STEPS IN DEVELOPING THE GERIATRIC NEPHROLOGY CURRICULUM FOR NEPHROLOGY TRAINEES

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STEPS IN DEVELOPING THE GERIATRIC NEPHROLOGY
CURRICULUM FOR NEPHROLOGY TRAINEES
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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
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Committee Membership Volunteer-membership in
response to Dr. Kohans invitations (30
individuals) Additional recommended
individuals total 45 individuals Extremely
enthusiastic and supportive of the idea
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Co-Chairs Dimitrios G. Oreopoulos Jocelyn
Wiggins
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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
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Designing contents of curriculum based on

• Jocelyn Wiggins previous publication on
  Geriatrics
• for the core curriculum nephrology. Am J Kid Dis
• 2005147-151
• 2) Table of contents of the 2-days course on
  Geriatric
• Nephrology. 2008 Renal Week ASN
• 3) Suggestions by the group

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FINAL PROGRAM
7 drafts and 2 months later Final content and
authors
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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

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Chapters are expected by November 2008 and a
meeting has been arranged during the ASN among
all authors to discuss their views and concerns.
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Review of all chapters by a selected group to
ensure compliance with above.
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Geriatric Nephrology beyond the written
curriculum
GOALS

• 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

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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

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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)

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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
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POSSIBLE FUTURE CONSIDERATIONS
Development of expanded Geriatric
Nephrology curriculum for those considering
dual Certification in Nephrology and Geriatrics
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THANK YOU
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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
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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 OHare 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
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? 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 OHare
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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
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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
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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
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PREVENTION OF PROGRESSION OF RENAL DISEASE IN THE
ELDERLY
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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
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 EDUCATION -         Develop educational
material for nephrology fellows,
families and patients -         Training the
trainers development of guidelines and
methods along CHAMP Lead Nicole Stankus