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Miao J, Thongprayoon C, Garcia Valencia O, Craici IM, Cheungpasitporn W. Navigating Nephrology's Decline Through a GPT-4 Analysis of Internal Medicine Specialties in the United States: Qualitative Study. JMIR MEDICAL EDUCATION 2024; 10:e57157. [PMID: 39388702 DOI: 10.2196/57157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Revised: 05/22/2024] [Accepted: 08/15/2024] [Indexed: 10/12/2024]
Abstract
Background The 2024 Nephrology fellowship match data show the declining interest in nephrology in the United States, with an 11% drop in candidates and a mere 66% (321/488) of positions filled. Objective The study aims to discern the factors influencing this trend using ChatGPT, a leading chatbot model, for insights into the comparative appeal of nephrology versus other internal medicine specialties. Methods Using the GPT-4 model, the study compared nephrology with 13 other internal medicine specialties, evaluating each on 7 criteria including intellectual complexity, work-life balance, procedural involvement, research opportunities, patient relationships, career demand, and financial compensation. Each criterion was assigned scores from 1 to 10, with the cumulative score determining the ranking. The approach included counteracting potential bias by instructing GPT-4 to favor other specialties over nephrology in reverse scenarios. Results GPT-4 ranked nephrology only above sleep medicine. While nephrology scored higher than hospice and palliative medicine, it fell short in key criteria such as work-life balance, patient relationships, and career demand. When examining the percentage of filled positions in the 2024 appointment year match, nephrology's filled rate was 66%, only higher than the 45% (155/348) filled rate of geriatric medicine. Nephrology's score decreased by 4%-14% in 5 criteria including intellectual challenge and complexity, procedural involvement, career opportunity and demand, research and academic opportunities, and financial compensation. Conclusions ChatGPT does not favor nephrology over most internal medicine specialties, highlighting its diminishing appeal as a career choice. This trend raises significant concerns, especially considering the overall physician shortage, and prompts a reevaluation of factors affecting specialty choice among medical residents.
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Affiliation(s)
- Jing Miao
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, 200 1st st sw, Rochester, MN, 55905, United States, 1 507 594 4700
| | - Charat Thongprayoon
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, 200 1st st sw, Rochester, MN, 55905, United States, 1 507 594 4700
| | - Oscar Garcia Valencia
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, 200 1st st sw, Rochester, MN, 55905, United States, 1 507 594 4700
| | - Iasmina M Craici
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, 200 1st st sw, Rochester, MN, 55905, United States, 1 507 594 4700
| | - Wisit Cheungpasitporn
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, 200 1st st sw, Rochester, MN, 55905, United States, 1 507 594 4700
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2
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Brouwer HJ, Barry M, Kluijtmans M, Damoiseaux RAMJ, de Groot E. Fostering the clinician as teacher: A realist review. MEDICAL EDUCATION 2024. [PMID: 39034500 DOI: 10.1111/medu.15476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Revised: 06/16/2024] [Accepted: 06/28/2024] [Indexed: 07/23/2024]
Abstract
BACKGROUND Clinician-teachers, physicians with educational responsibilities in either classroom or clinical setting, are assumed to add value by virtue of their dual role. The clinical responsibilities are often prioritised over the educational tasks. How and under which circumstances clinician-teachers are able to perform their educational role and create added value for different stakeholders is currently unclear. OBJECTIVES To identify for whom, how and under which circumstances educational activities executed by CTs by virtue of their dual role add value to others. SCOPE CTs activities linking the system of education and clinical practice beyond direct patient interactions and purposefully executed. METHODS A realist review was conducted. Databases were searched in two stages: a narrow conventional search, followed by a comprehensive artificial intelligence-aided search. Studies concerning clinician-teachers' dual role were included. Realist analysis was applied to identify in which contexts resource mechanisms triggered reasoning mechanisms, which led to specific outcomes for different stakeholders. RESULTS Sixty-six studies were included. In contexts where clinician-teachers' dual role was formally recognised and valued, clinician-teachers benefitted from the credibility and legitimacy bestowed on them, making the transfer of domain-specific knowledge more impactful. In contexts where sociocultural differences between both systems existed, CTs were able to mediate and adjust recommendations aligned with stakeholders' perceived relevance. Also, contexts organised to support both roles made resource mechanisms more impactful. Clinician-teachers added value to students' clinical competency and learning environment, and to educational organisations' curricular innovation. In their clinical workspace, clinician-teachers added value by enhancing colleague physicians' teaching expertise, implementing educational innovations and recruiting students for scarce specialisms. CONCLUSION Clinician-teachers add value to students, colleague physicians and the clinical and educational contexts at large. Domain-specific knowledge of both systems was important to gain credibility and achieve added value. Openness, formal recognition and allocated time for both roles in educational and clinical contexts towards the dual role are important to strengthen the impact of the dual role.
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Affiliation(s)
- Hiske Joanna Brouwer
- Department of General Practice & Nursing Science, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Margot Barry
- Department of General Practice & Nursing Science, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Manon Kluijtmans
- Education Center, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Roger Anna Maria Joseph Damoiseaux
- Department of General Practice & Nursing Science, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Esther de Groot
- Department of General Practice & Nursing Science, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
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3
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de Sousa MV. Post-Transplant Glomerulonephritis: Challenges and Solutions. Int J Nephrol Renovasc Dis 2024; 17:81-90. [PMID: 38495741 PMCID: PMC10944656 DOI: 10.2147/ijnrd.s391779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2023] [Accepted: 03/12/2024] [Indexed: 03/19/2024] Open
Abstract
Glomeruli can be damaged in several conditions after kidney transplantation, with a potential impact on the graft function and survival. Primary glomerulonephritis, a group of glomerular immunological damage that results in variable histological patterns and clinical phenotypes, can occur in kidney transplant recipients as a recurrent or de novo condition. Specific immunologic conditions associated with kidney transplantation, such as acute rejection episodes, can act as an additional trigger after transplantation, impacting the incidence of these glomerulopathies. The post-transplant GN recurrence ranges from 3% to 15%, varying according to the GN subtype and post-transplant time, mainly occurring after 3-5 years of kidney transplantation. Advances in the knowledge of glomerulonephritis pathophysiology have provided new approaches to pre-transplant risk evaluation and post-transplant monitoring. Glomeruli can be affected by several systemic viral infections, such as human immunodeficiency virus (HIV), hepatitis C virus (HCV), hepatitis B virus (HBV), severe acute respiratory syndrome coronavirus 2 (SARS-COV-2), cytomegalovirus (CMV), and BK virus. The diagnosis of these infections, as well as the identification of possible complications associated with them, are important to minimize the negative impacts of these conditions on kidney transplant recipients' outcomes.
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Affiliation(s)
- Marcos Vinicius de Sousa
- University of Campinas, School of Medical Sciences, Department of Internal Medicine, Division of Nephrology, Renal Transplant Unit, Transplant Research Laboratory, Campinas, SP, Brazil
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4
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Prabhavalkar S, Puri A, Shivashankar G. Perceptions towards Nephrology Specialty: The Good, the Bad and the Ugly. THE ULSTER MEDICAL JOURNAL 2024; 92:148-156. [PMID: 38292495 PMCID: PMC10824126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/01/2024]
Abstract
Background There is a decline in the interest in pursuing a career in nephrology globally as well as locally in Northern Ireland. There is also an expansion in the burden of kidney disease worldwide due to a combination of factors like higher detection rates, increase in population size and improved life expectancy. Workforce shortages in nephrology have a direct impact on provision of care for people with kidney disease. Understanding perceptions among doctors towards nephrology is an important factor in acknowledging the barriers in recruitment and advocating evidence based changes to improve current practices. Aim The aim of this study is to explore both the positive and the negative perceptions among medical students and trainees towards nephrology as a specialty in order to understand the factors that are most influential in either choosing or forgoing a career in nephrology. Methods Scoping review methodology was used to address the research question through a phenomenological lens. Sixteen articles were included that studied the perceptions towards nephrology mainly through questionnaires and also through direct quotations. Basic numerical analysis and content analysis was completed. Findings A total of 3745 participants including medical students, trainees and consultants participated in the 16 studies were included in this review at an international level. Most of the studies used survey (questionnaire) as their methodology (n= 10). The seven themes that emerged to describe perceptions towards nephrology were exposure to specialty; complex specialty; mentorship; work-life balance; financial compensation; personal interest; and procedural component. Exposure to specialty was the most influential factor in future career choice decision. The other factors that could improve recruitment in nephrology include innovative and novel teaching methods, good role models, flexible training and working patterns, and adequate financial remuneration. Conclusions In order to rekindle interest in nephrology we need a multi-pronged approach based on ensuring early exposure to the specialty, good mentorship, holistic clinical experience covering different aspects of the specialty and the opportunity of flexibly moulding one's interests and skills whilst ensuring service provision, and with an emphasis on adequate financial remuneration.
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Affiliation(s)
- Siddhesh Prabhavalkar
- Consultant Nephrologist, Altnagelvin Hospital, Western Health and Social Care Trust, Londonderry, Northern Ireland
| | - Aarushi Puri
- Final Year Medical Student, Anglia Ruskin University, Chelmsford, UK
| | - Girish Shivashankar
- Consultant Nephrologist, Altnagelvin Hospital, Western Health and Social Care Trust, Londonderry, Northern Ireland
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5
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Brazell M, Maidwell T, Nimmo A, Scott J. Developing a Renal Starter Club Program to Promote a Career in Nephrology. Kidney Int Rep 2023; 8:2814-2817. [PMID: 38106582 PMCID: PMC10719589 DOI: 10.1016/j.ekir.2023.09.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 09/14/2023] [Accepted: 09/25/2023] [Indexed: 12/19/2023] Open
Affiliation(s)
- Madeline Brazell
- Department of Renal Medicine, James Cook University Hospital, Middlesbrough, UK
| | | | - Ailish Nimmo
- Department of Renal Medicine, Royal Infirmary of Edinburgh, Edinburgh, UK
- Centre for Cardiovascular Science, University of Edinburgh, UK
| | - Jemima Scott
- School of Population Health Sciences, University of Bristol, Bristol, UK
- Department of Renal Medicine, North Bristol NHS Trust, Bristol, UK
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6
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Stauss M, Floyd L, Woywodt A. Weighing up Open Access Publishing in Nephrology-Bronze, Platinum, or Fools' Gold? KIDNEY360 2023; 4:1637-1640. [PMID: 37853553 PMCID: PMC10695644 DOI: 10.34067/kid.0000000000000282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 10/11/2023] [Indexed: 10/20/2023]
Affiliation(s)
- Madelena Stauss
- Department of Renal Medicine, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, United Kingdom
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7
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Bennett PN, Bohm C, Yee-Moon Wang A, Kanjanabuch T, Figueiredo AE, Harasemiw O, Brown L, Gabrys I, Jegatheesan D, Lambert K, Lightfoot CJ, MacRae J, Scholes-Robertson N, Stewart K, Tarca B, Verdin N, Warren M, West M, Zimmerman D, Finderup J, Ford E, Ribeiro HS, Xu Q, Thompson S. An International Survey of Peritoneal Dialysis Exercise Practices and Perceptions. Kidney Int Rep 2023; 8:1389-1398. [PMID: 37441469 PMCID: PMC10334400 DOI: 10.1016/j.ekir.2023.04.024] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2022] [Revised: 03/24/2023] [Accepted: 04/24/2023] [Indexed: 07/15/2023] Open
Abstract
Introduction Low activity levels and poor physical function are associated with technique failure and mortality in people receiving peritoneal dialysis (PD). Adequate levels of physical function are required to maintain independence for people choosing this predominantly home-based therapy. The objective of this study was to identify the exercise-related perceptions and practices of PD clinicians globally. Methods We conducted a cross-sectional survey of PD clinicians from English-, Thai-, Spanish-, and Portuguese-speaking PD-prevalent countries exploring clinicians' perceptions and practices of swimming, activity following PD catheter insertion, lifting, and falls prevention. This study was convened by the International Society of Peritoneal Dialysis and Global Renal Exercise Network between July and December 2021. Results Of 100 of the highest PD-prevalent countries, 85 responded and were represented in the findings. A total of 1125 PD clinicians (448 nephrologists, 558 nephrology nurses, 59 dietitians, and 56 others) responded from 61% high-income, 32% upper middle-income and 7% lower middle-income countries. The majority (n = 1054, 94%) agreed that structured exercise programs would be beneficial for people receiving PD. Most respondents believed people on PD could perform more exercise (n = 907, 81%) and that abdominal strengthening exercises could be safely performed (n = 661, 59%). Compared to clinicians in high-income countries, clinicians from lower middle-income status (odds ratio [OR], 5.57; 1.64 to 18.9) are more likely to promote participation in physical activity. Conclusion Clinicians know the importance of physical activity in people receiving PD. Exercise counseling and structured exercise plans could be included in the standard care of people receiving PD to maintain independence.
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Affiliation(s)
- Paul N. Bennett
- School of Nursing and Midwifery, Menzies Health Institute Queensland, Griffith University, Queensland, Australia
- Satellite Healthcare, USA
| | - Clara Bohm
- Chronic Disease Innovation Center, Manitoba, Canada
- Medicine/Nephrology, University of Manitoba, Manitoba, Canada
| | | | - Talerngsak Kanjanabuch
- Division of Nephrology and Center of Excellence in Kidney Metabolic Disorders, Faculty of Medicine, Chulalongkorn University, Thailand
| | - Ana Elizabeth Figueiredo
- Graduate Program in Medicine and Health Sciences, Pontifícia Universidade Católica do Rio Grande do Sul Escola de Ciências da Saúde e da Vida, Brazil
| | - Oksana Harasemiw
- Chronic Disease Innovation Center, Manitoba, Canada
- Medicine/Nephrology, University of Manitoba, Manitoba, Canada
| | - Leanne Brown
- Queensland University of Technology, Queensland, Australia
| | - Iwona Gabrys
- Alberta Kidney Care North, Alberta Health Services, Alberta, Canada
| | - Dev Jegatheesan
- The University of Queensland, Queensland, Australia
- Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Kelly Lambert
- University of Wollongong, Wollongong, New South Wales, Australia
| | - Courtney J. Lightfoot
- Department of Health Sciences, College of Medicine, Biological Sciences and Psychology, University of Leicester, UK
| | | | | | | | - Brett Tarca
- Alliance for Research in Exercise, Nutrition and Activity, University of South Australia, South Australia, Australia
| | - Nancy Verdin
- The Global Renal Exercise Network Patient Engagement Council, Canada
| | | | - Mike West
- University of California Davis, California, USA
| | | | | | - Emilie Ford
- Chronic Disease Innovation Center, Manitoba, Canada
- Medicine/Nephrology, University of Manitoba, Manitoba, Canada
| | - Heitor S. Ribeiro
- Research Center in Sports Sciences, Health Sciences and Human Development, University of Maia, Portugal
- University Center ICESP, Brazil
| | - Qunyan Xu
- Clinical and Health Sciences, University of South Australia, South Australia, Australia
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8
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Hull W, Jewell E, Shabir S, Borrows R. Nephrophobia: a retrospective study of medical students' attitudes towards nephrology education. BMC MEDICAL EDUCATION 2022; 22:667. [PMID: 36085042 PMCID: PMC9461189 DOI: 10.1186/s12909-022-03713-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Accepted: 03/28/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Nephrology is a subject which is challenged by a lack of applicants for trainee places. This study addresses the attitudes of medical students towards the subject and explores the causes of this lack of interest amongst potential specialty trainees. METHODS Students were asked to complete a survey ranking their attitudes towards nephrology and other specialties. This data was collated and analysed to show trends and allow comparison of the attitudes towards each specialty. RESULTS Students felt that along with geriatrics, their least favourite subject was nephrology. Students felt unconfident in diagnosing, managing and understanding chronic conditions more so than acute conditions. Nephrology was consistently amongst the least popular subject for all areas of diagnosis, management and pathophysiology. Renal anatomy was the only area of nephrology that students felt confident in. The less popular specialties of nephrology and geriatrics had the greatest room for improvement when directly instructed in specialty medical training. CONCLUSIONS Nephrology remains a problematic and unpopular specialty for medical students, driving their unwillingness to consider it as a future career route. This study identifies areas of misconception amongst medical students toward the specialty and highlights areas for improvement in renal training for students.
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Affiliation(s)
- William Hull
- Department of Renal Medicine Queen, Elizabeth Hospital Birmingham, Mindelsohn Way, Birmingham, B15 2TH, UK.
- University of Birmingham Medical School, Vincent Drive, Birmingham, B15 2TT, UK.
- North Middlesex University Hospitals, Sterling Way, London, N18 1QX, UK.
| | - Emilia Jewell
- University of Birmingham Medical School, Vincent Drive, Birmingham, B15 2TT, UK
| | - Shazia Shabir
- Department of Renal Medicine Queen, Elizabeth Hospital Birmingham, Mindelsohn Way, Birmingham, B15 2TH, UK
| | - Richard Borrows
- Department of Renal Medicine Queen, Elizabeth Hospital Birmingham, Mindelsohn Way, Birmingham, B15 2TH, UK
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9
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Graham-Brown MP, Beckwith HK, O'Hare S, Trewartha D, Burns A, Carr S. Impact of changing medical workforce demographics in renal medicine over 7 years: Analysis of GMC national trainee survey data. Clin Med (Lond) 2022; 21:e363-e370. [PMID: 35192479 DOI: 10.7861/clinmed.2020-1065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Increasing numbers of doctors in training are taking career breaks, with burnout cited as a potential cause. This study analysed General Medical Council (GMC) national training survey data (renal medicine) to understand the impacts of changing workforce demographics on trainee outcomes and wellbeing. Increasing proportions of female, Black, Asian and minority ethnic (BAME), and international medical graduates are entering the workforce. Specialty exam pass rates have fallen and are lower for BAME and international medical graduates in renal medicine. Time to complete higher specialty training has increased for female trainees. Self-reported burnout rates for renal trainees were higher than other medical specialties and highest for male BAME trainees. Burnout was only partially mitigated by less-than-full-time working, but had no impact on progression, sick-leave or time out of training. It is important to recognise changes to the workforce and proactively plan to effectively support a more diverse group of trainees, to enable them to succeed and reduce differential attainment.
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Affiliation(s)
- Matthew Pm Graham-Brown
- University of Leicester, Leicester, UK, Glenfield Hospital, Leicester, UK, and University Hospitals of Leicester NHS Trust, Leicester, UK
| | | | | | | | - Aine Burns
- University College London, London, UK and Royal Free Hospital, London, UK
| | - Sue Carr
- University Hospitals of Leicester NHS Trust, Leicester, UK and General Medical Council, London, UK
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10
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Prasad C, Sanger S, Chanchlani R, Kirpalani A, Noone D. Engaging medical students and residents in nephrology education: an updated scoping review. J Nephrol 2021; 35:3-32. [PMID: 34351594 DOI: 10.1007/s40620-021-01135-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Accepted: 07/24/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND There is global recognition that interest in nephrology among pediatric and adult trainees is waning, while the burden of kidney disease continues to wax. There is a growing need to engage trainees in nephrology education. The objective of this study was to systematically review the literature on nephrology education for medical students and residents published in the last six years, collate the findings, and extract major themes in order to better define the gaps in this field. METHODS A systematic literature search was conducted on four major academic search engines including MEDLINE (OvidSP), ERIC, EMBASE and Web of Science until October 22, 2020, retrieving a total of 2,694 studies. Forty studies published after September 2014 met the inclusion and exclusion criteria. These studies were analyzed based on study focus, type of study design, and outcomes. RESULTS The studies fell into three main areas of focus: (a) factors that influence interest in nephrology careers (b) current gaps in nephrology knowledge and (c) innovative educational strategies. Barriers to engaging learners in nephrology include a lack of exposure, lack of mentorship, and perceived complexity of nephrology. Baseline awareness is deficient in the management of chronic kidney disease and acute kidney injury. Applying active learning strategies may reduce the perceived barriers to understanding nephrology. CONCLUSION The importance of engaging the future nephrology workforce is well-recognized. Nephrologist educators should focus their efforts in studying curriculum interventions and their impact not only on learner satisfaction, but also future behavior, career choices, and patient outcomes.
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Affiliation(s)
- Charushree Prasad
- Division of Nephrology, Department of Pediatrics, McMaster University, Hamilton, ON, Canada.
| | | | - Rahul Chanchlani
- Division of Nephrology, Department of Pediatrics, McMaster University, Hamilton, ON, Canada
| | - Amrit Kirpalani
- Division of Nephrology, Department of Pediatrics, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Damien Noone
- Division of Nephrology, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
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11
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Nakhoul GN, Mehdi A, Taliercio JJ, Arrigain S, Schold JD, Spencer A, Greenfield J, Diwakar A, Snyder G, O'Toole J, Nally JV, Sedor JR, Kao PF, Bierer SB. "What do you think about nephrology?" A national survey of internal medicine residents. BMC Nephrol 2021; 22:190. [PMID: 34020598 PMCID: PMC8140430 DOI: 10.1186/s12882-021-02397-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Accepted: 05/07/2021] [Indexed: 11/11/2023] Open
Abstract
Background Interest in nephrology has been declining among internal medicine residents but the reasons behind this observation are not well characterized. Our objective was to evaluate factors influencing residents’ choice of subspecialty. Methods This is a mixed-method QUAL-QUAN design study that used the results of our previously published qualitative analysis on residents’ perception of nephrology to create and pilot a questionnaire of 60 questions. The final questionnaire was distributed to 26 programs across the United States and a total of 1992 residents. We calculated response rates and tabulated participant characteristics and percentage of participant responses. We categorized choice of fellowship into 2 medical categories (Highly Sought After vs. Less Sought After) and fitted a logistic regression model of choosing a highly vs. less sought after fellowship. Results Four hundred fifteen out of 1992 (21%) US residents responded to the survey. Of the 268 residents planning to pursue fellowship training, 67 (25%) selected a less sought after fellowship. Female sex was associated with significantly higher odds of selecting a less sought after fellowship (OR = 2.64, 95% CI: 1.47, 4.74). Major factors deterring residents from pursuing nephrology were perception of inadequate financial compensation, broad scope of clinical practice and complexity of patient population. We observed a decline in exposure to nephrology during the clinical years of medical school with only 35.4% of respondents rotating in nephrology versus 76.8% in residency. The quality of nephrology education was rated less positively during clinical medical school years (median of 50 on a 0–100 point scale) compared to the pre-clinical years (median 60) and residency (median 75). Conclusion Our study attempts to explain the declining interest in nephrology. Results suggest potential targets for improvement: diversified trainee exposure, sub-specialization of nephrology, and increased involvement of nephrologists in the education of trainees. Supplementary Information The online version contains supplementary material available at 10.1186/s12882-021-02397-9.
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Affiliation(s)
- Georges N Nakhoul
- Department of Hypertension and Nephrology, Glickman Kidney Urological Institute, Cleveland Clinic Foundation, Cleveland, OH, USA. .,Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH, USA.
| | - Ali Mehdi
- Department of Hypertension and Nephrology, Glickman Kidney Urological Institute, Cleveland Clinic Foundation, Cleveland, OH, USA.,Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH, USA
| | - Jonathan J Taliercio
- Department of Hypertension and Nephrology, Glickman Kidney Urological Institute, Cleveland Clinic Foundation, Cleveland, OH, USA.,Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH, USA
| | - Susana Arrigain
- Department of Quantitative Health Sciences, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Jesse D Schold
- Department of Quantitative Health Sciences, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Abby Spencer
- Department of Internal Medicine, Medicine Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | | | - Amit Diwakar
- Department of Internal Medicine, Cleveland Clinic Akron General Hospital, Akron, OH, USA
| | - Grace Snyder
- Department of Internal Medicine, Texas Institute for Graduate Medical Education and Research Hospital, Laredo, OH, USA
| | - John O'Toole
- Department of Hypertension and Nephrology, Glickman Kidney Urological Institute, Cleveland Clinic Foundation, Cleveland, OH, USA.,Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH, USA
| | - Joseph V Nally
- Department of Hypertension and Nephrology, Glickman Kidney Urological Institute, Cleveland Clinic Foundation, Cleveland, OH, USA.,Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH, USA
| | - John R Sedor
- Department of Hypertension and Nephrology, Glickman Kidney Urological Institute, Cleveland Clinic Foundation, Cleveland, OH, USA.,Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH, USA
| | - Patricia F Kao
- Department of Nephrology, Washington University in Saint Louis, Saint Louis, MO, USA
| | - S Beth Bierer
- Department of Internal Medicine, Medicine Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
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12
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Moura-Neto JA. "To Be, or Not to Be" a Nephrologist: Students' Dilemma and a Strategy for the Field. Blood Purif 2021; 50:696-701. [PMID: 33503624 DOI: 10.1159/000513155] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2020] [Accepted: 11/17/2020] [Indexed: 11/19/2022]
Abstract
The attractiveness of a career in nephrology has diminished over the past decades, leading to global concerns about the future of the specialty's workforce. The reasons physicians choose (and do not choose) a career in the field must be identified in order to boost recruitment of new nephrologists. In this article, a multilevel strategy is proposed to deal with the declining interest in the specialty: (1) increasing contact and providing early exposure to nephrology; (2) promoting mentoring and role models in medical schools; (3) improving the experience of trainees and medical students; (4) incorporating procedural skills and combined fellowship training with critical care in nephrology; (5) facilitating exchanges between trainees and young and senior nephrologists; (6) adopting an active approach to identify reasons for dissatisfaction, reduce burnout, and encourage a suitable work-life balance among nephrologists; (7) increasing remuneration; and (8) incentivizing advances in the field. Finally, a positive perspective for nephrology is presented to the next generation.
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13
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Bandyopadhyay S, Moudgil-Joshi J, Norton EJ, Haq M, Saunders KEA. Motivations, barriers, and social media: a qualitative study of uptake of women into neurosurgery. Br J Neurosurg 2020; 36:19-25. [PMID: 33215936 DOI: 10.1080/02688697.2020.1849555] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To explore how social media could be utilised to influence an individual's motivation to pursue a neurosurgical career, an emerging topic area. The focus of this study was on women interested in neurosurgery. SUMMARY BACKGROUND DATA Women are significantly under-represented in neurosurgery. 18% of all neurosurgeons - including 8% of consultants - are women. Most previous studies have used quantitative methods that are not best suited to gaining an in-depth understanding of the barriers that women face in pursuing a career in neurosurgery, or what would enable more women to go into the speciality. METHODS In this qualitative study, individual semi-structured interviews were conducted until data saturation was achieved. Participants were women pre-neurosurgical trainees. The interview data was examined through a thematic analysis involving open and axial coding. RESULTS Thirty women participated in the study. Four overarching themes were identified: (1) mentorship, (2) testimony from other women doing neurosurgery, (3) social media as a means of increasing interest in neurosurgery as a career choice, and (4) real-life exposure to the speciality. CONCLUSION There is scope to further improve uptake of women into neurosurgical training in the UK. Motivations and barriers to women pursuing neurosurgery should be addressed openly through early experience, role models and mentorship. Social media can help facilitate these opportunities, disseminate information and inspiration, and has the potential to undo societal biases.
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Affiliation(s)
- Soham Bandyopadhyay
- Oxford University Global Surgery Group, Nuffield Department of Surgical Sciences, Medical Sciences Division, University of Oxford, Oxford, UK
| | | | - Emma Jane Norton
- West Suffolk NHS Foundation Trust, Bury St Edmunds, UK.,Division of Anaesthesia, University of Cambridge, Addenbrooke's Hospital, Cambridge, UK
| | - Makinah Haq
- GKT School of Medical Education, King's College London, London, UK
| | - Kate E A Saunders
- Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, UK
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Hassen M, Archer E, Pellizzon A, Chikte UME, Davids MR. Human resources for nephrology in South Africa: A mixed-methods study. PLoS One 2020; 15:e0228890. [PMID: 32053647 PMCID: PMC7018074 DOI: 10.1371/journal.pone.0228890] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Accepted: 01/24/2020] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION The global nephrology workforce is shrinking and, in many countries, is unable to meet healthcare needs. Accurate data pertaining to human resources in nephrology in South Africa is lacking. This data is critical for the planning and delivery of renal services and the training of nephrologists in South Africa to meet the challenge of the growing burden of chronic kidney disease. METHODS A cross-sectional study of adult and paediatric nephrologists currently delivering nephrology services in South Africa was conducted. Participants were identified using various data sources, including the register of the Health Professions Council of South Africa. This cohort of doctors was described in terms of their demographics and distribution. A survey was then conducted among these nephrologists to collect additional information on their training, scope of practice, job satisfaction, challenges and future plans. Finally, two focus group interviews were conducted to probe themes identified from the survey data. RESULTS A total of 120 adult nephrologists and 22 paediatric nephrologists were identified (an overall density of 2.5 per million population). There is a male predominance (66%) and the median age is 45 years. The bulk of the workforce (128 nephrologists, 92%) is distributed in three of the nine South African provinces, and two provinces have no nephrologist at all. The survey was completed by 57% of the nephrologists. Most reported positive attitudes to their chosen profession; however, 35 nephrologists (43%) reported an excessive workload, 9 (11%) were planning emigration and 15 (19%) were planning early retirement. A higher frequency of dissatisfaction regarding remuneration (39% vs. 15%) and unsatisfactory work conditions (35% vs. 13%) was observed amongst nephrologists working in the public sector compared to the private sector. A total of 13 nephrologists participated in the focus group interviews. The themes which were identified included that of a rewarding profession, an overall shortage of nephrologists, poor career planning, a need for changes to nephrologists' training, excessive workloads with inadequate remuneration, and challenging work environments. CONCLUSION There are insufficient numbers of nephrologists in South Africa, with a markedly uneven distribution amongst the provinces and healthcare sectors. Qualitative data indicate that South African nephrologists are faced with the challenges of a high workload, obstructive policies and unsatisfactory remuneration. In the public sector, a chronic lack of nephrologist posts and other resources are additional challenges. A substantial proportion of the workforce is contemplating emigration.
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Affiliation(s)
- Muhammed Hassen
- Division of Nephrology, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa
| | - Elize Archer
- Centre for Health Professions Education, Stellenbosch University, Stellenbosch, South Africa
| | - Adriano Pellizzon
- Division of Nephrology, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa
| | - Usuf M. E. Chikte
- Division of Health Systems and Public Health, Department of Global Health, Stellenbosch University, Stellenbosch, South Africa
| | - Mogamat Razeen Davids
- Division of Nephrology, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa
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