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Goals Instructional Format Evaluation Goal Setting Feedback To learn to provide accurate and effective Two month inpatient rotations. Monthly online and Goals as outlined in Inpatient consultation service consultation based on effective data collection and Fellows assess patients in AM and oral evaluation of program materials construction of appropriate differential diagnoses; gather data, adjust dialysis the fellows by the and modified by to learn the principals and practice of renal schedules as needed. Rounds attending attending each month replacement therapy; to develop leadership and with attending nephrologists as nephrologists. based on fellow management skills appropriate to running an scheduled. Semi-annual performance. inpatient dialysis services; to develop skills needed New consultations received evaluation of faculty for effective patient-provider and consultant- during or after attending rounds by fellows. provider communication in care of patients with are seen as soon as possible; these Evaluation of renal disease. may be presented to the experience by fellows attending physician after rounds and faculty in if necessary. Acute dialysis rotation with other treatments are scheduled experiences. throughout the day as required. Goals Instructional Format Evaluation Goal Setting Feedback To learn the principals and practices currently used Two month inpatient rotations. Monthly online and Learning objectives set in the management of renal transplantation, Assessment of inpatients by oral evaluation of at onset by attending Renal Transplantation Service including: the evaluation of prospective recipients fellows in AM and as patients the fellows by the nephrologist. and donors, the choice of recipients for deceased arrive to the hospital; rounds with attending transplant Feedback provided by donor kidneys, the use of induction immune the transplant nephrologists as nephrologists. attending nephrologist suppression and the pharmacologic, immunologic, scheduled. Evaluation and and transplant and clinical basis of the regimen used; the peri- presentation to attending Semi-annual surgeon throughout operative management of the renal transplant surgeons in the transplant clinic; evaluation of faculty month. patient with emphasis on the management of peri- attendance and participation in by fellows. Regular operative diabetes, hypertension, and fluids; the the monthly renal transplant evaluation of causes of immediate graft non-function; the patient evaluation meeting; experience by fellows diagnosis and treatment of hyperacute, acute, and assistance at transplant surgical and faculty. chronic rejection; the differential diagnosis of early procedures as permitted by transplant dysfunction; the appropriate schedule. management of renal failure post-transplant; and the recognition, differential diagnosis and management of infections in the transplant patient. Goals Instructional Format Evaluation Goal Setting Feedback To learn the principals and practice of outpatient Bi-weekly clinical experiences. Monthly online Goals are as stated in nephrology, including: the provision of effective and Nephrology clinics on Mondays evaluation and this document and in efficient outpatient consultation; the diagnosis and from 1 – 5 PM, and on Thursdays additional oral input the outline for each Outpatient Clinic management of chronic renal diseases such as from 8 AM to noon at the Texas on an ad hoc basis. year of the fellowship. diabetic nephropathy, chronic glomerulonephritis Tech University nephrology clinic. Clinic chart reviews and the nephrotic syndrome, ADPKD and other may be instituted. Feedback is provided hereditary renal disorders, stone disease, in the clinic on case by complicated or secondary hypertension; the long Semi-annual case bases. term management of renal transplant patients; and evaluation of faculty the outpatient care of dialysis patients. In addition, by fellows. Regular the fellow should particularly learn the principals of evaluation of the management applicable to the pre-end stage experience by fellows patient, including the use of diet and medication in and faculty. the non dialytic management of renal failure. Goals Instructional Format Evaluation Goal Setting Feedback The goals of this rotations is the mastery of Six month rotations for second Online evaluations Goals are as set forth principals and the practice of chronic dialysis year fellows. The fellow rounds are completed at the in this document and therapy including the prescription and delivery of on dialysis shifts and reviews data end of each month. in the formal dialysis treatments, the interpretation of treatment with and without the attending Oral evaluations statements regarding adequacy, the care and management of dialysis physician. The fellow takes may be given at any the second year access, the management of anemia, the beeper call Monday through time during the curriculum. The Outpatient Dialysis management of renal bone disease, the evaluation Friday during daytime hours. The month by the attending and management of nutritional issues, the fellow rounds once each week attending physician. nephrologists may set management of hypertension, and the with the attending physician on specific goals for each management of intradialytic hypotension. each dialysis shift. Peritoneal Semi-annual month. Feedback is dialysis patients are seen in the evaluation of faculty supplied regularly clinic and at the dialysis center by fellows. Regular during dialysis rounds. with the peritoneal dialysis nurse. evaluation of the The fellow also attends and experience by fellows contributes to the monthly long and faculty. and short term care plan meetings and is urged to attend the monthly QI meetings. Goals Instructional Format Evaluation Goal Setting Feedback To learn the principals and practice of chronic One to two month rotation in the Rotation written Goals are stated in this peritoneal dialysis treatment, emphasizing the Red Bud Dialysis Center, during evaluations will be document and in the interpretation of tests of treatment adequacy, the which time the fellow will devote made by Dr. C.J. curriculum for the management of peritoneal and tunnel infections, his/her time to the care of the Wheeler. Oral second fellowship year. the management of catheter malfunction, and the patients in the peritoneal dialysis evaluation may be Feedback from the Peritoneal Dialysis management of anemia, hypertension, bone clinic. The schedule is set by the provided during this dialysis unit staff and disease and nutrition in the peritoneal dialysis dialysis unit staff. month. physicians. patient. Semi-annual evaluation of faculty by fellows. Regular evaluation of the experience by fellows and faculty Goals Instructional Format Evaluation Goal Setting Feedback To develop experience in the care of patients with Bimonthly clinic in the Semi-annual online The general goals are renal stone disease and to broaden the Department of Urology. Fellows evaluations are set forth in the overall understanding of the pathophysiology of renal stone see and evaluate patients with provided. Oral curriculum. The intent disease. The goal of the rotation is to make the stone disease and present cases to evaluations may be is that the fellows fellow more comfortable with the evaluation and Urology attendings in the clinic. given at any time become competent in care of the renal stone patient, to familiarize the during the month by the evaluation of renal Renal Stone Clinic fellow with urological techniques of stone removal the attending stones and are able to and lithotripsy, and to allow for organized physician. outline treatment and longitudinal follow up of intervention in stone its limitations. disease. Semi-annual Feedback is given in evaluation of faculty conference. by fellows. Regular evaluation of the experience by fellows and faculty. Goals Instructional Format Evaluation Goal Setting Feedback To learn the histology and pathology of the kidney Monthly conference. Biopsy Monthly online The goals are set forth Biopsy Conference by reviewing the results of biopsies performed by findings are presented and slides evaluations are in the overall the fellows or submitted to the pathology are interpreted by conference provided. curriculum. The intent department by other physicians. participants. Clinical data is is that the fellows presented by the fellows and competently interpret treatment is discussed by staff renal biopsies and are and fellows. The conference takes able to outline place the fourth Thursday of each treatment. Feedback month. is given in conference. Goals Instructional Format Evaluation Goal Setting Feedback The fellows will learn the principals of research, Monthly conference. Research is Research is Goals for the research Research Conference including its ethics, its designs, the analysis of data, performed by the fellow evaluated by the project are set by the and art of presentation of results. throughout the fellowship, faculty member faculty involved. The especially in the second year. primarily involved. overall goal is the Projects are suggested by the Presentations are generation of data fellow or faculty, and the reviewed in written worthy of publication schedule for its performance is form on a monthly in a peer reviewed arranged individually. basis. Final product journal. Feedback is Conference is held Thursdays at is reviewed by the individualized. 4PM. journal or conference peer review system. Goals Instructional Format Evaluation Goal Setting Feedback To learn to critically analyze the renal literature, the Bimonthly conference. Fellows Monthly online Goals as stated. appropriate use of statistical analysis, the ethics of present and critique papers from evaluations are Papers may be research, and to expand the fellow’s knowledge current peer reviewed journal provided. Individual specifically selected for Journal Club base by accessing new developments in nephrology. each Wednesday at 4 PM. presentations may fellows based on a Faculty, fellows and residents be evaluated at the fellow’s need to take part in the discussion. time of presentation. expand in a specific area. Feedback from audience. Goals Instructional Format Evaluation Goal Setting Feedback In depth review of renal anatomy, physiology, Weekly lecture conference. There is no scheduled The course outline pathophysiology, histopathology, epidemiology, Formal presentations by faculty fellow evaluation for indicates the topics and treatment. each Tuesday at 8 AM from this activity. A more covered, this varies Didactic Conference September through June. formal evaluation of with the semester. The Readings are assigned. The total the fellows’ learning overall two year cycles cycle of lectures covers two years. and quality of the includes renal One year is predominantly basic course material may anatomy, physiology, science and pathophysiologically be made after an “in histopathology, and based. The second year is more service” written therapeutics. The devoted to the pathology of renal exam becomes material should be disease and a number of clinical available. incorporated by fellow topics. into other activities as “knowledge base” Feedback is provided as this base is utilized in clinical rotations and in other conferences Goals Instructional Format Evaluation Goal Setting Feedback Clinically based review of clinical cases and Case presentation or group data Evaluation is General goal is to problems by fellow. Each conference presentation is presentation and discussion with presented as cover clinically based on a clinical encounter or problem specific to review of literature especially immediate feedback applicable aspects of the service on which the fellow is rotating. The outcomes research, randomized to presentation and physiology and Clinical Conferences services/rotations specifically represented are: controlled studies, and clinical answers to questions. pathophysiology and Transplant, Inpatient Consultation, Outpatient reviews. KDOQI Online evaluation of to outline the Dialysis, Peritoneal Dialysis, and Clinic. Transplant recommendations and clinical performance. The established and and Consultation problems are generally expected guidelines from other groups fellows’ performance defacto algorithms to be related to specific patients. Dialysis related should be considered if such here is used to judge used by practicing conferences may address general problems the applicable standards exist. their ability to utilize nephrologists in fellow is encountering (i.e. anemia, hypertension, the literature, analysis of clinical phosphate control, nutrition, catheter infection, integrate current problems. clearance, etc. , though in these cases a review of literature and Feedback is center data should be presented). guidelines into immediate. clinical practice, and generate new hypotheses. Nephrology Fellowship Program Learning Objectives Inpatient Consult Nephrology Services Symptoms Diseases/Conditions Risk Factors Systems of Care Psycho-social Ethics List symptoms of: Describe epidemiology, List risks for development of List the acute and Recognize and describe Describe impact of Hematuria, pathophysiology, and ARF in and out of hospital; lists non acute impact of chronic ESRD on society. Proteinuria, treatment of conditions risk factors for chronic renal indications for dialysis on long term Appropriately counsel Nephritis, RPGN, listed in curriculum disorders, describes impact of dialysis and QOL; recognize validity ESRD patients on end- Knowledge Nephrosis, ARF and documents and Tables A renal failure on survival; contraindications. of choosing not to of-life decisions. CRF, list symptoms of and B below. recognize impact of renal List indications and accept dialysis Provide accurate uremia and their failure on drug metabolism. List contraindications informed consent. pathogenesis risks incurred in uremia, for renal biopsy. Describe impact of recognized increased renal failure on cardiovascular risks in CRF and prognosis. ESRD Demonstrate the List historical data sought in Demonstrate ability to identify Obtain psychiatric Obtain social history ability to obtain the various renal disorders. risk factors during review of history to assess patient that allows culturally History Taking history relevant to Accurately elicit history of records and laboratory data. competence. sensitive discussion of renal disorders and medical conditions that Demonstrate ability to elicit Recognize and describe ethical issues. to uremia. may impact response to or historical data from chart for importance of family Recognize situations in effectiveness of dialysis. issues affecting response to and social support in which dialysis may be dialysis , survival and prognosis. adjustment to dialysis. futile therapy. List physical findings Accurately detect signs of: Accurately demonstrate Demonstrate sought when uremia, volume overload; physical findings that confirm or findings that Physical evaluating specific athero-embolic disease, deny presence of underlying risk indicate acute Exam symptoms elicited by relevant systemic disorders. factors for renal diseases. need for dialysis. history taking. Assess dialysis access. Perform complete Insert dialysis catheters, List patient risk factors that Demonstrate Demonstrate ability to Recognize the urinalysis to confirm order and manage HD, alter risk benefit ratio for ability to analyze deal with problems of limitations of therapy Procedures presence of listed CVVHD and PD. Perform diagnostic procedures. effectiveness of patient behavior on and identify those symptoms. renal biopsies; manage dialysis. dialysis. instances when complications of dialysis intervention may be and biopsies. See Table C. therapeutically futile. Demonstrates self Acknowledges importance of Demonstrates Demonstrates openness Recognizes and accept motivated independent prevention, describes roles of awareness of team to patient attitudes patient reasons to Attitudes & Values disease specific learning hypertension, obesity, salt nature of dialysis and concerns about refuse or withdraw intake, phosphate intake in treatment. Works renal replacement from treatment. development of renal disease. well with team. therapy. Makes accurate Demonstrates ability to Demonstrates ability to teach Demonstrates Demonstrates ability to Demonstrates active diagnoses of renal care for inpatients with patients their responsibilities ability to work interact sensitively and investigation of ethical disorders. Recognizes renal diseases. Participate with regard to reducing effectively with compassionately with questions and Behaviors symptoms of uremia, in clinical conference. behaviors, i.e., smoking other disciplines. patients, family other willingness to enter into electrolyte disorders, Demonstrate ability to cessation, medication and diet Teaches residents physicians and other discussions of ethics. and volume place acute catheters. non-compliance, weight loss, and students. staff members. Describes methods to overload and control of fluid intake. deal with non- appropriately compliant dialysis schedules dialysis. patients. Table A Knowledge of Disease/Condition Table B Knowledge of Table C Procedures for Disesase/Condition Disease/Condition Be able to describe: Be able to list: Be able to perform: 1. Techniques for evaluation of renal structure and function 1. The causes of secondary hypertension. 1. Placement of temporary dialysis 2. The approach to the diagnosis and management of acute renal failure in hospital patients 2. All common medications requiring catheters. 3. The radiographic, sonographic, and nuclear medicine findings in various forms of renal dose modification in renal insufficiency 2. Renal biopsy of native kidneys. failure. and renal failure. 3. Renal biopsy of renal transplants. 4. The metabolic consequences of acute renal failure 3. Indications for initiation of dialysis or 4. Evaluation and management of 5. The diagnosis and management of chronic renal disease in the hospitalized patient. CRRT in acute renal failure. patients post procedure or 6. The management of hospitalized patients with acute and chronic renal failure. 4. The indications for renal biopsy in the complication. 7. The diagnosis and management of patients with acute glomerulonephritis. hospitalized patient with renal disease. 5. Management of dialysis 8. The diagnosis and management of patients with renovascular disease and renal vasculitis. 5. The indications for hemodialysis, complications. 9. The diagnosis and management of patients with acute and chronic interstitial nephritis. hemofiltration, and hemoperfusion in 6. Hemodialysis, peritoneal dialysis, 10. The diagnosis and management of disorders of salt and water metabolism. ingestion of specific toxins. and CRRT in the acute hospital 11. The diagnosis and management of clinical disorders of calcium, potassium, magnesium 6. The components used in dialysis setting. and phosphorus. membranes and their relative 7. Acute venous catheterization for 12. The diagnosis and management of hospitalized patient with diuretic use. biocompatibility, and solute and water purposes of hemodialysis or CRRT. 13. The diagnosis and management of clinical acid base disorders. transport characteristics. 8. Evaluation and management of 14 The approach to, diagnosis of, and techniques for managing disorders of the lower urinary 7. Major drug interactions and dosing complications or ARF , HD, PD, and tract. adjustments in ARf. CRRT. 15. The choice and use of the various renal replacement techniques and their indications. 16. The use of dietary modification in management and prevention of renal failure. 17. The diagnosis and management of accelerate malignant hypertension in hospitalized Perform: patients. 1. Placement of catheters for acute 18. The diagnosis and management of hospitalized patients with acute pyelonephritis, and hemodialysis. renal abscess with special attention to infections in patients with polycystic kidney disease. 2. Initial assessment and triage of 19. The pathogenesis of uremia. patients with acute renal failure and 20. Types, advantages and disadvantages of maintenance hemodialysis, CRRT, and chronic dialysis patients with acute peritoneal dialysis. problems. 21. Principals of hemodialysis including machinery, dialysate, anticoagulation, clearance and 3. Dialysis decision making and complications. management in acute renal failure. 22. Principals of CRRT including machinery, dialysate, anticoagulation, clearance and 4. Management of CRRT methods as complications. indicated. 23. Principals of peritoneal dialysis including solute and water flux, membrane properties, 5. Accurate urinalysis. and dialysate composition. 6. Instruction of residents in the care of 24. Principals of dialysis adequacy in all forms of dialysis and use in determining dialysis patients with acute and chronic renal prescriptions. failure. 25. Role of temporary and tunneled catheters for HD and CRRT, access for PD; radiology of 7. Extrapolation of K/DOQI guidelines to access placement and evaluation. the setting of ARF in the hospital. 26. The metabolic consequences of ARF and the management of ARF with dialysis , effects 8. Calculation of KT/V or URR for and dosing of medications in ARF. hemodialysis, peritoneal dialysis, and 27. Fluid management in ARF patients; use of dialysis to manage fluids. CRRT in the hospital setting. 28. The diagnosis and management of anemia and osteodystrohy in ARF patients. 29. The role of nutritional support and dietary management in ARF patients; the impact of dialysis on nutritional requirements. 30. Ethical issues of dialysis; including withholding and withdrawing therapy in the hospital setting; role of social work and ethics committees. 31. Basic principals of financing and personnel management in acute dialysis setting. Nephrology Fellowship Program Learning Objectives Transplant Service Symptoms Diseases/Conditions Risk Factors Systems of Care Psycho-social Ethics List causes of See Tables A and B on List risk factors for acute rejection, List the indications Describe the impact of Describe the social decreased kidney next page and chronic rejection, chronic for dialysis pre and successful renal impact of transplant, Knowledge function, oliguria, curriculum documents. transplant nephropathy; recurrent post kidney transplant, failure of the ethics of LRKT, anuria, hematuria disease , recognize major drug transplant. List the renal transplant, and LURKT, non-beating and fever in the interactions and impact of renal contraindications for rejection on patient heart, and altruistic transplant patient. failure on drug dosing. renal transplant. and family. donation. Elicit symptoms of List historical data sought Uncover relevant history of Evaluate issues of Describe the risks and acute and chronic in pre-transplant patient diseases and conditions that may patient compliance, benefits of History Taking rejection, infections, assessment. Accurately adversely impact on transplant family and social transplantation for lymphocoele, elicit history of medical outcome. support, and the individual patient hematoma, and conditions that may psychological disorders and accurately ureterocoele in the impact transplantation. that may adversely provide for truly transplant patient. impact transplant informed consent. outcome. List physical findings Accurately detect signs of Accurately demonstrate physical Demonstrate sought when uremia, volume findings that confirm or deny findings that evaluating specific overload, volume presence of underlying risk factors indicate acute need Physical Exam symptoms elicited by depletion, infections for poor transplant outcome. for dialysis. history taking. associated with Demonstrates transplant, PTLD, and finding indicating medications side effects. need for further treatment. Perform complete Manage complications of List surgical considerations that Analyze data and Demonstrate ability to Recognize instances urinalysis renal transplant surgery. increase chances for post detects signs of deal with issues of when renal Procedures Perform tasks outlined in transplant renovascular problems, acute rejection, patient non- transplantation is Table C below. ureteral stenosis and disruption, chronic rejection, compliance. Recognizes contra-indicated. obstructive uropathy, and and chronic psychological impact of lymphocoele nephropathy. steroids. Demonstrates self Acknowledges importance of Demonstrates Demonstrates openness Recognizes and motivated independent prevention, describes roles of awareness of team to patient attitudes accept patient Attitudes & Values disease specific learning hypertension, obesity, medication nature of renal and concerns about reasons to refuse compliance, smoking, control of transplantation. renal transplantation. transplantation cholesterol, and diet. Works with team. option. Accurately diagnoses Demonstrates ability to Demonstrates ability to teach Demonstrates Demonstrates ability to Demonstrates active post transplant care for inpatients with patients their responsibilities with ability to work interact sensitively and investigation of complications. renal transplant. regard to reducing behaviors, i.e., effectively with compassionately with ethical questions and Recognizes rejection, Participate in clinical smoking cessation, medication other disciplines. patients, family other willingness to enter Behaviors electrolyte disorders, conference. Participates and diet non-compliance, weight Teaches residents physicians and other into discussions of and volume in monthly transplant loss, control of fluid intake. and students. staff members. ethics. Demonstrates overload and conference. ability to effectively appropriately intervene with non- responds. compliant patients. Table A Knowledge of Disease/Condition Table B Knowledge of Disease/Condition Table C Procedures for Disease/Condition Be able to describe Be able to list: Be able to perform: 1. Normal immune response to infection or other insult. 1. The common causes for acute renal failure in renal 1. Acute venous catheterization to place acute dialysis 2. The immunologic basis of hyperacute, acute and transplant patients. catheters. chronic allograft rejection. 2. The indications for biopsy of the renal allograft. 2. Renal allograft biopsy. 3. The immunologic basis for methods of 3. The histopathological criteria for the diagnosis of 3. Evaluation and management of complications in immunosuppression. acute and chronic rejection. renal transplant patients. 4. Immunogenetics and tissue typing, crossmatching and 4. Major drug interactions with immunosuppressive 4. Management of the complications of dialysis in renal surveillance for panel reactive antibodies. medications. transplant patients. 5. The system of organ sharing and allocation. 6. Surgical procedures for cadaveric and living kidney transplantation. 7. The diagnosis and management of acute renal failure in hospitalized transplant patients. 8. Radioographic, ultrasound, and nuclear medicine findings in various causes of acute allograft rejection. 9. The metabolic consequences of ARF in transplant patients. 10. The major side effects, metabolism, and complications caused by immunosuppressive medications. 11. The diagnosis and management of chronic renal failure in the hospitalized transplant patient. 12. The fluid management of hospitalized transplant patient with acute or chronic renal failure. 13. The diagnosis and management of transplant patients with recurrent or de novo glomerulonephritis. 14. The diagnosis and management of hemolytic uremic syndrome and other microangiopathies in the hospitalized transplant patient. 15. The diagnosis and management of transplant patients with PTLD, anemia, polycythemia, and other hematological disorders. 16. The diagnosis and management of disorders of the lower urinary tract in renal transplant patients. 17. Dietary modifications appropriate to the care of renal transplant patients. 18. The diagnosis and management of accelerated or malignant hypertension in transplant patients. 19. The diagnosis and management of pyelonephritis, renal abscess, and perirenal abscess in renal transplant patients. 20. Ethical issues in transplantation. 21. Economic issues for recipients, donors, and providers. Nephrology Fellowship Program Learning Objectives Outpatient Dialysis Services Symptoms Diseases/Conditions Risk Factors Systems of Care Psycho-social Ethics List uremic See Tables A and B on Describe impact of ESRD and List indications for Describe impact of Describe the impact symptoms and their next page and dialysis on vascular disease, chronic renal dialysis on patient and of dialysis on health pathogenesis. List curriculum documents. stroke, infection, and bone replacement. List family QOL. care and society. symptoms of disease. List risks of medications K/DOQI guidelines Describe the issues Knowledge complications seen used in dialysis patients on blood for chronic dialysis involved in in ESRD, HD and pressure, GI symptoms, bone care. withdrawal from PD> disease, and anemia. therapy and end-of- life decisions. Demonstrate ability Demonstrate ability to Demonstrate ability to review Demonstrate ability Describe common Accurately describe to elicit symptoms of obtain history of medical records to determine presence of to interact with compliance problems risks and benefits of History Taking uremia, volume conditions that require all conditions impacting the care primary care and describe dialysis and access status, bone disease, concurrent care and of the individual dialysis patient. physicians to ensure appropriate procedures. anemia, CAD, and impact survival or the appropriate overall interventions. Describe medication side ability to provide management of the attributes needed to effects. effective dialysis. dialysis patient. effectively provide home self care. List physical findings Accurately detect signs Accurately demonstrate physical Demonstrate sought when of: uremia, volume findings that confirm or deny findings that evaluating specific overload;, relevant presence of underlying risk indicate need for Physical Exam symptoms elicited by systemic disorders. Assess factors for renal diseases. dialysis, changes in history taking. dialysis access. Detect treatment protocol. access infections, steal, peritonitis and tunnel infections. Perform assessment Prescribe dialysis List risks factors that alter risk Analyze outcome Advise patients Participate in of dialysis therapy appropriately, monitors benefit ratios and change long data including KT/V, regarding issues of discussions using on-line real outcomes and adjusts RX, term outcomes for dialysis or PET tests, anemia compliance to diet, concerning patient time data. Adjusts evaluates and manages transplantation. data, nutritional medication, and withdrawal, Procedures therapy complications of ESRD data, and bone treatment attendance. dismissal, and appropriately. and dialysis per K/DOQI disease referral for guidelines. See Table C management data. transplantation. on next page. Adjusts RX. Demonstrates self Acknowledges importance of Demonstrates Demonstrates Recognizes and motivated independent prevention, describes roles of awareness of team openness to patient accept patient Attitudes & disease specific learning hypertension, obesity, nature of renal attitudes and concerns reasons to refuse Values medication compliance, transplantation. about renal transplantation smoking, control of cholesterol, Works with team. transplantation. option. and diet. Recognizes Demonstrates ability to Demonstrates ability to care for Demonstrates ability Demonstrates ability Demonstrates ability electrolyte disorders, care for inpatients with chronic dialysis patients, .attends to work effectively to interact sensitively to effectively Behaviors bone disease, renal transplant. monthly care plan and QI with other and compassionately intervene with non- anemia and volume Participate in clinical meetings. disciplines. with patients, family compliant patients. disorders. conference. Participates other physicians and in monthly transplant other staff members. conference. Table A Knowledge of Disease/Condition Table B Knowledge of Table C Procedures for Disease/Condition Disease/Condition Be able to describe Be able to list or access: Be able to perform: 1. The pathogenesis of uremia. 1. The components of hemodialysis 1. Dialysis prescription and supervision for maintenance 2. Types, advantages and disadvantages of maintenance membranes and their relative hemodialysis and peritoneal dialysis patients. hemodialysis,, and peritoneal dialysis. biocompatibility, and solute and water flux 2. Evaluation and management of complications in 3. Principals of hemodialysis including hemodynamics, solute characteristics. ESRD patients. and water flux, dialysis membrane properties, biocompatibility, 2. Major drug interactions and dosing 3. Management of complications of hemodialysis and and dialysate composition. adjustments necessary in ESRD , HD, and PD. peritoneal dialysis. 4. Water treatment and dialysate delivery systems for 3. National Kidney Foundation K/DOQI hemodialysis. guidelines for adequacy of dialysis and 5. Techniques, advantages, and disadvantages of dialyzer reuse. standards of care for chronic dialysis patients. 6. Principals of peritoneal dialysis including solute and water flux, membrane properties, and dialysate composition. Be able to calculate: 7. Connection and cycling systems in peritoneal dialysis. 1. KT/V, URR, and other clearance values for 8. Principals of dialysis adequacy in all forms of dialysis and use both hemodialysis and peritoneal dialysis in determining dialysis prescriptions. patients to determine treatment adequacy. 9. Surgical techniques for creation and management including native fistulae, synthetic grafts, shunts, vein transpositions, and peritoneal dialysis catheter placement. 10. The radiology of access placement and evaluation of accesses. 11. The metabolic consequences of ESRD 12. The use and dosing of medications in ESRD, 13. The major complications of ESRD and hemodialysis including access complications. 14. Fluid management in ESRD patients. 15. The diagnosis and management of anemia in ESRD patients. 16. The diagnosis and management of osteodystrohy in ESRD patients. 17. The diagnosis and management of cardiovascular disease and hyperlipidemia in ESRD patients. 18. The approach to and management of disorders of the upper urinary tract including acquired cystic disease in ESRD patients. 19. The approach to and management of disorders of the lower urinary tract including cystitis in ESRD patients. 20. The role of nutritional support and dietary management in ESRD patients. 21. Ethical issues of dialysis and dialysis withdrawal. 22. Role of Medicare dialysis networks, USRDS and voluntary societies in administration and financing of ESRD care. Nephrology Fellowship Program Learning Objectives Outpatient Nephrology Clinics Symptoms Diseases/Conditions Risk Factors Systems of Care Psycho-social Ethics List symptoms of: Describe epidemiology, List risk factors for development of Outline and describe Recognize impact of Describe the impact Hematuria, pathophysiology, and proteinuria, hematuria, and the K/DOQI renal disease and renal of chronic renal Proteinuria, treatment of conditions chronic renal disease, risk factors guidelines for chronic replacement on QOL disease on health Nephritis, RPGN, listed in curriculum for hypertension, risks for renal renal diseases. List decisions. Recognize care and society. Nephrosis, ARF and documents and in Tables failure associated with medication indications for factors that may lead Outline current CRF, list symptoms of A and B on next page. use. Describe modification of initiation of patient to decline or approaches to Knowledge uremia and their medication dosage in renal treatment in acute withdraw from counseling patients pathogenesis. List diseases. and chronic renal treatment,, whether for on end-of life issues symptoms of disease. ESRD or other in renal disease and secondary HTN. disorders. ESRD. Demonstrate the List historical data sought Demonstrate ability to accurately Obtain psychiatric Accurately describe ability to obtain in the various renal review records for history relevant history to assess patient risks and benefits of History Taking history relevant to disorders. Accurately to chronic and acute renal disease competence. treatments offered renal disorders and elicit history of medical and hypertension. Recognize and describe for renal disease. HTN and to uremia. conditions that may importance of family Accurately describe impact response to or and social support in risks and benefits for effectiveness of adjustment to chronic renal replacement treatment. renal disease. therapies. List physical findings Accurately detect signs Accurately demonstrate physical Demonstrate findings sought when of: uremia, volume findings that confirm or deny that indicate acute Physical Exam evaluating specific overload; athrero- presence of underlying risk factors need for dialysis. symptoms and embolic disease, and for renal diseases, cardiovascular systemic disorders relevant systemic diseases, and underlying or elicited by history disorders. Assess dialysis complicating systemic diseases.. taking. access. Perform accurate Perform tasks outlined in List patient risk factors that alter Demonstrate ability Demonstrate ability to Recognize the urinalysis. Table C on next page. risk benefit ratio for diagnostic to analyze deal with problems of limitations of Procedures procedures. effectiveness of patient behavior s. therapy and identify treatments. those instances when intervention may be futile or unneeded. Demonstrates self Acknowledges importance of Works well with Demonstrates openness Recognizes and motivated independent prevention, describes roles of nursing staff, allied to patient attitudes accept patient Attitudes & Values disease specific learning hypertension, obesity, salt intake, personnel, dialysis and concerns about reasons to refuse or phosphate intake in development and transplant renal replacement withdraw from of renal disease. teams. therapy. treatment. Accurately diagnoses Demonstrates ability to Demonstrates ability to teach Demonstrates ability Demonstrates ability to Demonstrates active Behaviors renal disorders, care for inpatients with patients their responsibilities with to work effectively interact sensitively and investigation of uremia, electrolyte renal diseases. regard to reducing behaviors, i.e., with other disciplines. compassionately with ethical questions and disorders, and Participate in clinical smoking cessation, medication Teaches residents patients, family other willingness to enter volume overload. conference and diet non-compliance, weight and students. physicians and other into discussions of Treats appropriately. loss, control of fluid intake. staff members. ethics. Table A Knowledge of Disease/Condition Table B Knowledge of Table C Procedures for Disease/Condition Disease/Condition Be able to describe: Be able to list: Be able to perform: 1. Techniques for evaluation of renal structure and function 1. The causes of secondary 1. Native kidney biopsy for diagnosis and 2. The approach to the diagnosis and management of proteinuria, hematuria, and chronic hypertension. management of acute and chronic kidney kidney disease in outpatients with special attention to treatments to delay or prevent 2. All common medications diseases. progression to end stage kidney disease. requiring dose adjustment in 2. Complete urinalysis. 3. The radiographic, sonographic, and nuclear medicine findings in various forms of chronic and patients with 3. Instruction of residents and students in the acute renal disease in the outpatient setting.. glomerulonephritis, vasculitis, evaluation and management of 4. The metabolic consequences of chronic renal diseases. proteinuria, hematuria, and proteinuria, hematuria, hypertension, and 5. Fluid management in outpatients with chronic renal disease. chronic kidney diseases. chronic renal diseases. 6. The management of hypertension in the outpatient with chronic renal diseases. 3. Indications for initiations of 4. Evaluation and management of patients 7. The diagnosis and management of patients with acute glomerulonephritis. dialysis and transplantation in with complications post renal biopsy. 8. The diagnosis and management of patients with renovascular disease and renal vasculitis. chronic and acute renal 5. Counseling of patients receiving biopsy 9. The diagnosis and management of patients with acute and chronic interstitial nephritis. failure. results. 10. The diagnosis and management of disorders of salt and water metabolism. 4. Indications for initiation of 11. The diagnosis and management of clinical disorders of calcium, potassium, magnesium and steroids and/or phosphorus. immunosuppressive drugs in 12. The diagnosis and management of outpatients with diuretic use. patients with 13. The diagnosis and management of clinical acid base disorders. glomerulonephritis and 14 The approach to, diagnosis of, and techniques for managing disorders of the lower urinary vasculitis.. tract. 5. Indications for renal biopsy 15. The choice and use of the various renal replacement techniques and their indications. in the diagnosis of acute, 16. The use of dietary modification in management in prevention and management of chronic subacute, and chronic renal renal diseases.. disorders. 17. The diagnosis and management of accelerate malignant hypertension in hospitalized patients. 18. The diagnosis and management of patients with acute pyelonephritis, and renal abscess with special attention to infections in patients with renal failure and polycystic kidney disease. 19. The diagnosis and management of outpatients with genetic renal diseases with special attention to ADPKD. Nephrology Fellowship Year One -- Description UMC Consultation Service Renal Transplantation Service Nephrology Clinic Inpatient renal consultation services that Inpatient service and outpatient Outpatient consultative and Educational Experience also serve as primary service for transplant clinic (Urology). The continuity clinic. Fellow performs established transplant patient. Fellow fellow directs care of new and new consultation evaluations and performs renal consultations, directs all established renal transplant patients directs care of established patients inpatient dialysis and continuous renal under direction of Nephrology faculty with glomerular and tubular replacement therapy (CRRT), and and transplant surgeon. The fellow is disease, chronic kidney disease, oversees the care of all renal transplant encouraged to observe and may and ESRD. patients under the guidance of faculty assist at transplant surgery. nephrologists. Teaching and management rounds are Daily rounds on transplant service Review of patient history, physical performed on a daily basis. Consultations with attending nephrologist. findings, and laboratory data. Teaching Methods are reviewed by responsible faculty Instruction by transplant surgeons in Discussion of diagnosis and member. Faculty is available for clinic. Informal teaching sessions decision making process. Review immediate support when needed. conducted as time permits. Review of recommendations or of findings and discussion of decision therapeutic decisions. Ad hoc making in clinic. Instruction by discussion of disease entities, surgical staff as fellow observes therapeutic options, and overall surgical procedures. plan of care. UMC Consultation Service Renal Transplantation Service Nephrology Clinic Patients include ESRD patients admitted New and established renal transplant Patients with chronic kidney from a faculty practice of over 170 chronic patients, a majority of whom have disease of various stages, ESRD dialysis patients and 250 transplant diabetes as the cause of renal failure. patients from faculty practice, patients, new consultations with acute Any patient transplanted in Lubbock patients with glomerular and and chronic renal diseases from the may be transferred to UMC for care tubular disorders, patients with hospital population. There are significant of any significant medical or surgical complicated hypertension issues, numbers of intensive care, burn, and issues at the request of the primary and new referral patients. New trauma patients with acute renal failure, care nephrologists. Other transplant and established renal transplant and extensive exposure to diabetic patients are also accepted for patients from UMC program. 50 nephropathy. The overall patient transfer upon request. All kidney to 60 % DM nephropathy. Mix of Diseases population includes significant numbers of transplant patients in UMC are Majority with hypertension. 5 – patients with various primary and placed on this service except for those 10 % polycystic kidney disease, 15 secondary kidney diseases due to the patients admitted to transplant – 20 % glomerulonephritis tertiary care nature of the hospital. surgery or Urology who are followed as consults. A broad spectrum of renal disorders is seen Mean age 55 – 60, 60% male, ~ 50% Ethnically more than 40% with increased experience with trauma minority status, > 50% diabetic. The Mexican American, 10- 15% and burn patients due to hospital activity catchment area for transplantation African American. 60% diabetic. in this area. There is a high incidence of includes the Texas panhandle, Age range from 14 to 80’s with Patient Characteristics diabetes, hypertension, and CVD. The eastern New Mexico, north Texas, many patients over 70. Gender hospital serves as both a primary and and the Abilene area. ratio near 1:1. tertiary care center with a complex patient population. Mean age 55 – 60, 60% male, > 50% minority status Ethnically more than 40% Mexican American, 10- 15% African American. UMC Consultation Service Renal Transplantation Service Nephrology Clinic Inpatient consultation rounds at bedside Inpatient ward rounds, transplant New patient referral and and in inpatient dialysis units. Intensive clinic visits, attendance at surgical consultation, established patient care unit rounds in multiple units. procedures return clinic visits. Emergency department consultations. Types of Clinical Encounters Acute and chronic hemodialysis, Insertion of dialysis catheters. Performance of consultations. continuous renal replacement therapies, Procedures needed for diagnosis of Urinalysis. peritoneal dialysis. Insertion of acute infection including lumbar puncture Procedures dialysis catheters. Biopsy of native and paracentesis, Observation of kidneys. Performance of consultation. transplant surgery; possible assistance at transplant surgery. Biopsy of transplant kidneys. Nephrology consult service at UMC. Transplant service, UMC. Transplant Nephrology division clinics, Texas Services clinic, Urology department, Texas Tech University Health Sciences Tech University Health Sciences Center. Center. Attached. Attached. Attached. Reading Lists UMC and CMC Consultation Service Renal Transplantation Service Nephrology Clinic Online and oral evaluation of the fellows Online and oral evaluation of the Online and oral evaluation of the by the attending nephrologists. fellows by the attending nephrologists fellows by the attending and transplant surgeon. nephrologists. Planned semi-annual audit of Evaluation Method of clinic charts to determine fellow adherence to K/DOQI care guidelines. Nephrology Fellowship Year Two -- Description University Outpatient Dialysis Peritoneal Dialysis Nephrology Clinic Fellows supervise hemodialysis patient Rotation at Redbud Dialysis the Outpatient consultative and care at the Dialysis Center of Lubbock, an fellows spend two months specifically continuity clinic. Fellow performs outpatient dialysis center owned and seeing peritoneal dialysis patients in new consultation evaluations and managed by Fresenius Dialysis Services concert with experienced nursing staff directs care of patients with and staffed by TTU nephrology faculty. and faculty. This is one of the largest glomerular and tubular disease, More than 90% of the patients are seen peritoneal clinics in Texas. chronic kidney disease, and ESRD by the fellow and faculty, (10% of patients care. are followed by private nephrologists associated with the program). There are six dialysis shifts; the fellow rounds with the faculty on about 60 TTS or MWF patients weekly. All aspects of dialysis and general care are discussed, and treatment is Educational Experience evaluated and adjusted as needed. The fellow attends short and long term care conferences, and may attend QI meetings. The rotations last six months during which the fellow has an opportunity to view the chronic aspects of ESRD patient care. After six months with the patients and faculty on one schedule, the fellow switches to the other set of patients. University Outpatient Dialysis Peritoneal Dialysis Nephrology Clinic Fellows round independently as needed The fellows see patients with the Review of patient history, physical and weekly with faculty as scheduled on nursing staff, and review labs and findings, and laboratory data. each of the hemodialysis shifts. Patient findings. Review labs and problems Discussion of diagnosis and decision Teaching Methods care is reviewed and decisions are with attending nephrolgist. making process. Review of discussed. recommendations or therapeutic decisions. Ad hoc discussion of disease entities, therapeutic options, and overall plan of care. All patients have end stage renal failure. The Redbud unit has more than 60 Patients with chronic kidney The most common diagnoses causing renal peritoneal dialysis patients. The most disease of various stages, ESRD failure are diabetes and hypertension, common diagnoses causing renal patients from faculty practice, followed by glomerular diseases, failure are diabetes and patients with glomerular and renovascular disease, and cystic/inherited hypertension, followed by glomerular tubular disorders, patients with renal disease. diseases, renovascular disease, and complicated hypertension issues, cystic/inherited renal disease. and new referral patients. New and established renal transplant Mix of Diseases patients from UMC program. 50 to 60 % DM nephropathy. Majority with hypertension. 5 – 10 % polycystic kidney disease, 15 – 20 % glomerulonephritis University Outpatient Dialysis Peritoneal Dialysis Nephrology Clinic The demographic distribution of the The demographic distribution of the Ethnically more than 50% Mexican patients reflects the region, with greater patients reflects the region, with American, ~ 10% African American. numbers of Mexican-American Hispanics greater numbers of Mexican- Patient Characteristics than other regions, and ~ 15 % African American Hispanics than other American patients. The age distribution is regions, and ~ 10 % African American typical for dialysis. patients. The age distribution is typical for dialysis. Rounds in the outpatient dialysis unit Scheduled clinic visits with nurses and New patient referral and Types of Clinical Encounters setting. Occasional visits with peritoneal faculty in the peritoneal dialysis clinic consultation, established patient dialysis patients. Attendance at QI, short rotation. return clinic visits. term and long term care plan meetings. Outpatient hemodialysis and peritoneal Outpatient peritoneal dialysis care. Performance of consultations. dialysis care. Urinalysis. Procedures University Outpatient Dialysis Peritoneal Dialysis Nephrology Clinic Dialysis Center of Lubbock Redbud Dialysis Center Nephrology Clinic, Texas Tech Services University Health Sciences Center Attached Attached Attached Reading Lists Online and oral evaluation by the Written and oral evaluation by the Online and oral evaluation of the attending nephrologists. Audit of quality attending nephrologists. fellows by the attending reports to determine adherence to nephrologists. Plan semi-annual Evaluation Method of K/DOQI care guidelines. Plan 360 degree audit of clinic charts to determine evaluation by dialysis center staff. fellow adherence to K/DOQI care guidelines Nephrology Fellowship Year 1 – Competency Matrix Year 1 UMC Consultation Service Renal Transplant Service Nephrology Clinic Diagnoses acute kidney injury and defines Correctly manages immunosuppressive Appropriately uses imaging its cause. Chooses correct treatment for treatment in the post transplant period techniques in work up of renal patient with acute kidney injury based on and in chronic transplant patients under disorders. Orders serological tests patient needs. Orders dialysis and CRRT the guidance of the attending physician. when indicated and interprets treatment correctly, manages their Diagnoses and treats acute and chronic results correctly. Recommends complications, and adjusts treatment as rejection and infections in transplant renal biopsy when indicated and needed. Chooses appropriate access patients, especially CMV and BK virus. arranges for procedure. Controls Patient Care modality. Recognizes and treats dialysis Diagnoses lymphocoele, urinoma, blood pressure and treats access infections and access failure in vascular disorders and ureteral proteinuria to reduce progression chronic dialysis patients (HD and PD). obstruction in the transplant setting. of renal disease. Correctly Recognizes chronic kidney disease in Recognizes recurrent FSGS, MPGN, IgA prescribes phosphate binders, previously undiagnosed patients and nephropathy, and diabetes. Manages vitamin D, and alkali treatment. treats this effectively. Diagnoses and HTN, diabetes and lipid disorders. Manages secondary complications treats patients with nephrotic syndrome, Diagnoses and treats steroid related of CKD. Pays careful attention to acute and chronic glomerulonephritis and complications, including aseptic necrosis vascular disease in CKD patients. rapidly progressive glomerulonephritis, and osteoporosis. Recognizes post Helps patients choose best ESRD interstitial nephritis and other renal transplant malignancy and post care option; arranges for disease. Adjusts medication use based on transplant lymphoproliferative disease. transplant work up; ensures timely kidney function. Manages post transplant anemia. Treats placement of dialysis access. CKD in transplants appropriately. Demonstrates knowledge of acute and Demonstrates knowledge of basic Demonstrates knowledge of the chronic kidney diseases and electrolyte transplant immunology, K/DOQI guidelines for chronic renal disorders and their treatment as outlined immunosuppressive therapies, transplant disease. Demonstrates knowledge in Table A. surgery complications, causes of renal of treatment of glomerular and Knowledge dysfunction in post transplant period, tubular diseases, polycystic Medical acute and chronic rejection and viral and diseases, and renal diseases bacterial infections as outlined in Table associated with systemic illnesses as B. outlined in Table C. Researches literature related to individual Adapts to use of newly introduced Incorporates K/DOQI guidelines patient issues as needed. Incorporates medications and protocols as these are into practice as these are new information in practice. Utilizes Up to developed. Uses literature searches as developed. Applies latest Learning Practice Date and search engines as required. required. Incorporates new information information about treatment in Based in practice. glomerular and interstitial disease. Effectively explains the syndrome of acute Effectively explains risks and benefits of Effectively explains the risks of kidney injury and its risks for death and transplantation and donation, early renal disease, and the need chronic kidney disease to patients and importance of patient compliance, and for interventions. Clearly outlines families. Explains risks and benefits of medication side effects to patients. Helps treatment options. Explains biopsy Communication Skills dialysis and CRRT treatment. Writes or patients understand and accept risks and benefit. Explains biopsy dictates clear opinions and complications such as acne and results and their meaning. Writes Interpersonal and recommendations to referring physicians. Cushingoid appearance. or dictates clear opinions and Explains long term plans for management recommendations to referring of CKD and ESRD to referring physicians. physicians. Clearly explains treatments for anemia, renal bone disease, hypertension, and reduction of proteinuria. Bases decisions about the need for dialysis Demonstrates understanding of Is prompt and courteous; keeps on patient welfare and prognosis. significant ethical issues related to kidney effective records; responds to Professionalism and Accepts patient rejection of dialysis or transplantation, including organ referring MD; applies best care other treatments while maintaining allocation issues, donor payment, “non- options. Recognizes influences of therapeutic relationship. Comports self in beating heart” donors, xeno- physician based issues on ESRD hospital in professional manner. transplantation, and drug costs. choice and avoids decisions based Understands issues in donor selection and on physician rather than patient Ethics recipient approval and listing process. benefit. Schedules dialysis with attention to nurse Takes an active role in transplant related Develops understanding of staffing, including avoidance of admission meetings, interacts with transplant office interactions of specialty and by arranging outpatient treatments. to allow continuity of care. Uses primary care clinics regarding care Arranges appointments after discharge as cardiovascular, dermatology, orthopedic, of chronic kidney disease patients. Systems Based Practice needed. Assures continuity of care by pulmonary, infectious disease, and Replies to consults in a manner interactions with dialysis units and clinics. endocrine consultation as needed. that guides care by primary Plans for access placement in new ESRD Develops skills needed to utilize the physician. Prepares patients for patients. Understands and uses PD as a computerized data base to analyze ESRD treatment and avoids need bridge to transplant or HD via current trends in patient outcomes. for emergent or urgent institution permanent access. Avoids use of Actively participates with transplant of dialysis. Arranges for access permanent catheters whenever possible. surgeon and nephrologists in decisions placement in sufficient time to regarding immunosuppression. allow fistula maturation to occur. Nephrology Fellowship Year 2 – Competency Matrix Year 2 University Associated Dialysis Peritoneal Dialysis Nephrology Clinic Provides safe and effective hemodialysis Provides safe and effective care of Appropriately uses imaging treatment in the outpatient setting. peritoneal dialysis patients, including techniques and serological tests Orders and manages dialysis treatment so adequate peritoneal clearance, glycemic and interprets results correctly. that K/DOQI treatment goals are control, volume and blood pressure Recommends and arranges renal achieved, including dialysis adequacy control, iron, anemia, albumin and biopsy when indicated. Controls (KT/V), anemia, iron balance, Ca, Phos, electrolyte control. Treats peritonitis and BP, and treats proteinuria. Ca x Phos, PTH, K, bicarbonate, albumin, catheter infections effectively. Correctly prescribes phosphate blood pressure, and treatment binders, vitamin D, and alkali compliance targets. Addresses acute treatment. Manages all secondary medical problems on dialysis effectively. complications of CKD. Addresses Patient Care Monitors access issues and arranges for vascular disease in CKD patients. correction of problems. Helps patients choose best ESRD care option; arranges for transplant work up; ensures timely placement of dialysis access. Demonstrates knowledge of hemodialysis Demonstrates knowledge of peritoneal Demonstrates knowledge of the techniques and kinetics, the principles of dialysis including PET tests, weekly K/DOQI guidelines for chronic renal renal bone disease and its treatment, and clearance, residual function, and disease. Demonstrates knowledge the causes and treatment of anemia in membrane transport characteristics. of treatment of glomerular and Medical Knowledge the dialysis patient. Demonstrates Demonstrates knowledge of nutritional tubular diseases, polycystic understanding of nutritional needs of needs of PD patients. diseases, and renal diseases dialysis patients and renal dietary associated with systemic illnesses. interventions. Demonstrates understanding of issues of vascular access and importance of monitoring access as well as access choice. Alters treatment plans in response to Alters treatment plans in response to Incorporates new K/DOQI patient outcomes with regard to targets. patient outcomes with regard to targets. guidelines into practice as these Practice Based Adapts to use of bone disease and Adapts to use of bone disease and are developed. Applies new anemia algorithms. Changes prescribing anemia algorithms. Changes prescribing information about treatment in Learning practices as needed to achieve unit practices as needed to achieve unit glomerular and interstitial disease. therapeutic goals for adequacy, anemia, therapeutic goals for adequacy, anemia, bone disease and nutrition. bone disease and nutrition. Effectively explains importance of Effectively explains importance of Effectively explains the risks of treatment compliance, nutritional treatment compliance, nutritional early renal disease, and the need Communication Skills recommendations, and proper dialysis recommendations, and proper dialysis for interventions. Clearly outlines access to patients and caregivers. access to patients and caregivers. treatment options. Explains biopsy Interpersonal and risks and benefit. Explains biopsy results and their meaning. Writes or dictates clear opinions and recommendations to referring physicians. Interacts effectively with dieticians, social Interacts effectively with dieticians, social Is prompt and courteous; keeps workers, nurses and technicians during workers, nurses and technicians during effective records; responds to Professionalism and rounds and meetings to ensure care is safe rounds and meetings to ensure care is referring MD; applies best care and appropriate. Rounds on patients in safe and appropriate. Rounds on options. Recognizes influences of timely and efficient manner, answering patients in timely and efficient manner, physician based issues on ESRD patient questions, and addressing issues. answering patient questions, and choice and avoids decisions based Is courteous, discreet, and appropriate at addressing issues. Is courteous, discreet, on physician rather than patient Ethics all times. and appropriate at all times. benefit. Exhibits knowledge of governmental, Exhibits knowledge of governmental, Understands the problems corporate, and unit guidelines and corporate, and unit guidelines and interactions of specialty and regulations. Works with dieticians and regulations. Works with dieticians and primary care clinics regarding care nurses in applying algorithms to achieve nurses in applying algorithms to achieve of chronic kidney disease patients. bone disease and anemia guidelines. bone disease and anemia guidelines. Develops plans to increase Attends care plan and QI meetings as Attends care plan and QI meetings as attention to CKD and early Systems Based Practice invited, participates in decisions regarding invited, participates in decisions intervention. Replies to consults in long and short term patient plans, and regarding long and short term patient a manner that guides care by reviews issues affecting water treatment, plans, and reviews issues affecting safety primary physician. Stresses safety, and unit goal setting. Develops and unit goal setting. Develops preparation for ESRD treatment understanding of governmental understanding of governmental and avoids emergent or urgent regulations and organizational guidelines regulations and organizational guidelines institution of dialysis. Arranges for for dialysis care and dialysis unit for dialysis care and dialysis unit access placement in sufficient time management. management. to allow fistula maturation to occur.
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