UNIVERSITY OF TEXAS SOUTHWESTERN MEDICAL CENTER CONTINUITY CLINIC LOCATED AT PARKLAND MEMORIAL HOSPITAL (PMH)
Fellows will spend one-half day per week in their continuity clinic. The only fellow who does not attend this clinic is the one assigned to the VA consult rotation, otherwise all fellows attend this clinic weekly for the duration of clinical training. In this setting, fellows will evaluate new out-patient consultations, formulate diagnostic and treatment plans and coordinate care with the referring physician. In this setting fellows will also have longitudinal care of patients with nephrological problems. Fellows are directly supervised by a faculty member and each patient encounter is used as a teaching opportunity. In general, fellows will see 2-3 new patients and 4-5 established patients per session. Fellows and attendings work closely to provide a strong teaching experience that emphasizes the core of out-patient Nephrology practice. KDOQI guidelines are emphasized in the outpatient management of patients
Goals and Objectives:
The out-patient setting will be a site where fellows are expected to learn the following core subjects: the pathogenesis, complications, and management of:
- chronic renal failure and its management, including dietary interventions
- diagnosis and management of hypertensive disorders
- the workup of the abnormal urinalysis and the microscopic examination of the urine
- the workup and management of renal dysfunction
- renal involvement in systemic diseases (i.e., SLE and vasculitis)
- glomerulonephritis
- the nephrotic syndrome
- diabetic nephropathy
- tubular interstitial renal diseases
- inherited cystic and congenital renal diseases
- drug metabolism in renal diseases
- evaluation of ESRD patients for various forms of therapy and their instruction regarding treatment options.
- understanding the immunological aspects of some renal diseases
- geriatric aspects of nephrology, including disorders of the aging kidney and urinary tract
- tubular interstitial renal diseases, including inherited transport diseases, cystic diseases and congenital disorders
- other genetic and inherited renal disorders
- psychosocial and ethical issues of CKD and ESRD patients.
- end-of-life care and pain management in the care of patients CKD and ESRD patients
General competencies
Patient Care:
By the end of this rotation, first year fellows are expected to develop and demonstrate the following skills:
A. Be aware of advantages and disadvantages of peritoneal and hemodialysis.
B. Educate patients regarding all aspects of CKD especially diet, medications, anemia and blood pressure control
C. Evaluate CKD in consultation and offer differential diagnoses of decreased GFR, proteinuria, and hypertension
- Prepare patients to choose a dialysis modality
E. Complete transplant evaluations and counsel patients regarding risks and benefits of transplantation
Medical Knowledge:
By the end of this rotation, first year fellows are expected to develop and demonstrate the following skills:
- Offer differential diagnosis of CKD
- Understand indications for renal biopsy
- Initiate appropriate renoprotective strategies
D. Be familiar with the full set of K/DOQI guidelines for outpatient management of chronic kidney disease
E. Be prepared to assume care for patients with all types of renal disease in the outpatient setting
Practice-Based Learning:
By the end of this rotation, both first and second year fellows are expected to develop and demonstrate the following skills:
A. Be able to track kidney function of CKD patients to evaluate success of renoprotective strategies
B. Use information technology to manage data for long term patient care
C. Understand and apply practice guidelines for the care of CKD patients
Communication and Interpersonal Skills:
By the end of this rotation, first year fellows are expected to develop and demonstrate the following skills:
A. Establish highly effective humanistic and therapeutic relationships with patients and families
B. Discuss implications of long-term dialysis care and different modalities with patients and family
C. Work with interdisciplinary team to initiate social work and dietician consultations for CKD patients
D. Work with the transplant center in the management of patients awaiting renal transplantation
E. Be comfortable discussing end-of-life decisions, palliative care options, and disposition issues with patients and family members and social workers
Professionalism:
By the end of this rotation, both first and second year fellows are expected to develop and demonstrate the following skills:
A. Demonstrate relationships with CKD patients and be familiar with their problems
B. Be able to act as a role model and teach medical students and residents regarding respect, compassion, integrity, and honesty
C. Demonstrate responsible behavior and total commitment to self-assessment
- Be willing to acknowledge errors
Systems-Based Practice:
By the end of this rotation, first year fellows are expected to develop and demonstrate the following skills:
A. Be familiar with coordinating long-term care of patients with CKD and understand resources available to dialysis patients
- Understand CMS and insurance issues of dialysis
In addition to the above, second year fellows will
C. Be able to refer patients to a transplant center and undertake the pre-transplant evaluation
D. Be able to coordinate vascular access surgery, assess access and help decide when to initiate dialysis therapy.
E. Assist a patient in the transition to dialysis and direct an interdisciplinary team to coordinate nutritional services, financial assistance, home care and other benefits.
