Honoring Nephrology Rotation

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WashingtonR

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Doing Nephrology rotation for early-M4 IM specialty rotation in prep for applying to IM. I'm looking to score a great LOR and matching eval. What are the best resources (case books, online content, etc) for M4/intern level nephro?

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I was always a fan of board review books for high yield knowledge. Would definitely be astute on your Internal Med knowledge at baseline. Anything on Amazon with "nephrology board review" or "internal medicine board review" should cover the most high yield things.

Like all rotations, the knowledge only gets you so far. The game - professionalism, cleverness, kindness, eagerness, gunning-under-the-radar - is still paramount to earning both the LOR and Honors. Yes, know your stuff. But more importantly, get there early, work hard, be happy and kind, etc. Be the likeable dude or dudette and you will shine no problem.

A nice way to prep for the game - try to figure out who is the attg, fellow, etc. anyone else on rotation with you before you start. Learn who they are, what they've published, etc. Know the enemy to beat the enemy. Chat with colleagues who have done this rotation before and get tips.
 
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I wouldn't read too much if I were you. You're not going to impress any Nephrology attending physicians by knowing anything special. If you have to, review the basics.

1.) Diuretics, where they all work.
2.) All the blood pressure agents and their indications, side effects. Make a table.
3.) Learn how to formally interpret an ABG. There are several good YouTube videos walking you through this . You may be asked to do one of these during your rotation.
4.) Know the differential for glomerular disease. For nephritic syndrome, I prefer to go based off of complement mediated vs. non-complement mediated. Know the loose cut offs for grams of proteinuria.

Clinical reasoning comes with time and experience on this rotation as you're going to be learning how things present which is part of becoming a doctor. You're going to see tons of AKIs. The diagnosis is usually made in my experience with a history as opposed to an exam or labs. The FeNa is next to useless IMO unless you are dealing with ruling out ATN in hepatorenal. It's more about pattern recognition and clinical picture. If an elderly patient is coming in for a nursing facility and confused, think dehydration and pre-renal. If a patient was pan-CT'ed in the ER and it's now two days later and the Cr just shot up randomly and didn't improve in a day, think CIN.

Also, reign in the temptation to diagnose zebras without good reason. While amyloidosis is a cool diagnosis, diabetic nephropathy is more common and likely unless you have very good reasons to suspect the latter. Also, know that in clinical practice even for simple AKIs, Nephrologists sometimes order a battery of tests. Learn the indication for each one of these tests, but also understand indication by the book is not always the same as clinical practice. Billing and liability are factors. From a private practice standpoint, I'm guessing you can bill more by ordering more tests. Even otherwise, if nephrology is being consulted, the primary team is basically asking you to explore all of what this could be or else they would not consult nephrology (unless they're inexperienced/lazy). If Wegener's was missed and nephrology was on board, Nephrology is going to get in trouble.

Focus on the other aspects mentioned by posters above as well...one thing though, I wouldn't read into the profiles of your superiors. I personally used to do this thinking it would give me a leg up, but knowing my attending published an article on Drosophila in undergrad doesn't tell me much and seeing their face inevitably gives me a preconceived notion that is oftentimes wrong. Instead, I just assume each attending is a demanding, hard-ass the first day and have all the information ready and I end up doing well. First impressions are important. Even if everyone says an attending is chill, assume they're not until you can tell they trust/like you.
 
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