4
Ambulatory Care Experience - Department of Nephrology
Goals and Objectives
Continuity Clinic:
The continuity clinics are conducted one half day per week throughout the two year training period. The primary site is the Loyola Out-Patient Center at LUMC that consists of several examining rooms. A variety of renal diseases are seen at this clinic including but not limited to, acute and chronic renal failure, secondary hypertension, glomerulonephritis, vasculitis, kidney stones and electrolyte disorders. In addition, long term follow-up of transplant patients are performed at this location.
Specific Objectives:
• Build a fund of knowledge in general nephrology and transplant medicine.
• Achieve competence in outpatient consultative nephrology.
• Develop excellence in communication and coordination of care with referring and primary care physicians.
• Acquire skills in dealing with multiple health care systems.
Methods:
• Outpatient consults and follow-up visits.
• Preparation of letters to referring physicians.
• Coordination of outpatient specialty care such as biopsies, initiation of dialysis and referral for transplant.
ACGMECompetencies / 1st Year / 2nd Year
Patient Care / · Performs excellent interviews and exams.
· Provides patient education and information in a respectful and helpful manner.
· Establishes a good working relationship with the patients and assumes responsibility for following up on all pertinent testing and monitors outside of clinic hours. / · Develops a complete panel of patients with a wide variety of renal diseases.
Medical Knowledge / · Achieves a good knowledge base of common renal disease.
· Reads about challenging problems encountered and formulates and implements state of the art treatment regimen. / · Demonstrates leadership in investigating new treatments and becomes more grounded in the basic science approach to clinical problems.
Practice-Based Learning and Improvement / · Performs self-assessment and eagerly accepts feedback from attendings and patients. / · Demonstrates changes in practice based on attending and patient feedback.
Interpersonal and Communication Skills / · Works well with colleagues, attendings and staff.
· Provides timely, concise and helpful consultative reports and follow up to referring physicians. / · Efficiently accomplishes patient goals within the health care systems.
· Achieves excellence in communicating via letter and report with referring physicians.
Professionalism / · Completes clinics in a timely and helpful manner.
· Is compassionate, honest and accepts responsibility for errors. / · Is well respected as a consultant by referring physicians and staff.
System-Based Practice / · Effectively uses resources to accomplish diagnostic and therapeutic goals for the patient.
· Reduces errors and develops systems and habits that assure proper follow-up. / · Applies new systematic approaches developed within the first year of training that improve outcomes.
Attending Supervision:
An attending physician that is a member of the LUMC nephrology faculty supervises each patient seen in the out-patient clinics. The supervisory methods include:
• Examination and discussion of each patient at each visit.
• Review of the written report prepared by the fellow with written concurrence and/or corrections and additions by the supervising attending.
• Review of the fellow’s management at each visit.
Evaluation:
• Fellows are supervised and given direct feedback on a case by case basis.
• The fellow is evaluated formally in writing semi-annually.
• The fellow provides a written evaluation of the attending and their clinic experience semi-annually.
Facilities:
• We have a brand new state-of-the-art outpatient facility fully equipped with electronic medical record access, physician order
entry and Web-based literature searches.
• The division also has a renal nurse that accompanies us at all of our clinics to help stream line patient flow and provide
support for post clinic follow-up calls and orders.
A more detailed description of the outpatient clinics is provided in Renal fellowship guidelines.