TEACHING CONFERENCES
In addition to clinics and fellow rotations, the division offers an intensive didactic lecture series for the trainees. These lectures are discussed in more detail below. Each week there is (a) clinical lecture series (Monday 1200-1300), (b) basic science lecture series (Thursday 1200-1300), (c) clinical conference (Friday 1600-1700) and (d) research conference (Tuesday 1700-1800). The clinical conference is divided into a journal club scheduled at least once per month, presentations of selected cases, and review of pathology specimens with the renal pathologist. The Monday and Thursday noon conferences are required conferences. The fellows must sign a sheet at the time of the conference. Attendance is monitored by the program director.
I. Nephrology Core Curriculum
During July and August, each Monday and Thursday lecture (1200-1300) is of an introductory nature and designed to provide fellows with a basic grounding in the science, clinical presentation, and treatment of a wide range of nephrologic diseases. In addition the basics of renal replacement therapy are covered. These are topics are those the fellow needs to be formally introduced to early in their training.
During the remainder of the academic year, lectures, discussions and case reviews (as described in detail below) will be conducted to provide the fellows with instruction in basic sciences relevant to nephrology including: physiology, anatomy, biochemistry; to review concepts central to the understanding of nephrology including: epidemiology, immunology, pathophysiology, pharmacology; to provide a forum for case discussions, review of management decisions and preparation for board examinations.
II. Renal Grand Rounds (Monday 1200-1300)
In the clinical lecture series, the trainee will be given lectures covering the
following areas:
• Nephrolithiasis
• Alterations in mineral metabolism in renal disease and renal osteodystrophy
• Disorders of fluid, electrolyte, and acid-base regulation
• Acute renal failure
• End-state renal disease
• Renal disorders of pregnancy
• Tubulointerstitial renal diseases, including inherited disease of transport, cystic diseases, and other congenital disorders
• Glomerular and vascular diseases, including the glomerulonephritis, diabetic nephropathy, and atheroembolic renal disease
• Effects of drugs on renal structure and function
• The pharmacology of commonly used medications and their kinetic and dosage alteration with renal failure, hemodialysis, and peritoneal dialysis
• An understanding of the special nutritional requirements of the hemodialysis and peritoneal dialysis patient
• Renal pathology
• Pathogenesis, natural history, and management of congenital and acquired diseases of the kidney and urinary tract and renal diseases, associated with systemic disorders such as diabetes, collagen-vascular diseases, and pregnancy
• The pathogenesis and management of urinary tract infections
• The pathogenesis and management of acute renal failure
• The clinical implications and technique of lithotripsy
• Indications for and interpretations of radiologic tests of the kidney and urinary tract
• Immunology to include basic principles; immunologic mechanisms of renal disease; and fundamental aspects of diagnostic laboratory immunology relevant to renal disease.
• Transplantation to include biology, diagnosis, and management of transplantation rejection; immunosuppressive agents; indications for and contraindications to renal transplantation; principles of transplant recipient evaluation and selection; principles of evaluation of transplant donors, both live and deceased, including histocompatibility testing; principles of organ harvesting, preservation, and sharing; and psychosocial aspects of organ donation and transplantation.
• Dialysis to include the kinetic principles of hemodialysis and peritoneal dialysis; the indication for each mode of dialysis; the short-term and long-term complications of each mode of dialysis and their management; the principles of dialysis access (acute and chronic vascular and peritoneal) including indications, techniques, and complications; urea kinetics and protein catabolic rate; dialysis modes and their relation to metabolism; nutritional management of dialysis patients; dialysis water treatment, delivery systems, and reuse of artificial kidneys; the artificial membrane used in hemodialysis and biocompatibility; and the psychosocial and ethical issues of dialysis.
• Formal lectures on renal pathology by the renal pathologist are provided
III. Basic Science lecture series (Thursday 1200-1300)
In this lecture series, the fellow will gain expertise in renal anatomy and physiology, normal and abnormal blood pressure regulation, mineral metabolism, and disorders of fluid, electrolyte, and acid-base regulation. Topics on molecular biology are provided as it pertains to the kidney.
IV. Clinical Conference (Friday 1600-1700)
There are three alternating formats to this conference:
1. Case presentation: On a rotating schedule the fellow presents an interesting case from one of the clinical services. The case is then discussed among the fellows, attending physicians, and the differential diagnosis is generated or expanded upon. The fellow then presents a review of the literature focused on a specific aspect of the case. This conference provides the fellow with the opportunity to improve skills in case presentation and improve diagnostic and therapeutic reasoning. The fellow provides a scholarly and in depth analysis of the case and approach to diagnosis.
2. Journal Club: The fellows select an article from top-tier journals that is approved by a member of the faculty. The article is circulated to the division at least two weeks in advance of the presentation date. Each fellow presents 2-4 times per year on average to include an equal number of basic science and clinical topics. Fellows are encouraged to state the hypothesis of the paper and determine whether the paper is the result of hypothesis-driven research or descriptive. The fellow goes through each figure or table in the order they were presented in the paper and discusses the methods used to generate the data, the statistical methods used to analyze the data, and the conclusions that may be drawn. The fellow then discusses whether the hypothesis is supported by the data and analyzes the strengths and weaknesses of the paper.
The conference provides fellows with an in-depth exposure to current basic science and clinical literature relating to the discipline of nephrology and medicine, including epidemiology of disease. In addition the conference allows fellows to develop 1) the analytic tools to critically evaluate the design and interpretation of research studies and 2) the presentation techniques to effectively communicate this evaluation.
3. Pathology Conference: The renal pathologist using a multi-head microscope reviews pathologic specimens obtained at various time from the last 1-2 months. During the conference the cases are presented by the fellow and a discussion of differential diagnosis with the pathologist is performed. This conference teaches the fellow the indications for performing a kidney biopsy and allows the fellow to learn how the kidney biopsy impacts diagnosis, therapy, and prognosis. The fellow learns how to read and interpret kidney biopsies and gains an understanding of the various histological methods that are used in this process.
V. Research conference (Tuesday 1700-1800)
During this conference research in progress is presented by our own faculty or a visiting professor. The fellow learns recent advances in nephrology and cell biology. Research fellows learn to present their research in a formal lecture setting.
VI. The fellow is encouraged to attend the Department of Internal Medicine lecture series to include:
A. Internal Medicine Grand Rounds (Fridays 0800-0900)
B. Clinical-Pathologic Conference (CPC) (Fridays 1200-1300)
C. Case presentations currently on the wards “Popourri” (Tuesday 1200-1300)
Of note, the Chairman of the Department of Internal Medicine has identified Internal Medicine Grand Rounds and the Clinical-Pathologic conference as required conferences for members of the Department of Internal Medicine.
VII. Interdisciplinary Topics Covered in Other Venues
A. Risk management (on line at UTSWMC): All new fellows must complete 15 hours of risk management education at the beginning of their appointment. After successful completion of the risk management program, the fellow has 2-3 years in which to complete an additional 15 hour course. The initial course consists of 10 core hours and 5 elective hours.
B. Mandatory training (PMH) is also given in the areas of patient abuse and neglect, pain management, patient rights and responsibilities and infection control, advance medical directives. Training also covers the Parkland Memorial Hospital mission and guiding principles and hazardous material safety. There is training that covers legibility, corrections, and appropriate use of abbreviations in medical records.
C. Medical ethics: several lectures are given through the year on this topic.
D. Issues of physician fatigue: this topic is covered yearly in the Internal Medicine Grand rounds or CPC time slot and is required for of all members of the Internal Medicine Housestaff.
VIII. Educational Assignments and Fellow Portfolio Development
As described in detail above the fellow is expected to prepare and make presentations at the Clinical Conference and Journal Club. In addition, a formal didactic lecture of their choosing involving some aspect of Nephrology is given by the 2nd year clinical fellow and delivered in the spring during during the Thursday Noon lecture time slot. The lecture topic is approved by a faculty member. Fellows Trainees also participate actively in the research conference by presenting their data or presenting topics related to their research projects. The various lecture presentations can be included in the fellow’s portfolio of educational accomplishments.
Updated November 21, 2007 Created by Megan Johnson
