1.1. Develop a strong knowledge of renal physiology and pathophysiology, especially related to age-related changes and age-associated diseases.
1.2. Understand the complex interrelated nature of geriatric syndromes and CKD including medical, psychosocial, functional and economic factors
1.3. Develop knowledge and expertise related to geriatric syndromes commonly seen in older CKD patients, (e.g. cognitive impairment, falls, frailty, malnutrition, depression, nonspecific presentation of disease)
1.4. Develop knowledge and expertise related to prescription of renal care, fluid management, dialysis modalities, access creation and renal transplantation in older CKD patients
1.5. Recognize the central role that function plays in the health status of the elderly and incorporate functional assessment (e.g. BADLs, IADLs) into routine care
1.6. Develop a strong clinical approach to a CKD patient presenting with cognitive impairment, including appropriate selection, administration and interpretation of standardized cognitive assessment tools
1.7. Prescribe medications appropriately, considering the pharmacodynamic and pharmacokinetic changes that occur in renal disease and aging
1.8. Recognize medications that are more likely to result in adverse drug reactions in older individuals with CKD

2.1. Refine written and oral communication skills related to geriatrics and nephrology subspecialty care
2.2. Recognize common barriers to communication in the elderly (hearing loss, vision, cognitive impairment) and adjust interview style accordingly
2.3. Strengthen communication skills to facilitate good rapport with patients, their families and colleagues
2.4. Respect patient’s perspectives and engage them in conversations to develop shared plans of care
2.5. Recognize the importance of a collateral history from caregivers in providing effective care to elderly patients while respecting the patient’s autonomy
2.6. Discuss advance healthcare planning with patients and families including the decision to start or stop dialysis
2.7. Learn to facilitate group meetings with patients, family and allied health in an effective manner
2.8. Discuss the risks, benefits and alternatives of renal replacement therapy in the context of advanced age, frailty and multi-morbidity

3.1. Understand the role of the physician on the healthcare team
3.2. Recognize the importance of the contribution of different healthcare team members in geriatrics and nephrology and utilize their skills appropriately
3.3. Develop skills to work effectively and collaboratively on interprofessional teams in geriatrics and nephrology
3.4. Provide collaborative care for older patients with CKD in a variety of settings (inpatient ward, outpatient clinic, rehab unit)

4.1. Develop appropriate management plans for frail older adults with CKD that utilizes resources effectively
4.2. Appreciate the concept of just allocation of scarce resources and recognize the potential conflict with one’s role as a health advocate
4.3. Become familiar with different clinical service models of geriatric care and CKD care, and respective resource requirements
4.4. Acquire the skills required to become a leader and specialized resource in geriatric nephrology
4.5. Become involved in practice audits or patient safety initiatives if available

5.1. Recognize non-biological determinants of health that contribute to the onset and progression of CKD and frailty
5.2. Identify system issues within healthcare that make it difficult for older CKD patient to access optimal care
5.3. Recognize opportunities for advocacy in geriatric nephrology
5.4. Learn to advocate effectively for the health needs of individual patients, especially those in vulnerable or marginalized populations

6.1. Participate regularly in educational sessions and journal clubs relevant to geriatric nephrology
6.2. Build knowledge of current evidence-based guidelines and landmark articles in geriatric nephrology
6.3. Practice critical appraisal of literature related to the care of older CKD patients, and integrate conclusions into clinical care appropriately
6.4. Strengthen skills in teaching junior learners, peers and other health care professionals on topics in geriatric nephrology
6.5. Identify personal knowledge gaps and commit to lifelong learning

7.1. Develop and demonstrate appropriate attitudes towards older patients with CKD and their families
7.2. Gain awareness of and insight into common ethical and legal issues in the care of elderly CKD patients
7.3. Act in a professional manner with patients, families and colleagues