Consultation Service

Description

The consultation rotation at the University of Alberta Hospital consists of 4-5 four-week blocks completed over a 2 year period. During these rotations, the trainee will be responsible for all requests for Nephrology consultations from all departments in the University of Alberta Hospital. The trainee will be expected to perform an appropriate history and physical examination on the patient, formulate a differential diagnosis, outline a detailed plan for investigation and management, and review the case with the attending nephrologist. The trainee will also be expected to follow-up all patients on the consult service throughout the duration of his/her stay in hospital. The trainee will act as a teacher for house-staff assigned to the service requesting the consult and to the junior house staff or clinical clerks assigned to the nephrology service. The trainee is expected to read the appropriate literature pertaining to the diagnosis, investigation and management of the patients under his/her care during the rotation and to employ evidence based medicine practice wherever possible. Pertinent literature reviews will be discussed with the attending physician for purposes of teaching.

The trainee will be expected to attend all multidisciplinary patient care rounds, pathology rounds and journal clubs as well as his/her regular mentored clinics during the consultation rotation. The trainee will continue his/her usual on-call duties.

General Objectives to Have Achieved by the End of the Rotation

  1. Act as a consultant in renal medicine
  2. Diagnose, investigate and manage acid-base disorders
  3. Diagnose, investigate and manage salt and water balance disorders
  4. Diagnose, investigate and manage potassium balance disorders
  5. Diagnose, investigate and manage mineral metabolism disorders
  6. Diagnose, investigate and manage renal disorders in patients in the Intensive Care Unit
  7. Describe pharmacologic principles and prescribing in renal patients
  8. Diagnose, investigate and manage renal osteodystrophy
  9. Diagnose, investigate and manage renal emergencies
  10. Recommend and institute strategies for renal protection
  11. Be knowledgeable regarding ethical issues: principles of futility, benevolence, non-maleficence and utilitarianism. Be aware of religious philosophies with respect to death and dying

Duties

  1. Trainees assigned to the Nephrology consult service will share the consult responsibilities with any RI-III GIM resident assigned to the consult service
  2. The nephrology trainee may assign consults to GIM residents working on the service, however remains ultimately responsible for their completion. Consults received between 8 am and 4 pm should be seen the same day; emergency consults should be seen immediately and discussed promptly with the attending staff
  3. Daily progress notes are expected when active changes in the clinical picture of the patient arise; frequent notes (ie. every 2 days) are required at other times. Follow up of patients’ investigations and clinical status is the responsibility of the trainee, and the attending staff should be kept apprised of developments at all times

Evaluation

Evaluation of the trainee will be completed by the attending staff of the consult service and the program training director based on an ongoing daily assessment of the consultative skills of the trainee. Questions relevant to inpatient consultation will be part of the written and oral trainee examinations.

Suggested References

  • Primer of Kidney Disease
  • Handbook of Dialysis - Daugirdas and Ing
  • Handbook of Transplantation - Danovitch
  • Brenner and Rector's The Kidney
  • Acid-Base Fluid and Electrolytes - Halperin and Goldstein 6. Up to Date (fellow's office)