Teaching renal physiology in the 21st century: focus on acid-base physiology

The times they are K+-changin': bringing the potassium curriculum out of the 20th century

PURPOSE OF REVIEW

Although most of the current medical education literature has focused on teaching strategies, little attention has been devoted to selecting appropriate course content. Despite elegant descriptions of physiologic mechanisms in recent decades, medical school curricula and students continue to rely on outdated textbooks and certification examination study aids composed to fit an antiquated exam blueprint.

RECENT FINDINGS

Advances in our understanding of potassium physiology offer multiple examples of key concepts that deserve to be included in the modern-day renal physiology curriculum, including the relationship of potassium to blood pressure and the potassium 'switch', the aldosterone paradox, and novel pharmacologic agents that target dietary potassium absorption and potassium handling in the kidney.

SUMMARY

Key advances in our understanding and application of renal physiology to patient care have not been readily integrated into the nephrology curriculum of medical students. Difficult questions remain regarding when new concepts are sufficiently established to be introduced to medical students in the preclinical years.

Effectiveness of an analogy-containing video project to reinforce pharmacy students' learning of kidney physiology

BACKGROUND AND PURPOSE

Kidney physiology is one of the most difficult topics covered in health professions education. This study examined the effectiveness of an analogy-containing video project to reinforce pharmacy students' knowledge of kidney physiology.

EDUCATIONAL ACTIVITY AND SETTING

Students were assigned in groups to create a video that used analogy to explain kidney physiology processes. Survey responses, a rubric, and an objective test were used to assess the project's effectiveness.

FINDINGS

Students generated various analogies, such as making tea or coffee, cars and roads, and the college application process to explain kidney physiology. Most of the submitted videos successfully met all criteria in the rubric. All students believed that the project was effective, to varying degrees, in reinforcing their knowledge. Weak to moderate positive correlations were found between time spent on the project and perceived effectiveness of use of analogy to accomplish most of the learning objectives investigated. Students reported that the project engaged both lower- and higher-order cognitive skills. Quiz score analysis showed higher average scores of students on physiology-related questions compared to non-physiology items. Notably, this improvement was most marked for bottom-performing students. About 60% of students recommended the use of videos as a class assignment, but only 50% believed that they should be used as an alternative to quizzes.

SUMMARY

An analogy-containing video project effectively reinforced student learning of kidney physiology. Further studies are needed to verify the effectiveness of this technique compared to other didactic and learning approaches.

Advancing Nephrology: Division Leaders Advise ASN

New treatments, new understanding, and new approaches to translational research are transforming the outlook for patients with kidney diseases. A number of new initiatives dedicated to advancing the field of nephrology-from value-based care to prize competitions-will further improve outcomes of patients with kidney disease. Because of individual nephrologists and kidney organizations in the United States, such as the American Society of Nephrology, the National Kidney Foundation, and the Renal Physicians Association, and international nephrologists and organizations, such as the International Society of Nephrology and the European Renal Association-European Dialysis and Transplant Association, we are beginning to gain traction to invigorate nephrology to meet the pandemic of global kidney diseases. Recognizing the timeliness of this opportunity, the American Society of Nephrology convened a Division Chief Retreat in Dallas, Texas, in June 2019 to address five key issues: (1) asserting the value of nephrology to the health system; (2) productivity and compensation; (3) financial support of faculty's and divisions' educational efforts; (4) faculty recruitment, retention, diversity, and inclusion; and (5) ensuring that fellowship programs prepare trainees to provide high-value nephrology care and enhance attraction of trainees to nephrology. Herein, we highlight the outcomes of these discussions and recommendations to the American Society of Nephrology.

Tackling acid-base disorders, one Twitter poll at a time

Understanding and interpretation of acid-base disorders is an important clinical skill that is applicable to the majority of physicians. Although this topic is taught early in medical school, acid-base disturbances have been described as challenging by postgraduate trainees. We describe the use of Twitter, an online microblogging platform, to augment education in acid-base disturbances by using polls in which the user is shown laboratory values and then asked to select the most likely etiology of the disorder. The answer and a brief explanation are then shared in a subsequent tweet. Both polling questions and answers are shared from the account for the online, mobile-optimized, nephrology teaching tool NephSIM (https://www.nephsim.com/). An anonymous survey was administered to assess attitudes toward these polls. Using Twitter as an approach to enhance teaching of acid-base disturbances was both feasible and an engaging way to teach a challenging topic for trainees and physicians. Moreover, the coronavirus disease 2019 (COVID-19) pandemic has demonstrated the importance of incorporating virtual learning opportunities in all levels of medical education.

Teaching Renal Physiology to the Millennial Student: the University of the Philippines Manila Experience

OBJECTIVES

To compare the conventional style from a multi-modal approach in the teaching of renal physiology among University of the Philippines-College of Medicine (UPCM) first-year medical students in terms of their attitudes and rating scale.

METHODS

We conducted an exploratory sequential mixed methods design using an online survey employing a likert scale followed by a focus group discussion of medical students taking the excretory module from 2016 to 2019. Abbreviated plenary live lectures, online videos embedded in a learning management system, patient contact experience ward work, role-playing, and quiz shows are used to integrate the lessons being taught.

RESULTS

One-hundred sixty-one respondents out of 185 medical students answered the online survey. We identified that the 67.8% of students found web-facilitated videos extremely effective in understanding renal physiology. Among the online videos, voice-over powerpoint format was proven to be most helpful. Students disclosed that the overall scheme was generally positive and it proved to be enjoyable and provided great learning experiences.

CONCLUSION

Applied to a class of millennial students, the pilot flight of the redesigned program attempted to engage the audience in such a way that they would not only memorize the topics by rote, they would be able to understand the topics so they could then correlate them to a real-world, clinical, or a laboratory setting following a multi-modal representation.

Faculty Use of Active Learning in Postgraduate Nephrology Education: A Mixed-Methods Study

Background

Active learning is an effective instructional tool in medical education. However, its integration by nephrology faculty remains limited despite residents’ declining interest in nephrology.

Study Design

A sequential explanatory mixed-methods study design was used to explore nephrology faculty understanding of difficult teaching topics and active learning integration using the theory of planned behavior as theoretical framework.

Setting & Participants

Nephrology faculty at 6 residency sites in Singapore were recruited.

Methodology

A 28-item questionnaire was administered to conveniently sampled faculty followed by 1-to-1 semi-structured interviews of a purposively sampled subset.

Analytical Approach

Quantitative data were analyzed using descriptive and regression statistics. Qualitative data were analyzed using thematic analysis in line with the theory of planned behavior constructs (attitude, subjective norm, perceived behavioral control, intention, and behavior).

Results

49 of 82 invited faculty responded, with 49% and 42% perceiving self-directed learning and interactive lectures, respectively, as active learning formats. Fluid, electrolyte, and acid-base disturbances; transplantation immunology; glomerulonephritis; and hemodialysis adequacy were cited as difficult topics by 75%, 63%, 45%, and 31% of responders, respectively. Only 55% reported integrating active learning formats when teaching difficult topics. Faculty in leadership roles and teaching difficult topics more regularly were more likely to adopt active learning formats. Multivariable logistic regression analysis showed that faculty attitude strongly and significantly predicted active learning intention. Thematic analysis identified 4 themes: active learning competence, barriers and challenges, environmental influence, and self-identity. Self-identity, defined as values developed from past behavior and experience, emerged as an important contributor to active learning adoption outside the theory of planned behavior framework.

Limitations

Sampling, context, and measurement biases may affect study reliability and generalizability.

Conclusions

Nephrology faculty lack active learning competence and face cognitive challenges when teaching difficult topics. Faculty teaching experience significantly influenced active learning adoption. Our findings build on the theoretical understanding of faculty instructional innovation adoption and can inform nephrology faculty development initiatives.