The Nephrology Curriculum is the combined effort of a number of the faculty members in the Einstein Division of Nephrology as well as input from fellows, and is reviewed yearly by fellows and faculty. A curriculum is constantly evolving; changing as medicine and nephrology change.
All fellows receive broad-based clinical education and experience in the care of patients with hypertension, renal parenchymal diseases, acute kidney injury, chronic kidney disease, disorders of mineral metabolism, disorders of water, acid-base, and electrolyte regulation, and disorders of drug metabolism with special reference to alterations in drug metabolism in the context of renal insufficiency and renal toxicity of drugs. Our clinical program also includes evaluation and care of the renal transplant recipient, application of various renal dialysis techniques including hemodialysis, peritoneal dialysis, and continuous venovenous hemodialysis and hemodiafiltration (CVVH and CVVHDF), performance of renal biopsy, establishment of vascular access for dialysis, radiology of vascular access, diagnostic reasoning with various diagnostic renal imaging techniques, and histopathological interpretation of native and allograft renal biopsies. Teaching and learning in these areas is evidence-based and connected to physiological precepts. Fellows are taught from and expected to read deeply in primary reference sources from the medical literature that addresses these knowledge areas.
Beyond this broad foundation, fellowship activities and experiences are tailored to an individual's career goals. Those trainees who desire to develop into independent clinical investigators receive curricular and individually-mentored training in specific research techniques, study designs, primary resource work, the questioning thought process, and statistical analysis. Tracks exist for clinical investigation/epidemiological training and wet-bench research training. Research track trainees engage personally in project work under the supervision of a research mentor. This may be either in a laboratory or in the clinical sphere. Those trainees who matriculate into the clinician-educator track receive advanced training in general ambulatory nephrology, maintenance hemodialysis and peritoneal dialysis, and renal transplantation medicine under the supervision of clinical track faculty.
The Nephrology Curriculum is a guide to what you are expected to learn in your 2 years as Nephrology Fellow. It is also a guide to help you and the faculty meet these goals as you rotate through each phase of your fellowship. Each rotation that you will spend time on during your fellowship is described, as well as what the general goals and objectives of each rotation are, what you can expect to encounter and what is expected of you during a given rotation.
Feedback during the fellowship is of utmost importance. We need your feedback to assess how well we are meeting the goals that are outlined in this curriculum. Every 6 months you will be given evaluation forms to rate the program and the attendings that you worked with. In addition, you are evaluated as well. At the completion of each rotation your attending will evaluate your performance; every 6 months you will meet with the Program Director and Division Director to review these evaluations and discuss any problems or areas that have been identified that require additional help or intervention.
In addition to the above evaluations you will be given quizzes based on the most recent Nephrology MKSAP. The purposes of these quizzes: to help you focus on specific areas of readings in an organized manner; to assess your knowledge base; to help you focus and prepare for the nephrology boards; to identify your strengths and weaknesses in nephrology. These quizzes will be scored and we will follow your scores during your two years. If areas of weakness are identified we will help you with additional readings and instruction. In addition, these quizzes help us identify any areas of weakness in our teaching or curriculum and provide us feedback that allows us to improve curriculum content and teaching.
As any attending will tell you, no one knows everything about nephrology at the end of their fellowship and the learning never stops in the years ahead. It is the goal of the faculty to help you lay the foundation of important, basic knowledge in nephrology, one that you can continue to build on in the years ahead, and to help you lay the foundation for on-going continuing education in the field of nephrology and medicine.
The following disorders receive formal didactic attention through attending rounds and various seminars over a cycle of 2 years. Fellows are provided the curriculum outline at the onset of their first training year. By providing this published curriculum, the fellow is guided into the literature in general and specific terms. We aim to cover all aspects of the curriculum through the various venues [mentioned later] on a 2 year cycle. Fellows are encouraged to use this curriculum outline as a guide for independent study and reading.
Broad Categories of the Curriculum
- Variables of single nephron glomerular filtration rate and autoregulation of renal blood flow;
- Renal tubular physiology and molecular mechanisms of sodium, bicarbonate, H ion, potassium, calcium, phosphorus, magnesium, and chloride transport;
- Normal and abnormal blood pressure regulation;
- Genetic disorders of tubular ion transport;
- Disorders of calcium, magnesium, and phosphorus homeostasis;
- Disorders of sodium, water, and extracellular fluid volume homeostasis;
- Disorders of acid-base regulation;
- Diagnosis and management of acute kidney injury;
- Principles and prescription of hemodialysis, peritoneal dialysis, and CVVH for acute kidney injury;
- Evaluation and management of the patient with chronic, progressive renal insufficiency;
- Evaluation and management of the patient with end-stage renal failure;
- Principles and prescription of hemodialysis and peritoneal dialysis for ESRD;
- Evaluation and management of anemia of renal disease, including use of erythropoietin;
- Diagnosis and management of the different forms of renal osteodystrophy;
- Diagnosis and management of primary hypertension;
- Diagnosis and management of secondary hypertension, particularly renovascular HTN;
- Nutritional management of the patient with acute kidney injury, progressive renal insufficiency, and end-stage renal disease on dialysis;
- Renal disorders associated with pregnancy, including pre-eclampsia, eclampsia, hypertension of pregnancy, and effect of pregnancy on established renal diseases, such as systemic lupus erythematosis, polycystic kidney disease, and other glomerulonephritides;
- Urinary tract and renal infections;
- Acute and chronic interstitial nephritis;
- Cystic diseases of the kidney;
- Diagnosis and management of primary and secondary glomerular diseases;
- Effect of renal insufficiency on drug metabolism, and the problem of renal drug toxicity;
- Management of drug intoxications by conservative and dialytic techniques;
- Pathophysiology and management of nephrolithiasis, including indications and complications of lithotripsy;
- Epidemiology, statistics, research design, data analysis.
- Risk management, aspects of managed care.
- Aspects of Dialysis Center management (medical director).
- Issues of dialysis, ESRD care, drug therapies for the geriatric patient.