ICU-Procedural (2nd Year)

Length of Rotation: 4 weeks

Type of Rotation: required

Overview:
Fellows will complete two months per year (total of 4 months in the 2-year fellowship training program) on the
ICU-Procedural rotation at Vidant Medical Center. Fellows will work closely with the Consult Attending, ICU
Attending, ICU fellow, and any housestaff or students who are assigned to the ICU.

Principle Teaching/Learning Activities:
(IC) Initial Consultation: Fellows will perform all initial evaluations on new consults in the ICU (MICU,
SICU, NSICU, CICU, CVICU) and will direct the initial plan of management. The fellow will discuss each
new consult in detail with the Consult Attending and they will see the patient together. The fellow is
expected to formulate a cogent diagnostic and therapeutic plan for presentation to the Consult Attending.
(DPC) Daily Patient Care: The fellow will coordinate daily follow-up as needed by him/herself. S/he
will communicate directly with both the Consult Attending and the ICU team to ensure timely delivery of
nephrology care to the critically ill patient.
(AR) Attending Rounds: The Consult Attending makes daily teaching and management Attending
Rounds with the team. The fellow shall discuss the nephrology-care for each patient for whom a
nephrology consultation was asked by the ICU team and assist in the management of all nephrology-
pertinent issues to the care of any critically ill patient. When finished discussing cases with the ICU Teams,
the fellow will rejoin the Consult Attending and Consult Fellow on rounds.
(DT) Diagnostic tests: Urinalysis, 24-hour urine studies, renal ultrasound, CAT scans, and other
diagnostic tests are reviewed with the Consult Attending and the ICU Team.
(DSP) Directly Supervised Procedures: Fellows will place temporary dialysis catheters when needed for
consultative patients in the ICU if they have not met the minimum requirement of 5 catheters. Fellows will
perform kidney biopsies as needed on consultative patients or outpatients under the direct supervision of the
Consult Attending or Service Attending or Office Doctor. Fellows will be able to articulate the indication(s)
for kidney biopsy and will interpret biopsy results with the nephropathologist whenever possible.
(HDR) Hemodialysis Rounds: Fellows will round on patients undergoing hemodialysis in the ICU.
(CRRT) Continuous Renal Replacement Therapy: Fellows will round at least once per day on patients
undergoing continuous renal replacement therapy in the intensive care unit.
(CC) Case Conference: Fellows on the ICU-Procedural rotation present patients at weekly case
conference on Thursday 12:30-1:30pm in the Medical Annex (3 MA 329).

Principle Educational Goals by Relevant Competency
In the tables below, the principle educational goals for the Nephrology Consult Rotation are listed 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 above.

1) Patient Care
Principle Educational Goals Learning Activity
Evaluate and manage patients with acute renal failure, fluid/electrolyte
imbalance and acid/base problems.
IC, DPC, AR, DT, HDR, CRRT
Evaluate and manage consultative patients with end-stage renal disease. IC, DPC, AR, DT, HDR, CRRT
Evaluate and manage patients with pregnancy related disorders: pre-
eclampsia, chronic hypertension in pregnancy.
IC, DPC, AR, DT, HDR, CRRT
Evaluate patients on hemodialysis and write hemodialysis orders. DPC, AR, HDR
Evaluate patients on peritoneal dialysis and write peritoneal dialysis
orders.
IC, DPC, AR
Evaluate patients on plasmapheresis and write plasmapheresis orders. IC, DPC, AR
Ensure proper drug dosing in all patients to avoid nephrotoxic agents
and dose-adjust for kidney function as needed.
IC, DPC, AR, DT, HDR, CRRT
Learn how to insert temporary dialysis catheters with proper technique DSP
Perform kidney biopsies with attending assistance utilizing proper
technique
DSP


2) Medical Knowledge
Principle Educational Goals Learning Activity
Build a clinically applicable knowledge base of the basic and clinical
sciences underlying the care of patients with acute and chronic kidney
disease.
IC, DPC, AR, CC
Access and critically evaluate current medical information and scientific
evidence relevant to care of patients with renal failure.
IC, DPC, AR, CC
Discuss interesting cases from the consult service at weekly case
conference
CC


3) Practice-Based Learning and Improvement
Principle Educational Goals Learning Activity
Identify, acknowledge and correct gaps in personal knowledge and skills
in the care of patients with acute and chronic kidney disease.
IC, DPC, AR, CC
Analyze rounding patterns and identify areas for improvement to
optimize and balance quality care of acute and chronically ill kidney
patients.
DPC, AR


4) Interpersonal Skills and Communication
Principle Educational Goals Learning Activity
Educate and update patients and their families as to the nature of the
patients kidney problem and concurrent illness.
IC, DPC, AR
Thoroughly explain to patients and their family necessary procedures
and tests in terms that the patient can understand to allow for true
informed consent as well as strengthening of patient-physician
relationships.
DPC, AR, DSP, HDR, CRRT
Communicate effectively with physician colleagues, nursing and other
staff to assure timely, comprehensive patient care.
IC, DPC, AR, HDR, CRRT
Communicate effectively with colleagues when signing out patients or
turning care over to the Renal Service.
DPC, AR



5) Professionalism
Principle Educational Goals Learning Activity
Professional conduct toward patients, families, colleagues, dialysis
nurses and staff, floor nurses and staff and all other members of the
health care team is expected.
All

6) Systems-Based Practice
Principle Educational Goals Learning Activity
Become familiar with and begin to utilize the multidisciplinary resources
necessary to care optimally for patients with acute and chronic kidney
disease: primary nephrologist, dialysis nurse, floor nurse, social worker,
rehabilitation unit, outpatient dialysis nurse.
IC, DPC, AR, HDR, CRRT
Collaborate with other members of the health care team to assure
comprehensive care for patients with kidney disease.
IC, DPC, AR, HDR, CRRT
Develop awareness of the limitations and opportunities inherent in the
care of patients on dialysis and develop strategies to optimize individual
patient care.
DPC, AR, HDR

Recommended Resources:
TEXTBOOK: Clinical Nephrology
Brenner and Rector
Burton Rose Acid Base
Daugirdas dialysis handbook
Kaplans HTN book
www.uptodate.com (free via Vidant Medical Center homepage)
LexiDrugs via uptodate
MDConsult via Vidant Medical Center homepage
www.hdcn.org (logon/password = ecukidney/library)
http://svch.blogspot.com/2004/07/procedure-skills-and-acls-refresher.html
http://content.nejm.org/cgi/reprint/334/22/1448.pdf
http://www.kidney.org/professionals/kdoqi/guidelines.cfm
http://ispd.org/lang-en/treatmentguidelines/guidelines
http://crrtonline.com/
ECU Plasmapheresis Manual
AJKD Core Curriculum Series (pdf articles have been emailed to each fellow)

Evaluation Methods
Fellows are formally evaluated by the ECU Consult Attending(s) using the standard milestone-based
ABIM evaluation form on New Innovations. This evaluation will be discussed with the fellow face-to-
face at the end of the rotation.

Approved by Governing Body PENDING











Revised 6/19/14