Grandview hospital and Miami Valley Hospital – Nephrology
MVH:WSU-IM: Neph
Update 08/2020
Faculty:
Nephrology Associates of Dayton Renal Physicians, Inc
Mark Oxman, DO A. Eduafo, MD
C. Eze, MD (Dr Siva) Siva Ambilavavan MD
A. Ammula, MD M. Schnell, MD
B Doerr DO Natalia Maroz, MD
S. Patel, MD Adedayo Odunsi, MD
J. Kaufhold MD Eric Barnes, DO
J. Jackson, DO Nilesh Mhaskar MD
Swe Oo MD Sampath Thiruveedi MD
Phone:
NAOD 937 438-3132 RPI 937 208-7930
Dialysis unit at Grandview 937 723-3847
Miami Valley Dialysis unit 937-208-3433
General Description:
This is an elective one-month rotation. There will generally be one to two residents assigned in any given month. The rotation consists of inpatient experiences with the patients admitted to the nephrology service or seen for consultation or management. We also recommend spending a half day in the Outpt dialysis unit when the physicians round. There will be one month of meaningful patient responsibility granted for this rotation. This is a self-directed rotation, requiring independent activity and initiative on the part of the resident.
Educational Purpose and Goals:
Internists must be capable of managing patients with chronic and acute renal failure. A general internist must be knowledgeable concerning preventable renal diseases, stages of kidney diesase and strategies to delay/prevent kidney deterioration, familial renal diseases, and common renal manifestation of systemic diseases. In addition, internists should be able to assess and manage acute and chronic renal failure, including determination of when it is appropriate to consult the nephrologist.
The goal of this rotation is to train residents in the field of nephrology through practical and didactic training, such that residents will have the ability to manage common renal disorders at the level of a general internist.
Principle Teaching Methods:
Residents will receive instruction on topics and gain experience with care of patients during bedside rounds. There will also be discussion of topics during didactic sessions and the resident will be assigned topics to read independently during the month.
Types of Clinical Encounters:
Inpatient.
Whenever possible, residents will have initial contact for new consults and admissions, then present their assessments and recommendations to the nephrology attending. Residents will follow patients they evaluated. The resident will make rounds on the inpatient service and write progress notes daily. Orders for therapy should be discussed with the attending physician. A resident may follow up to six patients at any given time. Whenever possible, Residents will be asked to perform consults only on patients they will have an opportunity to follow with an attending.
Outpatient:
Premier (MVH) Residents are to attend the nephrology clinic at the Medical Surgical Clinic of MVH with the RPI attending, on the 1st Tuesday and 3rd Wednesday morning of each month. Time is 8:30 AM to 12:00 noon, in the Specialty center located at 725 South Ludlow. Days and time may vary so check with the attending ahead of time.
Kettering Health Dayton (Grandview) IM residents will attend the Nephrology clinic at Cassano Clinic on Tuesday mornings from 8-12.
Generally there will be about 5 follow up patients and 1 new consultation.
phone 937-558-0200
They are also encouraged to spend a half day in the Outpt dialysis clinic when the nephrologist rounds, to see dialysis in depth.
Procedures:
The resident will observe and participate in Hemodialysis, Peritoneal dialysis, Continuous renal replacement therapy, and central venous catheter placement.
They will observe renal biopsy and renal angioplasty as available.
Supervision:
The attending physician will have responsibility for all patient care provided. Residents will be supervised by an attending for each patient, although the attending need not be physically present during each encounter. At the discretion of the attending physician, residents may be granted some independent decision making according to their ability and level of training.
Patient Characteristics and Service:
Patients encountered during this rotation will reflect the general population of Dayton, including a wide variety of socio-economic groups, ethnicity, age and gender groups. Resident assigned patients will be drawn from all patients referred to the attending service.
Mix of Diseases:
Residents will see a diverse collection of acute and chronic renal conditions. These include:
- Electrolyte, Acid/Base, and Fluid abnormalities
- Vascular renal disease
- Glomerular and interstitial diseases
- Obstructive renal disease
- Diabetic renal disease
- Nephrolithiasis
- Hereditary nephropathies and cystic kidney diseases
- Chronic kidney diseases in all stages, with need for Drug modifications
- Acute and chronic renal failure general evaluation, including dialysis management.
- Pyuria, Dysuria and lower tract urinary diseases
- Hematuria and proteinuria differential diagnosis and management
- Hypertensive Kidney disease and management of difficult to control hypertension.
- Renal tubular disorders/ RTA
- Renal transplants.
Expectations:
All rotating residents will demonstrate ability to satisfactorily evaluate a urinalysis and sediment. All residents will be evaluated by the supervising faculty for appropriate analytic approach to nephrologic conditions, and residents will be evaluated for basic and clinical knowledge of renal function and pathophysiology. Residents are expected to demonstrate professional communication skills throughout their interactions with patients and staff. Residents are expected to exhibit reliability in their clinical duties, as well as integrity and respect in their interactions with patients and colleagues. Residents will be able to demonstrate appropriate consultative principles of communication and responsiveness to professional consultative requests. By the completion of the rotation, all rotating residents will demonstrate ability to interact with dialysis unit systems, and will be able to assist patients with access to dialysis. Residents will demonstrate self-initiative in the use of information technology to access and retrieve materials for self-education and patient education regarding renal conditions. Residents will be expected to show progressive learning throughout the rotation, with emphasis on learning from any cognitive or procedural errors. They are also expected to facilitate any quality improvement initiatives.
Expectations based on PGY level of training:
Learning objectives for medical education progress with each year of training and experience.
In medical school, the first two years cover the coursework for 7 Master’s Degrees. In the Third year, the student learns how to conduct a medical interview and gather the data necessary to make a differential diagnosis. This includes learning to use diagnostic instruments and labwork. In the Fourth year of medical school, the student learns how to document their findings and begins to use this organizational process to make decisions about management of the patient.
In Medical residency, the Intern learns how to manage problems for the first 24 hours, and then how long to continue treatment. In the Second year of training, the Medicine resident learns how to manage a team, and develops a scientific approach to WHY we do what we do. In the third year, the resident should develop a Literature based approach to Internal Medicine care.
Specific Expectations for PGY 1:
PGY 1 rotating residents will demonstrate ability to perform an appropriate nephrologic history and physical, documenting their findings in the record in an appropriate consultative format, with generation of a differential diagnosis and initial plan of treatment.
PGY 2 and 3:
By the conclusion of the rotation, PGY 2 or 3 residents will perform the above skills, and also evidence appropriate ability to independently generate an appropriate management plan. They must also demonstrate understanding of cost effectiveness of care by incorporating cost effectiveness and wise use of system resources into the development of their diagnosis and treatment plans.
Rotation Specific Competency Objectives:
a. Patient care
PGY 2 residents will regularly integrate medical facts and clinical data while weighing alternatives and keep in mind patient preferences. They will incorporate consideration of risks and benefits when considering testing and therapies. They will present up-to-date scientific evidence to support their hypotheses. They will consistently monitor and follow up patients appropriately.
PGY 3 residents will demonstrate the above and in addition, will demonstrate appropriate reasoning in ambiguous situations, while continuing to seek to clarify the situation. Residents at this level of training will not overly rely on tests and procedures. PGY 3 residents will continuously revise assessments in the face of new data.
b. Medical knowledge
PGY 2 residents will demonstrate progression in knowledge and analytical thinking as they develop well formulated differential diagnoses for multi-problem and complex patients.
PGY 3 residents in addition to above, will demonstrate appropriate habits to stay current with new medical knowledge, and will exhibit knowledge of effective teaching methods.
c. Interpersonal and communication skills.
PGY 2 residents will develop and refine their individual style when communicating with patients and families. They will strive to create ethically sound relationships with patients, the physician team and supporting hospital personnel. They will create effective written communications through accurate, complete and legible notes. They will exhibit listening skills appropriate to patient centered interviewing and communication. They will recognize verbal and nonverbal cues from patients. They will be able to discuss end of life decisions with patients and families.
PGY 3 residents should additionally be able to successfully negotiate nearly all “difficult” patient encounters with minimal direction.
d. Professionalism
PGY 2 and 3 residents will serve as role models, demonstrating integrity, accountability, respect, compassion, patient advocacy, and dedication to patient care in all encounters. Residents will demonstrate a commitment to ethical principles pertaining to provision or withholding of clinical care, confidentiality of patient information, and informed consent.
PGY 3 residents will be especially sensitive and responsive to beliefs and preferences related to patients’ culture, age, gender and disabilities.
e. Practice Based learning and improvement
PGY 2 residents will consistently seek out and analyze data on practice experience, identify areas for improvement in knowledge or patient care performance and make appropriate adjustments.
PGY 3 residents will additionally model independent learning and development. they will regularly demonstrate knowledge of the impact of study design on validity or applicability to individual practice.
f. Systems based Practice
PGY 2 residents will be sensitive to health care costs while striving to provide quality care. They will effectively coordinate care with other health care professionals to meet patient needs. They will consistently understand and adopt available clinical practice guidelines, and recognize the limitations of these guidelines. They will work with patient care managers, discharge coordinators and social workers to improve patient care and outcomes.
PGY 3 residents, in addition, will enlist social and other out of hospital resources to assist patients with therapeutic plans.
Where to report the first day:
The MVH Nephrology rotation is staffed by two different Nephrology Groups. RPI and NAOD. Call the office of the appropriate group before the beginning of the month of your rotation for contact information. You will generally meet the attending in the Dialysis unit on the Third Floor of MVH, or in the ICU on the Fourth floor in the morning.
Daily Routine:
The resident will be available for consults daily from 8:30 to 4:30 Monday through Friday. There is no call assigned during this rotation.
Residents may come in for rounds on Holidays/ Weekends if they desire, but this is not mandatory.
Conferences:
Unless otherwise assigned, residents on the nephrology rotation are expected to attend Morning report, resident forum, and internal medicine Noon Conference.
They are encouraged to attend any Renal Biopsy or other local dinner conferences which may occur during their rotation.
Evaluations:
- Mid month performance evaluation
- Exit evaluation that goes back to the Department of Medicine Program Director.
Resources:
- Textbook: Nephrology Section of Harrison’s or Cecil’s Internal Medicine
- MKSAP Nephrology
- Up to Date .com
- www.JeffKaufhold.com has all of the NAOD Lectures online
- Articles on selected topics will be available from the attending
- Narins: Fluid and Electrolyte Disorders, Supplement to the Am J Med, 1982.