NEPHROLOGY

Department of Medicine

Overview

Nephrology is the subspecialty of InternalMedicine that is primarily concerned withdiseases of the kidney. The Nephrology programat Queen’s University is a two-year residencyprogram that prepares its trainees for independentpractice as consultant nephrologists. Residentsgraduate with in-depth and demonstrable skillsin all aspects of nephrology (also known as renalmedicine), and a working knowledge of the basicand applied sciences relevant to kidney diseaseand treatment.

Curriculum

The curriculum is offered over thirteen four-weekblocks each year. In the first year of the program,residents are provided with a broad range ofexperience in the various aspects of generalnephrology. The year includes Ambulatory Clinicrotations covering peritoneal dialysis, transplantation,and chronic kidney disease, in addition toHemodialysis and ward/consult rotations.

The ward and consult rotations in the first year offerexperience in acute management of nephrologypatients, emergency care and emergency procedures

Sassan Ghazan-Shahi, MDResident, Adult Nephrology

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such as biopsy, plasma exchange, dialysis initiation(peritoneal, hemodialysis, or continuous hemo -dialysis) and placement of hemodialysis catheters,both permanent and temporary. Residents functionat a junior consultant level, but receive considerableone-on-one interaction with the faculty. They areexpected to see all patients first, or review patientsseen by ward residents first, and then present theirmanagement plan to faculty.

A longitudinal general nephrology clinic runscontinuously throughout the year and enables

residents to make all clinical decisions on patientsthey see, with input from staff. They are alsoresponsible for on-going follow up. Residentsfunction at a junior consultant level, and receiveconsiderable one-on-one interaction with the faculty.

In the second year of the program, residentsconsolidate their skills in general nephrology. They also pursue a variety of subspecialty experiencesdesigned to allow a more in-depth exploration of special areas of nephrology and the associatedservices that are utilized in nephrology practice.

Block PGY4 Rotations

1 Ward/Consults

2 Ward/Consults

3 Ambulatory (CKD, Transplant, PD)

4 Ambulatory (GN, Transplant)

5 Hemodialysis

6 Ambulatory (CKD, PD) Resident

7 Research Clinic

8 Hemodialysis

9 Ward/Consults

10 Ambulatory (GN, Transplant)

11 Ambulatory (CKD, PD)

12 Ward/Consults

13 Research

Block PGY5 Rotations

1 Ambulatory (GN, Transplant)

2 Ambulatory (CKD, PD)

3 Ambulatory (GN, Transplant)

4 Hemodialysis

5 Ward/Consults

6 Elective (Renal Transplantation) Resident

7 Research Clinic

8 Ward/Consults

9 Elective (ICU)

10 Hemodialysis

11 Elective (IVR)

12 Ward/Consults (Junior Attending)

13 Hemodialysis (Junior Attending)

EXAMPLE BLOCK SCHEDULE

Residents attend compulsory teaching sessions inRenal Pathology, in addition to further ambulatoryclinics and ward/consult rotations. There is anincreased level of responsibility and residentsfunction as Junior Attendings.

The curriculum in the second year is deliberatelyflexible so that residents can pursue areas of specificinterest and enhance their future career opportunities.

Conferences

All Nephrology residents are provided with generousfunding to attend the annual meetings of theCanadian Society of Nephrology and the AmericanSociety of Nephrology. If a resident is presenting at another conference, additional funding may also be available. Locally, our residents attendthe Queen’s Conference on Academic ResidencyEducation (QCARE) for senior residents. It includesworkshops on practice management and a mocktrial involving physician negligence and liability

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Research

Residents who wish to pursue research are stronglysupported by the Division, and a research project isa mandatory component of the program. At thebeginning of training, residents are informed of theDivisional members who perform research, eitherclinical or basic science, by the Nephrology ResearchDirector. The Division is fortunate to have many ofits faculty members participating in independent orcollaborative research. Protected time is a priority,and each resident has protected research blocks ineach year of training. There are also a number oftrained epidemiologists in the Division, so residentsgain valuable expertise in critical appraisal andinterpretation of medical literature.

Karen Yeates, MD, MPH, FRCPCAssistant ProfessorDepartment of MedicineDivision of Nephrology

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Educational Activities

All residents attend weekly academic half-days.These generally include presentations by facultymembers, and residents also present on a regularbasis.

Nephrology Grand Rounds provide opportunitiesfor cases to be presented. During PathologyRounds, residents attempt to interpret renal biopsyfindings followed by discussions of case historiesand relevant management issues. There are BiopsyPathology review sessions once a month with ourNephropathologist for residents. The Division hasbeen very successful in attracting both national andinternational nephrologists to speak at our roundsand speakers will often host separate teachingsessions for residents. A bi-weekly Journal Clubprovides an opportunity for articles to be presented,critiqued, and discussed.

M. Khaled Shamseddin, MD, FRCPCProgram DirectorAdult Nephrology

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Training Sites

The Division of Nephrology is based at KingstonGeneral Hospital (KGH), southeastern Ontario’sleading center for complex-acute and specialty careand home to the Cancer Centre of SoutheasternOntario. KGH serves almost 500,000 peoplethrough its Kingston facility and 24 regional affiliateand satellite sites. KGH was ranked in 2011 as oneof Canada’s Top 40 Research Hospitals by ResearchInfo source.

There is an extremely broad patient base at KGH,and the volume of clinical material enables residentsto learn all aspects of adult nephrology. Facilitiesand teaching are excellent, especially in dialysis.

Residents are able to participate in a variety ofcommunity and rural experiences. CKD clinicsoccur in smaller communities like Belleville andPicton, and all residents are given the opportunityto travel to Moose Factory to deliver nephrologycare for aboriginal populations in the James Bayregion. Nephrology residents have also had theopportunity to undertake international electives in locations as such as Tanzania and Australia.

Learning Environment

The smaller size of Nephrology at Queen’s is an assetto residents choosing to train here. The philosophy of our program is that residents are here to learn andnot to provide service. Faculty members do not relyon residents for clinical work and we are able toprovide an excellent education/service ratio. Our sizealso enables residents to have hands-on experienceat any time and prevents competition amongsttrainees for procedural skills.

Why Nephrology at Queen’s?

NbmW/Our smaller size promotes collegiality andcreates a positive work environment in whichresident concerns are listened to and addressed.

Education/service ratio: residents are here first andforemost to learn and the program maintains adedicated focus on teaching, education, and research.

Research: excellent clinical and basic science researchopportunities are available for all residents.

Patients: an extremely broad patient base providesample opportunity for learning

Teaching: there is a comprehensive teaching programwith dedicated academic half-days and visitingprofessor lectures

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ADULT NEPHROLOGY TRAINING PROGRAMQueen’s UniversityDivision of Nephrology Kingston General Hospital, Burr 03-038 76 Stuart Street Kingston ON K7L 2V7

meds.queensu.ca/departments/nephrology

Dr. M. Khaled Shamseddin, Program Director ks136@queensu.ca

Ms. Michelle Wolfreys, Program Assistantmichelle.wolfreys@queensu.ca