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Inpatient General Medicine, Nephrology - Harrison Team

Harrison Service Inpatient General Medicine / Nephrology Competency-Based Curriculum

Tinsley R. Harrison was born in Talladega, Alabama, on March 18, 1900. He was the son of Groce Harrison, himself a sixth-generation physician. Having graduated from high school at the age of 15, Harrison attended the University of Michigan, where he also completed one year of medical school before transferring to Johns Hopkins School of Medicine in the fall of 1919. His roommate and tennis partner at Johns Hopkins was Alfred Blalock, with whom he developed a close lifelong friendship. He completed his internship at Peter Bent Brigham Hospital in Boston, returned to Hopkins for further training in internal medicine, and completed his residency at Vanderbilt University.

Harrison's special field of interest was cardiovascular medicine as well as the pathophysiological mechanisms of disease. His name is best known among medical practitioners as the founding editor and editor-in-chief of the first five editions of Harrison's Principles of Internal Medicine. The text initiated several unique approaches to medical textbook writing, and remains, in its current edition, one of the most widely read and regarded textbooks in medicine.

Harrison dedicated his career to patient care, research, publishing, medical education, and medical practice.

"No greater opportunity or obligation can fall the lot of human being than to be a physician . In the care of the suffering he needs technical skills, scientific knowledge, and human understanding, he who uses these with courage, humility, and wisdom will provide a unique service for his fellow man and will build an enduring edifice of character within himself. The physician must should ask of his destiny no more than this, and he should be content with no less. " – Tinsley R. Harrison

Overview

Inpatient general internal medicine/nephrology involves caring for acutely patients with a broad range of clinical problems. This is best achieved by adopting a team approach consisting of the general internist/nephrologist, appropriate medical specialist or subspecialists, nurses, social workers, pharmacists, and others as indicated. Residents must learn to recognize acute and chronic critical illnesses, to develop differential diagnoses, to develop care plans, and to allocate limited resources appropnately to patients. Residents will also need to gain experience and a level of comfort in dealing with ethical and social issues.

Principal Teaching / Learning Activities

-Resident Morning Report (RMR)—
Three mornings each week (Monday, Tuesday, & Thursday) from about 7:45-8:45 AM all Interns, Junior Assistant Residents and Senior Assistant Residents on inpatient floor teams meet with assigned faculty to review patients admitted the previous day. Patients are presented briefly by the intern or resident who admitted them and discussed by the group, facilitated by the attending physician. The focus of the discussion is selected by the presenting resident and may reflect differential diagnosis, specific management issues, or other topics. Faculty members include general internists and subspecialists.

Each Friday from 8:00-9:00 AM the Senior residents meet with assigned specialist attending physicians to review patients admitted the previous day. Selected patients are presented by the residents and further discussion including literature review and didactic teaching is guided by the attending physician.

-Sign-out Rounds (SR) --
Every evening, Monday through Friday, the senior residents (Chief Resident, or his/her designate will be present during the first few months of the academic year), supervise sign-out rounds, which are attended by the out-going day team and incoming ADMITTING team. These may include topical discussions.

-Teaching Attending Rounds (AR) –
Attending rounds format will vary depending on the preference of the attending. There should be discussion of the patients with concurrent teaching. At the very least this should include bedside rounds on the new patients and others whom the resident/attending feel should be seen by the team. If possible beside rounds should be done on all patients.

-Management Rounds (MR) --
Each day the Attending physician responsible for care of patients on this service will meet with the residents at the mutually agreeable and arranged times, to review specific aspects of patient management. It will be during these occasions that residents are supervised in details of recordkeeping, interaction with other healthcare team members, communication with consultants and family members, and all other aspects of patient management.

-Palliative Care and/or Ethics Rounds (PCR)—
Once each month a voluntary faculty member with special interest and expertise in medical ethics and palliative care conducts palliative care rounds for all residents on inpatient teams. A particular patient or patients is/are selected for presentation. Discussion is directed and facilitated by the faculty member, emphasizing issues pertaining to death and dying, and relevant care and communication skills necessary for residents to develop.

-Noon Conference (NC) -- Each weekday usually from 12 noon to 1 p.m. all residents attend a scheduled conference reviewing core topics in Internal Medicine.

-Journal Club (JC) -- Journal Club is held monthly. Following an annual presentation on the fundamentals of evidence-based medicine, individual residents are assigned a single article to critically review and present, facilitated by a faculty member, and followed by a group discussion.

-Grand Rounds (GR) --
Medical Grand Rounds are held each Wednesday from 8:00 -9:00 a.m. in the Medical Center Auditorium. Formats vary and include invited guests/visiting professor presentations, clinical-pathological conferences, resident presentations, or other didactic, topical, or patient related topics.

-Ambulatory Care Conference -- (ACC)
Each month faculty members meet with residents to review individual topics pertaining to ambulatory care medicine. This follows a three- year cyclic schedule of topics, so that our ambulatory care curriculum is presented in its entirety during the time of training for individual residents.

-Back to Basics (BTB)-
Each month the residents choose a key topic in medicine to review in detail form pathophysiolgy to clinical manifestations and management. The topics are chosen by the residents and reviewed by the chief resident prior to discussion Topics generally follow a triennial cycle, covering all subspecialty areas within internal medicine during the time of training of individual residents.

- Turnover Rounds (TR)--
Turnover rounds occur at the end/beginning of each rotation and from 6:30- 7:30 a.m. daily. These facilitate transfers of patient care from one resident to another. (Sign in Rounds are a daily version of turnover rounds.)

-EBM conference (EBM)-
Each month the ambulatory resident and intern are expected to investigate a clinical question that they do not have the answer for. Under the guidance of the faculty, they then formulate the question in a scientific format, search the literature for evidence, and develop an answer to the question. This is presented in a conference. Included in the presentation are the question, the search methods, the evidence found, and the conclusions derived.

-Patient Safety and Quality Improvement Conference (PSQI) –
Formerly the Morbidity and Mortality Conference. We now have a monthly conference dedicated to identifying issues that affect patient safety. The issues maybe as varied as knowledge gaps in care for patients with unusual diseases to errors that occur in the course of care. There is a discussion about the residents' role in preventing such issues in the future. If warranted an action plan is made with follow up at subsequent meetings.

-Autopsy Rounds (AuR)
When a death occurs on any of the teaching teams the family is offered the option of performing an autopsy. If an autopsy is performed, we hold a multidisciplinary presentation of the findings that includes medicine, pathology, radiology, surgery, and/or ob/gyn residents and faculty that were involved.

-MKSAP study pan (MKSAP)-
This self directed study plan helps residents stay on track with their didactic reading and helps them evaluate their medical knowledge (strengths and areas of deficit). Residents can help develop individualized study plans to fill in any knowledge gaps and reinforce what they already know. This also helps residents develop skills and habits needed for lifelong learning.

-In-Training Examination (ITE) --
All of our residents must take this examination annually for their own assessment of progress and for edification. When examination results become available, the program director discusses these individually with residents and counsels residents about individualized study programs to facilitate their acquisition of knowledge.

Description of the Rotation / Resident Responsibilities

Teams of one junior/senior resident and 1 to 3 interns are assigned to the inpatient general medicine each month. Patient care responsibilities are usually to patients on the 5700 patient care unit, but additional patients may be included on this service as well. Individual patient care is supervised by patients' individual attending physicians. Daily teaching rounds are made under the direction of a member of the attending staff with specialty training in internal medicine or nephrology.

Whenever possible these rounds will be multidisciplinary in nature, incorporating all health personnel participating in the care of individual patients. This will include but need not be limited to nurses, therapists, social workers, case managers, discharge planners, and certainly attending physicians and consultants. Rounds will be made together, as a team, assuring that all patients are seen and that all members of the team have familiarity with the problems of all patients in the unit. Work rounds must be made efficiently - and it is for that reason that interns must be familiar with their patients prior to the beginning of work rounds - in order to complete these by the time of morning report (except on the day of medical grand rounds). This is a time when it is essential that the residents, as a team, cornmunicate with patients' attending physicians and consultants as well as all of the ancillary medical staff involved in their care.

PGY1: Interns have the primary responsibility for the day-to-day management of assigned patients.

For new admissions, they are responsible for completing a thorough evaluation including history, physical examination, and review of the avaialbe data. This should then be assimilated into a thorought assessment of the patient's status and problems, followed by the formulation of a diagnostic and therapeutic plan. Interns are encouraged to seek the guidance of the supervising resident in completing any of the above tasks with which they feel they need help.

Interns should be intimately familiar with their patients. They should evaluate all patients already admitted and collect all pertinent data in time for work rounds. This will include reviewing graphic sheets and events of the preceding evening, and being familiar with all new admissions, diagnostic information, and therapeutic interventions; interns must be prepared to comprehensively present their patients on work and attending rounds.

Interns should seve as role models for their students and inculcate good habits in their trainees.

PGY2/3: Junior residents have a responsibility to provide supervision and teaching to their interns and students.

For new admissions, they are responsible for supervising the intern's evaluation of the patient and development of the assessment and plan. Residents are expected to have a brief admitting note that summarizes the patient's status and an outline of the team's thoughts on the patient's status and plan. The resident should be aware of the intern's limitiations and offer guidance where they feel it is needed.

Junior residents are expected to present didactic information appropriate to individual patients' problems to their interns and students. They are expected to have relevant medical literature each morning to use to supplement discussion of patient management.

The junior resident serves as the team leader. She/he should ensure that the team members develop good habits and should serve as a role model for them.

Students, at 3rd and 4th year levels, will be incorporated into all of these activities. Their history and physical and progress notes cannot be the official notes of record. This means that residents should countersign student notes but must record their own assessments. Students, by New Jersey Statute, are not permitted to write orders. They are encouraged to use a duplicate but unofficial order sheet to do so, for educational purposes, but these cannot be part of the permanent record.

It is required that residents acquire competence in certain procedures (see following). Therefore the residents, together with interns, must aggressively and assertively insist on learning and doing all procedures on all patients under their care. Similarly it is expected that residents will write all orders for all patients under their care.

A reading and reference list will be provided.

Competency-Based Goals and Objectives

Residents will learn to be familiar with diagnosis, diffremtial diagnosis, pathophysiology and management, and preventative aspects of the following topics.

  • Acute and chronic renal failure
  • Acute tubular necrosis
  • How to prepate the patient for renal replacement therapy and transplantation
  • Medications to avoid in renal insuffiency
  • Care of patients on hemodialysis and peritoneal dialysis
  • Identification, preparation, and postoperative care of kidney transplant patients
  • Use of immunosuppressive medications, including their side effects, monitoring and prevention, follow up, and drug interactions
  • Recognize and treat opportunistic infections and malignancies in transplant patients including the prevention of these complications
  • Evaluation and management of transplant patients with a rise in creatinine including acute or chronic rejection, dehydration, cyclosporin or tacrolimus toxicity, obstruction, uretal leak, drug interaction, and others.
  • Evaluation of transplant patients with fever
  • Care of dialysis catheters, fistulas, and grafts
  • Management of calcium/phosphorus, sodium/potassium, acid/base balance, anemia, volume status, adequacy of dialysis, and other metabolic problems
  • Recognixe the high morbidity and mortality of patients with end stage renal disease and the importance of prevention and adequate/ appropriate care
  • Learn when to call a nephrologist for renal insufficiency
  • Evaluation and management of proteinuria and microalbuminuria , hematuria, nephrotic/nephritic syndromes, renal insufficiency
  • Indications/contraindications/side effects of kidney biopsy
  • Indications for hemodialysis/CWHD
  • Management of nephrolithiasis/urolithiasis, urinary retention, incontinence, BPH and pyelonephritis
  • Recognize that DM and HTN are the leading causes of renal insufficiency and to appreciate the importance of aggressive care of these and other risk factors to prevent CRF associated with morbidity/mortality
  • Management of renovascular disease
  • Management of electrolytes and acid base disorders
  • Other topics as might be encountered during the rotation

Evaluations

Assessment Methods (of Resident)

The evaluation methods that apply to these rotations include some or all of the following:

  • Evaluation of resident competence by faculty attendings (AE)- Formal formative evaluations should occur at the completion of the specific rotation. It is to be based on direct observation on rounds, at conferences, and at the bedside. All faculty members are encouraged to complete the form prior to the completion of the rotation and review their impressions directly with the resident. All completed evaluation forms are returned to the Program Director for review and placed in the resident's permanent file.
  • Mini CEXs may be used when warranted, particularly in the beginning of the academic year.
  • Self-evaluation by In-service training examination scores
  • MKSAP study plan (MKSAP)
  • Participation and presentations at didactic conferences (DC)
  • Multi Source evaluations by patients and staff (MS)

Assessment Method (of Program)

Residents have the ability to evaluate teaching faculty and experience at the end of each rotation. They are encouraged to use this opportunity to give constructive feedback.

Residents are encouraged to maintain a high level of communication with the Program Director and faculty. These informal meetings can be used to disseminate information, receive timely feedback, and for other purposes.

Annually, all residents are required to complete and return an evaluation form of the faculty and the program. Evaluations are collected in a fashion to assure the anonymity of the resident. The feedback received during informal meetings, formal meetings, and the semi-annual evaluation form will be used to make programmatic change.

Principle Educational Goals by Relevent Competency

In the tables below, the principle educational goals for the Faculty Inpatient Service rotation are indicated for each of the six ACGME competencies. The second column of the table indicates the most relevant principle teaching/learning activity for each goal, using the legend below.

* Legend for Learning Activities (See preceding for descriptions)
ACC-Ambulatory Care Conference
AE-Attending Evaluations
AR- Attending Rounds
AuR- Autopsy Rounds
BTB-Back to Basics
DPC-Direct Patient Care
EBM-Evidence Based Medicine
GR- Grand Rounds
ITE-In-Training Exam
JC- Journal Club
MKSAP-Knowledge Self Study Plan
MR- Management Rounds
MS-Multisource Evaluations
NC- Noon Conference
PCR-Palliative Care/Ethics Rounds
PSQI-Patient Safety/Quality Improvement
RMR- Resident Morning Report
SR- Signout Rounds
TR-Turnover Rounds

1.) Patient Care

Goals and Objectives: PGY-1 Learning Activities* Assessment
Master basic patient interviewing skills DPC, AR, MR AE, AR, TR, MR, MS
Master basic patient exam skills DPC, AR, MR AE, AR, TR, MR
Master basic psycho-social evaluation skills DPC, AR, , MR, PCR AE, AR, TR, MR
Define and prioritize patients' medical problems DPC, AR, MR AE, AR, TR, SR, MR,, RMR
Generate and prioritize differential diagnoses DPC, AR, MR AE, AR, TR, SR, MR, RMR
Develop rational, evidence-based management strategies DPC, AR,PCR, JC, MR AE, AR, TR, PR, MR, RMR
Goals and Objectives: : PGY-2 (in addition to above) Learning Activities* Assessment
Interview patients more skillfully DPC, AR, MR AE, AR, MR, SR, TR
Examine patients more skillfully DPC, AR, MR AE, AR, MR, SR, TR
Evaluate psycho-social issues more skillfully DPC, AR, MR, PCR AE, AR, MR, PCR, TR
Define and prioritize patients' medical problems DPC, AR, MR, RMR AE, AR, MR, RMR, TR
Generate and prioritize differential diagnoses DPC, AR,RMR, MR AE, AR, MR, RMR, TR
Develop rational, evidence-based management strategies DPC, AR, RMR, PCR, JC, MR AE, AR, JC, MR, RMR, TR
Manage a large volume of patients DPC, AR, RMR , MR AE, AR, MR, SR, TR
Develop and display leadership skills and responsibility DPC, AR, RMR, PCR, JC, MR AE, AR, MR, RMR, SR TR
Learn to be team leaders DPC, AR,RMR, JC, MR AE, AR, NC, , MR, SR, TR
Learn to be efficient teachers DPC, AR, ,RMR, JC, MR AE, AR, SR, MR, CMR, TR
Goals and Objectives: : PGY-3 (in addition to above) Learning Activities* Assessment
Efficiently and effectively direct the initial evaluation and continued management of patients requiring hospitalization including appropriate discharge planning. DPC, AR, PR, MR AE, AR, MR, SR, TR
Complete obtainment of certification in required Internal Medicine procedures. Supervises junior trainees in these procedures once certified to teach DPC, AR, PR, MR AE, AR, MR, SR, TR
Systematically obtains and reviews all prior/obtainable medical records pertinent to patient care. DPC, AR, PR, MR AE, AR, MR, SR, TR
Understands significance of all diagnostic test results affecting patient care. DPC, AR, PR, MR AE, AR, MR, SR, TR
Clinical judgment – makes informed decisions using risk/benefit analysis based on sound scientific evidence, patient performance after informed consent and consultation with consultants and more senior physicians (attending). DPC, AR, PR, MR, JC AE, AR, MR, SR, TR, JC
Begin to function as independent primary care givers DPC, AR, PR, MR AE, AR, MR, SR, TR

2.) Medical Knowledge

Goals and Objectives: : PGY-1 Learning Activities* Assessment
Read and expand clinically applicable knowledge base of the basic and clinical sciences DPC, AR, RMR, AuR, SR, NC, GR,
BTB, MKSAP
AE, AR, TR, MKSAP, MR, SR
Access and critically evaluate medical information and scientific evidence relevant to patient care DPC, AR, RMR, AuR, SR, NC, GR,
BTB
AE, AR, TR, MKSAP, MR, SR
Goals and Objectives: : PGY-2 (in addition to above) Learning Activities* Assessment
Read and expand clinically applicable knowledge base of the internal medicine specialties DPC, AR, RMR, AuR, SR, NC, GR,
BTB, MKSAP
AE, AR, TR, MKSAP, MR, SR
Access and critically evaluate medical information and scientific evidence relevant to patient care DPC, AR, RMR, JC, MKSAP AE, AR, PR, JC, SR TR
Teach medical students and interns DPC, AR, RMR, AuR, SR, NC, GR,
BTB, MKSAP
AE, AR, TR, MKSAP, MR, SR
Read relevant articles and literature in journals DPC, AR, RMR, AuR, SR, NC, GR,
BTB, MKSAP
AE, AR, TR, MKSAP, MR, SR
Goals and Objectives: : PGY-3 (in addition to above) Learning Activities* Assessment
Develop medical knowledge about each patient illness so as to be able to make independent decisions based on scientific evidence and patient preference. DPC, AR, RMR, AuR, SR, NC, GR, BTB, MKSAP AE, AR, TR, MKSAP, MR, SR
Demonstrates knowledge by leading discussions on areas of pathophysiology concerning patient care including ongoing management of hospitalized patients. DPC, AR, RMR, JC, MKSAP AE, AR, PR, JC, SR TR
Demonstrates ability to access information from 3 different sources and to synthesize sources into an indepth understanding. DPC, AR, RMR, AuR, SR, NC, GR, BTB, MKSAP AE, AR, TR, MKSAP, MR, SR
Develop medical knowledge adequate to practice independently DPC, AR, RMR, AuR, SR, NC, GR, BTB, MKSAP AE, AR, TR, MKSAP, MR, SR

3.) Practice- Based Learning and Improvement

Goals and Objectives: : PGY-1 Learning Activities* Assessment
Identify and acknowledge gaps in personal knowledge and skills DPC, AR, PR, MR, MKSAP AE, AR, MR, SR, TR, MKSAP
Develop and implement strategies for filling gaps in knowledge and skills DPC, AR, PR, MR, MKSAP AE, AR, MR, SR, TR, MKSAP
Accepts guidance from more experienced physicians and uses scientific evidence and practice outcomes for practice improvement. DPC, AR, PR, MR AE, AR, MR, SR, TR
Readily acknowledges practice omissions (errors) determined by self or supervisors and takes corrective measures. DPC, AR, PR, MR, PSQI AE, AR, MR, SR, TR, PQSI
Goals and Objectives: : PGY-2 (in addition to above) Learning Activities* Assessment
Develop plans for practice improvement from feedback. DPC, AR, PR, MR, PSQI AE, AR, MR, SR, TR, PQSI
Reduces level/rate of practice omissions from PGY-1 level (errors). DPC, AR, PR, MR, PSQI AE, AR, MR, SR, TR, PQSI
Improves efficiency of patient care (timelines) while maintaining quality and thoroughness. DPC, AR, PR, MR, PSQI AE, AR, MR, SR, TR, PQSI
Goals and Objectives: : PGY-3 (in addition to above) Learning Activities* Assessment
Continues to progressively reduce practice omissions/commissions from R-1, R-2 levels. DPC, AR, PR, MR, PSQI I AE, AR, MR, SR, TR, PQS
From medical knowledge and patient care experiences is able to question patient care practices not supported by scientific evidence/evidenced based care. DPC, AR, PR, MR, PSQI, EBM AE, AR, MR, SR, TR, PQSI
Develop PI skills to use in independent practice DPC, AR, PR, MR, PSQI AE, AR, MR, SR, TR, PQSI

4) Interpersonal Skills and Communication

Goals and Objectives: : PGY-1 Learning Activities* Assessment
Communicate effectively with patients and families DPC, AR, MR, PCR AE, AR, RMR, SR, MS
Communicate effectively with physician colleagues at all levels DPC, AR, MR, PCR AE, AR, RMR, SR, MS
Communicate effectively with all non-physician members of the health care team to assure comprehensive and timely care of patients DPC, AR, MR, PCR AE, AR, RMR, SR, MS
Present patient information clearly, in notes and during presentations DPC, AR, MR, PCR AE, AR, RMR, SR, MS
Goals and Objectives: : PGY-2 (in addition to above) Learning Activities* Assessment
Successfully communicate with patients and families in a group meeting DPC, AR, MR, PCR AE, AR, RMR, SR, MS
Supervise, lead, manage and teach more junior housestaff and medical students. DPC, AR, MR, PCR AE, AR, RMR, SR, MS
Present patient information concisely and clearly, verbally and in writing at an advanced level DPC, AR, MR, PCR AE, AR, RMR, SR, MS
Goals and Objectives: : PGY-3 (in addition to above) Learning Activities* Assessment
Successfully communicate with patients and families that may be considered difficult (angry, anxious, etc) advanced level DPC, AR, MR, PCR AE, AR, RMR, SR, MS
Become fascicle at discussing difficult issues such as end of life care and delivering bad news DPC, AR, MR, PCR AE, AR, RMR, SR, MS
Effectively teach students and junior trainees to improve their communication skills DPC, AR, MR, PCR AE, AR, RMR, SR, MS

5) Professionalism

Goals and Objectives: : PGY-1 Learning Activities* Assessment
Demonstrate respect, compassion, integrity, and altruism in relationships with patients, families, and colleagues while maintaining confidentially. DPC, AR, MR, PCR AE, AR, RMR, SR, MS
Always act in a moral, honest professional manner, and maintain appropriate relations with patients. DPC, AR, MR, PCR AE, AR, RMR, SR, MS
Respect and defend each patient's autonomy and privacy and always act in the patients' best interest DPC, AR, MR, PCR AE, AR, RMR, SR, MS
Goals and Objectives: : PGY-2 (in addition to above) Learning Activities* Assessment
Maintain a good record of attendance at conferences, completion of assignments, participation in clinical and didactic activities, prompt completion of dictations DPC, AR, MR, PCR, MKSAP AE, AR, RMR, SR, MS
Understand and apply principles of medical ethics toward patients, families, colleagues, and all members of the health care team DPC, AR, MR, PCR AE, AR, RMR, SR, MS
Goals and Objectives: : PGY-3 (in addition to above) Learning Activities* Assessment
Understand the principles of moral and ethical behavior required of an independent practitioner DPC, AR, MR, PCR AE, AR, RMR, SR, MS
Become familiar with actual or potential conflicts of interest; particularly those involving personal financial gain. DPC, AR, MR, PCR AE, AR, RMR, SR, MS

6) Systems-Based Practice

Goals and Objectives: : PGY-1 Learning Activities* Assessment
Understand and utilize the multidisciplinary resources necessary to care optimally for patients DPC, MR, AR, AuR AE, AR, RMR, SR
Collaborate with other members of the health care team to assure comprehensive patient care DPC, MR, TR, SR, AR AE, AR, RMR, SR
Use evidence-based, cost-conscious strategies in the care of patients DPC, AR, EBM, JC AE, AR, RMR, SR, EBM, JC
Goals and Objectives: : PGY-2 (in addition to above) Learning Activities* Assessment
Apply evidence-based and cost-conscious strategies toward disease prevention, diagnosis and disease management. DPC, MR, TR, SR, AR AE, AR, RMR, SR
Develop understanding of the role of non-physician personnel in the care of patients DPC, MR, TR, SR, AR AE, AR, RMR, SR
Learn to efficient lead a team through management rounds DPC, MR, TR, SR, AR AE, AR, RMR, SR
Goals and Objectives: : PGY-3 (in addition to above) Learning Activities* Assessment
Develop lifelong strategies to optimize care for individual patients as an independent practitioner DPC, MR, TR, SR, AR AE, AR, RMR, SR

Procedures

Residents will learn, as appropriate to individual patients, the indications and contraindications and the performance of those medical procedures required by the American Board of Internal Medicine and Residency Review Committee (as detailed in the inpatient general medicine curriculum) and perform all procedures on patients under their care.

Reference List

*All residents are expected to read about their patients in an appropriate general medicine text. In addition, a vast variety of print and on-line reference material is available though the library (24-hour access for all residents) and the on-line portal. Because it is frequently updated, extensively referenced, and includes abstracts of reference articles, the program highly recommends UpToDate as an adjunctive information source. MDConsult is also a valuable resource and residents should become familiar with use as a rapid search engine for clinical information

General Nephrology

  1. Levey AS, Bosch JP, Lewis JB, Greene T, Rogers N, Roth D. A more accurate method to estimate glomerular filtration rate from serum creatinine: a new prediction equation. Modification of Diet in Renal Disease Study Group. Ann Intern Med. 1999 Mar 16 ;130(6):461-70.
  2. Gluck SL. Acid-base. Lancet. 1998 Aug 8;352(9126):474-9. Review.
  3. Halperin ML, Kamel KS. Potassium. Lancet. 1998 Jul 11;352(9122):135-40. Review.
  4. Bushinsky DA, Monk RD. Electrolyte quintet: Calcium. Lancet. 1998 Jul 25;352(9124):306-11. Review.
  5. Kumar S, Berl T. Sodium. Lancet. 1998 Jul 18;352(9123):220-8. Review.
  6. Weisinger JR, Bellorin-Font E. Magnesium and phosphorus. Lancet. 1998 Aug 1;352(9125):391-6. Review.
  7. Stevens LA, Coresh J, Greene T, Levey AS. Assessing kidney function--measured and estimated glomerular filtration rate. N Engl J Med. 2006 Jun 8;354(23):2473-83.

Acute Renal Failure

  1. Barrett BJ, Parfrey PS. Clinical practice. Preventing nephropathy induced by contrast medium. N Engl J Med. 2006 Jan 26;354(4):379-86. Review.
  2. Marenzi G, Assanelli E, Marana I, Lauri G, Campodonico J, Grazi M, De Metrio M, Galli S, Fabbiocchi F, Montorsi P, Veglia F, Bartorelli AL. N- acetylcysteine and contrast-induced nephropathy in primary angioplasty. N Engl J Med. 2006 Jun 29;354(26):2773-82.
  3. Mehta RL. Continuous renal replacement therapy in the critically ill patient. Kidney Int. 2005 Feb;67(2):781-95.
  4. Ronco C, Bellomo R, Homel P, Brendolan A, Dan M, Piccinni P, La Greca G. Effects of different doses in continuous veno-venous haemofiltration on outcomes of acute renal failure: a prospective randomised trial. Lancet. 2000 Jul 1;356(9223):26-30.
  5. Schiffl H, Lang SM, Fischer R. Daily hemodialysis and the outcome of acute renal failure. N Engl J Med. 2002 Jan 31;346(5):305-10.
  6. Stacul F, Adam A, Becker CR, Davidson C, Lameire N, McCullough PA, Tumlin J; CIN Consensus Working Panel. Strategies to reduce the risk of contrastinduced nephropathy. Am J Cardiol. 2006 Sep 18;98(6A):59K-77K. Epub 2006 Mar 20. Review.
  7. Thadhani R, Pascual M, Bonventre JV. Acute renal failure. N Engl J Med. 1996 May 30;334(22):1448-60. Review.

Chronic Renal Failure

  1. Hou FF, Zhang X, Zhang GH, Xie D, Chen PY, Zhang WR, Jiang JP, Liang M, Wang GB, Liu ZR, Geng RW. Efficacy and safety of benazepril for advanced chronic renal insufficiency. N Engl J Med. 2006 Jan 12;354(2):131-40.
  2. Drueke TB, Locatelli F, Clyne N, Eckardt KU, Macdougall IC, Tsakiris D, Burger HU, Scherhag A; CREATE Investigators. Normalization of hemoglobin level in patients with chronic kidney disease and anemia. N Engl J Med. 2006 Nov 16;355(20):2071-84.
  3. Singh AK, Szczech L, Tang KL, Barnhart H, Sapp S, Wolfson M, Reddan D; CHOIR Investigators. Correction of anemia with epoetin alfa in chronic kidney disease. N Engl J Med. 2006 Nov 16;355(20):2085-98.
  4. Wolf G, Ritz E. Combination therapy with ACE inhibitors and angiotensin II receptor blockers to halt progression of chronic renal disease: pathophysiology and indications. Kidney Int. 2005 Mar;67(3):799-812. Review.

Transplant

  1. Halloran PF. Immunosuppressive drugs for kidney transplantation. N Engl J Med. 2004 Dec 23;351(26):2715-29. Review.