METHODIST MEDICAL CENTER TRANSPLANT ROTATION
Service
The Renal Transplant Service at Methodist Hospital provides additional transplant experience for the fellowship training program. The Methodist Medical Center currently performs 60-70 kidney or combined kidney -pancreas transplants/year. The in-patient service rounds twice daily. The team consists of the fellow, nephrology attending, transplant surgeon, and/or urology attending. Nursing staff, pharmacists, dieticians and social workers also participate in rounds with the In-Patient Service daily.
Fellows will participate in all of the clinical and academic activities of the Renal Transplant Service. The fellow becomes familiar with the pre-transplant workup of the patients. They will learn the principals of selection of candidates for transplantation, donor evaluation, management of patients on the list, and management of patients in the peri- and post operative period.
Responsibilities
The clinical fellow is assigned to this rotation 3-4 months during the 2 years of clinical training. The Methodist Medical Center currently performs 60-70 renal or combined renal-pancreas transplants/year. The fellow will manage 5-6 new transplants while being supervised by the transplant attending. The fellow is involved in the pre-operative evaluation of patients and conducts daily post-operative follow up to include planning and dictation of detailed discharge plans. 5-10 core biopsies of renal transplant allografts are typically performed. Review of the renal pathology occurs the following day. The fellow will observe at least one renal donation and one recipient operation in the operating room during the rotation. Under the supervision of the attending the fellow will admit, manage, and discharge all transplant patients admitted to the hospital. The fellow will attend a nephrology journal club twice/month and present a patient and/or topic relative to transplantation once/month.
Expectations
A. During this rotation the fellow will gain expertise in the areas listed below. This expertise will be acquired from attending required teaching conferences and daily attending rounds.
-Supervised involvement in the decision-making for patients during pre-and post-transplant care
-Evaluation and selection of transplant candidates
-Pre-operative evaluation and preparation of transplant recipients
-Immediate post-operative management of transplant recipients, including administration of immunosuppressant medications
-Clinical diagnosis of all forms of rejection, including laboratory, histopathologic, and imaging techniques
-Medical management of rejection, including use of immunosuppressant drugs and other agents
-Recognition and medical management of the surgical and nonsurgical complications of transplantations.
-Management of post-transplant complications – including rejection, chronic allograft dysfunction, post-transplant malignancies, infections, cardiovascular diseases, hypertension, and fluid/ electrolyte problems
-Technical expertise: percutaneous biopsy of allograft kidneys
-Principles of tissue typing
B. The fellow will become familiar with the indications for percutaneous renal allograft biopsy. The fellow will become skilled in this procedure and be familiar with the risks and complications of the procedure.
C. The fellow will be responsible for all dialysis treatments of post-transplant patients in the event of allograft non-function or failure or should a patient require re-initiation due to long term allograft failure. He/she will also manage dialysis for patients admitted specifically for pre-transplant workup.
General competencies
A. Patient Care:
By the end of this rotation, first year fellows are expected to develop and demonstrate the following skills:
1. Communicate effectively and demonstrate respectful behavior when interacting with patients referred for transplant evaluation.
2. Gather essential and accurate information about their patients
3. Make informed decisions about diagnostic and therapeutic interventions based on medical knowledge, patient preferences and judgment
4. Understand out management plans, such as treatment of rejection, adjustment of immunosuppressive medications and diagnostic procedures
5. Use information technology to educate patients about transplantation and donation
6. Perform transplant renal biopsies under supervision.
7. Provide health maintenance and preventive health care, specifically aimed at preventing complications of renal transplantation including toxicity of drugs, opportunistic infection, malignancy, cardiovascular disease
8. Work with members of the transplant team, including surgeons, other consultants, social workers, nurse practitioners, members of the organ procurement organization and UNOS
9. Demonstrate competency in performing transplant renal biopsies
10. Independently formulate a diagnostic and treatment plan for complications of renal transplantation
B. Medical Knowledge:
Fellows are expected to develop competency in transplant as described in detail above:
1. By demonstrating knowledge in established and evolving biomedical, clinical, epidemiological and social-behavioral sciences (as listed above)
2. By demonstrating the ability of applying this knowledge to patient care and understanding complex mechanisms of diseases
3. By being highly resourceful in developing knowledge
C. Practice based learning:
By the end of this rotation, first and second year fellows are expected to develop and demonstrate the following skills:
1. Understand the resources involved in procuring and allocating organs for transplantation: the role of UNOS, organ procurement organizations, donor networks, tissue typing laboratories
2. Understand the cost-effectiveness of renal transplantation (deceased donor vs. living donor) as well as the cost-effectiveness of various immunosuppressive regimens
3. Assist patients with chronic kidney disease in obtaining access to evaluation for transplantation
4. Work with members of the transplant team to improve and consolidate cost-effective health care delivery
D. Communication and interpersonal skills
By the end of this rotation, first year fellows are expected to develop and demonstrate the following skills:
1. Establish rapport with patients from different backgrounds
2. Provide appropriate counseling to patients and their families regarding their therapeutic options: risks and benefits of renal transplantation, both from deceased and living donors
3. Communicate effectively with all members of the transplant team
4. Interact with other physicians, nurses, and therapists caring for the patient
5. Interact with the staff of the transplant unit to promote cooperative care
6. Provide teaching to residents and medical students
7. Work with pertinent hospital personnel to arrange transplant biopsies
8. Communicate results of biopsies to nephrologists and transplant team
E. Professionalism:
By the end of this rotation, first and second year fellows are expected to develop and demonstrate the following skills:
1. Demonstrate a commitment to ethical principles particularly as pertains obtaining organs for transplantation and allocating them equitably
2. Demonstrate compassion and integrity by being responsive to patients’ needs regardless of culture, age, gender, ability to pay
3. Interact professionally with other members of the health care team, colleagues and students
F. Systems-Based Practice:
By the end of this rotation, first and second year fellows are expected to develop and demonstrate the following skills:
1. Understand the resources involved in procuring and allocating organs for transplantation: the role of UNOS, organ procurement organizations, donor networks, tissue typing laboratories
2. Understand the cost-effectiveness of renal transplantation (deceased donor vs. living donor) as well as the cost-effectiveness of various immunosuppressive regimens
3. Assist patients with chronic kidney disease in obtaining access to evaluation for transplantation
4. Work with members of the transplant team to improve and consolidate cost-effective health care delivery
