NEPHROLOGY FELLOWSHIP PROGRAM
IV. Evaluations
Evaluations are conducted using the following guidelines of the American Board of Internal Medicine. In addition, separate forms for each rotation will be included based on educational goals and procedures.
A. American Board of Internal Medicine Guidelines for Evaluation
The board defines the certifiable nephrologist at the completion of required training as being competent to provide comprehensive and specialized medical care based on a high standard of demonstrated component skills. These skills should clearly exceed those demonstrated by the certified internist. Specifically, the Board asks program directors and their faculties to evaluate the following components of clinical competence:
- Clinical Judgment: This is the process by which clinical decisions are made. Good clinical judgment encompasses a) integrating medical facts and clinical data, b) weighing alternatives, c) understanding the limitations of knowledge, d) recognizing complications of disease and side-effects of treatments, e) instituting prompt measures to deal with serious or life-threatening clinical manifestations, f) incorporating the consideration of risks and benefits to the patient, and g) developing a logical plan for evaluation and both immediate and long-term management. It implies that the individual can adapt to changes in medicine throughout his/her career.
- Medical Knowledge: This is defined as the specialized, current knowledge necessary to function as an expert clinical nephrologist. This includes a broad base of knowledge of the pathogenesis, natural history and management of congenital and acquired diseases of the kidney and urinary tract; renal physiology; disorders of fluid, electrolyte and acid base regulation; normal and disordered mineral metabolism; acute and chronic renal failure; the management of patients receiving immunosuppressive therapy; and the management and diagnosis of severe hypertension. The clinical nephrologist also must be proficient in the principles and applications of various forms of renal replacement therapy including the management and systems operations of hemodialysis, peritoneal dialysis and renal transplantation.
- Clinical Skills: These refined abilities include a) obtaining appropriately directed medical histories that are precise, logical, thorough and reliable; b) conducting expert, focused physical examinations that elicit subtle findings and are directed toward the patient's problems; and c) demonstrating understanding and proficiency while minimizing risk and discomfort to patients in the performance of certain diagnostic and technical procedures.
- Humanistic Qualities: These are integrity, respect, and compassion as demonstrated in the care of patients and their families. They include the abilities to be honest, involved, and responsive to the patient's wishes; to respect the patient's need for information; to establish the patient's trust; to provide empathy; and to maintain credibility and rapport with patients and their families.
- Professional Attitudes and Behavior: The attitudes, behaviors and communication skills defined as essential in relating to patients and educating them, their families, and other health care professionals. These include the ability and willingness to describe the diagnosis and likely clinical course to the patient and the family; explain therapeutic options (including benefits and side-effects); accept responsibility; and prepare comprehensive consultation notes in medical records and letters to referring physicians, patients and appropriate agencies.
- Medical Care: The outcome of the integration of the foregoing component skills is the ability to manage patients effectively and responsibly. Excellent medical care results from the consistent ability to apply appropriate, comprehensive care of high quality; to be responsive to the patient's needs; to use laboratory test, consultations and diagnostic procedures efficiently, effectively and in the patients best interest; and to maintain the patient's welfare as the physician's primary concern.
- Commitment to Scholarship: This encompasses the commitment to maintain and update clinical skills throughout one's professional career, to acquire new knowledge through computer access and by reading the current medical literature, to participate in the design and conduct of clinical studies or related research, to attend scientific and clinical meetings for nephrologists and to evaluate critically the new medical scientific information relevant to the subspecialty.
- Moral and Ethical Behavior: This implies the consistent demonstration of a high standard of moral and ethical behavior expected within the clinical setting and of the medical profession. The ABIM considers it unethical for a physician to refuse to treat a patient solely on the basis of that patient's disease, when that disease is within the physician's area of competence. This philosophy has particular relevance to patients with AIDS or HIV seropositivity
A standardized evaluation form will be filled out by fellows for evaluation of teaching during the monthly rotations. Evaluation of outpatient clinic and longitudinal dialysis care teaching will be performed by fellows every six months for Attendings involved. There will be a separate form which evaluates educational goals and suspension of procedures.
