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Rubin M, Lecker SH, Ramkumar N, Sozio SM, Hoover RS, Zeidel ML, Ko BS. American Society of Nephrology Kidney Tutored Research and Education for Kidney Scholars (TREKS) Program: A 10-Year Interim Analysis. J Am Soc Nephrol 2024; 35:00001751-990000000-00294. [PMID: 38652562 PMCID: PMC11387023 DOI: 10.1681/asn.0000000000000384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2024] [Accepted: 04/16/2024] [Indexed: 04/25/2024] Open
Abstract
In response to decreasing numbers of individuals entering into nephrology fellowships, the American Society of Nephrology launched Kidney Tutored Research and Education for Kidney Scholars (TREKS) to stimulate interest in nephrology among medical students, graduate students, and postdoctoral fellows. The program combines a 1-week intensive exposure to kidney physiology with a longitudinal mentorship program at the participants' home institutions. Ten years in, an analysis was conducted to assess its effectiveness. We surveyed participants to assess their opinions regarding nephrology before and after the course and followed them longitudinally to determine their career choices. TREKS applicants who were not selected to participate were used as a comparison group. Three hundred eighty-one people participated in the program, and 242 completed the survey. After TREKS, both medical students and graduate students showed increased interest in nephrology, with rank scores of 5.6±0.2 before to 7.5±0.1 after the course for medical students (mean±SD, n =189, P = 0.001) and 7.3±0.3 to 8.7±0.3 ( n =53, P = 0.001) for graduate students. In long-term follow-up, TREKS medical students chose a nephrology pipeline residency at a higher rate than medical students overall (57% versus 31%, P = 0.01) and TREKS applicants who did not participate (47% versus 31%, P = 0.04). Nephrology fellowship rates for these groups exceeded the general population but did not significantly differ between TREKS participants and applicants. Doctor of Philosophy students and postdoctoral TREKS participants had a higher rate of participation in nephrology research compared with TREKS applicants (66% versus 30%, P = 0.01). In summary, the American Society of Nephrology Kidney TREKS program has demonstrated that it can increase interest in nephrology in the short term and increase the number of individuals going into nephrology careers. This long-term effect is most evident in Doctor of Philosophy students and postdoctoral participants. Further study is needed to assess the impact of TREKS on enrollment in nephrology fellowship programs.
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Affiliation(s)
- Molly Rubin
- ASN Alliance for Kidney Health, Washington, DC
| | - Stewart H Lecker
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Nirupama Ramkumar
- Division of Nephrology and Hypertension, Department of Internal Medicine, University of Utah Health, Salt Lake City, Utah
| | - Stephen M Sozio
- Division of Nephrology, Department of Medicine, Department of Epidemiology, Johns Hopkins School of Medicine, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Robert S Hoover
- Section of Nephrology and Hypertension, Deming Department of Medicine, Tulane University, New Orleans, Louisiana
| | - Mark L Zeidel
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Benjamin S Ko
- Department of Medicine, University of Chicago School of Medicine, Chicago, Illinois
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Perrotta AM, Rotondi S, Amicone M, Cirella I, Siligato R, Fontana S, Sivo C, Vestri AR, Gambaro G, Piccoli GB, Mazzaferro S. Residents' satisfaction and suggestions to improve nephrology residency in Italy, and comparison with the organization in other European countries. J Nephrol 2024; 37:611-623. [PMID: 38492168 DOI: 10.1007/s40620-024-01901-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Accepted: 01/15/2024] [Indexed: 03/18/2024]
Abstract
BACKGROUND In Italy, nephrology residency is available in twenty-one nephrology schools, each with its own strengths and weaknesses. The present study is aimed at exploring the residents' satisfaction with their training programs. METHODS Between April 20th and May 19th, 2021, a questionnaire on residency satisfaction consisting of 49 items was sent to 586 residents and 175 recently certified specialists (qualified to practice as nephrologists in 2019 and 2020), with a response rate of 81% and 51%, respectively. The teaching organization was contextualized with a survey involving 13 European nephrology schools. RESULTS Most residency fellowship programs received a good rating with regard to "satisfaction", in particular for the following items: number of hospitalizations followed-up, chronic hemodialysis training, follow-up of transplanted patients, diagnosis and treatment of glomerulonephritis. The teachings that were identified as being of lower quality or insufficient intensity included vascular access management, ultrasound diagnostics and renal nutrition. The need for improvement in formal teaching programs was underlined. Young nephrologists were rather satisfied with their salary and with the quality of the work they were doing, but only few were interested in an academic career since it was generally held that it is "too difficult" to obtain a university position. Many young nephrologists who filled in the questionnaire felt that lack of experience in peritoneal dialysis and vascular access management was a barrier to finding an ideal job. Compared to other European training programs, the Italian program differs with regard to longer exposure to nephrology (as compared to internal medicine), and greater flexibility for internships in different settings, including abroad. CONCLUSIONS This first nationwide survey on the satisfaction of residents in nephrology indicates that, despite rather good overall satisfaction, there is room for improvement to make nephrology a more appealing choice and to fulfill the needs of a growing number of renal disease patients.
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Affiliation(s)
- Adolfo Marco Perrotta
- Department of Translational and Precision Medicine, Nephrology Unit, Sapienza University of Rome, 00185, Rome, Italy
| | - Silverio Rotondi
- Department of Translational and Precision Medicine, Nephrology Unit, Sapienza University of Rome, 00185, Rome, Italy
| | - Maria Amicone
- Department of Public Health, "Federico II" University of Naples, 80131, Naples, Italy
| | - Irene Cirella
- Department of Medicine, Nephrology, Dialysis and Transplantation Unit, University of Padova, 35128, Padova, Italy
| | - Rossella Siligato
- Department of Clinical and Experimental Medicine, Unit of Nephrology and Dialysis, University of Messina, 98125, Messina, Italy
| | - Simone Fontana
- Nephrology and Dialysis Unit, San Raffaele Hospital, Vita Salute University, 20158, Milan, Italy
| | - Carmen Sivo
- Department of Emergency and Organ Transplantation, Section of Nephrology, University of Bari, 70121, Bari, Italy
| | - Anna Rita Vestri
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00161, Rome, Italy
| | - Giovanni Gambaro
- Department of Medicine, University of Verona, 37100, Verona, Italy
| | | | - Sandro Mazzaferro
- Department of Translational and Precision Medicine, Nephrology Unit, Sapienza University of Rome, 00185, Rome, Italy.
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William JH, Dad T, Hilburg RE, Jain K, Husain SA. Engaging Trainees by Enriching Nephrology Elective Experiences. Clin J Am Soc Nephrol 2022; 17:1073-1075. [PMID: 35318268 PMCID: PMC9269637 DOI: 10.2215/cjn.00070122] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Jeffrey H. William
- Division of Nephrology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts
| | - Taimur Dad
- Division of Nephrology, Tufts Medical Center, Boston, Massachusetts
| | - Rachel E. Hilburg
- Department of Medicine, Division of Nephrology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Koyal Jain
- University of North Carolina Kidney Center, Division of Nephrology and Hypertension, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - S. Ali Husain
- Division of Nephrology, Department of Medicine, Columbia University Medical Center, New York, New York
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Ashoor I, Weidemann D, Elenberg E, Halbach S, Harshman L, Kula A, Mahan JD, Nada A, Quiroga A, Mahon AR, Smith J, Somers M, Brophy PD. The Pediatric Nephrology Workforce Crisis: A Call to Action. J Pediatr 2021; 239:5-10.e4. [PMID: 33798511 DOI: 10.1016/j.jpeds.2021.03.033] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 03/18/2021] [Indexed: 12/21/2022]
Affiliation(s)
- Isa Ashoor
- Department of Pediatrics, LSU Health School of Medicine, New Orleans, LA
| | - Darcy Weidemann
- Department of Pediatrics, University of Missouri Kansas City School of Medicine, Kansas City, MO.
| | - Ewa Elenberg
- Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston, TX
| | - Susan Halbach
- Department of Pediatrics, University of Washington School of Medicine, Seattle, WA
| | - Lyndsay Harshman
- Department of Pediatrics, University of Iowa Stead Family Department of Pediatrics, Iowa City, IA
| | - Alexander Kula
- Department of Pediatrics, University of Washington School of Medicine, Seattle, WA
| | - John D Mahan
- Department of Pediatrics, The Ohio State University School of Medicine, Columbus, OH
| | - Arwa Nada
- Department of Pediatrics, Le Bonheur Children's Hospital, University of Tennessee Health Science Center, Memphis, TN
| | - Alejandro Quiroga
- Department of Pediatrics, Helen DeVos Children's Hospital, Grand Rapids, MI
| | | | - Jodi Smith
- Department of Pediatrics, University of Washington School of Medicine, Seattle, WA
| | - Michael Somers
- Department of Pediatrics, Harvard Medical School and Boston Children's Hospital, Boston, MA
| | - Patrick D Brophy
- Department of Pediatrics, University of Rochester School of Medicine, Rochester, NY
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Affiliation(s)
- Mark G. Parker
- Division of Nephrology and Transplantation, Department of Medicine, Maine Medical Center, Portland, Maine,Department of Quality and Safety, Maine Medical Center, Portland, Maine,Tufts University School of Medicine, Boston, Massachusetts
| | - Stephen M. Sozio
- Division of Nephrology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland,Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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Addressing the nephrology workforce shortage via a novel undergraduate pipeline program: the Kidney Disease Screening and Awareness Program (KDSAP) at 10 years. Kidney Int 2021; 100:1174-1178. [PMID: 34678335 DOI: 10.1016/j.kint.2021.10.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 09/28/2021] [Accepted: 10/06/2021] [Indexed: 11/21/2022]
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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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Plotkin JB, Xu EJ, Fine DM, Knicely DH, Sperati CJ, Sozio SM. A Night Float System in Nephrology Fellowship: A Mixed Methods Evaluation. KIDNEY360 2020; 1:631-639. [PMID: 35372934 PMCID: PMC8815554 DOI: 10.34067/kid.0001572020] [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: 03/25/2020] [Accepted: 05/06/2020] [Indexed: 06/14/2023]
Abstract
BACKGROUND Johns Hopkins was an early adopter of an in-house nephrology fellowship night float to improve work-life balance. Our study aimed to elucidate attitudes to guide fellowship structuring. METHODS We performed a mixed-methods study surveying Johns Hopkins fellows, alumni, and faculty and conducting one focus group of current fellows. Surveys were developed through literature review, queried on a five-point Likert scale, and analyzed with t and ANOVA tests. The focus group transcript was analyzed by two independent reviewers. RESULTS Survey response rates were 14 (100%) fellows, 32 (91%) alumni, and 17 (94%) faculty. All groups felt quality of patient care was good to excellent with no significant differences among groups (range of means [SD], 4.1 [0.7]-4.6 [0.7]; P=0.12), although fellows had a statistically significantly more positive view than faculty on autonomy (4.6 [0.5] versus 4.1 [0.3]; P=0.006). Fellows perceived a positive effect across all domains of night float on the day team experience (range, 4.2 [0.8]-4.6 [0.6]; P<0.001 compared with neutral effect). Focus group themes included patient care, care continuity, professional development, wellness, and structural components. One fellow said, "…my bias is that every program would switch to a night float system if they could." All groups were satisfied with night float with 4.7 [0.5], 4.2 [0.8], and 4.0 [0.9] for fellows, faculty, and alumni, respectively; fellows were most enthusiastic (P=0.03). All three groups preferred night float, and fellows did so unanimously. CONCLUSIONS Night float was well liked and enhanced the perceived daytime fellow experience. Alumni and faculty were positive about night float, although less so, possibly due to concerns for adequate preparation to handle overnight calls after graduation. Night float implementation at other nephrology programs should be considered based on program resources; such changes should be assessed by similar methods.
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Affiliation(s)
- Jennifer B. Plotkin
- Department of Medicine, University of California, Los Angeles, Los Angeles, California
| | - Eric J. Xu
- Division of Nephrology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Derek M. Fine
- Division of Nephrology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Daphne H. Knicely
- Division of Nephrology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - C. John Sperati
- Division of Nephrology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Stephen M. Sozio
- Division of Nephrology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, Maryland
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Shaikh A, Patel N, Nair D, Campbell KN. Current Paradigms and Emerging Opportunities in Nephrology Training. Adv Chronic Kidney Dis 2020; 27:291-296.e1. [PMID: 33131641 DOI: 10.1053/j.ackd.2020.05.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Revised: 05/08/2020] [Accepted: 05/11/2020] [Indexed: 01/16/2023]
Abstract
Nephrology is facing a period of remarkable and unprecedented change. The pipeline of device and therapeutic drug development, the growing success of clinical trials, and the emergence of novel clinical practice and training pathways each hold the promise of transforming patient care. Nephrology is also at the forefront of health policy in the United States, given the recent Advancing American Kidney Health initiative. Despite these developments, significant barriers exist to ensure a robust pipeline of well-qualified nephrologists, including but not limited to trainees' declining trainee interest in the specialty, lower board pass rates, and a perceived erosion in stature of the subspecialty. There is a lack of consensus among training program directors regarding procedural training requirements, the number of fellowship positions needed, and the value of the match. There is widespread agreement, however, that any initiative to reassert the value of nephrology must include significant focus on reinvigorating the trainee experience before and during fellowship. We discuss the current state of education in nephrology (from medical school to beyond fellowship) and highlight ways to increase interest in nephrology to reinvigorate the specialty.
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Rangarajan S, Agarwal A. Current State and Future of Research in Nephrology. Adv Chronic Kidney Dis 2020; 27:305-311.e1. [PMID: 33131643 DOI: 10.1053/j.ackd.2020.05.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2020] [Revised: 05/04/2020] [Accepted: 05/06/2020] [Indexed: 01/17/2023]
Abstract
The focus of this article is to review the available funding opportunities for the nephrology workforce at all career levels and review the current challenges involved in the career of a physician-scientist. While the scarcity of nephrology fellows for training programs is a continuing challenge, increased funding for the National Institutes of Health is encouraging particularly for early career investigators. In addition to National Institutes of Health funding, other funding sources are also discussed as they provide much needed bridge funding during key transition periods for young careers. Recent initiatives such as the Advancing American Kidney Health, KidneyX, and National Institute of Diabetes and Digestive and Kidney Diseases' Kidney Precision Medicine Project offer new research opportunities for bringing much needed innovation to improve lives of people with kidney diseases. The time is now for us to seize the opportunity and ensure that a strong workforce will be able to take advantage of these potential game changers for nephrology.
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Spruance VM, Rankin TL. Reimagining Institutional Research Training: Coordinating a Highly Interactive Community of Young Investigators Prepared to Excel. Clin J Am Soc Nephrol 2020; 15:1361-1363. [PMID: 32245782 PMCID: PMC7480553 DOI: 10.2215/cjn.14741219] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Victoria M Spruance
- Division of Kidney, Urologic, and Hematologic Diseases, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland
| | - Tracy L Rankin
- Division of Kidney, Urologic, and Hematologic Diseases, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland
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12
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Farkas AH, Allenbaugh J, Bonifacino E, Turner R, Corbelli JA. Mentorship of US Medical Students: a Systematic Review. J Gen Intern Med 2019; 34:2602-2609. [PMID: 31485967 PMCID: PMC6848625 DOI: 10.1007/s11606-019-05256-4] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Revised: 02/06/2019] [Accepted: 07/03/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Mentoring of medical students remains a core pillar of medical education, yet the changing landscape of medicine has called for new and innovative mentoring models to guide students in professional development, career placement, and overall student well-being. The objective of this review is to identify and describe models of mentorship for US medical students. METHODS We searched PubMed, PsycINFO, Education Resources Information Center, and Cochrane Databases of Systematic Reviews following PRISMA guidelines. We included original, English-language studies of any research design including descriptive studies that described a mentorship program at a US medical school designed for medical students. RESULTS Our search yielded 3743 unique citations. Thirty articles met our inclusion criteria. There was significant diversity of the identified programs with regard to program objectives and size. The traditional dyad model of mentorship was the most frequently cited model, with a combination of models (dyad and group mentorship) cited as the second most common. Outcome measures of the programs were largely survey based, with satisfaction being the most measured outcome. Overall, satisfaction was highly rated throughout all the measured mentoring programs. Seven programs provided objective outcomes measures, including improved residency match data and increased scholarly productivity. The programs with objective outcomes measures were smaller, and 6/7 of them focused on a specific clinical area. Five of these programs relied on the traditional dyad model of mentorship. Cost and faculty time were the most frequently cited barriers to these programs. DISCUSSION Our review demonstrates that mentoring programs for medical students can positively improve medical school satisfaction and career development. These results underscore the need for continued innovative mentoring programs to foster optimal student development in the setting of the increasingly competitive residency match process, growing expectations about student research productivity, and the national focus for overall student wellness.
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Affiliation(s)
- Amy H Farkas
- Division of General Internal Medicine, Medical College of Wisconsin, Milwaukee VA Medical Center, 5000 W National Ave, Milwaukee, WI, 53295, USA.
| | - Jill Allenbaugh
- Division of General Internal Medicine, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA
| | - Eliana Bonifacino
- Division of General Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Rose Turner
- Falk Health Science Library University of Pittsburgh, Pittsburgh, PA, USA
| | - Jennifer A Corbelli
- Division of General Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
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Bayliss GP, Cobb J, Decker B, Hellman R, Vasavada N, Mackelaite L, Shadur C, Ilori T, Ibrahim T, Leight K, Hsiao LL, Molitoris BA, Okusa MD, Parker MG. Kidney Mentoring and Assessment Program for Students: a guide for engaging medical students in nephrology. Clin Kidney J 2019; 12:761-766. [PMID: 31807288 PMCID: PMC6885673 DOI: 10.1093/ckj/sfz108] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Indexed: 12/31/2022] Open
Abstract
Background The American Society of Nephrology's (ASN) Workforce Committee created a unique program called the Kidney Mentoring and Awareness Program for Students to engage medical students in the fight against kidney diseases and interest them in careers in nephrology. Methods The program provided a framework and 2 years of funding to three medical schools to organize and carry out health screenings in underserved areas of their communities as well as a structure for student mentoring by the practicing nephrologists. Results The Workforce Committee identified three medical schools (Emory University, Atlanta, GA; Indiana University, Indianapolis, IN and University of Louisville, Louisville, KY) and engaged faculty at each school to serve as advisors. The ASN committed funding to the groups for 2 years, after which the groups became self-sufficient. Three nephrologists participated in each chapter, building on existing relationships with community groups to identify sites and carry out kidney screening events. Conclusions We report here the experience of those chapters and a blueprint for other schools interested in setting up a similarly structured program to interest students in nephrology while working with community groups to spread awareness of the major underlying causes of kidney disease.
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Affiliation(s)
- George P Bayliss
- Division of Kidney Disease and Hypertension, Rhode Island Hospital, Providence, RI, USA.,Alpert Medical School, Brown University, Providence, RI, USA
| | - Jason Cobb
- Renal Division, Emory University School of Medicine, Atlanta, GA, USA
| | - Brian Decker
- Division of Nephrology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Richard Hellman
- Division of Nephrology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Nina Vasavada
- Division of Nephrology and Hypertension, University of Louisville, Louisville, KY, USA
| | - Lina Mackelaite
- Division of Nephrology and Hypertension, University of Louisville, Louisville, KY, USA
| | | | - Titilayo Ilori
- Renal Division, Emory University School of Medicine, Atlanta, GA, USA.,Division of Nephrology, University of Arizona, Tuscon, AZ, USA
| | - Tod Ibrahim
- American Society of Nephrology, Washington, DC, USA
| | | | - Li-Li Hsiao
- Renal Division, Brigham and Women's Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Bruce A Molitoris
- Division of Nephrology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Mark D Okusa
- Division of Nephrology, University of Virginia, Charlottesville, VA, USA
| | - Mark G Parker
- Division of Nephrology and Transplantation, Maine Medical Center, Portland, ME, USA.,Tufts University School of Medicine, Portland, ME, USA
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14
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Jim B, Yee J. Mentorship in Medicine and Nephrology: More Important Than Ever. Adv Chronic Kidney Dis 2018; 25:514-518. [PMID: 30527551 DOI: 10.1053/j.ackd.2018.07.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Accepted: 07/20/2018] [Indexed: 11/11/2022]
Abstract
Mentorship has always been important in medicine. In fact, one can argue that that is how doctors are trained. Moreover, mentorship has been proven to preserve and elevate those who wish to pursue academic medicine. In nephrology, mentorship has become paramount, as interest in the field has declined during this decade. In this article, we will delineate how mentorship impacts physician careers, describe different types of mentors and their characteristics, and summarize responsibilities of mentors and mentees. We will discuss specific challenges in nephrology and the steps that have been taken to address them via mentorship. We conclude that mentorship is a powerful tool that can help provide an optimistic future for our field.
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Piccoli GB, Breuer C, Cabiddu G, Testa A, Jadeau C, Brunori G. Where Are You Going, Nephrology? Considerations on Models of Care in an Evolving Discipline. J Clin Med 2018; 7:jcm7080199. [PMID: 30081442 PMCID: PMC6111293 DOI: 10.3390/jcm7080199] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Revised: 07/21/2018] [Accepted: 08/01/2018] [Indexed: 12/18/2022] Open
Abstract
Nephrology is a complex discipline, including care of kidney disease, dialysis, and transplantation. While in Europe, about 1:10 individuals is affected by chronic kidney disease (CKD), 1:1000 lives thanks to dialysis or transplantation, whose costs are as high as 2% of all the health care budget. Nephrology has important links with surgery, bioethics, cardiovascular and internal medicine, and is, not surprisingly, in a delicate balance between specialization and comprehensiveness, development and consolidation, cost constraints, and competition with internal medicine and other specialties. This paper proposes an interpretation of the different systems of nephrology care summarising the present choices into three not mutually exclusive main models (“scientific”, “pragmatic”, “holistic”, or “comprehensive”), and hypothesizing an “ideal-utopic” prevention-based fourth one. The so-called scientific model is built around kidney transplantation and care of glomerulonephritis and immunologic diseases, which probably pose the most important challenges in our discipline, but do not mirror the most common clinical problems. Conversely, the pragmatic one is built around dialysis (the most expensive and frequent mode of renal replacement therapy) and pre-dialysis treatment, focusing attention on the most common diseases, the holistic, or comprehensive, model comprehends both, and is integrated by several subspecialties, such as interventional nephrology, obstetric nephrology, and the ideal-utopic one is based upon prevention, and early care of common diseases. Each model has strength and weakness, which are commented to enhance discussion on the crucial issue of the philosophy of care behind its practical organization. Increased reflection and research on models of nephrology care is urgently needed if we wish to rise to the challenge of providing earlier and better care for older and more complex kidney patients with acute and chronic kidney diseases, with reduced budgets.
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Affiliation(s)
- Giorgina Barbara Piccoli
- Department of Clinical and Biological Sciences, University of Torino Italy, 10100 Torino, Italy.
- Nephrologie, Centre Hospitalier Le Mans, 72000 Le Mans, France.
| | - Conrad Breuer
- Direction, Centre Hospitalier Le Mans, 72000 Le Mans, France.
| | | | | | - Christelle Jadeau
- Centre de Recherche Clinique, Centre Hospitalier Le Mans, 72000 Le Mans, France.
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16
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Mullangi S, Sozio SM, Segal P, Menez S, Martire C, Shafi T. Point-of-care ultrasound education to improve care of dialysis patients. Semin Dial 2018; 31:154-162. [PMID: 29314256 PMCID: PMC5839962 DOI: 10.1111/sdi.12664] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Point-of-care ultrasound (POCUS) is rapidly emerging as a bedside diagnostic tool that can enhance physical diagnosis and facilitate clinical decision making. Although ultrasound is widely used by nephrologists for vascular access and kidney imaging, diagnostic POCUS skills in other anatomic areas are not part of routine nephrology training. In this narrative review, we will provide an overview of selected POCUS techniques, highlight potential uses of POCUS in routine nephrology practice, and describe a new curriculum implemented at Johns Hopkins University School of Medicine to teach diagnostic POCUS skills to nephrology fellows.
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Affiliation(s)
- Surekha Mullangi
- Division of Nephrology, Department of Medicine, The Johns Hopkins University, Baltimore, Maryland
| | - Stephen M. Sozio
- Division of Nephrology, Department of Medicine, The Johns Hopkins University, Baltimore, Maryland
- Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Baltimore, Maryland
| | - Paul Segal
- Division of Nephrology, Department of Medicine, The Johns Hopkins University, Baltimore, Maryland
| | - Steven Menez
- Division of Nephrology, Department of Medicine, The Johns Hopkins University, Baltimore, Maryland
| | - Carol Martire
- Division of Nephrology, Department of Medicine, The Johns Hopkins University, Baltimore, Maryland
- Department of Medicine, The Johns Hopkins University, Baltimore, Maryland
| | - Tariq Shafi
- Division of Nephrology, Department of Medicine, The Johns Hopkins University, Baltimore, Maryland
- Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Baltimore, Maryland
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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17
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Affiliation(s)
- Michael J. Ross
- Division of Nephrology, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York
| | - Gregory Braden
- Renal Division, Baystate Medical Center, Springfield, Massachusetts; and
- Tufts University School of Medicine, Boston, Massachusetts
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18
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Gomez AC, Warburton KM, Miller RK, Negoianu D, Cohen JB. An Interactive Ambulatory Nephrology Curriculum for Internal Medicine Interns: Design, Implementation, and Participant Feedback. Am J Kidney Dis 2017; 70:415-421. [PMID: 28579421 DOI: 10.1053/j.ajkd.2017.03.022] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Accepted: 03/25/2017] [Indexed: 01/13/2023]
Abstract
While diminishing nephrology fellow recruitment is a known issue, more work is needed to evaluate possible interventions to reverse this trend. We designed and implemented a curriculum to increase exposure to ambulatory nephrology among internal medicine interns. The curriculum focused on key aspects of outpatient nephrology practice, including supervised clinic visits, formal themed didactic content, and an online interactive forum with assigned evidence-based readings and small-group responses to relevant cases. We obtained postcourse surveys from all participating interns. Of the 43 interns who took part in the first year of the ambulatory nephrology curriculum, 100% reported a positive didactic experience and 91% reported a positive interactive online experience. 77% reported an improvement in their familiarity with clinical nephrology practice (median 2-point increase in familiarity score on a 7-point scale, P<0.001 by signed rank testing). Qualitative feedback included praise for the high-yield topics covered by the lectures and energizing teachers. In conclusion, we successfully implemented an ambulatory nephrology curriculum using a framework that integrated formal didactics, interactive online learning, and key clinical components of outpatient nephrology care. Future investigation will evaluate whether early implementation of this curriculum is associated with increased pursuit of nephrology as a career.
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Affiliation(s)
- Alexis C Gomez
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | | | - Rachel K Miller
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA; Geriatrics Division, University of Pennsylvania, Philadelphia, PA
| | - Dan Negoianu
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA; Renal-Electrolyte and Hypertension Division, University of Pennsylvania, Philadelphia, PA
| | - Jordana B Cohen
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA; Renal-Electrolyte and Hypertension Division, University of Pennsylvania, Philadelphia, PA.
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19
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Rope RW, Pivert KA, Parker MG, Sozio SM, Merell SB. Education in Nephrology Fellowship: A Survey-Based Needs Assessment. J Am Soc Nephrol 2017; 28:1983-1990. [PMID: 28428332 DOI: 10.1681/asn.2016101061] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Educational needs assessments for nephrology fellowship training are limited. This study assessed fellows' perceptions of current educational needs and interest in novel modalities that may improve their educational experience and quantified educational resources used by programs and fellows. We distributed a seven-question electronic survey to all United States-based fellows receiving complimentary American Society of Nephrology (ASN) membership at the end of the 2015-2016 academic year in conjunction with the ASN Nephrology Fellows Survey. One third (320 of 863; 37%) of fellows in Accreditation Council for Graduate Medical Education-accredited positions responded. Most respondents rated overall quality of teaching in fellowship as either "good" (37%) or "excellent" (44%), and most (55%) second-year fellows felt "fully prepared" for independent practice. Common educational resources used by fellows included UpToDate, Journal of the American Society of Nephrology/Clinical Journal of the American Society of Nephrology, and Nephrology Self-Assessment Program; others-including ASN's online curricula-were used less often. Fellows indicated interest in additional instruction in several core topics, including home dialysis modalities, ultrasonography, and pathology. Respondents strongly supported interventions to improve pathology instruction and increase time for physiology and clinical review. In conclusion, current nephrology fellows perceive several gaps in training. Innovation in education and training is needed to better prepare future nephrologists for the growing challenges of kidney care.
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Affiliation(s)
- Robert W Rope
- Division of Nephrology, Stanford University School of Medicine, Stanford, California;
| | | | - Mark G Parker
- Division of Nephrology, Maine Medical Center and Tufts University School of Medicine, Portland, Maine
| | - Stephen M Sozio
- Division of Nephrology and.,Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University School of Medicine, Baltimore, Maryland; and
| | - Sylvia Bereknyei Merell
- Division of General Medical Disciplines, Stanford University School of Medicine, Stanford, California
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