1. Programme title

THE REnal Medicine fellowship

 


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2. Introduction
This is a higher medical degree granted to those who pass through a two-year structured curriculum in the various aspects related to the diagnosis and management of kidney disease. Candidates granted the degree are considered specialists in renal Medicine and granted the privileges of this specialty.

Physicians who are having recognized degree (by the Sudan Medical Council) in General Internal Medicine are eligible 'to join the (Fellowship inNephrology) program.


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3. Objectives
At the conclusion of the renal fellowship training program, the Nephrology trainee should be competent to provide an independent consulting and management service for the care of patients with kidney disease, with disordered fluid and electrolyte balance (with or without kidney disease), or with hypertension in providing such service, the trainee should have acquired the specialized knowledge and skills detailed below, but also the generic attributes of a consultant physician. These include attitudes and behaviors consistent with High personal and professional ethical standards
An approach to practice which is centered on patients' needs
A commitment to provide service and care to patients of all sociocultural and age groups
Acceptance of the need to work with colleagues in a multidisciplinary team
A willingness to devote time to teaching students and junior colleagues
A commitment to continuing professional self-education


Specific objectives:

By the end of training period tranee should acquire the following competences

Patient-based Competencies:
Make a clinical assessment and direct the management of a patient presenting with:
Disturbed fluid and electrolytes balance, including hypervolemia, hypovolemia, and abnormalities of plasma Na and K concentration
Disturbed acid-base balance, with a particular emphasis on metabolic acidosis and alkalosis disturbed bone and mineral metabolism, including abnormalities in plasma Ca, Mg and phosphate, renal osteodystrophy and urinary tract stone disease Regional variations in stone etiology
Urinary tract infection and/or obstruction Renal tuberculosis
Schistosomiasis
Tubulointerstitial diseases Chinese herb nephropathy
Leptospirosis
Glomerular disease: including primary glomerular disease presenting as nephritic syndrome, nephrotic syndrome, and asymptomatic hematuria/proteinuria, as well as systemic diseases such as HCV, vasculitis, SLE and amyloidosis, Malaria nephropathy and AIDS nephropathy
Diabetic nephropathy Diabetic nephropathy in indigenous populations
Hypertension, particularly when associated with evidence for renal disease or dysfunction
Renal functional impairment of uncertain etiology Balkan nephropathy
Acute renal failure, including the critically ill patient in an intensive care setting
including causes of ARF: toxins, venoms, Hairdye and infections
Chronic kidney disease, including the management of pre-end stage disease as well as renal replacement therapy (modes of dialysis) for ESRD
A request or indication for renal transplantation, or a functioning renal transplant [to include selection, preparation, post op care, management of immunosuppression, common medical complications, etc]
Inherited renal disease
N.B. Experience in relation to each of the above competencies should ideally be acquired in a range of patient groups, including;

  • Children
  • Pregnant women
  • The elderly

Population-based Competencies

Source and interpret the best available epidemiological evidence to guide the management of a patient presenting with kidney disease
Design a research protocol to ascertain the burden of kidney disease in a national or regional population
Implement a strategy for the prevention of kidney disease in a defined patient population
Diabetic nephropathy in indigenous populations
Endemic stone disease
Promote the support by health systems of programs for treating patients with renal disease, and contribute to the cost-effective implementation of such programs
Participate in the management of health services so as to achieve optimal allocation of resources for the care of patients with kidney disease


REQUIRED KNOWLEDGE AND SKILLS

Knowledge
Trainees should be able to draw on a comprehensive knowledge base, sufficient to understand clinical problems and support optimum patient care decisions, in the following areas.

K1 Basic Renal Sciences

  • o K1.1 Anatomy and histology of the normal kidney
  • o K1.2 Embryology of the kidney and urinary tract
  • o K1.3 Normal fluid and electrolyte homeostasis
  • o K1.4 Physiology of glomerular filtration
  • o K1.5 Physiology of tubular function
  • o K1.6 Renal endocrinology, especially erythropoietin and Vitamin D
  • o K1.7 Renal pharmacology, especially diuretic, immunosuppressive and antibiotic agents
  • o K1.8 Immunology of infection and transplant rejection
  • o K1.9 Molecular biology and genetics relevant to the kidney

K2 Renal Pathology, Pathophysiology, Immunology and Microbiology

  • o K2.1 Patterns of abnormal microscopic structure in the kidney, including the basic histopathology of common renal diseases*
  • o K2.2 Pathophysiology of disturbed metabolism of water, sodium, potassium, acid, calcium, magnesium and phosphate, due to renal and extra-renal diseases
  • o K2.3 Immunopathology of glomerulonephritis and interstitial nephritis
  • o K2.4 Pathogenesis of diabetic nephropathy and other systemic diseases affecting the kidney*
  • o K2.5 Microbiology and pathogenesis of urinary tract infection
  • o K2.6 Pathophysiology of urinary tract obstruction
  • o K2.7 Pathogenesis of essential hypertension and hypertension in renal and endocrine disorders
  • o K2.8 Pathophysiology of progressive kidney disease
  • o K2.9 Etiological factors and pathogenesis relevant to environmental kidney disease
  • o K2.10 Pathophysiology of renal transplant rejection

*Note that in this and subsequent sections emphasis should be placed on conditions, which are common in the region where the trainee is working.

K3 Clinical Manifestations and Natural History of Kidney Disease and Hypertension

  • o K3.1 Patterns of clinical presentation of kidney disease, and the approach to differential diagnosis of common presenting syndromes
  • o K3.2 Natural history of specific kidney diseases, both primary (especially glomerulonephritis) and secondary (especially diabetic nephropathy)
  • o K3.3 Kidney disease and hypertension in pregnancy
  • o K3.4 Pathogenesis of characteristic features of acute and chronic kidney failure
  • o K3.5 Endorgan disease and clinical consequences in hypertension
  • o K3.6 The short- and long-term course of renal transplantation

K4 Investigation and Diagnosis of Kidney Disease and Hypertension

  • o K4.1 Comprehensive renal function testing: assessing glomerular and tubular function
  • o K4.2 Immunological investigations in kidney disease
  • o K4.3 Rationale and interpretation of urinalysis, urine microscopy, urine culture and sensitivity testing
  • o K4.4 Indications for and interpretation of renal biopsy
  • o K4.5 Hormone and cytokine assays in the investigation of kidney disease and hypertension
  • o K4.6 Radiological and other imaging modalities in the investigation of kidney disease and hypertension
  • o K4.7 Molecular biology in the diagnosis of kidney disease

K5 Treatment of Kidney Disease and Hypertension

  • o K5.1 Nutrition and dietary management of kidney disease, before and after end stage renal failure
  • o K5.2 Other non-pharmacological measures in the management of kidney failure
  • o K5.3 Drug therapies for kidney disease and its complications
  • o K5.4 Non-pharmacological measures and drug therapy of hypertension
  • o K5.5 Renal replacement therapy using dialysis: principles of prescribing and monitoring peritoneal dialysis (including CAPD) and hemodialysis
  • o K5.6 Renal transplantation: patient selection and preparation, immunosuppressive therapy, acute and long term postoperative management
  • o K5.7 Published guidelines for management of common kidney disorders as well as complications of kidney failure

K6 Clinical Epidemiology, Prevention and Population Health

  • o K6.1 The principles of Evidence-Based Medicine: evaluation and application of findings from the clinical research literature
  • o K6.2 Epidemiology of disease in populations: outbreaks and trends
  • o K6.3 Research-based interventions in populations with kidney disease
  • o K6.4 Clinical trial design and implementation
  • o K6.5 Basic research methodology, including biostatistics

K7 Miscellaneous

  • o K7.1 Ethical issues in management of patients with ESRD (such as patient selection for dialysis and transplantation, donor selection, resource allocation, etc.)
  • o K7.2 Advocacy for cost effective care of patients with kidney disease
  • o K7.3 Public education focused on prevention of kidney disease

Skills

Trainees should achieve competence and confidence in performing the following clinical skills

  • S1 Perform a complete clinical history and physical examination of a patient presenting with kidney disease and/or hypertension (to include digital rectal examination and fundoscopy).
  • S2 Integrate all clinical and investigative findings into a coherent diagnosis, with formulation of a differential diagnosis, management plan and prognosis
  • S3 Perform a dipstick urinalysis, and fresh urine microscopy to detect cellular elements, crystals and casts
  • S4 Perform a transcutaneous renal biopsy, under local anesthetic, on a native or transplanted kidney (Minimum No required 10)
  • S5 Place temporary intravascular lines for hemodialysis access (Minimum No required 10)
  • S6 Place permanent intravascular lines for hemodialysis access [desirable]
  • S7 Connect a patient to the hemodialysis circuit [desirable]
  • S8 Place an acute peritoneal catheter [Minimum No required 10)
  • S9 Place a Tenchkoff catheter (or equivalent) for commencing CAPD [optional]
  • S10 Perform a urinary tract ultrasound examination [desirable]
  • S11 Assess and manage a poorly functioning vascular access device (shunt or fistula)

By the end of training, the trainees should have acquired the following competencies and should be able to function successfully as):

  1. Medical expert
  2. Communicator
  3. Collaborator
  4. Manager
  5. Health advocate
  6. Scholar
  7. Professional

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4. Contents

4.1 Training programme structure is based on four rotations over six recognized training centers for a total period of two years

An elective period for six month is made available for those who wish to gain further experience in renal transplantation. This can be through our joined agreement with the Sind Institute of Urology and Transplantation in Pakistan and Madras Mission Hospital in Chennai, India.


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5. Methods of Teaching and Training

Under supervision, with growing responsibility for independent decision-making.

  • 5.1 Self-directed learning by use of Library materials (texts and journals) and on-line resources
  • 5.2 Participation in Journal Clubs or equivalent formats for maintaining familiarity with current trial evidence and new advances
  • 5.3 Formal teaching by lectures, tutorials or demonstration sessions
  • 5.4 Case presentations and discussions with supervisor and clinical department members
  • 5.5 Maintain a logbook of cases managed and procedures performed
  • 5.6 Morbidity and mortality meeting

 


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6. Resources

6.1 Human Resources

  1. Professor B.I. Kabalo. Professor of Nephrology
  2. Professor Omer Abbude Professor of Nephrology
  3. DR Hisham Hassan Abdelwahab Consultant Renal Physician
  4. DR Haleema Mohammed Ali Fidail Consultant Renal Physician
  5. DR. A. Sabee!. Consultant Renal Physician
  6. DR. Mohamed Alamin Aawad. Consultant Renal Physician
  7. DR. A. Rahman A. Wahab, Consultant Renal Physician
  8. DR.Omer Alshalhama Consultant Renal Physician
  9. DR. A. Sabee!. Consultant Renal Physician
  10. DR. Mohamed B Ghalib Consultant Renal Physician
  11. DR. Altigany M. A., Consultant Paediatric Nephrologist
  12. DR. Mohamed Babikir Alfakki Consultant Paediatric Nephrologist
  13. Mr Mohammed Fadlalla Alsheikh Consultant Transplant Surgeon
  14. Mr Nizar Zolfo Consultant Renal Transplant Surgeon

Visiting Consultants

  1. Professor Adib Rizvi
  2. Professor Magdi Yagoub
  3. Professor Ibrahim Fahal
  4. Professor Hassan Abuaisha
  5. Professor Abdurahman Musa
  6. Dr.Abdurrahman Ali
  7. Professor Neil Turner

Supervisors

  1. Professor B.I. Kabalo. Professor of Nephrology
  2. Professor Omer Abbude Professor of Nephrology
  3. DR Hisham Hassan Abdelwahab Consultant Renal Physician
  4. DR Haleema Mohammed Ali Fidail Consultant Renal Physician
  5. DR. A. Sabeel. Consultant Renal Physician
  6. DR. Mohamed Elamin Awad. Consultant Renal Physician
  7. DR. A. Rahman A. Wahab, Consultant RenalPhysician
  8. DR.Omer Alshalhama Consultant Renal Physician
  9. DR. A. Sabee!. Consultant Renal Physician
  10. DR. Mohamed B Ghalib Consultant Renal Physician
  11. DR. Altigany M. A., Consultant Paediatric Nephrologist
  12. DR. Mohamed Babikir Alfakki Consultant Paediatric Nephrologist
  13. Mr Mohammed Fadlalla Alsheikh Consultant Transplant Surgeon
  14. Mr Nizar Zolfo Consultant Renal Transplant Surgeon

Physical Resources

  1. Renal Histopathology (Military Hospital,Soba University)
  2. Active Urology department. (All Centres)
  3. Active Immunology department. (Soba University Hospital, Military Hospital,Alrayan Centre and Police Hospital)
  4. Transplant and vascular surgery (Soba University, Ahmed Gasim Hospital,Ibn Sinaa Hospital and Alzaytona Hospital)
  5. Radiology department.(All centers)
  6. A modern Haemodialysis unit with (All centers)
  7. Availability PD (All centres)

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7. Methods of Students' assessment

  1. 7.1 EYE BOF (Best of five)
  2. 7.2 DOPS /Direct observation of procedural skill
  3. 7.3 Mini PAT/mini peer assessment tool

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8. Degree awarded

FELLOWSHIP IN RENAL MEDICINE


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9. List of references and other resources

  1. Comprehensive Clinical Nephrology by John Feehally, MA, DM, FRCP, Jurgen Floege and Richard J. Johnson, MD
    ISBN: 978-0-323-04602-2
  2. Oxford Textbook of Clinical Nephrology
    Source: Oxford University Press (OUP)
    Author(s): Alex M. Davison, J. Stewart Cameron, Jean-Pierre Grunfeld, Hôspital Necker, Paris, David N. S. Kerr, Eberhard Ritz, and Christopher G. Winearls
    ISBN-10:0198508247
    ISBN-13:9780198508243
  3. Journal of the American Society of Nephrology http://jasn.asnjournals.org/
  4. Kidney International http://www.nature.com/ki/index.html
  5. Nephrology Dialysis Transplantation http://ndt.oxfordjournals.org/

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10. Annex

Includes: log-books, tutor report form, etc

10.1 Trainer feedback
10.2 Trainee feedback
10.3 Portfolio
10.4 Rotation evaluation by trainees
10.5 Forms of formative assessment

   
 
 
 
         
         
         
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