Inpatient and Outpatient US Clinical Experience in Nephrology in Chicago

Information about this clinical experience:

This rotation split between the inpatient and outpatient settings will be under the supervision of a board-certified nephrologist with years of experience practicing both hospital and outpatient medicine. The physician holds hospital appointments at Advocate Health, Ascension, and Endeavor Health Swedish Hospital, institutions that have residency programs in internal medicine, family medicine, and other specialties. The preceptor has considerable experience as an educator, having taught both medical students and residents. From time to time, family medicine residents from Swedish Health rotate through the doctor’s practice.

This preceptor works for a large nephrology group in Chicago. On a typical day, the physician visits the hospital, dialysis center, and clinic. Rotators will have the opportunity to accompany the doctor to these locations to see how nephrology care is delivered to patients in different settings. In the outpatient practice, the rotator will have the chance to participate in the intake process and obtain preliminary history from the patient.

As part of the intake process, this physician will teach you how to properly perform a blood pressure measurement. Although this may sound basic, multiple research studies have shown that clinicians often fail to accurately measure blood pressure. In one study, only 1 in 10 clinicians were able to answer all 6 of the best practice questions for blood pressure measurement. According to Dr. Patrice Harris, former AMA President, gaps in knowledge of best practices “can lead to diagnosis errors, which means getting an accurate reading is vital…”

Following the intake process, you will accompany the preceptor to see the patient. During the encounter, you will observe how a highly experienced nephrologist evaluates patients with a range of problems in the field, including chronic kidney disease, hypertension, hematuria, proteinuria, electrolyte imbalances, and acid-base disorders. You will become familiar with the type of questions that frame the approach to the evaluation of these problems. Given how prevalent renal disease is, the knowledge you gain during this clinical experience will allow you to provide proper care to these patients as a resident. Of note, for new patients to the practice, after the evaluation has been completed, the preceptor likes to have the student independently formulate an assessment and plan for presentation and discussion with the preceptor.

As assessment of volume status is particularly important in nephrology patients, this physician will teach you how to perform this assessment. Assessment of volume status is very challenging and errors are common, leading to inappropriate therapy. One of the goals of this experience is to become more proficient in this area.

One important way students contribute to patient care in this doctor’s practice is by writing out patient care instructions based on what has happened during the encounter. This requires the student to accurately capture the key elements of the encounter, the recommendations of the preceptor, and the action plan moving forward. The instructions that the student will develop must consider the patient’s health literacy level. This will be an excellent opportunity to grow your skills as an educator.

Other learning opportunities during this clinical experience include a once per month peritoneal dialysis clinic. For students interested in transplant nephrology, the preceptor has a colleague that specializes in this area – please let the preceptor know if you would like spend time with the colleague. Periodically, the attending will give didactics to you on important topics such as hypertension, hyponatremia, hyperkalemia, and glomerulonephritis.

During your experience, you will learn the following U.S. medical practices under the preceptor’s supervision:

• Taking patient histories.

• Performing physical exams under the physician’s supervision.

• Entering information in EMR (Epic).

• Have opportunities to research the literature to answer clinical questions at the point of care.

• Deliver talks about important topics in your specialty area.

• Being involved in patient education.

• Teaching other team members.

• Spending time with other healthcare professionals to understand their roles and responsibilities.

As a result of hospital policies, inpatient activities will be more observational.