Consult Rotation (1

st
year)
Length of Rotation: 4 weeks
Type of Rotation: required
Overview:
Fellows will complete three months on the nephrology consult rotation at Vidant Medical Center in the
st
year!
Fellows will work closely with the Consult "ttending and any housestaff or students who are assigned to the
rotation!
Principle Teaching/Learning Activities:
# (IC) Initial Consultation: Fellows will perform all initial e$aluations on new consults %including acute
transplant recipients& and will direct the initial plan of management! The fellow will discuss each new
consult in detail with the Consult "ttending and they will see the patient together!
# (PC) aily Patient Care: The fellow will coordinate daily follow'up as needed (y him)herself or other
resident)student mem(ers of the consult team!
# (AR) Atten!ing Roun!s: The Consult "ttending makes daily teaching and management "ttending
Rounds with the team!
# (ITR) Inpatient Transplant Roun!s: "cute transplant recipients will (e e$aluated (y the Consult Fellow
under the super$ision of the Consult "ttending %with or without the assistance of the Transplant "ttending*
at the discretion of (oth the Consult Fellow and)or Consult "ttending&!
# (T) iagnostic tests: +rinalysis* ,4 hour urine studies* renal ultrasound* C"T scans* and other diagnostic
tests are re$iewed with the Consult "ttending
# ("P) irectly "upervise! Proce!ures: Fellows will place temporary dialysis catheters when needed for
consultati$e patients! +ntil deemed proficient* these procedures are directly super$ised (y the Consult
"ttending! Fellows may perform kidney (iopsies as needed on consultati$e patients under the direct
super$ision of the Consult "ttending!
# (#R) #e$o!ialysis Roun!s: Fellows will round on patients undergoing hemodialysis in the dialysis
unit or -off'unit. at the patient/s (edside!
# (CC) Case Con%erence: Fellows on the consult rotation present patients at weekly case conference on
Thursday ,:01':01pm in the Medical "nne2 %0 M" 0,3&!
Principle &!ucational 'oals (y Relevant Co$petency
4n the ta(les (elow* the principle educational goals for the 5ephrology Consult Rotation are listed for each of
the si2 "C6M7 competencies! The second column of the ta(le indicates the most rele$ant principle
teaching)learning acti$ity for each goal* using the legend a(o$e!

1) Patient Care
Principle &!ucational 'oals Learning Activity
7$aluate and manage* with attending assistance* patients with acute
renal failure* fluid)electrolyte im(alance and acid)(ase pro(lems!
4C* 89C* "R* 8T* :8R
7$aluate and manage* with attending assistance* consultati$e patients
with end'stage renal disease!
4C* 89C* "R* 8T* :8R
7$aluate and manage* with attending assistance* patients with pregnancy
related disorders: pre'eclampsia* chronic hypertension in pregnancy!
4C* 89C* "R* 8T* :8R
;ith attending assistance* e$aluate patients on hemodialysis and write
hemodialysis orders!
89C* "R* :8R
;ith attending assistance* e$aluate patients on peritoneal dialysis and
write peritoneal dialysis orders!
4C* 89C* "R
;ith attending assistance* e$aluate patients on plasmapheresis and write
plasmapheresis orders!
4C* 89C* "R
;ith attending and pharmacy assistance* ensure proper drug dosing in
all patients to a$oid nephroto2ic agents and dose'ad<ust for kidney
function as needed!
4C* 89C* "R* 8T* :8R
;ith attending assistance* learn how to insert temporary dialysis
catheters with proper technique
8=9
9erform kidney (iopsies with attending assistance utili>ing proper
technique
8=9
;ith attending assistance* learn the immediate postoperati$e
management of transplant recipients!
4TR
?ecome familiar with the administration immunosuppressi$e
medications!
4TR
?ecome familiar with the medical management of transplant re<ection in
patients!
4TR
)) *e!ical +nowle!ge
Principle &!ucational 'oals Learning Activity
?uild a clinically applica(le knowledge (ase of the (asic and clinical
sciences underlying the care of patients with acute and chronic kidney
disease!
4C* 89C* "R* CC
"ccess and critically e$aluate current medical information and scientific
e$idence rele$ant to care of patients with renal failure!
4C* 89C* "R* CC
8iscuss interesting cases from the consult ser$ice at weekly case
conference
CC
8escri(e the pathogenesis and management of acute renal failure in the
transplant setting!
4TR
?ecome familiar with the infectious complications of transplantation! 4TR
,) Practice-.ase! Learning an! I$prove$ent
Principle &!ucational 'oals Learning Activity
4dentify* acknowledge and correct gaps in personal knowledge and skills
in the care of patients with acute and chronic kidney disease!
4C* 89C* "R* CC
"naly>e rounding patterns and identify areas for impro$ement to
optimi>e and (alance quality care of acute and chronically ill kidney
patients!
89C* "R
?ecome familiar with the peri'transplant process! 4TR
/) Interpersonal "0ills an! Co$$unication
Principle &!ucational 'oals Learning Activity
;ith attending assistance* educate and update patients and their families
as to the nature of the patient/s kidney pro(lem and concurrent illness!
4C* 89C* "R
;ith attending assistance* thoroughly e2plain to patients and their
family necessary procedures and tests in terms that the patient can
understand to allow for true informed consent as well as strengthening of
patient'physician relationships!
89C* "R* 8=9* :8R
Communicate effecti$ely with physician colleagues* nursing and other
staff to assure timely* comprehensi$e patient care!
4C* 89C* "R* :8R* 4TR
Communicate effecti$ely with colleagues when signing out patients or
turning care o$er to the Renal =er$ice!
89C* "R* 4TR
Communicate effecti$ely with dialysis social worker* outpatient
physician e2tender* outpatient dialysis nurses and primary nephrologist
when making discharge arrangements!
89C* "R* :8R* 4TR
1) Pro%essionalis$
Principle &!ucational 'oals Learning Activity
9rofessional conduct toward patients* families* colleagues* dialysis
nurses and staff* floor nurses and staff and all other mem(ers of the
health care team is e2pected!
"ll
2) "yste$s-.ase! Practice
Principle &!ucational 'oals Learning Activity
?ecome familiar with and (egin to utili>e the multidisciplinary resources
necessary to care optimally for patients with acute and chronic kidney
disease: primary nephrologist* dialysis nurse* floor nurse* social worker*
reha(ilitation unit* outpatient physician e2tender* outpatient dialysis
nurse* discharge planner* dietician* case manager
4C* 89C* "R* :8R* 4TR
Colla(orate with other mem(ers of the health care team to assure
comprehensi$e care for patients with kidney disease!
4C* 89C* "R* :8R* 4TR
8e$elop awareness of the limitations and opportunities inherent in the
care of patients on dialysis and de$elop strategies to optimi>e indi$idual
patient care!
89C* "R* :8R* 4TR
Reco$$en!e! Resources:
T7@T?AAB: Clinical 5ephrology
?renner and Rector
?urton Rose -"cid C ?ase.
8augirdas dialysis hand(ook
Baplan/s :T5 (ook
www!uptodate!com %free $ia Vidant Medical Center homepage&
Le2i8rugs $ia uptodate
M8Consult $ia Vidant Medical Center homepage
www!hdcn!org %logon)password D ecukidney)li(rary&
http:))s$ch!(logspot!com),114)1E)procedure'skills'and'acls'refresher!html
http:))content!ne<m!org)cgi)reprint)004),,)44F!pdf
http:))www!kidney!org)professionals)kdoqi)guidelines!cfm
http:))ispd!org)lang'en)treatmentguidelines)guidelines
http:))crrtonline!com)
7C+ 9lasmapheresis Manual
"GB8 Core Curriculum =eries %pdf articles ha$e (een emailed to each fellow&
The fellow will (e gi$en a packet of rea!ing $aterial that includes articles)handouts on:
immunology* immunosuppression* donor e$aluation* recipient e$aluation* preoperati$e cardiac
clearance and guidelines on the longterm management of renal transplant recipients!
&valuation *etho!s
Fellows are formally e$aluated (y the 7C+ Consult "ttending%s& using the standard competency'(ased
"?4M e$aluation form on 5ew 4nno$ations! This e$aluation will (e discussed with the fellow face'to'
face at the end of the rotation!
Approve! (y 'overning .o!y 3/4/536 1/3/15
Revised 3/15/11; 6/19/14; 9/3/14