basic science research papers • Basic Science Conferences by local and visiting research professors • Research Conferences given by trainees, local and visiting research professors • Attendance at nephrology meetings with heavy emphasis on clinical and basic research • Basic science and research topics are covered in the Pathophysiology course

B. Hands on experience in the conduct of medical research: All fellows with no previous experience in direct research are required to complete a minimum of a 1-month research in the first year and 8 months of research in the second year of training. Fellows who have worked and published research papers have the choice of using the research rotation for an, in-depth rotation, focusing on a topic in consultative nephrology, dialysis or transplantation. C. Research requirements for nephrology fellows with no formal research training: One-month of research experience is required for Nephrology in the first year. In the second year, at least six months of research experience is required. A Nephrology fellow will first have the opportunity to get familiarized with the ongoing research activities of the faculty members of the Program and thereafter select a research project. Under the mentorship of the selected faculty member, the fellow will acquire knowledge in the design and interpretation of research studies, research ethics and responsible use of informed consent, research methodology and interpretation of data, and training in writing and presenting the outcome of the studies. D. Research requirements for nephrology fellow with prior research training: Nephrology fellows are selected, in part, because of their strength and track-record in clinical and basic research. This is usually reflected by their letters of recommendation and publications reflecting intensive training in research methods and skills.

23

For fellows that are interested, the STAR program offers them the opportunity to obtain advanced degrees in clinical or basic research. These fellows are required to spend 80% of their time in research in the second year. Fellows in the STAR program can either continue after their second year to get a Masters in clinical science or a PhD in health outcome research or in basic science. Instruction in basic sciences as they relate to Nephrology is given at a Pathophysiology Course with basic Science lectures , Research Conferences, Journal Club meetings, ESRD conferences, and, Renal Grand Rounds. Each fellow attends local/regional and national and international scientific conferences or training sessions each year. Nationally and internationally recognized Nephrologists visit the program each year, approximately half of these visiting professors work in basic sciences related to Nephrology. 4. Conference and Scholarly Activities

Renal Conferences • Renal Grand Rounds • ESRD Conference • Consult Service Teaching Seminar/Journal club • Pathophysiology Course • Transplant Conference • Basic science and research conferences Multidisciplinary Conference • Renal-Pathology Conference • Medical Grand Rounds • Noon-Conference • Morning Report Visiting Professorships • The Program is visited by national and international professors each year. They represent authorities in




including complete lectures from all national and international conferences. • NEPHROL: An international web-site where practicing nephrologists exchange views and experience Special Courses Special courses lasting days to weeks are spaced through the two year training include: • Introduction to Renal Pathology • Advances in Renal Transplantation

24

• Comprehensive Course on Elements of Dialytic Therapy • STAR program. Selected fellows are accepted as candidates for a masters or PhD program Other Scholarly Conferences Each year the fellow is given the opportunity to attend: • Annual Scientific Symposium of the National Kidney Foundation of Sourthern California • UCLA Society of Nephrology Conferences • Either the National Meeting of the American Society of Nephrology or the National Meeting of the


5. Teaching and Communication Experience Fellows are give daily opportunity to learn from and model after the attending nephrologists in teaching, communication and leadership skills. These skills are specifically developed in the following activities: • Lectures to residents, interns and medical students taking nephrology elective. • Opportunities to teach at rounds and transplant conferences • Presentation/participation as active discussants at Nephrology Grand Rounds. • Presentation/participation as active discussants at Journal Clubs

6. Training in Self-Instruction and Informatics










25

D. Reading Material

• Daugirdas and Ing Handbook of Dialysis, Little & Brown Co. • Nissenson, Fine, Gentile Clinical Dialysis, 3rd Edition, Appleton Century Crofts Publishers • Nissenson, Fine, Editors Dialysis Therapy, Hanley and Belfus Publishers

E. Evaluations

1. The program director meets all residents informally on a weekly basis and formally on a quarterly basis and at the end of each year. 2. After each rotation, a resident is evaluated by the attending nephrologist using the standard American Board of Internal Medicine (ABIM) format: "Evaluation of Subspecialty Trainees". Fellows have 2 written tests per year to evaluate their knowledge of the syllabus. Evaluation include assessmnet of: • Clinical judgment • Medical knowledge • Clinical skills: medical interviewing, physical examination, procedural skills • Humanistic qualities • Professionalism • Medical care • Continuing Scholarship • Overall clinical competence as a nephrologist 3. Procedure records of each resident are maintained using the standard forms provided in the ABIM Guidelines on Evaluation of Clinical Competence and Other Information: "Trainee's Log of Supervised Procedures." 4. The program director or his designate meets with each resident quarterly for performance review and counseling. Evaluation includes residents' technical proficiency, teaching skills, communication, humanistic qualities, professional attitudes and behavior and commitment to scholarship. A written summary is filed for each such encounter. 5. The program director or his designate completes written American Board of Internal Medicine (ABIM) tracking form on clinical competence of each resident annually and at the conclusion of the fellow's training. 6. In case of adverse evaluations, special programs are instituted for remedial education and training. In case of persistent documented deficiency unresponsive to corrective actions, the resident is discontinued from the program.

V. Continuity Clinics (PGY 4) A. Goals & Objectives Residents are expected to see new patients and follow their old patients in these clinics two half days a week for their entire duration of fellowship training as required by ACGME. During this rotation they always have a precepting attending who overlooks the management and care of the patient but provides adequate independence to the residents to formulate their own plan.

26

The goals and objectives of the training program include: • To educate and train residents in cognitive knowledge, procedural skills, interpersonal skills, professional







1. Patient Care They must be able to provide patient care that is compassionate, appropriate, and effective for the treatment of health problems and the promotion of health. Residents are expected to:


• gather essential and accurate information about their patients from various sources including but not limited to referring physician, computer data base, other subspecialists and the patient themselves.

• make informed decisions about diagnostic and therapeutic interventions based on patient information and preferences, up-to-date scientific evidence, and clinical judgment The studies include but are not limited to biopsies, chemistry panels, various radiological and nuclear medicine studies

• develop and carry out patient management plans along with other health professionals after discussing with the precepting attending

• counsel and educate patients and their families regarding renal failure, various complications from renal failure, advise them regarding possible outcomes including end stage renal disease, various dialysis modalities and transplant

• use information technology to support patient care decisions and patient education • perform competently all medical and invasive procedures considered essential for the area of practice

including but not limited to renal biopsy, placement of emergent access if needed and urine analysis. • provide health care services aimed at preventing health problems or maintaining health including but not

limited to prevention of renal disease progression, cardiovascular disease and other preventive practices appropriate for patients age.

• work with health care professionals, including those from other disciplines including but not limited to vascular surgery, radiology, endocrinology and cardiology, to provide patient-focused care


27


• Diagnosis, work up and management of acute renal failure • Management of chronic kidney disease • Management of anemia associated with renal failure • Management of secondary hyperparathyroidism in the setting of renal failure • Drug dosage in the setting of various degrees of renal insufficiency • Diagnosis, work up and management of various electrolyte abnormalities • Diagnosis, work up and management of secondary hypertension • Diagnosis, work up and management of renal stones














28







D. Methods of Teaching and Implementation

1. Clinical Experience A. Two half days per week throughout the training is devoted to continuity clinical training. It is estimated that you will manage:

• 2 new, and 6 follow-up patients per week. Longitudinal follow-up are also seen throughout the year, in in-patient and out-patient nephrology rotations.

B. Patient- mix includes diversity in

• Age and sex: adolescent to geriatric age group of both sexes • Social economic status • Racial-cultural background


2. Technical and Other Skills

1. Indications, contraindications, complications and interpretation of results in: • Urinalysis • Percutaneous biopsy of native and transplant kidneys • Peritoneal dialysis • Placement of temporary vascular access for hemodialysis and other extracorporeal therapies • Acute and chronic hemodialysis • Renal imaging • Continuous renal replacement therapy


• Radiology of vascular access • Balloon angioplasty of vascular access

29

• Therapeutic plasmapheresis • Bone biopsy • Placement of peritoneal catheters



B. Hands on experience in the conduct of medical research: All fellows with no previous experience in direct research are required to complete a minimum of a 1-month research in the first year and 8 months of research in the second year of training. Fellows who have worked and published research papers have the choice of using the research rotation for an, in-depth rotation, focusing on a topic in consultative nephrology, dialysis or transplantation. C. Research requirements for nephrology fellows with no formal research training: One-month of research experience is required for Nephrology in the first year. In the second year, at least six months of research experience is required. A Nephrology fellow will first have the opportunity to get familiarized with the ongoing research activities of the faculty members of the Program and thereafter select a research project. Under the mentorship of the selected faculty member, the fellow will acquire knowledge in the design and interpretation of research studies, research ethics and responsible use of informed consent, research methodology and interpretation of data, and training in writing and presenting the outcome of the studies. D. Research requirements for nephrology fellow with prior research training: Nephrology fellows are selected, in part, because of their strength and track-record in clinical and basic research. This is usually reflected by their letters of recommendation and publications reflecting intensive training in research methods and skills. For fellows that are interested, the STAR program offers them the opportunity to obtain advanced degrees in clinical or basic research. These fellows are required to spend 80% of their time in research in the second year. Fellows in the STAR program can either continue after their second year to get a Masters in clinical science or a PhD in health outcome research or in basic science. Instruction in basic sciences as they relate to Nephrology is given at a Pathophysiology Course, a Basic Science Course, Research Conference, Journal Club meetings, a ESRD conference and, Renal Grand Rounds. Each fellow attends local/regional and national and international scientific conferences or training sessions each year. Nationally and internationally recognized Nephrologists visit the program each year, approximately half of these visiting professors work in basic sciences related to Nephrology. 4. Conference and Scholarly Activities

Renal Conferences

30

• Renal Grand Rounds • ESRD Conferences • Consult Service Teaching Seminar/Journal club • Pathophysiology Course • Transplant Conference • Basic science and research conferences Multidisciplinary Conference • Renal-Pathology Conference • Medical Grand Rounds • Noon-Conference • Morning Report Visiting Professorships • The Program is visited by national and international professors each year. They represent authorities in






31

5. Teaching and Communication Experience Fellows are give daily opportunity to learn from and model after the attending nephrologists in teaching, communication and leadership skills. These skills are specifically developed in the following activities: • Weekly lectures to residents, interns and medical students taking nephrology elective. • Opportunities to teach at the weekly "Nephrology Core Curriculum for Residents." • Presentations and participation as active discussants at the weekly UCLA Nephrology Grand Rounds. • Presentation of research papers and participation as active discussants at the weekly Journal Club











D. Reading material


1. The program director meets all residents informally on a weekly basis and formally on a quarterly basis and at the end of each year. 2. After each rotation, a resident is evaluated by the attending nephrologist using the standard American

32

Board of Internal Medicine (ABIM) format: "Evaluation of Subspecialty Trainees". Fellows have 2 written tests per year to evaluate their knowledge of the syllabus. Evaluation include assessment of: • Clinical judgment • Medical knowledge • Clinical skills: medical interviewing, physical examination, procedural skills • Humanistic qualities • Professionalism • Medical care • Continuing Scholarship • Overall clinical competence as a nephrologist 3. Procedure records of each resident are maintained using the standard forms provided in the ABIM Guidelines on Evaluation of Clinical Competence and Other Information: "Trainee's Log of Supervised Procedures." 4. The program director or his designate meets with each resident quarterly for performance review and counseling. Evaluation includes residents' technical proficiency, teaching skills, communication, humanistic qualities, professional attitudes and behavior and commitment to scholarship. A written summary is filed for each such encounter.

5. The program director or his designate completes written American Board of Internal Medicine (ABIM) tracking form on clinical competence of each resident annually and at the conclusion of the fellow's training.In case of adverse evaluations, special programs are instituted for remedial education and training.

6. In case of persistent documented deficiency unresponsive to corrective actions, the resident is discontinued from the program.

VI. Inpatient General Nephrology (PGY5) A. Goals & Objectives Residents are expected to see new consults and follow up on previous consults in this inpatient rotation. During this rotation they always have a precepting attending who overlooks the management and care of the patient but provides adequate independence to the residents to formulate their own plan. The goals and objectives of the training program include: • To educate and train residents in cognitive knowledge, procedural skills, interpersonal skills, professional





• To acquire knowledge and experience in: occupational safety and health, critical assessment and decision sciences, evaluation of medical literature, clinical epidemiology, clinical study design, relative and absolute risks of disease, medical statistics and medical decision-making, psychosocial, economic and ethical issues

33

in nephrology, cultural, social, family, behavioral and economic issues, educational and counseling skills, and research and critical assessment of new therapies and of the medical literature.

There is a progressive increase in responsibility for the second year fellows in the Nephrology Training Program.

• Orient and supervise the first year fellows in learning procedures and conduct didactic lectures • Responsible for Training and teaching medical students and housestaff clinically and by giving lectures

in a didactic setting • Responsible for organizing the CKD (Chronic Kidney Disease) Wednesday Conference including

contacting physicians inside and outside of division to speak on relevant topics as well as giving lectures themselves.

• Responsible for scheduling the annual rotations on the different services for all the UCLA fellows as well as the rotations for fellows who rotate on the Transplant & Dialysis Services at UCLA from outside institutions. Additionally, create the Nephrology call schedule on a monthly basis.

• Review the nephrology fellowship applications and assist in interviewing the applicants. B. Core Competencies

1. Patient Care Residents are trained and educated to provide patient care that is compassionate, appropriate, and effective for the treatment of health problems and the promotion of health. Residents are expected to:


• gather essential and accurate information about their patients from various resources including consulting physician/team, computer database, other subspecialties and nursing and ancillary staff


• develop and carry out patient management plans in accordance to the accepted guidelines • counsel and educate patients and their families about renal failure, electrolyte abnormalities,

hypertension and dialysis modalities • use information technology to support patient care decisions and patient education • perform competently all medical and invasive procedures considered essential for the area of practice

including temporary dialysis access placement, renal biopsy and urine analysis • provide health care services aimed at preventing health problems or maintaining health including

prevention of renal and cardiovascular disease progression • work with health care professionals, including those from other disciplines, to provide patient-focused



• Diagnosis, work up and management of acute kidney injury and its various causes • Acid base physiology with sound understanding of pathophysiology and management

34

• Evaluation and selection of patients for acute hemodialysis including continuous renal replacement therapy

• Various complications of dialysis including access issues • Drug dosage in patients on dialysis • Various procedures including emergent vascular access placement for hemodialysis and renal biopsy • Work up and management of various electrolyte abnormalities in hospitalized patients • Management of hypertensive urgencies and emergencies • Residents are expected to take care of patients with different level of complexities eg floor, step down

and intensive critical care units • Residents are also expected to teach other healthcare professionals regarding various renal, acid-base,

electrolyte abnormalities and hypertension • Addressing renal issues in non-renal transplant patients both pre and post operative













35






• practice cost-effective health care and resource allocation that does not compromise quality of care • advocate for quality patient care and assist patients in dealing with system complexities • know how to partner with health care managers and health care providers to assess, coordinate, and

improve health care and know how these activities can affect system performance C. Methods of Teaching and Implementation

7. Clinical Experience • A. Total of 16 weeks will be devoted to inpatient nephrology training. During this time, the fellow is

expected to manage ~500-600 new and 250 follow-up in-patients per rotation.

B. Patient- mix includes diversity in • Age and sex: 21 years and older to geriatric age group of both sexes. On occasion 18-21 years old will

also be seen. • Social economic status • Racial, ethnic & cultural background



G. Indications, contraindications, complications and interpretation of results in: • Urinalysis • Percutaneous biopsy of native • Peritoneal dialysis • Placement of temporary vascular access for hemodialysis and other extracorporeal therapies • Acute and chronic hemodialysis • Renal imaging • Continuous renal replacement therapy


36



• Journal Club on both clinical and basic science research papers • Basic Science Conference by local and visiting research professors • Research Conference given by trainees, local and visiting research professors • Attendance at national and local nephrology meetings with heavy emphasis on clinical and basic

research • Basic science and research topics are covered in the Pathophysiology course

B. Hands on experience in the conduct of medical research: All fellows with no previous experience in direct research are encouraged to complete a minimum of a 1-month research in the first year and 7-8 months of research in the second year of training. Fellows who have worked and published research papers have the choice of using the research rotation for an, in-depth rotation, focusing on a topic in consultative nephrology, dialysis or transplantation. C. Research requirements for nephrology fellows with no formal research training: One-month of research experience is required for Nephrology in the first year. In the second year, at least six months of research experience is required. A Nephrology fellow will first have the opportunity to get familiarized with the ongoing research activities of the faculty members of the Program and thereafter select a research project. Under the mentorship of the selected faculty member, the fellow will acquire knowledge in the design and interpretation of research studies, research ethics and responsible use of informed consent, research methodology and interpretation of data, and training in writing and presenting the outcome of the studies. D. Research requirements for nephrology fellow with prior research training: Nephrology fellows are selected, in part, because of their strength and track-record in clinical and basic research. This is usually reflected by their letters of recommendation and publications reflecting intensive training in research methods and skills. For fellows that are interested, the STAR program offers them the opportunity to obtain advanced degrees in clinical or basic research. These fellows are required to spend 80% of their time in research in the second year. Fellows in the STAR program can either continue after their second year to get a Masters in clinical science or a PhD in health outcome research or in basic science. Instruction in basic sciences as they relate to Nephrology is given at a Pathophysiology Course, a Basic Science Course, Research Conference, Journal Club meetings, a ESRD conference and, Renal Grand Rounds. Each fellow attends local/regional and national and international scientific conferences or training sessions each year.

37

Nationally and internationally recognized Nephrologists visit the program each year, approximately half of these visiting professors work in basic sciences related to Nephrology. 10. Conference and Scholarly Activities

Renal Conferences • Renal Grand Rounds • Nephrology Noon Conference (includes Basic Science & Research) • Consult Service Teaching Seminar/Journal club • Pathophysiology Course • Transplant Conference Multidisciplinary Conference • Renal-Pathology Conference • Medical Grand Rounds • Noon-Conference • Morning Report Visiting Professorships • National and international professors visit each year. They represent authorities in a wide spectrum of

basic research and clinical expertise in the field of nephrology and related disciplines. Special Courses • Introduction to Renal Pathology • Advances in Renal Transplantation Attendance at Scholarly Conferences • Annual Scientific Symposium on the National Kidney Foundation of Southern California • UCLA Society of Nephrology Conferences • Either the National Meeting of the American Society of Nephrology or the National Meeting of the


including complete lectures from all national and international conferences. • NEPHROL: An international web-site where practicing nephrologists exchange views and experience Special Courses Special courses lasting days to weeks are spaced through the two year training include: • Introduction to Renal Pathology • Advances in Renal Transplantation • Comprehensive Course on Elements of Dialytic Therapy • STAR program. Selected fellows are accepted as candidates for a masters or PhD program Other Scholarly Conferences Each year the fellow is given the opportunity to attend: • Annual Scientific Symposium of the National Kidney Foundation of Sourthern California • 4 UCLA Society of Nephrology Conferences • Either the National Meeting of the American Society of Nephrology or the National Meeting of the

National Kidney Foundation Journal, Video and Audio Material Every resident can receive journal subscriptions and video-tapes on lectures if available.

38

11. Teaching and Communication Experience Fellows are given daily opportunity to learn from and model after the attending nephrologists in teaching, communication and leadership skills. These skills are specifically developed in the following activities: • Weekly lectures to residents, interns and medical students taking nephrology elective. • Opportunities to teach at the weekly "Nephrology Core Curriculum for Residents." • Presentations and participation as active discussants at the weekly UCLA Nephrology Grand Rounds. • Presentation of research papers and participation as active discussants at Journal Clubs.

12. Training in Self-Instruction and Informatics Fellows are provided with educational and informatics facilities and trained to utilize them on a daily basis to effectively search and gather information for critical analysis of clinical problems and the resource and ability to make appropriate decisions. This is expected to be a life-long culture the fellows will carry with them upon graduation. Specifically, the following sources and facilities are available: • Up-To-Date: Our program subscribes to this well known electronic clinical reference in nephrology and









D. Reading Material Fellows are strongly encouraged to stay current with literature by reading the following journals (JASN, AJKD, Kidney International, American Journal of Nephrology, Clinical & Experimental Nephrology, Current Opinion in Nephrology and Hypertension, New England Journal of Medicine, JAMA, Lancet, Nature, Science).

GENERAL NEPHROLOGY

1. Brenner and Rector The Kidney, Saunders

39

2. Massry and Glassock Textbook of Nephrology, Williams & Williams. 3. Nissenson, Fine and Gentile Clinical Dialysis, Appleton & Lange.




1. Brenner, Coe, Rector Clinical Nephrology, Saunders. 2. Burton David Rose Pathophysiology of renal disease, McGraw-Hill. 4. Robert W. Schrier Renal and electrolyte disorders, Little & Brown Co.

RENAL PATHOLOGY


E. Evaluations 7. The program director meets all residents informally on a weekly basis and formally on a quarterly basis and

at the end of each year. 8. After each rotation, a resident is evaluated by the attending nephrologist using the standard American Board

of Internal Medicine (ABIM) format: "Evaluation of Subspecialty Trainees". PGY4s have 2 written tests per year to evaluate their knowledge of the syllabus and an in-service test. Evaluation include assessment of: • Clinical judgment • Medical knowledge • Clinical skills: medical interviewing, physical examination, procedural skills • Humanistic qualities • Professionalism • Medical care • Continuing Scholarship • Overall clinical competence as a nephrologist

9. Procedure records of each resident are maintained using the standard forms provided in the ABIM Guidelines on Evaluation of Clinical Competence and Other Information: "Trainee's Log of Supervised Procedures."

10. The program director or his designate meets with each resident quarterly for performancereview and counseling. Evaluation includes residents' technical proficiency, teaching skills, communication, humanistic qualities, professional attitudes and behavior and commitment to scholarship. A written summary is filed for each such encounter.

11. The program director or his/her designate completes written American Board of Internal Medicine (ABIM) tracking form on clinical competence of each resident annually and at the conclusion of the fellow's training.

In case of adverse evaluations, special programs are instituted for remedial education and training. In case of persistent documented deficiency unresponsive to corrective actions, the resident is discontinued from the program.

40

VII. Transplant Nephrology Rotation (PGY5) A. Goals & Objectives

Renal Transplantation

Each fellow must complete 2- months of rotation on the renal transplant service. Additional elective transplant rotation can be arranged. Clinical experience consists of active involvement, under supervision, in the management of pre- and immediate post-transplant and long-term care of donors and recipients and include: h) Evaluation and selection of transplant candidates i) Preoperative evaluation and preparation of transplant recipients j) Immediate postoperative management of transplant recipients, including administration of

immunosuppressants k) Clinical diagnosis of all forms of rejections including laboratory, histopathologic and imaging

techniques l) Medical management of rejection, including use of immunosuppresssant drugs and other agents m) Recognition and medical management of surgical and nonsurgical complications of transplantaions n) Long-term follow-up of transplant recipients in the ambulatory setting.

PGY5 fellows do a one month rotation of inpatient transplant nephrology each with similar responsibilities. They also do one month of transplant clinic each year. During this rotation they always have a precepting attending who overlooks the management and care of the patient but provides adequate independence to the residents to formulate their own plan. The goals and objectives of the training program include: • To educate and train residents in cognitive knowledge, procedural skills, interpersonal skills, professional






Progressive Responsibility for Second Year Fellows: There is a progressive increase in responsibility for the second year fellows in the Nephrology Training Program.

• Orient and supervise the first year fellows in learning procedures and conduct didactic lectures

41

• Responsible for Training and teaching medical students and housestaff clinically and by giving lectures in a didactic setting

• Responsible for organizing the CKD (Chronic Kidney Disease) Wednesday Conference including contacting physicians inside and outside of division to speak on relevant topics as well as giving lectures themselves.


• Review the nephrology fellowship applications and assist in interviewing the applicants.




• gather essential and accurate information about their patients • make informed decisions about diagnostic and therapeutic interventions based on patient information

and preferences, up-to-date scientific evidence, and clinical judgment • develop and carry out patient management plans • counsel and educate patients and their families • use information technology to support patient care decisions and patient education • perform competently all medical and invasive procedures considered essential for the area of practice • provide health care services aimed at preventing health problems or maintaining health • work with health care professionals, including those from other disciplines, to provide patient-focused



• Evaluation and selection of renal transplant candidates • Preoperative evaluation and preparation of renal transplant recipients • Immediate postoperative management of transplant recipients including administration of

immunosuppresants • Clinical diagnosis of all forms of rejection including laboratory, histopathological and imaging

techniques • Medical management of rejection, including use of immunosuppresants • Recognition and medical management of surgical and nonsurgical complications of renal transplantation • Long term follow-up of renal transplant recipients in ambulatory setting • demonstrate an investigatory and analytic thinking approach to clinical situations

42

• know and apply the basic and clinically supportive sciences towards evaluation of patients for cadaveric and living donor transplant, follow patients immediate pre, peri and post transplant, evaluate renal failure for rejection, recurrence of original disease, calcineurin inhibitor toxicity, surgical complications

• Residents are expected to take care of patients with different level of complexities eg floor, step down and intensive critical care units

• Residents are also expected to teach other healthcare professionals regarding various renal transplant issues














• demonstrate sensitivity and responsiveness to patients’ culture, age, gender, and disabilities

43

11. Systems-Based Practice Residents must demonstrate an awareness of and responsiveness to the larger context and system of health care and the ability to effectively call on system resources to provide care that is of optimal value. Residents are expected to:

• understand how their patient care and other professional practices affect other health care professionals, the health care organization, and the larger society and how these elements of the system affect their own practice know how types of medical practice and delivery systems differ from one another, including methods of controlling health care costs and allocating resources



C. Method of Teaching & Implementation


• During your transplant rotation you will manage at least 30 new patients and 45 longitudinal follow-up patients.

• Longitudinal follow-up of transplant patients are also seen throughout the year, in the in-patient and outpatient nephrology rotations.




2. Technical and Other Skills H. Indications, contraindications, complications and interpretation of results in:



44


I. Research Experience

A. Throughout the 24 months of fellowship training faculty members (all are involved in active research) inculcates a research culture into the thinking and clinical practice of the trainees. In addition, specific instruction on topics including the design and interpretation of research studies; the essentials of informed consent and the critical assessment of new therapies and the biomedical literature are taught and discussed during the:


B. Hands on experience in the conduct of medical research: All fellows with no previous experience in direct research are required to complete a minimum of a 1-month research in the first year and 8 months of research in the second year of training. Fellows who have worked and published research papers have the choice of using the research rotation for an, in-depth rotation, focusing on a topic in consultative nephrology, dialysis or transplantation. C. Research requirements for nephrology fellows with no formal research training: One-month of research experience is required for Nephrology in the first year. In the second year, at least six months of research experience is required. A Nephrology fellow will first have the opportunity to get familiarized with the ongoing research activities of the faculty members of the Program and thereafter select a research project. Under the mentorship of the selected faculty member, the fellow will acquire knowledge in the design and interpretation of research studies, research ethics and responsible use of informed consent, research methodology and interpretation of data, and training in writing and presenting the outcome of the studies. D. Research requirements for nephrology fellow with prior research training: Nephrology fellows are selected, in part, because of their strength and track-record in clinical and basic research. This is usually reflected by their letters of recommendation and publications reflecting intensive training in research methods and skills. For fellows that are interested, the STAR program offers them the opportunity to obtain advanced degrees in clinical or basic research. These fellows are required to spend 80% of their time in research in the second year. Fellows in the STAR program can either continue after their second year to get a Masters in clinical science or a PhD in health outcome research or in basic science. Instruction in basic sciences as they relate to Nephrology is given at a Pathophysiology Course, a Basic Science Course, Research Conference, Journal Club meetings, a ESRD conference and, Renal Grand Rounds. Each fellow attends local/regional and national and international scientific conferences or training sessions each year. Nationally and internationally recognized Nephrologists visit the program each year, approximately half of these visiting professors work in basic sciences related to Nephrology.

45

J. Conference and Scholarly Activities Renal Conferences • Renal Grand Rounds • ESRD Conference • Pathophysiology Course • Transplant Conference/Journal Club • Basic Science and research conferences Multidisciplinary Conference • Renal-Pathology Conference • Medical Grand Rounds • Noon-Conference • Morning Report Visiting Professorships • The Program is visited by national and international professors each year. They represent authorities in




including complete lectures from all national and international conferences. • NEPHROL: An international web-site where practicing nephrologists exchange views and experience Special Courses Special courses lasting days to weeks are spaced through the two year training include: • Introduction to Renal Pathology • Advances in Renal Transplantation • Comprehensive Course on Elements of Dialytic Therapy • STAR program. Selected fellows are accepted as candidates for a masters or PhD program Other Scholarly Conferences Each year the fellow is given the opportunity to attend: • Annual Scientific Symposium of the National Kidney Foundation of Sourthern California • 4 UCLA Society of Nephrology Conferences • Either the National Meeting of the American Society of Nephrology or the National Meeting of the


46

K. Teaching and Communication Experience Fellows are give daily opportunity to learn from and model after the attending nephrologists in teaching, communication and leadership skills. These skills are specifically developed in the following activities: • Lectures to residents, interns and medical students taking nephrology elective. • Opportunities to teach at rounds and transplant conferences • Presentation/participation as active discussants at the Nephrology Grand Rounds. • Presentation/participation of research papers as active discussants at the transplant Journal Club

L. Training in Self-Instruction and Informatics










D. Reading material


1. The program director meets all residents informally on a weekly basis and formally on a quarterly basis and at the end of each year. 2. After each rotation, a resident is evaluated by the attending nephrologist using the standard American Board of Internal Medicine (ABIM) format: "Evaluation of Subspecialty Trainees". Fellows have 2

47

written tests per year to evaluate their knowledge of the syllabus. Evaluation include assessmnet of: • Clinical judgment • Medical knowledge • Clinical skills: medical interviewing, physical examination, procedural skills • Humanistic qualities • Professionalism • Medical care • Continuing Scholarship • Overall clinical competence as a nephrologist 3. Procedure records of each resident are maintained using the standard forms provided in the ABIM Guidelines on Evaluation of Clinical Competence and Other Information: "Trainee's Log of Supervised Procedures." 4. The program director or his designate meets with each resident every six months form performance

review and counseling. Evaluation includes residents' technical proficiency, teaching skills, communication, humanistic qualities, professional attitudes and behavior and commitment to scholarship. A written summary is filed for each such encounter.

5. The program director or his designate completes written American Board of Internal Medicine (ABIM) tracking form on clinical competence of each resident annually and at the conclusion of the fellow's training. In case of adverse evaluations, special programs are instituted for remedial education and training.

6. In case of persistent documented deficiency unresponsive to corrective actions, the resident is discontinued from the program. VIII. Continuity Clinics (PGY 5) A. Goals & Objectives Residents are expected to see new patients and follow their old patients in these clinics two half days a week for their entire duration of fellowship training as required by ACGME. During this rotation they always have a precepting attending who overlooks the management and care of the patient but provides adequate independence to the residents to formulate their own plan. The duties of PGY4 and PGY5 are not very different with both years having similar responsibilities. The goals and objectives of the training program include: • To educate and train residents in cognitive knowledge, procedural skills, interpersonal skills, professional





48


Progressive Responsibility for Second Year Fellows: There is a progressive increase in responsibility for the second year fellows in the Nephrology Training Program.

• Orient and supervise the first year fellows in learning procedures and conduct didactic lectures • Responsible for Training and teaching medical students and housestaff clinically and by giving lectures

in a didactic setting • Responsible for organizing the CKD (Chronic Kidney Disease) Wednesday Conference including

contacting physicians inside and outside of division to speak on relevant topics as well as giving lectures themselves.


• Review the nephrology fellowship applications and assist in interviewing the applicants. B. Core Competencies

1. Patient Care They must be able to provide patient care that is compassionate, appropriate, and effective for the treatment of health problems and the promotion of health. Residents are expected to:


• gather essential and accurate information about their patients from various sources including but not limited to referring physician, computer data base, other subspecialists and the patient themselves.

• make informed decisions about diagnostic and therapeutic interventions based on patient information and preferences, up-to-date scientific evidence, and clinical judgment The studies include but are not limited to biopsies, chemistry panels, various radiological and nuclear medicine studies

• develop and carry out patient management plans along with other health professionals after discussing with the precepting attending

• counsel and educate patients and their families regarding renal failure, various complications from renal failure, advise them regarding possible outcomes including end stage renal disease, various dialysis modalities and transplant

• use information technology to support patient care decisions and patient education • perform competently all medical and invasive procedures considered essential for the area of practice

including but not limited to renal biopsy, placement of emergent access if needed and urine analysis. • provide health care services aimed at preventing health problems or maintaining health including but not

limited to prevention of renal disease progression, cardiovascular disease and other preventive practices appropriate for patients age.

• work with health care professionals, including those from other disciplines including but not limited to vascular surgery, radiology, endocrinology and cardiology, to provide patient-focused care

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• Diagnosis, work up and management of acute renal failure • Management of chronic kidney disease • Management of anemia associated with renal failure • Management of secondary hyperparathyroidism in the setting of renal failure • Drug dosage in the setting of various degrees of renal insufficiency • Diagnosis, work up and management of various electrolyte abnormalities • Diagnosis, work up and management of secondary hypertension • Diagnosis, work up and management of renal stones













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C. Methods of Teaching and Implementation

1. Clinical Experience A. Two half days per week throughout the training is devoted to continuity clinical training. It is estimated that you will manage:

• 2 new, and 6 followup patients per week. Longitudinal follow-up are also seen throughout the year, in in-patient and out-patient nephrology rotations.





1. Indications, contraindications, complications and interpretation of results in: • Urinalysis • Percutaneous biopsy of native and transplant kidneys • Peritoneal dialysis • Placement of temporary vascular access for hemodialysis and other extracorporeal therapies • Acute and chronic hemodialysis • Renal imaging • Continuous renal replacement therapy


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B. Hands on experience in the conduct of medical research: All fellows with no previous experience in direct research are required to complete a minimum of a 1-month research in the first year and 8 months of research in the second year of training. Fellows who have worked and published research papers have the choice of using the research rotation for an, in-depth rotation, focusing on a topic in consultative nephrology, dialysis or transplantation. C. Research requirements for nephrology fellows with no formal research training: One-month of research experience is required for Nephrology in the first year. In the second year, at least six months of research experience is required. A Nephrology fellow will first have the opportunity to get familiarized with the ongoing research activities of the faculty members of the Program and thereafter select a research project. Under the mentorship of the selected faculty member, the fellow will acquire knowledge in the design and interpretation of research studies, research ethics and responsible use of informed consent, research methodology and interpretation of data, and training in writing and presenting the outcome of the studies. D. Research requirements for nephrology fellow with prior research training: Nephrology fellows are selected, in part, because of their strength and track-record in clinical and basic research. This is usually reflected by their letters of recommendation and publications reflecting intensive training in research methods and skills. For fellows that are interested, the STAR program offers them the opportunity to obtain advanced degrees in clinical or basic research. These fellows are required to spend 80% of their time in research in the second year. Fellows in the STAR program can either continue after their second year to get a Masters in clinical science or a PhD in health outcome research or in basic science. Instruction in basic sciences as they relate to Nephrology is given at a Pathophysiology Course, a Basic Science Course, Research Conference, Journal Club meetings, a ESRD conference and, Renal Grand Rounds. Each fellow attends local/regional and national and international scientific conferences or training sessions each year. Nationally and internationally recognized Nephrologists visit the program each year, approximately half of these visiting professors work in basic sciences related to Nephrology.

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4. Conference and Scholarly Activities Renal Conferences • Renal Grand Rounds • ESRD Conferences • Consult Service Teaching Seminar/Journal club • Pathophysiology Course • Transplant Conference • Basic science and research conferences Multidisciplinary Conference • Renal-Pathology Conference • Medical Grand Rounds • Noon-Conference • Morning Report Visiting Professorships • The Program is visited by national and international professors each year. They represent authorities in






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5. Teaching and Communication Experience

Fellows are give daily opportunity to learn from and model after the attending nephrologists in teaching, communication and leadership skills. These skills are specifically developed in the following activities: • Weekly lectures to residents, interns and medical students taking nephrology elective. • Opportunities to teach at the weekly "Nephrology Core Curriculum for Residents." • Presentations and participation as active discussants at the weekly UCLA Nephrology Grand Rounds. • Presentation of research papers and participation as active discussants at the weekly Journal Club











D. Reading material


1. The program director meets all residents informally on a weekly basis and formally on a quarterly basis and at the end of each year.

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2. After each rotation, a resident is evaluated by the attending nephrologist using the standard American Board of Internal Medicine (ABIM) format: "Evaluation of Subspecialty Trainees". Fellows have 2 written tests per year to evaluate their knowledge of the syllabus. Evaluation include assessment of: • Clinical judgment • Medical knowledge • Clinical skills: medical interviewing, physical examination, procedural skills • Humanistic qualities • Professionalism • Medical care • Continuing Scholarship • Overall clinical competence as a nephrologist 3. Procedure records of each resident are maintained using the standard forms provided in the ABIM Guidelines on Evaluation of Clinical Competence and Other Information: "Trainee's Log of Supervised Procedures." 4. The program director or his designate meets with each resident quarterly for performance

review and counseling. Evaluation includes residents' technical proficiency, teaching skills, communication, humanistic qualities, professional attitudes and behavior and commitment to scholarship. A written summary is filed for each such encounter.

5. The program director or his designate completes written American Board of Internal Medicine (ABIM) tracking form on clinical competence of each resident annually and at the conclusion of the fellow's training.In case of adverse evaluations, special programs are instituted for remedial education and training.

6. In case of persistent documented deficiency unresponsive to corrective actions, the resident is discontinued from the program.

IX. Syllabus A. Core syllabus 1. Background a) Renal anatomy, physiology and pathology: Renal anatomy, physiology and pathology are complex but essential parts of the curriculum in nephrology. Fellows acquire a knowleldge of these areas in didactic lectures, patient conferences, and pathology conferences. Expertise in this area is essential for fellows to be competent in evaluating complex electrolyte disorders and glomerular diseases. b) Fluid, Electrolyte and Acid Base: Regulation and Disorders: Electrolyte disorders are a common reason for nephrologists to be consulted. Fellows acquire a knowledge of this area in didactic lectures, patient conferences, and in their inpatient rotations and outpatient clinics. Expertise in this area is essential for fellows to be competent in evaluating electrolyte disorders which they will be required to know as practicing nephrologists.

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c) Mineral and Divalent ions: Metabolism and Disorders: Expertise in this area is essential for fellows to be competent in evaluating renal stone disease and abnormalities in divalent cation metabolism in patients with ESRD. Fellows acquire a knowledge of this area in didactic lectures, patient conferences, and in their inpatient and outpatient rotations. d) Glomerulonephropathies: Fellows acquire a knowledge of glomerular diseases in didactic lectures, patient conferences, in their inpatient rotations and outpatient clinics, and during renal pathology conferences. A knowledge of the diagnosis and treatment of glomerular diseases is essential for the practicing nephrologist. e) Systemic, infectious, malignant and renal cystic diseases: Systemic, infectious, and malignant diseases of the kidney are a common cause of renal morbidity and mortality. Diabetes is the most common cause of ESRD in the US. Polycystic kidney disease is the cause of 10% of ESRD in the US. Fellows acquire a knowledge of these diseases in didactic lectures, patient conferences, in their inpatient rotations and outpatient clinics, and during renal pathology conferences. f) Hypertensive Disorders: Hypertension is an important cause of renal, cardiovascular and neurological disease. Fellows acquire a knowledge of systemic and infectious diseases in didactic lectures, patient conferences, in their inpatient rotations and outpatient clinics, and during renal pathology conferences. g) Renal Vascular Hypertension and Atheroembolic and Ischemic Kidney Disease: Renovascular diseases include fibromuscular disease which can be seen in young women, and atherosclerotic disease in older age groups. Vascular diseases are important causes of renal, cardiovascular and neurological disease. Fellows acquire a knowledge of these diseases in didactic lectures, patient conferences, in their inpatient rotations and outpatient clinics, and during renal pathology conferences. h) Drugs and the Kidney: Numerous drugs affect the kidney’s function. Fellows must be aware of the effect of the medications they prescribe on the kidney. Furthermore, the dose of numerous drugs need to be altered in patients with renal disease and so the knowledge of drug metabolism and pharmacokinetics is essential. Furthermore IV drug abuse can cause several renal diseases including glomerulonephritis, amyloid, polyarteritis, and hepatis related renal diseases. Fellows acquire knowledge of these diseases in didactic lectures, patient conferences, in their inpatient i) Acute Renal Failure and ICU related Nephrology: Acute renal failure is a common disorder in the inpatient setting. Fellows are required to become expert in distinguishing the causes of acute renal failure and formulating a rationale management plan. j) Chronic Renal Failure and End Stage Renal Failure:

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There are approximately 700,000 patients in the USA with ESRD. Fellows learn to manage the medical and renal problems these patients manifest. In addition, fellows learn to care for the chronic dialysis needs of these patients and there access problems. A team approach is utilized coordinating the care with nursing staff, nutritionists, social services, radiology and vascular surgery. k) Renal Transplantation: Approximately 80,000 patients in the USA await a kidney transplant. Approximately 300 transplants are performed yearly at UCLA. Fellows are responsible for managing the patients preoperatively and postoperatively. Furthermore, fellows are responsible for the chronic care of their transplant patients in the outpatient setting. Fellows acquire expertise in didactic lectures, patient conferences, in their inpatient rotations and outpatient clinics, and during renal pathology conferences. l) Hemodialysis and Extracorporeal Therapy: Becoming expert in dialysis is a key factor in the success of the practicing nephrologist. Fellows acquire these skills by performing over 1,000 acute dialyses per year and managing approximately 60-70 outpatient dialysis patients. 2. Specific Program Content Renal osteodystrophy, nephrolithiasis and disorders of mineral metabolism

Renal Transport of Calcium, Magnesium, and Phosphate Disorders of Calcium, Magnesium and Phosphorus Metabolism Renal Osteodystrophies Pathogenesis and Management of Nephrolithiasis

Pathophysiology and disorders of fluid, electrolyte and acid-base homeostasis

Elements of Normal Renal Structure and Function Glomerular Filtration Metabolic and Molecular Basis of Solute Transport Glucose, Amino Acids, Sodium, Chloride and Water Potassium, Hydrogen and Bicarbonate Urea Uric Acid and the Organic Anions and Cations

Disturbances in Control of Fluid Volume and Composition Pathogenesis of Edema Formation Disorders of Water Metabolism The Dysnatremias The Dyskalemias Acid-Base Disorders

Uses and Abuses of Diuretics Laboratory assessment of renal disease Clearance

Urine Analysis

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Diagnostic Immunology Renal Biopsy Renal Imaging

Acute renal failure

Incidence and Etiology Pathophysiology and Pathology Diagnosis and Clinical Course Complications, Management and Outcome

Chronic renal failure and its management by conservative methods, including nutritional management of uremia

Pathophysiology of Uremia Uremic Anemia Antihypertensive Therapy Nutritional Therapy in the Management of Renal Disease Strategies for Delaying Progression or Regression of Renal Failure

End-stage renal disease

Pathophysiology and Clinical Characteristics of Anephric Patinets Conservative Management

The Legal, Psychosocial and Ethical Issues Principle and Practice of End-of-Life Management

Dialytic Management: Hemodialysis and Peritoneal Dialysis The Kinetic Principles of Hemodialysis and Peritoneal Dialysis Indications for Each Dialysis Modality Acute and Chronic Complications Dialysis Access: Acute and Chronic Hemodialysis and Peritoneal Dialysis KT/V and Protein Catabolic Rate Metabolic Characteristics of Hemodialysis and Peritoneal Dialysis Nutritional Management of Dialysis Patients Dialysis Water Treatment, delivery systems and reuse of dialyzers The Psychosocial and Ethical Issues of Dialysis

Renal Transplantation Biology of Transplant Rejection Indications for and Contraindications to Renal Transplantation Principles of Transplant Recipient Selection and Evaluation Principles of Live and Cadaveric Transplant Donors Evaluation Histocompatibility Fundamentals of organ harvesting, preservation and sharing Psychosocial Aspects of Organ Donation and Transplantation

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Hypertensive disorders

Vascular Biology and Hypertension Essential Hypertension Renovascular Hypertension and Ischemic Nephropathy Hypertension in Renal Parenchymal Disease

Renal disorders of pregnancy

Pregnancy Associated Changes in the Renal Structure and Function Cardiovascular Physiology in Pregnancy Hypertension in Pregnancy Renal Disorders Complicating Pregnancy Pregnancy in Women with Renal Disease Management of Renal Failure in Pregnancy Management of Pregnancy in End-Stage Renal Failure Patients

Urinary tract infections

Obstrucive Nephropathy Nephrological Aspect of Prostatic Disorders Urinary Tract Infection, Pyelonephritis and Reflux Nephropathy

Renal Immunology

Basic Principles Immunologic Mechanisms of Renal Disease

Tubulointerstitial renal diseases, including inherited diseases of transport, cystic diseases, and other congenital disorders

Tubulointerstitial Disease Inherited Disorders of the Renal Tubule Cystic Diseases of the Kidney

Glomerular and vascular diseases, including the glomerulonephritides, diabetic nephropathy and atheroembolic renal disease

Glomerular Disease Primary Glomerular Disease Secondary Glomerular Disease

Vascular Disease Microvascular Disease of the Kidney Vascular Complications Involving the Renal Vessels

Diabetic Nephropathy Disorders of drug metabolism and renal drug toxicity

Prescribing Drugs in Renal Disease Toxic Nephropathies

Genetic and inherited renal disorders

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Geriatric aspects of nephrology, including disorders of the aging kidney and urinary tract Renal neoplasia Molecular and cellular biology for clinical nephrology B. Other practice related syllabus Occupational and Health-Care Regulations

Occupational Safety and Health Administration (OSHA) Regulations Universal Precautions and Protection of Health-Care Workers (Mandatory Annual Occupational Safety and Infection Control Training Classes)

Medical Ethics

Basic Ethical Principles Patients’ Rights Ethical Responsibility to Society Principles of Research in Ethics

Medical Practice Issues

Fundamentals of Medical-Legal Issues Health Care Economics and Assessment of Patient Care Quality

Quality Assessment Quality Improvement Risk Management Cost Effectiveness

Health Care Monitoring: Regulatory and Accreditation Aspects Practice Management Techniques (Series of Lectures on Practice Fundamentals)

End-of-Life Care

Team Approach to Palliative Care for Terminally Ill Uremic Patients. Psychosocial, Cultural and Religious Issues Related to Death and Dying. Principles and Practice of Hospice and Home Care

Medical Communication and Teaching

Basic Communication Skills Leadership, Collaboration and Team Skills Fundamentals of an Effective Teacher

Clinical Skills Professional Attitudes and Behaviors

Patient Counseling Skills and Community Education.

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X. Principal Teaching Method The most important educational content, including the mix of diseases, 1) Clinical Experience patient characteristics and types of clinical encounters. 2) Didactic Instruction 3) Clinical & Didactic 4) Not covered

Disorders of mineral metabolism, including nephrolithiasis and renal osteodystrophy

3

Disorders of fluid, electrolyte, and acid-base regulation 3

Acute renal failure 3

Chronic renal failure and its management by conservative methods, including nutritional management of uremia

3

End-stage renal disease 3

Hypertensive disorders 3

Renal disorders of pregnancy 3

Urinary tract infections 3

Tubulointerstitial renal diseases, including inherited diseases of transport, cystic diseases, and other congenital disorders

3

Glomerular and vascular diseases, including the glomerulonephritides, diabetic nephropathy, and atheroembolic renal disease

3

Disorders of drug metabolism and renal drug toxicity 3

Genetic and inherited renal disorders 3

Geriatric aspects of nephrology, including disorders of the aging kidney and urinary tract

3

Renal anatomy, physiology, and pathology 3

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

3

Normal mineral metabolism and its alteration in renal diseases, metabolic bone disease, and nephrolithiasis

3

Normal and abnormal blood pressure regulation 3

Clinical pharmacology, including drug metabolism and pharmacokinetics and the effects of drugs on renal structure and function

3

Nutritional aspects of renal disorders 3

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Basic principles of immunology 3

Immunologic mechanisms of renal disease 3

Fundamental aspects of diagnostic laboratory immunology relevant to renal diseases

3

Renal transplantation:

Evaluation and selection of transplant candidates 3

Preoperative evaluation and preparation of transplant recipients and donors

3

Immediate postoperative management of transplant recipients, including administration of immunosuppressants

3

Clinical diagnosis of all forms of rejection including laboratory, histopathologic, and imaging techniques

3

Medical management of rejection, including use of immunosuppressant drugs and other agents

3

Recognition and medical management of the surgical and nonsurgical complications of transplantations

3

Biology of transplantation rejection 3

Indications for and contraindications to renal transplantation 3

Principles of transplant recipient evaluation and selection 3

Principles of evaluation of transplant donors, both live and cadaveric, including histocompatibility testing

3

Principles of organ harvesting, preservation, and sharing 3

Psychosocial aspects of organ donation and transplantation 3

The pathogenesis and management of urinary tract infections 3

The pathogenesis and management of acute renal failure 3

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

3

Disorders of fluids and electrolytes and acid-base balance 3

Dialysis and Extracorporeal Therapy:

Evaluation and selection of patients for acute hemodialysis or continuous renal replacement therapies

3

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Evaluation of end-stage renal disease patients for various forms of therapy and their instruction regarding treatment options

3

Drug dosage modification during dialysis and other extracorporeal therapies

3

Evaluation and management of medical complications in patients during and between dialyses and other extracorporeal therapies, including dialysis access, and an understanding of the pathogenesis and prevention of such complications

3

An understanding of the principles and practice of peritoneal dialysis, including the establishment of peritoneal access, the principles of dialysis catheters, and how to choose appropriate catheters

3

An understanding of the technology of peritoneal dialysis, including the use of automated cyclers

3

Assessment of peritoneal dialysis efficiency, using peritoneal equilibration testing and the principles of peritoneal biopsy

3

An understanding of how to write a peritoneal dialysis prescription and how to assess peritoneal dialysis adequacy

3

The pharmacology of commonly used medications and their kinetic and dosage alteration with peritoneal dialysis

3

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

3

An understanding of the special nutritional requirements of hemodialysis and peritoneal dialysis patients

3

The kinetic principles of hemodialysis and peritoneal dialysis 3

The indication for each mode of dialysis 3

The short-term and long-term complications of each mode of dialysis and their management

3

The principles of dialysis access (acute and chronic vascular and peritoneal), including indications, techniques, and complications

3

Urea kinetics and protein catabolic rate 3

Dialysis modes and their relation to metabolism 3

Nutritional management of dialysis patients 3

Dialysis water treatment, delivery systems, and reuse of artificial kidneys 3

The artificial membranes used in hemodialysis and biocompatibility 3

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The psychosocial and ethical issues of dialysis 3

Other content areas:

Radiology of vascular access 3

Balloon angioplasty of vascular access 2

Therapeutic plasmapheresis 3

Bone biopsy 2

Placement of peritoneal catheters 2

Renal ultrasound 3

Lithotripsy 2

Urinalysis 3

Percutaneous biopsy of both autologous and transplanted kidneys 1

Placement of temporary vascular access for hemodialysis and related

procedures 1

Peritoneal Dialysis 3

Acute and long term hemodialysis and related procedures 3

Continuous renal replacement therapy 3

Physiology and pathology of the aging kidney 3

Drug dosing and renal toxicity in elderly patients 3

OSHA regulations and universal precautions and protection of health care workers

3

Quality assessment & improvement 3

Cost effectiveness 3

Health care policy 3

Evaluation of medical literature 3

Clinical study design 3

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Medical decision-making 3

Cultural, social, family, behavioral and economic issues 3

Principles of palliative care for terminally ill patients 3

Patient counseling skills and community education 3

E. Principal ancillary reading materials and pathology references

GENERAL NEPHROLOGY 1. Brenner and Rector The Kidney, Saunders 2. Massry and Glassock Textbook of Nephrology, Williams & Williams. 3. Nissenson, Fine and Gentile Clinical Dialysis, Appleton & Lange.




1. Brenner, Coe, Rector Clinical Nephrology, Saunders. 2. Burton David Rose Pathophysiology of renal disease, McGraw-Hill.

3. Robert W. Schrier Renal and electrolyte disorders, Little & Brown Co. RENAL PATHOLOGY


DIALYSIS

1. Daugirdas and Ing Handbook of Dialysis, Little & Brown Co. 2. Nissenson, Fine, Gentile Clinical Dialysis, 3rd Edition, Appleton Century Crofts Publishers 3. Nissenson, Fine, Editors Dialysis Therapy, Hanley and Belfus Publishers

TRANSPLANTATION

Danovitch G. M. Handbook of Kidney Transplantation, Little & Brown Co.

2008-2009

Documents

methods of teaching

goals objectivesb

clinical experience

overall goals

management skills

goals objectivesresidents

interpersonal skills

procedural skills