We are the first subspecialty to embrace and move forward rapidly with the geriatric teaching for the subspecialists. We could potentially become a blueprint for other subspecialties when they are ready to proceed towards this important goal. We as nephrologists have a unique position in being consultants not only to primary care physicians but also to other subspecialists, thus potentially may have the ability to extend our newly acquired geriatrics competencies and have a large impact on the overall geriatric care via the &quot;educational diffusion&quot;. Most of the hands-on teaching will have to be done by clinician-educators who are nephrologists and may not have skills needed to make this geriatrics curriculum the tool that it could become
Involvement of a PhD-educators would allow us to create MCQs not only for this curriculum, but also for the Nephrology Boards. In the future those could be “multi-level”, more basic for the general nephrology trainees, and advanced for ones who would pursue a dual certification, as well as for the use of the teaching academic faculty. Automated wed teaching tracking tools could have a dual use: internal use by the Fellowship Programs to track the progress of their trainees, and external researchers interested in studying web-based learning. C are of the Ho spitalized A ging M edical P atient (CHAMP) is a “teach the teacher” type educational initiative developed at the University of Chicago and currently being “exported” to other teaching institutions in order to improve geriatric training on general medical wards. Hands-on and direct feedback technique is geared towards a small group of learners and could be offered to nephrology faculty as part of the annual Geriatrics conference.
Discussion cases could be developed by our authors, as appropriate, and offered to the teaching faculty for their use. Number of Geriatric programs have taped interviews and other visual aids in use for their learners. Those potentially could be cataloged and adjusted for the nephrology needs POGOe is a partner site of the Association of American Medical Colleges’ MedEdPORTAL, is an online clearinghouse of geriatric educational products. Materials are indexed based on content area or learner type, and range from resources to aid in enhancement of patient assessment to pocket cards, web-based modules and virtual patient cases.
STEPS IN DEVELOPING THE GERIATRIC NEPHROLOGY CURRICULUM FOR ...
STEPS IN DEVELOPING THE GERIATRIC NEPHROLOGY CURRICULUM FOR NEPHROLOGY TRAINEES
THE MANDATE (ACGME) Accreditation Council for Graduate Medical Education “ Fellows must receive formal instruction, clinical experience and demonstrate competence in the prevention evaluation and management of geriatric aspects of nephrology, including disorders of the aging kidney, and urinary tract; They must also receive formal instruction in geriatric medicine including physiology and pathology of the aging kidney and drug dosing and renal toxicity”. Programs not in compliance with these regulations are by issued citations and, in conjunction with other violation, placed on warning by the ACGME Donald Kohan
Committee Membership Volunteer-membership in response to Dr. Kohan’s invitations (30 individuals) Additional recommended individuals total 45 individuals Extremely enthusiastic and supportive of the idea
Co-Chairs Dimitrios G. Oreopoulos Jocelyn Wiggins
Reporting to ASN Training Program Directors, Executive Committee, Chair Donald Kohan Funding Support (to cover the costs of the ASN staff) by the Association of Specialty Professor $15,000
Designing contents of curriculum based on: <ul><li>Jocelyn Wiggins previous publication on Geriatrics </li></ul><ul><li>for the core curriculum nephrology. Am J Kid Dis </li></ul><ul><li>2005:147-151 </li></ul><ul><li>2) Table of contents of the 2-days course on Geriatric </li></ul><ul><li>Nephrology. 2008 Renal Week ASN </li></ul><ul><li>3) Suggestions by the group </li></ul>
FINAL PROGRAM 7 drafts and 2 months later Final content and authors
INSTRUCTIONS TO AUTHORS ● Each chapter should be brief (no more than 5 pages) ● Concentrate only on geriatric knowledge, or those referring to nephrology as applied to geriatrics and avoid general nephrology concepts ● Utilize tables, charts or graft as much as possible ● Limited key references
Chapters are expected by November 2008 and a meeting has been arranged during the ASN among all authors to discuss their views and concerns.
Review of all chapters by a selected group to ensure compliance with above.
Geriatric Nephrology: beyond the written curriculum <ul><li>Extend this initiative so it really becomes a teaching tool and not just another version of a textbook </li></ul><ul><li>Teach academic nephrologists how to teach geriatric nephrology </li></ul><ul><li>Summarize core competencies in geriatric nephrology </li></ul>GOALS:
Education: goals and tools <ul><li>Multiple choice questions </li></ul><ul><li>PhD- educators </li></ul><ul><li>Automated teaching tracking tools </li></ul><ul><li>web informatics specialists </li></ul><ul><li>Yearly 2-day hands-on "teach the teacher" national conference for the academic nephrologists (clinicians educators) </li></ul><ul><li>collaboration with CHAMP group </li></ul>
Other Teaching Tools <ul><li>Slides (3-5) will accompany each chapter of our curriculum (in development) </li></ul><ul><li>Discussion cases in geriatric nephrology (proposed) </li></ul><ul><li>Virtual patient cases (proposed) </li></ul><ul><li>Links to www.pogoe.org (proposed) </li></ul>
Recommendations - Curriculum to be accessible through the ASN site; free access - updated - Regular Geriatric Nephrology Course during Renal Week (annually or bienially) - Links a) To all presentations (AV) of the 2 days course on geriatric nephrology (2008) b) Books c) Geriatric Nephrology Journal d) International Society for Geriatric Nephrology
POSSIBLE FUTURE CONSIDERATIONS Development of expanded Geriatric Nephrology curriculum for those considering dual Certification in Nephrology and Geriatrics
WHY DO WE NEED A GERIATRIC NEPHROLOGY CURRICULUM? (How geriatric nephrology differs from general nephrology? Why knowing geriatrics is important to the nephrologist?) Author: Jocelyn Wiggins THE COMING PANDEMIC OF CKD AND THE AGING POPULATION Author(s): Jocelyn Wiggins & Sanjeet Kumar Patel
PATHOPHYSIOLOGY OF RENAL FAILURE IN THE ELDERLY RENAL SENESCENCE (Anatomical and physiological changes in the kidney with aging) Author: Lynn Schlanger AGE ASSOCIATED DECLINE OF RENAL FUNCTION (Focus on modifiable factors with high impact on outcome. Role of oxidative stress. Is renal failure unavoidable in all elderly? Can renal failure be reversed? Author(s): Gary Striker and Luigi Ferrucci RATE OF DECLINE OF GFR AND CLINICAL EVALUATION OF ELDERLY WITH LOW eGFR (Identifying which elderly will progress to ESRD, assessment for CKD risk factors, albumin to creatinine ratio in “spot” urine specimen, urinalysis findings) Author: Ann O’Hare and Rose Shim LIMITATIONS OF VARIOUS FORMULAE AND OTHER WAYS OF ASSESSING GFR IN THE ELDERLY – IS THERE A ROLE OF CYSTATIN C? Author: Devraj Munikrishnappa
GLOMERULAR DISEASE (Diagnosis – management – should we do more renal biopsies?) Author: Christine Abrass DIABETIC CKD IN THE ELDERLY (Diabetes care and goals of glycemic control as they apply to the elderly – choice of various agents) Author: Mark Williams HYPERTENSION IN THE ELDERLY (Goals of blood pressure control and choice of agents) Author: Ann O’Hare
<ul><li>MANAGEMENT OF TRADITIONAL AND NON-TRADITIONAL CV RISK FACTORS IN THE ELDERLY Author: Wolfgang Winkelmayer VASCULAR DISEASE IN THE ELDERLY Author: Nobuyuki Miyawaki ANEMIA IN THE ELDERLY WITH CKD (identifiable causes – role of inflammation. HCT targets – treatment) Author: Julio Vijil BONE DISEASE AND Ca ABNORMALITIES IN THE ELDERLY WITH CKD (Interpretation of DEXA findings – vitamin D requirements – use of bisphosphonates) Author: Harmeet Singh SODIUM DISORDERS IN THE ELDERLY Author: Michael Michelis FLUID BALANCE DISORDERS IN THE ELDERLY Author: Myron Miller NUTRITIONAL ABNORMALITIES AND NUTRITIONAL NEEDS OF THE ELDERLY WITH CKD (Diagnosis – management) Author: John Morley </li></ul>
<ul><li>THE ELDERLY PATIENT WITH STAGE 5 CKD METHODS TO ASSESS QUALITY OF LIFE, FUNCTIONALITY AND COGNITION AND THEIR APPLICATIONS IN RISK STRATIFICAITON AND DECISION MAKING Author: Manjula Tamura DIALYSIS DECISIONS IN ELDERLY PATIENTS WITH ADVANCED CKD STAGES – THE ROLE OF NON-DIALYTIC TREATMENT Author: Mark Swidler HEMODIALYSIS IN THE ELDERLY – VASCULAR ACCESS OPTIONS (Discuss use of anticoagulants) Author: John Danziger PERITONEAL DIALYSIS IN THE ELDERLY Author: John Danziger ASSISTED HOME DIALYSIS IN THE ELDERLY Author(s): Matthew Oliver and Robert Quinn TRANSPLANTATION IN THE ELDERLY Author: Erica Hartman INTEGRATED CARE OF THE ELDERLY WITH ESRD Author: Jocelyn Wiggins ACUTE KIDNEY INJURY IN THE ELDERLY Author: Mitchell Rosner </li></ul>
UROLOGICAL ISSUES INCONTINENCE AND VOIDING PROBLEMS (Diagnosis management) Author(s): George Kuchel and Catherine Dubeau NOCTURIA IN THE ELDERLY Author: Dean Kujubu OBSTRUCTIVE UROPATHY (Screening for prostate cancer, medical management of BPH, Adverse consequences of bladder catheterization) Author: Jay Hollander URINARY INFECTIONS IN THE ELDERLY (Diagnosis – management – asymptomatic positive cultures) Author: Manisha Juthani-Mehta
PREVENTION OF PROGRESSION OF RENAL DISEASE IN THE ELDERLY
GERIATRIC MEDICINE AND ROLE OF GERIATRICIANS RECOGNIZING DELIRIUM – DIMENTIA – SEVERE DEPRESSION Author: Manjula Tamura QOL ASSESSMENT TOOLS Author: Julio Virgil FALLS (causes and prevention) Author: John Morley GERIATRIC ASSESSMENT (An approach to the geriatric patient) Author: Stephen Gambert ASSOCIATION BETWEEN CKD AND FRAILTY AND PREVENTION OF FUNCTIONAL LOSSES (Improvement of quality of life and reduction of morbidity and mortality) Author: Emaad Abdel-Rahman END OF LIFE DECISIONS – HOSPICE CARE (How to discuss prognosis and incorporate it into clinical decision making) Author: Richard Swartz INTERACTION OF DIALYSIS TEAMS WITH GERIATRITIANS Author: Nicole Stankus and Kellie Campbell
EDUCATION - Develop educational material for nephrology fellows, families and patients - Training the trainers – development of guidelines and methods along CHAMP Lead: Nicole Stankus