MEDU-4019 - Clinical Nephrology/Renal Transplantation

MEDU-4019 - Clinical Nephrology/Renal Transplantation

Elective Title: Clinical Nephrology/Renal Transplantation
Course Number: MEDU-4019
Elective Type: clinical Duration/Weeks: 4 Max Enrollment: 3
Prerequisites: Successful completion of Year 2
Additional Requirements: Successful completion of Internal Medicine clerkship.
Responsible Faculty Director: Ann Kathleen N. Gamilla-Crudo, MD Periods Offered: 1-7; 9-13 excluding holiday period 8 
Coordinator: Victoria Garcia & Kiki Baldwin Other Faculty: John Badalamenti, MD; Tina Kochar, MBBS; Shancy Jacob, DO; Muhammad Mujtaba, MBBS; Syed Hussain
Location to Report on First Day:
4.200 John Sealy Annex at 8:00 am

This course will introduce students to the common renal disorders that a generalist or subspecialty physician is likely to encounter. A diversified clinical experience in Nephrology with emphasis on patient evaluation and management is provided as well as instruction aimed toward assisting students in attaining and understanding of renal pathophysiology and its application to the care of patients with kidney disease and hypertension.

Specific objectives for the Clinical Nephrology elective are as follows:
1. Acquire an understanding of normal renal physiology and the pathophysiologic mechanisms of common renal diseases.
2. Develop ability and skills in the evaluation and management of common renal disorders including volume, acid-base, and electrolyte disorders, acute and chronic renal failure, proteinuria, hematuria, and hypertension.
3. Acquire an understanding of how to recognize, evaluate, and manage the renal problems associated with systemic diseases such as diabetes mellitus, autoimmune/connective tissue diseases, infections, heart failure, and chronic liver failure.
4. Acquire proficiency in the performance and interpretation of a urinalysis.
5. Acquire expertise in the clinical assessment of volume status.

Description of course activities
This elective will involve activities in both the inpatient and outpatient setting. The clinical experience is derived from the inpatient Nephrology Consult service and the Nephrology outpatient clinic. Students will have the opportunity to participate in the evaluation and management of patients in all of these areas. Patient care and teaching rounds with the Nephrology attending physician and renal fellow are held Monday through Friday. Regular small group teaching conferences are held at frequent intervals to discuss cases and clinical problems. Additional instruction in various aspects of clinical nephrology is provided during Nephrology Case Conference, Nephrology Clinical Conference, Renal Biopsy Conference, and Nephrology Research Conference which are held regularly each week.

Type of students who would benefit from the course
This elective is particularly valuable for students interested in primary care specialties (internal medicine or family practice) in which renal disease is a common occurrence. This elective is also valuable for students interested in the evaluation and management of acid base, fluid and electrolyte disorders and other renal problems present in surgical, obstetrical, pediatric, or other medical disciplines.

Weekly Schedule
  Clinical Activities (estimated schedule)  
Day of Week   AM   PM
Monday 8 5
Tuesday 8 5
Wednesday 8 5
Thursday 8 5
Friday 8 5

 Average number of patients seen per week: 15-18
 Call Schedule: n/a

Research Activities (estimated schedule)
Activity Hours per Week
Faculty Contact-Time
Self-Directed Study

Method of Student Evaluation
1.  Clinical Observation
  A. Where are students observed on this elective?
    Inpatient Service   Ambulatory   Surgery   Standardized patients
Patients simulators   Other
  B. Frequency - How often are students observed clinically?
  C. Format - What method(s) are used to document the student's clinical performance?
    Daily oral feedback   End of period oral feedback   Written feedback

2.  Oral Presentation
  A. Audience - To whom does the student present?
    faculty, students, residents, fellows
  B. Frequency / Duration of Presentation(s)?
    At least once weekly
  C. Format - What guidelines are set for the student's presentation?
    30-40 min oral presentation: Roundtable discussion w/faculty, fellows, resident/s and student/s
  D. Assessment - Who assesses the student's presentation performance?
    Self-assessment   Peer assessment   Faculty assessment
  E. Method of content selection
    Current cases  Student-selected topic   Assigned topic

3.  Written Assignment (H&P's, notes, papers, abstracts, etc.)
  A. Frequency of written assignment(s)?
  B. Format - What guidelines are set for the student's written work?
    standard written H&P's and notes
  C. Length of written assignment(s)?
    Abstract   Annotated bibliography   1 - 2 page paper   3+ page paper
  D. Are recent references required?   No    If yes, how are they selected?
  E. Method of content selection - e.g. student-selected, relate to cases, etc.?
    Student-selected on current related cases
  F. Audience - Who assesses the student's written performance?
    Peer Assessment     Faculty Assessment     Other

4.  Examination
    Oral   Written multiple choice   Written essay / short answer   OSCE

5.  Extra Course Activities
  What expectations do you have for the student to demonstrate participation in the elective (e.g. small group activities, seminars, thoughtful questions, providing resources, journal club, resident lecture attendance)?

6.  Additional Costs
  Please list any additional costs and/or purchases (books, materials, movies to watch, etc.) that are required for this course. Include an estimated total cost. If there are no additional costs, please enter "None".

7.  Other Modes of Evaluation
  Please explain below.
    Students will be evaluated in the following categories:
1. Ability to perform an accurate nephrology oriented history and physical examination and ability to perform and interpret a urinalysis.
2. Ability to select laboratory tests that are indicated and cost effective for the evaluation of specific renal disorders.
3. Problem-solving and clinical judgment.
4. Ability to develop a management plan incorporating personal and family interrelationships and socioeconomic factors.
5. Professional responsibilities and interpersonal relationships with members of the health care team, patients, and their families.
6. Evidence of acquisition of new knowledge in clinical Nephrology.

8.  If this course is an Acting Internship, please complete the following:
  A. Objectives for the AI should relate directly to the Entrustable Professional Activities (EPAs). Each AI should describe how the four key Year-4 EPAs that our school has identified as being Year-4 skills are assessed. The Year-4 objectives are:
1. Entering and discussing orders/prescriptions.
2. Give or receive patient handover to transition care responsibility.
3. Recognizing a patient requiring urgent or emergent care and initiating management.
4. Obtaining informed consent for tests and procedures.
Specify how the student will be given formative feedback on their clinical skills.

Year-4 students should demonstrate mastery of EPAs they developed in the clerkship year, including recommending and interpreting common diagnostic and screening tests, and performing general procedures of a physician. They should be able to demonstrate masterfully and independently skills they mastered in Years 2-3, including efficiently performing comprehensive admission-notes and succinct daily progress notes and perform accurate, concise, and hypothesis-driven clinical presentations, form clinical questions and retrieve evidence to advance patient care. They should be able to demonstrate basic understanding of and beginning mastery of collaborate as a member of the interprofessional team and identify system failures and contribute to a culture of safety improvement.

List advanced clinical skills that a student will be assured an opportunity to practice.

How specifically will this AI build on developing skills from the clerkship year to prepare students for internship?

What opportunities will typically be available to all students who take this AI (procedures, required presentations, etc.)? What opportunities may be available based on patient load/presentation or student initiative (ie. Writing a case report)?

An AI should have expectation of a minimum of 32 hours per week of clinical responsibilities. Duty hours should be capped at ACGME limits for an intern, thus up to 24 hours followed by 4 hours of activities related to patient safety, education, and handoff. Students cannot work more than 80 hours per week averaged over 4 weeks. They can only have 1 day off in a 7-day work week with 8 hours off between shifts.

Clinical responsibilities will vary depending on specialty, but how is the student functioning with work commensurate to a PGY1 with an appropriate level of training?

How is the student demonstrating drawing clinical conclusions and/or developing a management plan and documentation as an intern would do?

How and by whom will midpoint feedback be provided to the student? How will you remediate deficiencies identified at midpoint?

Acting Internship students often seek letters of recommendation following their experience. How many different Faculty will work directly with the student and have knowledge of the student's abilities to detail in a written evaluation? Describe the degree of supervision and interaction with faculty vs. residents or other providers and how feedback will be obtained if more direct work is with residents or other providers.