Getting Started:

In-Pt. Renal Rotation Information

 

INTRODUCTION:

The RUMC Section of Nephrology uses a 12-month calendar for their schedule: Fellows Service Schedule 2018-19.pdf and Attending Service Schedule 2018-19.pdf. The RUMC Department of Medicine runs on a thirteen 4-week rotation schedule. Therefore you may work with up to two Attendings and two  Fellows during your month (more if you include weekend call), although you will usually spend the majority of your time with a single Attending and Fellow who will be responsible for your evaluation at the end of your rotation. The weekends are rotated for Attendings and Fellows as well so you may interact with most if not all of the Fellows and Attendings during your rotation: Fellows' Weekend Call Schedule 2018-19.pdf. In addition, it is not unusual to have Residents from West-Suburban or another hospital’s Internal Medicine residency program rotating with us. They are often on yet a different rotation schedule. Residents from outside hospitals will have to get a name badge and fulfill other “red-tape” requirements their first day prior to starting rounds. They may also need a “Crash Course” in EPIC, Rush’s Electronic Health Record. This is pre-arranged by the Department of Medicine. We may also have Medical Students rotating with us.


Depending on the month and what IM program you are from, you may start your rotation any day of the week. The Rush Residents typically all start and leave the rotation at the same time. Therefore, those Residents leaving the rotation need to coordinate, with the Fellow, patient hand-offs to the incoming Residents. The Fellow may meet with you the morning of your first day of the rotation to help distribute the patients as well as review the way the service is run and what is expected of all parties. You will then go off and round on your patients. Depending on how busy the service is, the Fellow and the Attending may round separately from the Residents that first day, making most of the clinical decisions. After that first day, rounds are always together as a group. If there are any new consults, they may be seen in the morning, during rounds, or after rounds that day; the Fellow will help guide the timing of rounds and consults every day. Consults are typically seen and worked-up by the Resident before presenting to the Attending, but this is flexible depending on the time of day and the acuity of the consult. Whenever a new consult is called during the day, it is important to let the renal Fellow know ASAP, as dialysis may need to be scheduled.


Make sure to review the Resident Learning Objectives for the rotation.

Here are the Medical Student M4 Elective Objectives for the rotation.

 

DAILY ROUNDS:

Group (Students, Residents, Fellow, Attending) rounds typically begin at 9:30-10:00 AM (Attending dependent) Monday through Friday and are over by noon to allow you to go to any Internal Medicine conferences. You are expected round on your patients prior to group rounds.  Daily EPIC notes are to be written on each patient and should focus on nephrologic issues. These notes can be written anytime but are best completed only after morning rounds in which the Attending, Fellow and Resident have made the necessary decisions and recommendations. Residents also round on weekends, but the weekend schedule must be within the constraints of duty hour limitations. Medical students do not typically come in on weekends.


Again, new consults may be seen in the morning, during rounds, or after rounds (and after Residents’ noon conference) and are typically seen and worked-up by the Resident before presenting to the Attending, but this is flexible depending on the time of day and the acuity of the consult. Consults may be “called in” to the Fellow or the Resident, and each should inform the other of all consultation requests.


This is a MUST READ document: In-Pt Rotation Pointers 6.18.pdf: a survival guide to help you understand the daily routine of the service as well as to help you focus your patient management on Renal Issues.


RESIDENT CALL:

There is a Renal Call Pager that the resident on-call takes during the day. Thus, a call schedule needs to be made the first day of the rotation. New consults are assigned first to that resident and the team works together after that to do the rest. That pager is handed over to the Renal Fellow for the evening and night. Thus, the renal resident does not take night call.


CONFERENCES/TEACHING:

In addition to the teaching that occurs on rounds and during the presentation of consults, there are Nephrology conferences that residents may attend, although the Internal Medicine conferences should always take precedence. Nephrology Clinical Conferences and the Core Curriculum lectures are held on Mondays or Tuesdays at noon, generally in the DOM conference room on 10 Kellogg, lunch is provided. Renal Biopsy Conference is held on Thursdays at 1:00 PM in the Pathology conference room in 5 Jelke.

    

You should try to read as much as possible to enhance your learning experience. UpToDate is always a quick reference source. Books that may be useful include 1) Schrier’s, Renal and Electrolyte Disorders, 2) two books by Rose: Pathophysiology of Renal Disease and Clinical Physiology of Acid-Base and Fluid and Electrolyte Disorders and 3) Daugirdas’ Handbook of Dialysis. A number of articles are available for reference: Reading Resources. There are also a number of case-based Workshops that we may discuss as a group, time permitting.