Nephrology curriculum standards

Ready to perform without supervision

Expected behaviours of a trainee who can routinely perform this activity without needing supervision

The trainee will:

• provide patients with information about the variation in type, such as living or deceased, and quality of donor organs
• discuss risks and benefits of transplantation appropriate to patients’ age and decision-making capacity, also considering mental health and intellectual impairment
• empower patients to self-manage through education, and support problem solving
• encourage patients’ access to self-monitoring devices and assistive technologies
• communicate with multidisciplinary team members, involving patients in that dialogue

Requires some supervision

Possible behaviours of a trainee who needs some supervision to perform this activity

The trainee may:

• provide healthy lifestyle advice and information to patients
• promote the importance of effective self-management
• partner with patients and motivate them to comply with agreed care plans
• summarise the patients’ issues in the discharge summary, and ensure it is transferred to stakeholders

Ready to perform without supervision

Expected behaviours of a trainee who can routinely perform this activity without needing supervision

The trainee will:

• use telehealth and digitally integrated support services to provide innovative models of post-transplant care
• review medicine use and ensure patients understand safe medication administration to prevent errors
• support patients’ self-management post-transplant by balancing minimising risk with helping them become more independent
• participate in quality improvement processes examining issues impacting on patients’ ability to undertake normal activities of daily living

Requires some supervision

Possible behaviours of a trainee who needs some supervision to perform this activity

The trainee may:

• participate in continuous quality improvement processes and clinical audits on chronic disease management
• identify activities that may improve patients’ quality of life

Ready to perform without supervision

Expected behaviours of a trainee who can routinely perform this activity without needing supervision

The trainee will:

• contribute to the development of clinical pathways for chronic diseases management and post-transplant surveillance based on current clinical guidelines
• educate patients to recognise and monitor their symptoms, and undertake strategies to assist their recovery

Requires some supervision

Possible behaviours of a trainee who needs some supervision to perform this activity

The trainee may:

• use clinical practice guidelines for chronic diseases management

Ready to perform without supervision

Expected behaviours of a trainee who can routinely perform this activity without needing supervision

The trainee will:

• resolve clinical areas of uncertainty by searching and critically appraising evidence
• review current literature on transplantation

Requires some supervision

Possible behaviours of a trainee who needs some supervision to perform this activity

The trainee may:

• apply the literature to an individual patient
• recognise appropriate use of review articles

Ready to perform without supervision

Expected behaviours of a trainee who can routinely perform this activity without needing supervision

The trainee will:

• encourage patients to join culturally aligned local networks to receive support for long-term self-management
• use a shared decision-making model with patients, families and/or carers
• identify and implement strategies to improve the inequity of access to services

Requires some supervision

Possible behaviours of a trainee who needs some supervision to perform this activity

The trainee may:

• work with patients’ cultural beliefs, values, and practices in developing relevant management plans
• explain the impact patients’ cultural and spiritual beliefs may have on their decision to accept a donor organ

Ready to perform without supervision

Expected behaviours of a trainee who can routinely perform this activity without needing supervision

The trainee will:

• obtain informed consent for living kidney donation • support a multidisciplinary team approach with the ethical principles in clinical decision making about transplantation • undertake transplantation only when it is believed that it provides benefit to the recipient
• ensure just and equitable assessment of patients’ eligibility for transplantation
• ensure that donated organs are given freely and voluntarily, without coercion, exploitation, or payment
• obtain patients’ consent for receiving transplanted organs with thorough discussion of risks and benefits, and with the understanding that patients may withdraw their consent to transplantation at any stage before the procedure
• share information about patients’ health care, consistent with privacy law and professional guidelines about confidentiality
• use consent processes for the release and exchange of health information
• assess patients’ decision-making capacities, and appropriately identify and use alternative decision makers when needed
• avoid any potential or perceived conflicts of interest by not being involved in decision making about end-of-life care or determination of death of individuals who may become organ donors

Requires some supervision

Possible behaviours of a trainee who needs some supervision to perform this activity

The trainee may:

• share information between relevant service providers
• seek input from other health professionals involved in patients’ care
• assess patients when assessing eligibility for transplantation based on factors such as past lifestyle, previous refusal of an offer of an organ for transplantation, or refusal to participate in research

Ready to perform without supervision

Expected behaviours of a trainee who can routinely perform this activity without needing supervision

The trainee will:

• modify treatment options in response to infectious complications and knowledge of microbiological principles
• make optimal use of scarce resources such as donor organs

Requires some supervision

Possible behaviours of a trainee who needs some supervision to perform this activity

The trainee may:

• identify patients who require a kidney biopsy
• follow-up results of investigations, and monitor responses to treatments
• identify patient-specific clinical features that influence transplant eligibility and outcomes
• assess patients’ capacity for decision making
• develop management plans for transplantation and/or patients on the waiting list

Ready to perform without supervision

Expected behaviours of a trainee who can routinely perform this activity without needing supervision

The trainee will:

• involve the multidisciplinary team, particularly nurses and live donor program coordinators, in the initial counselling of potential kidney transplant recipients and donors
• coordinate whole-person care through all stages of patients’ care journeys

Requires some supervision

Possible behaviours of a trainee who needs some supervision to perform this activity

The trainee may:

• demonstrate awareness of personal and other team members’ skills, expertise, and roles in caring for transplant patients
• select appropriate patient education resources related to nephrology
• synthesise patient information to determine dialysis small solute clearance and solutions to non-achievement

Ready to perform without supervision

Expected behaviours of a trainee who can routinely perform this activity without needing supervision

The trainee will:

• use health screening for early intervention and chronic diseases management
• assess alternative models of health care delivery for patients with chronic diseases and disabilities
• participate in government initiatives for chronic diseases management to reduce hospital admissions and improve patients’ quality of life
• facilitate patients’ access to initiatives and services for patients with chronic diseases and disabilities
• incorporate prevention, health promotion, and health surveillance into patient interactions
• recognise and apply local/national and international kidney guidelines, such as CARI and KDIGO

Requires some supervision

Possible behaviours of a trainee who needs some supervision to perform this activity

The trainee may:

• develop and implement local protocols for pre-transplant assessment of recipients and living donors
• access and refer patients to government initiatives and services for patients with chronic diseases and disabilities
• advocate for deceased and living donation