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Vocational Training
Nephrology
Supervising Committee
Specialist Advisory Committee (SAC) in Nephrology.
Definition of Specialty
Nephrology encompasses: the physiology of normal and abnormal renal function;
the science, clinical expression, investigation and management of diseases of
the kidneys and urinary tract, including specialised management of hypertension;
the pathophysiology of renal failure; the management of acute and chronic renal
failure; and of end stage renal disease by dialysis and renal transplantation.
General Principles of Training
- Advanced training
in nephrology should provide broad experience in all aspects of nephrology.
-
This experience should involve trainees in the clinical management of patients
with a wide variety of renal diseases. Trainees are expected to have an understanding
of physiology, pathology, pharmacology and immunology in so far as each applies
to the kidney.
- The training should include experience in all forms
of dialysis and renal transplantation.
- In Australia experience in
hospital patient and ambulatory care nephrology and in New Zealand in outpatient
care nephrology is mandatory.
- It is a requirement of the SAC that
two of your mandatory core years must be undertaken at a different site. This
does not mean that a trainee cannot undertake 24 months of core training at
the one institution but the trainee would still have to complete another 12
core months of clinical work at a different institution. This requirement applies
to all trainees commencing advanced training from 2006 onwards.
Components
of Training
Core Training
A minimum
of 2 years should be spent in clinical nephrology training with responsibility
for patient care. Posts devoted to dialysis without other significant medical
components will not be accepted for more than 6 months of core training.
The
following special areas of experience should be included in this training:
- diagnosis
of renal disease, including urine microscopy; assessment of renal function; renal
biopsy and its interpretation;
- organ imaging and other specialised
investigations;
- specialised knowledge of the management of hypertension;
- fluid
and electrolyte balance;
- management of acute and chronic renal failure;
- techniques
of haemodialysis, haemofiltration and peritoneal dialysis;
- renal transplantation;
- urolithiasis;
- urinary
tract infection;
- cooperative management of urological problems.
Suggested
minimum benchmarks for exposure to clinical nephrology over the 2 core years of
advanced training are:- participation in 50 general nephrology (non dialysis
or transplantation) outpatient clinics;
- supervision of 50 patients
with acute renal failure;
- supervision of 50 CAPD patients in an inpatient
or outpatient setting;
- supervision of 50 haemodialysis patients in
an inpatient or outpatient setting;
- renal transplantation:
-
pre transplant assessment: involvement in the pre transplant assessment of 12
patients (comprising a mixture of potential recipients and potential living donors)
-
acute transplantation: participation in 12 acute renal transplants over 2 years
of core training. Acute renal transplantation is defined as participation in the
peri-operative and early outpatient (first 3 months) care of transplant recipients
-
chronic transplantation: 48 episodes of contact with chronic transplant recipients
(more than 3 months subsequent to their transplant).
Non
Core Training
Normally the SAC may approve a maximum of one year elective
training which may be undertaken in any field which has relevance to the management
of renal patients.
Procedural
Skills
Trainees are expected to gain expertise in urine microscopy,
renal biopsy and placement of acute vascular access for dialysis.
In Australia,
suggested minimum benchmarks for nephrological procedures over the 2 core years
of advanced training are:
- 100 urine microscopies;
- 50 renal
biopsies, including 6 supervised or unsupervised transplant biopsies;
- placement
of 50 acute vascular accesses.
New Zealand trainees are strongly encouraged
to gain experience in performing percutaneous renal biopsies including renal transplantation
biopsies. In centres where biopsies are performed by radiologists, the trainees
with the support of their supervisors, are encouraged to obtain exposure to renal
biopsies from the radiologists.
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