FELLOWSHIP IN TRANSPLANT NEPHROLOGY

Preamble

More than 2.5 Lakh people suffer from last-stage kidney diseases every year. In that 7 out of 10 patients go for dialysis and nearly 6 out of those 10 can’t continue due to heavy treatment fees.

There are various dialysis centers available but they are majorly based in cities.

It is a fact that India is the diabetes capital of the world, and an increase in diabetes patients also leads to a proportionate increase in the number of Chronic Kidney Disease patients. As a majority of patients suffering from kidney disease come up at the end stage, dialysis and kidney transplant become the only option.

Post-transplant, one of the major challenges is to sensitize the patient about the importance of post transplant care as any negligence can worsen the condition further and even be fatal.

There is huge demand for specialist for comprehensive management of end stage kidney diseases and renal transplant. Transplant nephrology is a very specialized profession which demands critical skills with more compassionate approach and sound understanding of ethical and legislative aspects of organ donation.

This is post doctoral fellowship course in renal transplant. The fellows will have hands on approach in renal transplant. Course will cover pretransplant immunological work up, management of transplant donor and recipient and post transplant management of complications and follow up.

Yenepoya medical college is providing comprehensive care through the Nephro-Urology care center from more than a decade. We have MCh urology program from last 6 years. We have all the expertise, clinical material, infrastructure to offer fellowship program in transplant nephrology.

PROGRAM CODE -TN04

Eligibility for admission

Post DM (Nephrology) / DNB (Nephrology)

Aim of the Program/Course:

To provide high-level in-house clinical training in transplant nephrology for eligible candidates so that the trained fellow gain experience, knowledge and competency in transplant nephrology to practice renal transplant.

Program Outcomes

Knowledge domain:

P01.Demonstrate ability to take a detailed history and undertake physical examination of a potential kidney donor/recipient or kidney transplant recipient

P02.Demonstrate knowledge on transplant immunology and all facets of clinical renal transplantation.

P03.Undertake pre, peri and post operative management of renal transplant patients.

P04.Demonstrate knowledge about management of long-term post-transplant recipients.

P05.Gain firsthand knowledge of pre-transplant work up of any solid organ recipient.

P06.Acquire knowledge for interpretation of slides for clinic-pathological correlation

PO7.Demonstrate knowledge about regulatory policies and practices prescribed by the hospital in line with National organ transplant program of Government of India.

Skill Domain:

P08.Develop skills to perform transplant surgery –perfusion of allograft , intra operative and immediate post operative management.

P09.Acquire clinical skill to undertake patient and donor evaluation and preparation for living and deceased donor transplantation.

P010.Understand and describe surgical techniques in donor nephrectomy and kidney transplantation.

P011.Diagnose and manage acute peri-operative and post-operative early transplant complications.

P012.Assist/Perform Ultrasound ( POCUS) and doppler of transplant kidney.

P013.Attain basic skills in biomedical research including critical analysis of medical literature and generating research questions, hypothesis and undertake research projects.

Attitude/Communication Domain:

P014.Demonstrate ability to perform an adequate psychosocial assessment of donors, candidates or recipients.

P015.Acquire skills to communicate effectively with patient and next of kin by providing empathic, compassionate, confident and evidence-based counselling of kidney transplant options and post-transplant complications

P016. Demonstrate ability to practice according to ethical principles of providing or withholding of clinical care, confidentiality of patient information, obtaining informed consent and general practice of medicine

Program Specific Outcomes

• PSO01. Understand the presentation (history and clinical examination), evaluation and management of common renal disorders.
• PSO02. Know what is involved in a transplant work-up?
• PSO03. Assess the suitability of a patient for renal transplant and appreciate the issues of transplantation.
• PSO04. Formulate appropriate treatment plan.
• PSO05. Be conversant with counseling techniques for the recipients/ donors / family members and primary care takers.
• PSO06. Communicate effectively and demonstrate caring and respectful behavior when interacting with patients and their families.
• PSO07. Adopt ethical principles in all aspects of nephrology practice/ research. (Professional honesty and integrity, humility, informed consent, counseling and recognize patients’ rights and privileges).
• PSO08. Perform competently all medical and invasive procedures, i.e., (a) percutaneous renal biopsy of native and transplanted kidneys, (b) placement of temporary vascular access or peritoneal catheter for renal replacement therapy (RRT), (c) Perform haemodialysis, acute and chronic peritoneal dialysis and continuous renal replacement therapy, and (d) Urine analysis.
• PSO09. Develop desired skills to independently manage emergency situations related to renal disease.
• PSO10. Acquire knowledge for the prevention of renal diseases.
• PSO11. Develop the expertise to perform a scientific study including formulating hypothesis, research questions, designing appropriate study, analyze and interpret the results.
• PSO12. Demonstrate competence in presentation of case reports, short study findings at institute level, regional, or national professional and scientific society meetings.
• PSO13. Demonstrate ability to comply and participate in regulatory policies and practices prescribed by the hospital in line with National organ transplant program of Government of India.
• PSO14. Demonstrate ability to appropriately perform open disclosures of transplant-related adverse events.
• PSO15. Explain the risks and benefits of renal transplant procedure and listen compassionately to patient's preferences and expectations.
• PSO16. Demonstrate satisfactory performance of percutaneous biopsy of native and transplant kidneys.
• PSO17. Appreciate administrative skills to manage multi-disciplinary team including nurses, pharmacists, residents, rehab services, social workers and nutritionists.
• PSO18. Assist/Perform transplant kidney biopsy procedure.
• PSO19. Understand and interpret radiological imaging of renal allografts.
• PSO20. Demonstrate skill to safely interpret histocompatibility tests and be able to interact with the histocompatibility team for further analysis and interpretation.
• PSO21. Conduct transplant kidney biopsies and interpret under microscope under supervision of specialized renal pathologist.
• PSO22. Recognize and manage surgical complications in collaboration with transplant urologists.

Program structure

Duration of the course	13 months
Theory	4 hours per week
Practical and Clinics	12 hours per week
Contact hours	42 hours per week
E-learning hours	4 hours per week
Research Work	2 hours per week
Self-Directed Learning	6 hours per week
Clinical services/ Diagnostic services	18 hours per week

Attendance

80% Attendance

Syllabus / Course contents

• Basic Sciences and Applied Sciences
• Anatomy
• Diagnostic Evaluations
• Immunology and Immunogenetics of transplantation
• Histocompatibility testing
• Transplant pharmacology
• Epidemiology of renal disease and approach to a patient with renal disease
• Laboratory assessment of kidney disease: Clearance, urinalysis and kidney biopsy
• Interpretation of urine electrolyte and acid-base parameters
• Radiologic assessment of the kidney
• Organ procurement, preservation and allocation of kidneys from deceased donors
• Psychosocial and economic aspects of kidney donation and transplantation
• Legal and ethical aspects of kidney donation and transplantation
• Pre-transplant evaluation and management of the transplant candidate
• Pre-transplant evaluation and management of the kidney donor
• Management of dialysis patients on the waiting list
• Surgical techniques of kidney donation and transplantation
• Physiology of the transplanted kidney
• Perioperative management of kidney transplant candidates and donors
• Post-operative management of kidney transplant recipients and donors
• Epidemiology of major causes of post-transplant morbidity and mortality
• Management of EARLY post-transplant complications
• Management of LATE post-transplant complications
• Diagnosis, prophylaxis and management of post-transplant rejection
• Infectious diseases in kidney transplantation
• Kidney transplantation in various disease conditions
• Technical and practical aspects of performing kidney transplant biopsies
• Interpretation of kidney transplant biopsies and histopathology
• Use and interpretation of radiological tests in kidney transplantation care
• The management of the elderly transplant recipient
• The management of the failing kidney transplant and return to dialysis.
• Overview of administration, legislation and leadership in operating a kidney transplant programme.
• Fundamentals of research methodology and principles of clinical ethics and professionalism Recent Advances Apart from the topics listed above, the advances in the field of nephrology would include relevant publications of importance to the field of Nephrology including in review articles, original publications and communications at premier scientific meetings in Nephrology.

Teaching - Learning methods and Academic Activities

Teaching - Learning method	Academic Activities
Experiential learning	Case presentation
Integrated/Inter-disciplinary learning	Scientific society meetings / Clinical Meet / Grand round
Participatory learning	Journal club, Seminar and interactive lectures, Grand rounds
Problem-solving methodologies	Clinical Audit, Transplant Meeting
Self-directed learning	Research work, Portfolio
Patient-centric and Evidence-based learning	Case presentation, Transplant meetings
Project-based learning	Research work
Any other: Visits to institutes	Visits to institutions of excellence, Visit to laboratories, diagnostic facilities, affiliated clinical units and other areas

Scheme of Examination

Internal Assessment (Frequency, Pattern-Theory and Practical)

Formative assessment: - Assessment of academic activities like journal club, seminar, case presentation, clinical meets and clinical audits, etc

Internal Assessment: Theory and Practical Examination of 50 marks each.

Theory paper will consist of 5 long essays

Practical examination:

OSCE (Objective Structured Clinical Examination) 2 Stations with one observation station	20 Marks
Practical Skills Demonstration. / Two short Case	30 Marks
Total	50 Marks

University Examination (Pattern-Theory and Practical)

The final Examination: Theory and Practical Examination of 100 marks each.

Theory paper will consist of 10 long essays

Duration of Theory Papers: 3 hours

Practical Examination : -

OSCE (Objective Structured Clinical Examination) 2 Stations with one observation station	20 Marks
1 Long Case/ 1 short case	50 Marks
Viva Voce: Discuss case scenarios, complex concepts, clarity of subject, case-based discussions, etc.	20 Marks
Portfolio	10 Marks
Total	100 Marks

Eligibility to appear for University Examination

• Minimum 80% attendance
• At least one presentation/poster in international/national/state conferences
• Portfolio submission

Criteria for pass

• Minimum 50% marks in Theory
• Minimum 50% marks in Practical

Declaration of Results

Declared by the Yenepoya (Deemed to be University)/ Yenepoya Medical College

Logbook/Portfolio (if applicable)

Portfolio should record the learning experiences with reflections and which must be countersigned by the course director

Recommended books

1. Diagnostic Atlas of Renal Pathology, Fogo, Agnes B 7th ED. Elsevier
2. Davison AM, editor. Oxford Textbook of Clinical Nephrology Volume 3. Oxford University Press, USA; 2005.
3. Morris P, Knechtle SJ. Kidney transplantation: principles and practice. Elsevier Health Sciences; 2008 Jun 30.
4. Knechtle SJ, Marson LP, Morris PJ. Kidney Transplantation-Principles and Practice E-Book: Kidney Transplantation-Principles and Practice E-Book. Elsevier Health Sciences; 2019 Aug 31.
5. Wein AJ, Kavoussi LR, Partin AW, et al. Campbell-Walsh-Wein Urology. 12th ed. Philadelphia: Saunders Elsevier; 2020.
6. Indian Council of Medical Research. National Ethical Guidelines for Biomedical and Health Research involving Human Participants. New Delhi; 2017. Available from:https://icmr.nic.in/guidelines/ICMR_Ethical_Guidelines_2017.pdf

Journals

1. Kidney International – Elsevier
2. American Journal of Kidney Diseases – Elsevier
3. Journal of American Society of Nephrology – LWW
4. Nephrology Dialysis and Transplantation – Elsevier
5. Seminars in Dialysis – Wiley
6. Clinical Transplantation – Wiley
7. Transplant Proceedings – Elsevier
8. New England Journal of Medicine – Massachusetts Medical Society
9. Journal of Indian Society of Nephrology – Medknow Publications
10. Journal of Association of Physicians of India – JAPI Oaye Press
11. Indian Journal of Transplantation

Any other information

• ANNEXURE
• Blueprint for Theory and Practical Examination (Enclosed)
• Question paper layout for theory examinations (Enclosed)
• Portfolio template (if applicable) (Enclosed)
• Any other Checklists/Formats for assessment (OSCE checklist enclosed)