440curriculum Kidneydisease
440curriculum Kidneydisease
440curriculum Kidneydisease
Erick Andrez
Brian Kaneshiro
Judy Lee
Kayla Martinez
The following curriculum is designed for students at the university level that are enrolled in the
nephrology training program within the department of medicine. The intended population is
targeted towards the management of renal diseases of individuals/patients within the healthcare
and/or intensive care settings. The following program curriculum will incorporate all aspects of
nephrology from a variety of renal diseases to taking the necessary steps to diagnosing and
treating end-stage renal disease. CORE COMPETENCIES: The curriculum will be split into
two parts, the didactic program content and clinical patient care setting, that will expand patient
care, supervisory, and teaching skills as competent Nephrologists. Every year, a questionnaire
will be sent out to the participants to gauge the depth of exposure to a wide variety of renal
diseases to see if extra steps could be taken to deal with areas that are deficient. In the Academic
Track, the participant is expected to spend two or more years in a basic or clinical science
research project working under the supervision of one faculty member. CURRICULUM FOR
participants will be expected to integrate medical problems with preventive practices, cultural,
FELLOWSHIP PROGRAM
The objective is to prepare physicians who have completed three years of residency training in
Internal Medicine to become competent Nephrologists. The training will provide the fellow with
exposure to a wide variety of renal diseases and electrolyte abnormalities and a chance to
perform the procedures necessary for the diagnosis and treatment of end-stage renal disease. The
program will allow the trainees to assume increasing responsibility in the management of renal
GOAL
Based upon the Survey of Experts and Curricular Resources, the learner-oriented goals for
Patient Care:
• Elicit the patient’s history, past history, and the context in which the illness or symptoms occur
• Develop verbal and nonverbal communication skills in order to facilitate communication, elicit
• Recognize psychosocial issues that may affect patient compliance and outcomes
• Accept personal responsibility to follow-up on patient care plans and test results
• Apply appropriate preventative care for the patient with kidney disease seen in an outpatient
setting
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most patients
• Coordinate patient care among all members of the health care team
• Develop skills for end of life and palliative care discussions and planning for the ill patient with
• Optimize discharge planning and follow-up in the nephrology clinic or dialysis unit
• Perform procedures (urine microscopy, temporary catheters, renal biopsy) required by the
ABIM
In addition, by the end of the 2nd Year of Fellowship, one should be able to:
• Use the interview to identify cognitive impairment, anxiety, denial and defensiveness and be
• Independently perform the procedures (urine microscopy, temporary catheters, renal biopsy)
• Efficiently evaluate and manage patients in the inpatient and outpatient setting at the level of a
nephrology sub-specialist
• Coordinate patient care among all members of the healthcare team and demonstrate leadership
• Demonstrate effective ability to lead end of life and palliative care discussions and planning for
Medical Knowledge:
• Expand clinically applicable knowledge base of basic and clinical nephrology sciences
• Develop skills for effective case presentation and discussion of optimizing medical care for all
In addition, by the end of the 2nd Year of Fellowship, one should be able to:
nephrology problems
Curricular Response: Chronic Kidney Disease in Elderly 6
application
• Solidify knowledge base by educating others (medical students, residents, PAs, co-fellows,
faculty)
• Demonstrate a level of knowledge appropriate for level of training compared with one’s peers
• nephrology conditions
• Communicate effectively with patients with kidney disease and their families
• Communicate effectively with all non-physician members of the health care team to assure
comprehensive and timely care of patients with all forms of kidney disease
• Learn to communicate effectively through concise, logical and clinically useful discharge
summaries
By the end of the 1st Year of Fellowship, one must be able to:
• Document all clinical responses to patient care needs legibly in the chart
• Develop skills to address frustration with our current healthcare system, or programmatic issues
• Deliver bad news to patients with kidney disease (and their families) with empathy
• Create clinically useful discharge summaries for nephrologists and other health care providers
• Demonstrate effective listening skills and reliable responsiveness to the needs of students,
residents and co-fellows as well as the opinions and requests of multidisciplinary team members
• Communicate effectively with other consultants and primary care doctors to coordinate
effective care and follow-up for the patient with kidney disease
• Deliver polished and professional formal presentations on all nephrologic issues and renal
diseases
• Communicate near misses or mismanagement issues with the healthcare providers involved in
an educational manner
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Professionalism:
• Display the elements of professionalism: altruism, accountability, excellence, duty, honor and
By the end of the 1st Year of Fellowship, one must be able to:
• Demonstrate a personal sense of altruism by consistently acting in one’s patients’ best interest
• Conduct clinical nephrology research with honesty, integrity and protection of patients’ rights
• Identify and acknowledge gaps in personal knowledge and skills in the care of one’s patients
• Develop and implement strategies for filling gaps in knowledge and skills
By the end of the 1st Year of Fellowship, one must be able to:
In addition, by the end of the 2nd Year of Fellowship, one should be able to:
• Teach students, residents and peers effectively about various renal issues
• Use information technology to enhance care of complex patients with kidney disease
• Analyze and improve one’s own practice by reviewing charts through audits
Systems-Based Practice:
• Understand and utilize the multidisciplinary resources necessary to care optimally for
• Learn to collaborate with other members of the health care team to assure comprehensive care
• Use evidence-based, cost conscious strategies in the care of patients with all forms of kidney
disease
By the end of the 1st Year of Fellowship, one must be able to:
• Collaborate with discharge planners to arrange safe and appropriate discharges for patients with
kidney disease
• Develop a working knowledge of various care systems and the most appropriate disposition for
By the end of the 2nd Year of Fellowship, one should be able to:
• Direct other subspecialty, surgical, nutritional, podiatric and social service consultations for
• Use systemic approaches to reduce errors and effectively transition kidney disease patients
• Strive to optimize patient follow-up by effective discharge planning to the nephrology clinic or
dialysis unit
Curricular Response: Chronic Kidney Disease in Elderly 11
• Practice effective allocation of health care resources to avoid compromising quality of care
• Recognize system deficiencies/complexities and strive for system improvement for patients
The core conferences take place approximately every week. This series of lectures covers the
core curriculum and is repeated annually. Topics covering both research and clinical practice
are covered throughout the year. Nephrology Faculty as well as allied specialties and
subspecialties are invited to present. A series of lectures in medical ethics and good research
• Expand clinically applicable knowledge base of the basic and clinical sciences underlying the
• Access and critically evaluate medical literature, and be able to apply knowledge to clinical
practice
concepts
interventions.
- Renal Rounds: Friday 1:00 - 2:00 pm - Clinical and Physiologic discussions of case material
relevant to active patients presented by the consultation service in conjunction with the Pediatric
Renal group. Monthly guest speakers also present their current clinical or basic science research
in Nephrology.
- Renal Journal Club: Tuesday 8:30-9:30 AM presentation and discussion of important recent
patients biopsied with clinicopathological discussions run by the Renal Pathology division.
-There are in addition two weekly "work-sessions" related to clinical care in which the clinical
- Bi-Weekly Dialysis Conference: Tuesday 2:00 PM - Joint session with psychiatry, social
- Weekly Transplant Patient Conference: Monday 7:00-8:00 AM Joint session with psychiatry,
social service, and nursing services to review active transplant patient care problems. This is
followed by a weekly meeting with surgery, urology, and pediatrics to evaluate new transplant
Every year, a questionnaire will be sent out to the fellows to gauge the depth
of exposure and to see if extra steps could be taken to deal with areas that are deficient.
1. Glomerular diseases
3. Hypertension
7. Acid-base disorders
12. Transplantation
Glomerular Diseases
I. PROGRAM CONTENT
1. Structure and function of the normal glomerulus and how alteration of these leads to
concepts of autoimmunity and the factors that may be responsible for and mediate immunologic
glomerular injury
1. The causes, clinical decision making, and treatment of common and uncommon causes
response to corticosteroid treatment, the development of acute renal failure in adults. and the
clinical and pathological features of this disorder in association with hepatitis C and
cryoglobulinemia
clinical syndromes and the association with conditions of reduced renal mass. The demographics,
clinical course, and outcome of the clinicopathologic syndromes of 'primary" focal sclerosis,
of both idiopathic membranous nephropathy and secondary membranous disease, and indepth
5. IgA nephropathy, especially its clinical course, natural history, and prognostic markers
fungal infections, and their epidemiology, clinical course, and response to therapy, especially
systemic diseases with respect to pathology, clinical and serological features, and response to
treatment of:
Sjogren's syndrome, mixed connective tissue disease, rheumatoid arthritis, Bechet's syndrome,
3. Indications for and complications of renal biopsy, as well as the morphological and
renal limited and secondary to systemic diseases, including the indications, complications, and
I. PROGRAM CONTENT
(DN)
4. Therapy of established DN
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hemodialysis and peritoneal dialysis, kidney transplantation, and kidney pancreas transplantation
1. Various ways in which diabetes mellitus (DM) may affect the kidneys and urinary tract
2. Cardinal clinical and histological features, as well as the epidemiology and course of
transplantation
2. Unique medical and surgical problems facing patients with advanced DN as well as
their management
A. Trainees must have experience in the evaluation and management of patients with progressive
complication is needed.
B. Trainees must have experience in the evaluation and management of patients with endstage
C. Trainees must have experience with the evaluation of patients with diabetic nephropathy for
renal transplantation.
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D. Trainees must have experience managing patients with diabetic nephropathy during and after
renal transplantation.
Hypertension
I. PROGRAM CONTENT
A. Trainees must acquire knowledge and understanding of the following areas during the course
of their training:
1. Epidemiology of hypertension
6. Hypertension in renal parenchymal disease during chronic dialysis and after renal
transplantation
management
A. Trainees should be familiar with and have experience in the following areas in both the
1. Trainees must be able to assess the severity of hypertension and end-organ damage.
They should be familiar with the role of ambulatory blood pressure monitoring in the evaluation
nonpharmacologic modalities as well as the use and side-effects of antihypertensive agents, and
4. Trainees must be able to identify symptoms and signs suggestive of secondary causes
of hypertension and be familiar with the various screening and diagnostic tests as well as the
5. Trainees must become familiar with the management of the various hypertensive
I. PROGRAM CONTENT
A. Trainees must acquire knowledge and understanding of the following areas during the
a. Hormonal
b. Nutritional
c. Electrolyte
d. Acid-base
e. Volume
d. Nondialytic therapy
e. Dialytic therapies
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i. Role of hemodialysis
13. Role of extracorporeal therapy in the management of drug overdose, specifically ethylene
A. Trainees must have experience in the evaluation and management of acute renal failure.
B. Trainees must have experience in the evaluation and management of fluid-electrolyte and
C. Trainees should have experience in the evaluation of hemodynamics and the proper use of
D. Trainees should have experience in the use of various ialytic techniques, including
E. Trainees should have experience in the use of extracorporeal therapy to remove specific
toxins.
1. PROGRAM CONTENT
A. Trainees must acquire knowledge and understanding of the following areas during the
i. Diabetes mellitus
ii. Hypertension
3. Current concepts and the results of clinical studies pertaining to the role of hypertension,
dietary composition, and divalent cations on the progression of chronic renal diseases
4. Predialysis management of CRF with particular regard to diet, anemia, metabolic bone
a. Management of the anemia of chronic renal failure with the use of iron, erythropoietin
6. Indications for initiation of ESRD therapy and placement of ESRD access in patients with
CRF
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7. Appropriate use of drugs, including dose modification, for patients with progressive CRF
A. Trainees must have at least one year of continuous outpatient clinic experience in the
B. Trainees must have a sufficient number of patients to evaluate and manage so that they
acquire expertise in the management of patients with glomerular, interstitial, and obstructive
renal processes. In addition, trainees should have a sufficient number of patients to work with
studies, renal arteriography, and renal ultrasound in the diagnosis of patients with CRF.
D. Trainees must be competent to perform - and must have performed a sufficient number of
E. Trainees must have interpreted an appropriate number of renal biopsies so that they are
Dialysis
1.PROGRAM CONTENT
B. Available water treatment and dialysis delivery machines for hemodialysis and connection
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emphasis on differences in membrane composition, biocompatibility, and solute and water flux
D. Importance of and correct method of determining the dialysis prescription for hemodialysis
and peritoneal dialysis and of monitoring the actual delivered dose of dialysis
L. Role of Medicare, the Health Care Financing Administration, Networks, US Renal Data
System, and voluntary organizations/societies (e.g., National Kidney Foundation, the ASN,
and the Renal Physicians Association) in the delivery and financing of care for ESRD patients
A. Trainees must manage patients with acute renal failure requiring dialysis treatment including
intermittent hemodialysis, continuous peritoneal dialysis, and the extracorporeal continuous renal
replacement therapies.
B. Trainees must manage patients with chronic renal failure on maintenance hemodialysis
longitudinally for a sufficient time to allow participation in the prescription of and monitoring of
the dose of delivered dialysis. assessment and adjustment of the need for and dose of
erythropoietin, evaluation and treatment of renal osteodystrophy, and ongoing evaluation of the
dialysis access
C. Trainees must manage patients with chronic renal failure on maintenance peritoneal dialysis
longitudinally as outlined above for hemodialysis patients. In addition. Trainees must participate
in the assessment of patients for suitability of various forms of dialytic therapy. along with a
multidisciplinary team.
Acid-Base Disorders
1. PROGRAM CONTENT
A. Trainees must acquire knowledge and understanding of the following areas during the
renal acidification processes and the physiology of bicarbonate reabsorption, titratable acid
management
and management
management
management
A. Trainees should be familiar with and have experience in the following areas in both the
1. Trainees must assess the accuracy of the acid-base parameters and interpret serum and
2. Trainees must determine from the patient's history, physical findings, and laboratory
data the nature of the prevailing acid-base disorder and whether a simple or mixed acid-base
disorder is present.
3. Trainees must have experience in managing renal tubular acidosis, uremic acidosis,
4. Trainees must have experience managing all other types of metabolic acidosis.
alkalosis.
1. PROGRAM CONTENT
A. Trainees must acquire knowledge and understanding of the following areas during the course
of their training:
systems, tubular sodium transport processes, and the regulation of renal sodium excretion
management
countercurrent mechanism for urine concentration, the cellular physiology of collecting duct
movement, tubular transport processes for potassium reabsorption and secretion, and the
12. Disorders of sodium, water, and potassium balance in end-stage renal disease
A. Trainees should be familiar with and have experience in the following areas in both the
1. Trainees must be able to assess the validity and relevance of serum and urine
2. Trainees must be able to assess volume status (including the interpretation of central
venous pressure and Swan-Ganz measurements) and recognize and manage hypovolemic and
edematous disorders.
3. Trainees must be familiar with the use and complications of diuretic therapy.
4. Trainees must be able to evaluate and manage hyponatremia in the acute and chronic
setting.
5. Trainees must be able to evaluate and manage hypernatremia in the acute and chronic
setting.
7. Trainees must be able to evaluate and manage the patient with hypokalemia for
hyperkalemia. They must be familiar with the acute as well as the long term management of
these disorders.
8. Trainees must be able to evaluate and manage disorders of sodium, water, and
1. PROGRAM CONTENT
2. Clinical, diagnostic and epidemiologic differences between simple, acquired, and inherited
a. Familiarity with the natural history of inherited cystic and non-cystic disease
5. Treatment
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hypertension
progressive
valve prolapse diverticular disease, intracranial aneurysm, and hepatic cystic disease
A. Trainees should have experience in the diagnosis and management of various forms of
cystic renal disease, with particular emphasis on autosomal dominant polycystic kidney
B. Trainees should have experiences in the diagnosis and management of patients with non-
cystic inherited diseases, with emphasis on Alport's syndrome and its renal and extrarenal
complications.
C. Trainees should be familiar with the principles of genetic counseling of patients with inherited
renal disorders.
1. PROGRAM CONTENT
c. Obstructive nephropathy
c. Association with major tubular defects, including diabetes insipidus, acidification, and
potassium excretion
4. Diagnostic procedures
b. Evaluation of obstruction
1. Clinical features, causes, course, and treatment of acute allergic interstitial nephritis
Curricular Response: Chronic Kidney Disease in Elderly 32
acute pyelonephritis
with:
4. Clinical and radiological features, course, and treatment of reflux nephropathy (chronic
pyelonephritis) and analgesic nephropathy, and the differential diagnosis of papillary necrosis
2. Clinical laboratory tests to evaluate aspects of tubular function, concentrating ability, urine
C. Trainees should be aware of unusual syndromes affecting the renal interstitium, such as
diseases
I. PROGRAM CONTENT
A. Trainees must acquire knowledge and understanding of the following areas during the
5. Bone physiology
6. Methods to diagnose and treat different types of renal osteodystrophy, the interpretation
A. Trainees should also be familiar with, and preferably have experience in, the direct diagnosis
and management of the following areas, in both an outpatient and inpatient setting:
hypermagnesemia
Transplantation
1. PROGRAM CONTENT
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A. Immunology/lmmunogenetics
4. Mechanisms of tolerance
antibodies
B. Transplant Pharmacology
transplant for the prophylaxis of infection and the treatment of concurrent illnesses, with an
1. Historical perspective
H. Ethics of transplantation
I. Economics of transplantation
fluid volume, falling urine output, and primary nonfunction of the transplanted kidney
diagnosis and therapy of rejection, infection. the hemolytic uremic syndrome, and urological and
vascular complications; and diagnosis and management of drug interactions and toxicities
I. PROGRAM CONTENT
A. Trainees must acquire knowledge and understanding of the following areas during the
1. Changes in the anatomy and function of the urinary tract during pregnancy, focusing
on the relevance of these changes to clinical circumstances, stressing alterations in the calyces
and ureters, renal hemodynamics, and tubular function (principally potassium and glucose)
PCO2
of the normal gestational changes in weights intravascular and extracellular volume status, renal
6. Tests of kidney function, including indications for renal biopsy during pregnancy
7. Familiarity with the clinical spectrum and management of renal disorders in gestation.
This includes: pathogenesis and treatment or urinary tract infections; acute renal failure
(especially those primarily associated with gestation, i.e., septic abortion, abruption,
Curricular Response: Chronic Kidney Disease in Elderly 37
preeclampsia, acute fatty liver, and idiopathic postpartum renal failure); and chronic glomerular
8. Recognition of the presentation of stone disease during gestation and familiarity with
9. Familiarity with the administration of both acute and chronic renal replacement
10. Knowledge of the effects of pregnancy on the natural history of renal allografts and of
preeclampsia and its variants such as HELLP syndrome. This includes the use in gravidas of
antihypertensive drugs and the prevention and treatment of eclampsia, including the
12. Capability to perform preconception counseling pertinent for the maternal and fetal
prognoses for women with chronic hypertension and/or underlying kidney disorders
A. Trainees must diagnose and manage women whose pregnancies are complicated by acute
I. PROGRAM CONTENT
A. Trainees are encouraged to develop knowledge and expertise in the following areas,
4. Measurement of microalbuminuria
8. Renal radiology
a. Urography
b. Ultrasonography
c. Radionuclide scans
d. Computed tomography
1. Urinalysis
Curricular Response: Chronic Kidney Disease in Elderly 39
2. Accurate and timed complete collection of urine for renal function testing, proteinuria,
and microalbuminuria
I. PROGRAM CONTENT
A. Trainees must acquire knowledge and understanding of the following areas during the
A. Trainees should also be familiar with, and preferably have experience in, the following
1. Trainees must diagnose and manage patients with different drug-induced renal
syndromes.
2. Trainees should be able to prescribe for and adjust drug dosage in patients with renal
dysfunction.
5. Trainees should be familiar with common overdoses and the need for extracorporeal
therapy.
I. PROGRAM CONTENT
A. Programs are encouraged to use the resource document Project Professionalism, from the
American Board of Internal Medicine (ABIM; Philadelphia, 1995), to assist trainees in the
acquisition of knowledge and understanding of the following areas during the course of training:
1. Elements of professionalism
a. Altruism
g. Common sense
Curricular Response: Chronic Kidney Disease in Elderly 41
2. Threats to professionalism
f. Lack of conscientiousness
g. Conflicts of interest
1. Utilizing ABIM peer evaluation professional associate rating forms from multiple
evaluators
deficiencies
I. PROGRAM CONTENT
A. Trainees must acquire knowledge and understanding of the following areas during the
1. Hypothesis development
review board (IRB) regulating research on humans or to the institutional animal care and use
committee (IACUC)
b. Integrity in the collection and recording of data c. Integrity in the interpretation of data
a. Self-deception
c. Conflicts of interest
i. Scientist-scientist relationship
A. Trainees working in a laboratory must develop familiarity with and a working knowledge of
B. Trainees working on a clinical research project in a general clinical research center should
admit study subjects to the center, participate in obtaining informed consent, and play an active
Curricular Response: Chronic Kidney Disease in Elderly 43
C. Trainees participating in clinical outcomes studies must be familiar with the methods used
to acquire data and should participate in a meaningful way in the analysis of such information.
Patient Care
Goals: Provide patient care that is compassionate, appropriate and effective for the treatment
Objectives: By the end of the first year the fellow is expected to develop and demonstrate the
following skills:
vii. weight gain and other acute symptoms associated with the hemodialysis procedure
Curricular Response: Chronic Kidney Disease in Elderly 44
By the end of the second-year fellows will be familiar with a more chronic picture provided by
the continuity of care afforded by following patients for up to a year. By the end of the year,
i. Serve as the primary care provider for a cohort of patients receiving chronic
viii. Be familiar with the K/DOQI guidelines and protocols for management of
anemia
Medical Knowledge
Goal: The renal fellow must demonstrate knowledge of principles of hemodialysis including
technical aspects, indications for dialysis, management of dialysis and problems related to end
iii. the short-term and long-term complications of each mode of dialysis and their
management
iv. the principles of dialysis access (acute and long-term vascular and peritoneal),
infections.
ix. dialysis water treatment, delivery systems, and reuse of artificial kidneys;
Goals: The renal fellow must demonstrate the ability to investigate and evaluate their care of
patients, to appraise and assimilate scientific evidence, and to continuously improve patient care
based on constant self-evaluation and lifelong learning. Residents are expected to develop skills
and habits to be able to achieve benchmarks established for the care of patients with end stage
renal disease outlined by K/DOQI and other professional society guidelines as they relate to
Objectives: By the end of this rotation, both first and second year fellows are expected to
ii. Teach about errors in management (both one’s own, and those of others) with
tact
Curricular Response: Chronic Kidney Disease in Elderly 46
iv. Apply scientific evidence from the literature to one’s own patients and
v. Become familiar with published guidelines for care of patients with ESRD and
vi. Evaluate their panel of chronic dialysis patients for the degree to which they
Goal: Renal fellows must demonstrate an awareness of and responsiveness to the larger
context and system of health care, as well as the ability to call effectively on other
resources in the system to provide optimal health care for patients with end stage
Objectives: By the end of this rotation, first year fellows are expected to develop and
ii. Be able to coordinate care of individual patients with other members of the
iii. Be able to call on system resources such as ethics consults and risk management
when appropriate
iv. In addition to the above, by the end of the second month of hemodialysis rotation,
first year fellows are expected to develop and demonstrate the following skills:
Curricular Response: Chronic Kidney Disease in Elderly 47
evidence forms, death forms) ESRD networks and CMS when required
vi. Understand the government policies determining health care coverage for
vii. Become familiar with the systems issues related to home dialysis and
nocturnal dialysis
viii. Become familiar with the policies related to transport services for dialysis
patients
Professionalism
Goal: The renal fellow must demonstrate a commitment to carrying out professional
to understand and become comfortable with the complex psychosocial issues related
Objectives: By the end of this rotation, all fellows are expected to develop and demonstrate the
following skills:
ii. Maintain a focus on excellent patient care, and the patient’s needs
Goal: Renal fellows must demonstrate interpersonal and communication skills that result in
the effective exchange of information and teaming with patients, their families, and
professional associates.
Objectives: By the end of the second month of the dialysis rotation, first year fellows are
i. Be able to tell patients and family members about the initiation of the dialysis
procedure
ii. Obtain informed consent from patients for the hemodialysis procedure
iii. Be able to interact with vascular radiology and vascular surgery in the
In addition to the above, by the end of the third month of the rotation, first year fellows
iii. Work as part of the interdisciplinary team of nurses, nurse practitioner, surgeons,
iv. Discuss end-of-life issues and advanced directives with patients and family
members
Curricular Response: Chronic Kidney Disease in Elderly 49
Teaching Methods:
TRANSPLANTATION
Patient Care
Goals: Renal Fellows must be able to provide patient care that is compassionate,
appropriate, and effective for the treatment of renal transplant donors and recipients.
Objectives: By the end of the rotation the renal fellow is expected to develop and demonstrate
iii. Make informed decisions about diagnostic and therapeutic interventions based on
post-transplant period
Curricular Response: Chronic Kidney Disease in Elderly 50
vi. Interpret diagnostic tests including urinalysis, renal ultrasound, renal CT scan,
renal biopsy
vii. Use information technology to educate patients about transplantation and donation
ix. Provide health maintenance and preventive health care, specifically aimed at
x. Work with members of the transplant team, including surgeons, other consultants,
and UNOS
xii. Independently formulate a diagnostic and treatment plan for complications of renal
transplantation
Medical Knowledge
Goal: The renal fellow must demonstrate knowledge of established and evolving biomedical,
transplantation
Objectives: By the end of the rotation the renal fellow is expected to acquire knowledge of:
i. Indications for renal transplantation, criteria for selection of donors and recipients,
iii. Clinical and laboratory diagnosis of cellular and antibody mediated rejection, use of
ix. Long –term follow-up of renal function: chronic allograft nephropathy, calcineurin
treatment
xii. Principles of tissue typing and management of living donor transplants with a
positive crossmatch
including PTLD
Goals: The renal fellow must demonstrate the ability to investigate and evaluate their care of
Objectives: By the end of this rotation, first and second year fellows are expected to develop and
ii. Participate in Transplant case management conferences and apply knowledge from
iii. Use information technology to obtain and manage medical information relating to
iv. Apply information from large studies to improve care of patients, recognizing
vi. Use knowledge obtained from the literature and experience to teach colleagues,
Goal: Renal Fellows must demonstrate an awareness of and responsiveness to the larger
context and system of health care as well as the ability to call effectively on other
Objectives: By the end of this rotation, first and second year fellows are expected to develop and
regimens
iii. Assist patients with chronic kidney disease in obtaining access to evaluation for
transplantation
iv. Work with members of the transplant team to improve and consolidate cost-effective
Professionalism
Goal: The renal fellow must demonstrate a commitment to carrying out professional
Objectives: By the end of this rotation, first and second year fellows are expected to develop and
Interact professionally with other members of the health care team, colleagues and
students
Goal: Renal fellows must demonstrate interpersonal and communications skills that result in
the effective exchange of information and teaming with patients, their families and
professional associates.
Objectives: By the end of this rotation, first year fellows are expected to develop and
ii. Provide appropriate counseling to patients and their families regarding their
therapeutic options: risks and benefits of renal transplantation, both from deceased
iv. Interact with other physicians, nurses, and therapists caring for the patient
v. Interact with the staff of the transplant unit to promote cooperative care
Fellows are evaluated by the Transplant Attending of the Month at the end of each month of
rotation; the evaluation is entered on the E*value system. In addition, the monthly Transplant
Attending gives the fellow verbal feedback at the end of the month.
The Transplant Rotation is discussed routinely at monthly Quality Improvement Meeting with
the Program Director and the Fellows, and at the periodic meetings with the Faculty and fellows.
The rotation is also evaluated in the written yearly evaluation of the program by the fellows.
1. Based upon the Health Framework for California Public Schools: Kindergarten through
Grade twelve, the scope of topics related to Chronic Kidney Disease in the Elderly
include:
ii. Identify trusted adults who promote healthy growth and development
2. Based upon the Journal of the National Kidney Foundation (2018), the scope of topics
i. Symptoms/Quality of Life
3. Based upon the Middle School and High School: Building a 21st Century Health
Curriculum, the scope of topics related to Chronic Kidney Disease in the Elderly include:
a. Mental/Emotional Health
i. The learner will analyze health standards at the state and national levels
ii. The learner will explain how personal health choices impact health
4. Based upon the Standards of Learning for Public Schools of Virginia the scope of topics
Community Resources
Four community resources for chronic kidney disease in the elderly include:
iii. https://www.freseniuskidneycare.com/
iv. The Fresenius Kidney Center provides clinical care for people with
chronic kidney disease as well as end stage renal disease. They offer
v. Specific cost relating to the services they provide are unfortunately not
iii. https://www.kidney.org/
Curricular Response: Chronic Kidney Disease in Elderly 57
disease.
iii. https://uclahealth.org/nephrology/default.cfm
services.
a. PEACE Center
iii. https://saddleback.com/care/supportgroup/kidney-disease-support-
group/lake-forest
Curricular Response: Chronic Kidney Disease in Elderly 58
with one another, they will have a strong support system throughout their
journey.
Curricular Response: Chronic Kidney Disease in Elderly 59
Work Cited
California State Board of Education. (2003). Health Framework for California Public Schools:
https://www.cde.ca.gov/ci/cr/cf/documents/healthfw.pdf
http://www.columbianephrology.org/files/CURRICULUM.pdf
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