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 experienceand demonstrate competence in the prevention evaluationand management of geriatric aspects of nephrology, includingdisorders of the aging kidney, and urinary tract; They mustalso receive formal instruction in geriatric medicine includingphysiology and pathology of the aging kidney and drug dosingand renal toxicity”. Programs not in compliance with these regulations are by issued citations and, in conjunction with other violation, placedon 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:

1) Jocelyn Wiggins previous publication on Geriatricsfor the core curriculum nephrology. Am J Kid Dis2005:147-151

2) Table of contents of the 2-days course on GeriatricNephrology. 2008 Renal Week ASN

3) Suggestions by the group

FINAL PROGRAM

7 drafts and 2 months laterFinal 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

• Extend this initiative so it really becomes a teaching tool and not just another version of a textbook

• Teach academic nephrologists how to teach geriatric nephrology

• Summarize core competencies in geriatric nephrology

GOALS:

Education: goals and tools

• Multiple choice questions

PhD- educators • Automated teaching tracking tools

web informatics specialists• Yearly  2-day hands-on "teach the teacher"

national conference for the academic nephrologists (clinicians educators)

collaboration with CHAMP group

Other Teaching Tools

• Slides (3-5) will accompany each chapter of our curriculum (in development)

• Discussion cases in geriatric nephrology (proposed)

• Virtual patient cases (proposed)

• Links to www.pogoe.org (proposed)

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) Booksc) Geriatric Nephrology Journal d) International Society for Geriatric Nephrology

POSSIBLE FUTURE CONSIDERATIONS

Development of expanded Geriatric Nephrologycurriculum for those considering dualCertification in Nephrology and Geriatrics

THANK YOU

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

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

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

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 CHAMPLead: Nicole Stankus