Wednesday, August 24, 2011

Crazy idea or genius? Nephrology Merit Badges

I want to create a series of buttons to give to residents and students to mark achievements in nephrology.

My birthday is coming up, looking at the 1 inch beginner button system

One of the common resident complaints regarding nephrology is that it's too hard. The nephrologist response to this complaint  is usually to deny the difficulty, because its not hard for the nephrologist. Perhaps that denial is counterproductive, first it's hard to disrupt a widely held belief that is continually reinforced by the community of medicine, secondly when you deny the difficulty you insult the intelligence of the student struggling with new concepts. Its essentially saying, "Hard? differentiating among the pulmonary renal syndromes is easy, what are you stupid?"

Instead of denying the difficulty we should re-frame the meme. Yes, nephrology is hard and look how cool it is that you mastered these concepts.

Merit badges, or pieces of flare as my fellow interjected, would add levity and encourage residents to tackle deeper concepts.

Potential nephrology merit badges:
  • It's the heart, no it's the kidney, no it's the heart, no it's the kidney...: diagnose and successfully treat a case of cardiorenal syndrome
  • ABG guru: interpret ABGs showing all four primary acid-base disturbances
  • Quinton: insert a temporary dialysis access to provide emergency dialysis access
  • Tissue is the Issue: perform a renal biopsy
  • Look Closely: correctly interpret a urine microscopy specimen
  • K/DOQI Genius  : use the K/DOQI guidelines to craft a plan of care for a CKD patient
  • RIFLEry: use the rifle criteria to correctly stage a case of AKI
  • RTA (pronounced like Fonzie would RTAAAAAA!): use urinary anion gap and other clues to correctly diagnose and classify an RTA
  • Bud Rose: use free water clearance to draw meaningful conclusions about hypo- or hypernatremia
  • Put on your Helmut (Rennke): be a star in the pathology room
  • Gerry Appel: exceptional management of nephrotic syndrome
  • Ron Falk: diagnose and manage a patient with ANCA-associated vasculitis
  • The Town Schrier: Use FENa, FEUrea and BUN:Cr ratio in a meaningful way to diagnose a subtle case of pre-renal azotemia
  • Mark Halperin: Master of the Cortical Collecting Duct: use the TTKG equation intelligently to help in the management of a patient
  • Wisdom of Solomon: prevent a case of contrast nephropathy
  • Cry me a river: for expertise in the use of high dose diuretics
  • EPA Super Fund Site: use dialysis to correct uremia in AKI

Suggested merit badges from other creative nephrologists:
  • Way to Go KDIGO: use the KDIGO guidelines to do what ever you want to your dialysis patient 
  • Golden Pocket: Forgetting to tighten the cap on the urine that you are bringing back to the lab to spin
Thanks to Steve Rankin and Edgar Lerma
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