Sharing innovations to enhance renal fellow education in dialysis

Great nephrologists begin with great teachers: update on the nephrology curriculum

PURPOSE OF REVIEW

The purpose of this review is to highlight developments and opportunities in the nephrology curriculum from the basic science foundation years through teaching medical students, residents and fellows in the clinical realm.

RECENT FINDINGS

Teaching skills are a vital tool for nephrologists both to promote excellent patient care and attract talented learners to the field. Exposure to dynamic and inspiring nephrologists is one of the main factors given by students and residents for selecting a career in nephrology. Nephrology teaching, including case discussions, problem-based learning, team-based learning and flipped classrooms, provides motivating active learning for medical students and is equally effective for didactics in graduate medical education. Avenues for teaching in the clinical realm include the microskills framework, bedside teaching and grounding in evidence-based medicine. Areas of growth include blended nephrology/subspecialty fields as well as social media applications.

SUMMARY

Medical education is a satisfying and exciting area of growth in the field of nephrology. The recent literature provides a framework for best practices in active learning as well as providing numerous examples of educational interventions and innovations. In addition, this field is ripe for further development and scholarly activity.

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.