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Wu J, Ke Y, Chen Z, Alhendi MA, Zhu L, Ma K. Online-to-offline combined with problem-based learning is an effective teaching modality in the standardized residency training of nephrology. BMC MEDICAL EDUCATION 2024; 24:712. [PMID: 38956620 PMCID: PMC11221083 DOI: 10.1186/s12909-024-05675-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/11/2023] [Accepted: 06/19/2024] [Indexed: 07/04/2024]
Abstract
BACKGROUND The online-to-offline (O2O) teaching method is recognized as a new educational model that integrates network learning into offline classroom education, while problem-based learning (PBL) is a teaching modality that guides students to apply acquired theoretical knowledge to solve practical problems. However, implementing O2O combined with PBL has not been extensively explored in nephrology residency training. This study aims to explore the efficacy of O2O combined with PBL in the standardized residency training of nephrology by comparing it with the traditional lecture-based teaching (LBT). METHODS Sixty residency trainees who participated in the standardized training of internal medicine in the nephrology department of the Second Affiliated Hospital of Zhejiang University School of Medicine were equally allocated into O2O combined with PBL (O2O/PBL) or the LBT group demographically matched. Examinations of theory, practice skills, clinical thinking and teaching satisfaction surveys were utilized to assess the teaching effects of the two groups. RESULTS Participants from the O2O/PBL group outperformed those from the LBT group in the examination of theory (81.233 ± 9.156 vs. 75.800 ± 7.009, mean ± SEM), practice skills (104.433 ± 3.569 vs.100.316 ± 4.628, mean ± SEM) and clinical thinking (88.933 ± 4.473 vs. 86.667 ± 3.844, mean ± SEM). There was no significant difference in the teaching satisfaction between the two groups. CONCLUSION The current study shows the positive impact of O2O combined with PBL approach on standardized residency training in nephrology without reducing teaching satisfaction.
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Affiliation(s)
- Junxia Wu
- Department of Nephrology, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, 310009, Zhejiang, PR, China
| | - You Ke
- Department of Nephrology, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, 310009, Zhejiang, PR, China
| | - Zhida Chen
- Department of Nephrology, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, 310009, Zhejiang, PR, China
| | - Mhd Alaa Alhendi
- School of Medicine, Zhejiang University, Hangzhou, 310009, Zhejiang, China
| | - Lina Zhu
- Department of Nephrology, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, 310009, Zhejiang, PR, China
| | - Kunling Ma
- Department of Nephrology, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, 310009, Zhejiang, PR, China.
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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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Hu J, Sonnleitner M, Weldon E, Kejriwal S, Brown B, Shah A. An Escape Room to Teach First- and Second-Year Medical Students Nephrology. MEDICAL SCIENCE EDUCATOR 2024; 34:71-76. [PMID: 38510392 PMCID: PMC10948694 DOI: 10.1007/s40670-023-01917-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/04/2023] [Indexed: 03/22/2024]
Abstract
An escape room is a team-based activity that requires players to solve a series of puzzles to complete a story and "break out" of a room. It has recently gained traction in medical education for its ability to interactively and effectively present learning objectives. This was a prospective educational study that describes the successful application of a nephrology themed escape room for first- and second-year medical students. Compared to pre-escape room participation, the 52 students demonstrated a statistically significant improvement in self-reported knowledge for renal physiology (p < 0.01), pharmacology (p < 0.01), pathology (p < 0.01), and relevant clinical practice guidelines (p < 0.01). A majority of the students also claimed that the escape room was "more effective" than traditional lectures (80.8%) and textbooks (73.1%) and "equally effective" as third-party board preparation resources (69.2%) and their institution's problem-based learning curriculum (51.9%). The escape room also facilitated a high-level peer-to-peer collaboration with 82.7% and 76.9% of students reporting that they worked with someone in their year and outside of their year for at least half of the game, respectively. Ninety-five percent of the first-years and 84.6% of the second-years believed that the escape room was effective at preparing them for their respective exams, and an overwhelming majority (90.4%) described the escape room as "very enjoyable." Overall, this nephrology themed escape room was an engaging and well received educational modality and may be an effective supplemental study resource for medical students. Further studies are needed to assess knowledge acquisition. Supplementary Information The online version contains supplementary material available at 10.1007/s40670-023-01917-6.
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Affiliation(s)
- Jonathan Hu
- University of Hawaii, John A. Burns School of Medicine, Honolulu, HI USA
| | | | - Edward Weldon
- University of Hawaii, John A. Burns School of Medicine, Honolulu, HI USA
| | - Sameer Kejriwal
- University of Hawaii, John A. Burns School of Medicine, Honolulu, HI USA
| | - Bryan Brown
- University of Hawaii, John A. Burns School of Medicine, Honolulu, HI USA
- The Queen’s Medical Center, Honolulu, HI USA
| | - Ashish Shah
- San Diego School of Medicine, University of California, San Diego, CA USA
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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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Ali A, Al-Omar D, Lami F, Bhandari S. Perception and satisfaction of nephrology education and training in Iraq. J R Coll Physicians Edinb 2023; 53:13-18. [PMID: 36799506 DOI: 10.1177/14782715231158024] [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] [Indexed: 02/18/2023] Open
Abstract
BACKGROUND Interest in training in nephrology is declining around the world. This is a particularly worrisome issue for future nephrology practice with the aging population and the increasing number of patients with kidney disease. We wished to understand the perception and measure the satisfaction of Iraqi medical interns regarding nephrology and explore factors affecting career decisions towards becoming a specialist nephrologist. METHODS A web-based authors-constructed survey consisting of a Likert-type scale questionnaire to assess perception and satisfaction was used. It comprised multiple-choice yes/no/maybe questions and addressed the willingness to pursue a career in nephrology. Iraqi medical interns in their final 2 years of training, 2021-2022, were assessed. RESULTS One hundred and twenty internal medicine Iraqi fellows participated in the survey (response rate 84.2%). Sixty-eight fellows (74%) described nephrology as a complex science. Acid-base and electrolytes disorders and transplantation were the most challenging topics, followed by glomerular diseases. Twenty-one fellows (23%) were satisfied with the quality of training and nephrology education during their medical school, residency and internship. In addition, 14% stated that they would pursue a future career in nephrology. The most selected barrier (34%) against choosing nephrology was a fellow's perception of the patient's complexity and the potentially futile outcome. CONCLUSION The majority (76%) of Iraqi medical interns are currently not satisfied with nephrology training and education. One in seven would pursue a future career in nephrology. New targeted innovative approaches are urgently needed for the various grades of trainees to highlight the benefits of nephrology as a career.
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Affiliation(s)
- Ala Ali
- Nephrology and Renal Transplantation Centre, The Medical City, Baghdad, Iraq
| | - Dhurgham Al-Omar
- Ibn-Sina Training Hospital, Iraq Ministry of Health, Baghdad, Iraq
| | - Faris Lami
- Department of Epidemiology, College of Medicine, Baghdad University, Baghdad, Iraq
| | - Sunil Bhandari
- Department of Renal Medicine, Hull University Teaching Hospitals NHS Trust and Hull York Medical School, Hull, UK
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Priamvada GS, Kotzen ES, Jain K. Clinician Educator Pathway for Nephrology Fellows: The University of North Carolina Experience. Adv Chronic Kidney Dis 2022; 29:516-519. [PMID: 36371115 DOI: 10.1053/j.ackd.2022.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 03/16/2022] [Accepted: 04/25/2022] [Indexed: 11/11/2022]
Abstract
Nephrologists have a significant role in educating and mentoring trainees. They are considered role models and a major reason for fellows to be attracted to the specialty. Nephrology training programs not only support fellows in their teaching endeavors but also provide them with the necessary knowledge and skills required for advancing their careers as clinician educators. However, such career development tracks are limited in number and most focus on early career faculty. Here we present an overview of the various teaching opportunities for fellows at the University of North Carolina (UNC) Nephrology fellowship program and the development of a fellow-oriented clinician educator track. Our goal as part of the nephrology community is to empower the current nephrology fellows to develop fulfilling careers as nephrology clinician educators.
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Affiliation(s)
- Gargi S Priamvada
- Division of Nephrology and Hypertension, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Elizabeth S Kotzen
- Division of Nephrology and Hypertension, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Koyal Jain
- Division of Nephrology and Hypertension, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC
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Yang F, Lin W, Wang Y. Flipped classroom combined with case-based learning is an effective teaching modality in nephrology clerkship. BMC MEDICAL EDUCATION 2021; 21:276. [PMID: 33990199 PMCID: PMC8122572 DOI: 10.1186/s12909-021-02723-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Accepted: 05/06/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND The flipped classroom (FC) is recognized as an effective teaching approaches by emphasizing on the development of high-order abilities; however, the implementation of FC has not been well explored in nephrology education. The present study aims to investigate the efficacy of FC in teaching nephrology via comparing with the traditional lecture-based teaching (LBT). METHODS Sixty-two medical clerkship students at Zhejiang University School of Medicine were equally allocated into either LBT or FC group demographically matched. The glomerular diseases module was chosen for the teaching content. Students from the FC group were required to study the pre-class materials in annotated PPT format in advance. In the class, case-based learning (CBL) was employed, students encountered the related clinical cases and participated in the face-to -face discussion. Students from the LBT group attended a didactic lecture during the class. Quiz and questionnaires were performed to assess the efficacy of FC versus LBT. RESULTS Participants from the FC group performed better in the quiz than those from the LBT group with higher total scores (78.06 ± 2.515 vs. 65.16 ± 3.209, mean ± SEM), particularly the scores of the case analysis-related questions (35.81 ± 1.657 vs. 27.42 ± 1.910, mean ± SEM). In the survey, more students considered FC beneficial to comprehension, critical thinking, patient management and team work as compared with LBT. Meanwhile, more participants agreed increased in-class pressure in FC than in LBT. CONCLUSIONS This study shows the positive impact of FC combined with CBL approach on nephrology education and provides an alternative pre-class and in-class format for the FC implementation.
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Affiliation(s)
- Fuye Yang
- Department of Nephrology, The Second Affiliated Hospital, Zhejiang University School of Medicine, 31009, Hangzhou, Zhejiang, P.R. China.
| | - Wanbing Lin
- Department of Nephrology, The Second Affiliated Hospital, Zhejiang University School of Medicine, 31009, Hangzhou, Zhejiang, P.R. China
| | - Yan Wang
- College of Life Science, Xinyang Normal University, 464000, Xinyang, Henan, P.R. China
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Beck N, Furgeson S, Chonchol M, Kendrick J. Internal Medicine Residents' Perceptions of Nephrology as a Career: A Focus Group Study. KIDNEY360 2020; 1:1052-1059. [PMID: 35368786 PMCID: PMC8815490 DOI: 10.34067/kid.0003652020] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 08/19/2020] [Indexed: 06/14/2023]
Abstract
BACKGROUND Interest in nephrology as a career has declined dramatically over the past several years. Only 62% of nephrology fellowship positions are filled for the upcoming 2020 appointment year. The purpose of this study was to identify perceptions, attitudes, motivators, and barriers to a career in nephrology among internal medicine residents. METHODS We recruited focus groups of internal medicine residents (N=25) from the University of Colorado, and asked questions aimed at exploring perceptions, attitudes, and barriers to a career in nephrology, and ways to increase interest in nephrology. All focus groups were conducted on the University of Colorado Denver Anschutz Medical Campus. Focus group sessions were recorded and transcribed. Thematic analysis was used to identify key concepts and themes. RESULTS Residents described many barriers to a career in nephrology, including lack of exposure, lack of advances in the field, low monetary compensation, high complexity, lack of role models/mentors, and low-prestige/noncompetitive nature of the field. Most residents had no exposure to outpatient nephrology. Lack of new therapeutics was a significant deterrent to nephrology. Nephrology teaching in medical school was described as not clinically relevant and too complicated. Several residents felt they were not smart enough for nephrology. Only three residents had a role model within nephrology. Residents used the word "stigmatized" to describe nephrology, and discussed how low prestige decreased their interest in a field. Participants expressed suggestions to increase interest in nephrology through earlier and more outpatient nephrology exposure, enhanced interactions with nephrologists, and research and advancements in the field. CONCLUSIONS Residents identified several modifiable barriers to a career in nephrology. Changing how nephrology is taught in medical school, enhancing interactions with nephrologists through increased exposure, and highlighting research and advancements in nephrology may change the perception of nephrology and increase the number of residents entering the field.
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Affiliation(s)
- Natalie Beck
- Division of Renal Diseases and Hypertension, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Seth Furgeson
- Division of Renal Diseases and Hypertension, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Michel Chonchol
- Division of Renal Diseases and Hypertension, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Jessica Kendrick
- Division of Renal Diseases and Hypertension, University of Colorado Anschutz Medical Campus, Aurora, Colorado
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Arora T. I Love Nephrology, but Should I Be a Nephrologist? An Early Career Trainee Perspective. Clin J Am Soc Nephrol 2020; 15:1193-1194. [PMID: 32398272 PMCID: PMC7409742 DOI: 10.2215/cjn.01490220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Tanima Arora
- Clinical and Translational Research Accelerator, Yale University School of Medicine, New Haven, Connecticut
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10
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Sanghavi SF, Campbell KN. Careers in Critical Care Nephrology: Opportunities and Challenges. Clin J Am Soc Nephrol 2020; 15:1198-1200. [PMID: 32646914 PMCID: PMC7409749 DOI: 10.2215/cjn.10500919] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Sarah F Sanghavi
- Division of Nephrology, Department of Medicine, Veterans Affairs Puget Sound Health Care System, Seattle, Washington
| | - Kirk N Campbell
- Division of Nephrology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
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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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Agrawal V, Plantinga L, Abdel-Kader K, Pivert K, Provenzano A, Soman S, Choi MJ, Jaar BG. Burnout and Emotional Well-Being among Nephrology Fellows: A National Online Survey. J Am Soc Nephrol 2020; 31:675-685. [PMID: 32123052 DOI: 10.1681/asn.2019070715] [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: 01/07/2023] Open
Abstract
BACKGROUND Physician burnout and emotional distress are associated with work dissatisfaction and provision of suboptimal patient care. Little is known about burnout among nephrology fellows. METHODS Validated items on burnout, depressive symptoms, and well being were included in the American Society of Nephrology annual survey emailed to US nephrology fellows in May to June 2018. Burnout was defined as an affirmative response to two single-item questions of experiencing emotional exhaustion or depersonalization. RESULTS Responses from 347 of 808 eligible first- and second-year adult nephrology fellows were examined (response rate=42.9%). Most fellows were aged 30-34 years (56.8%), male (62.0%), married or partnered (72.6%), international medical graduates (62.5%), and pursuing a clinical nephrology fellowship (87.0%). Emotional exhaustion and depersonalization were reported by 28.0% and 14.4% of the fellows, respectively, with an overall burnout prevalence of 30.0%. Most fellows indicated having strong program leadership (75.2%), positive work-life balance (69.2%), presence of social support (89.3%), and career satisfaction (73.2%); 44.7% reported a disruptive work environment and 35.4% reported depressive symptoms. Multivariable logistic regression revealed a statistically significant association between female gender (odds ratio [OR], 1.90; 95% confidence interval [95% CI], 1.09 to 3.32), poor work-life balance (OR, 3.97; 95% CI, 2.22 to 7.07), or a disruptive work environment (OR, 2.63; 95% CI, 1.48 to 4.66) and burnout. CONCLUSIONS About one third of US nephrology fellows surveyed reported experiencing burnout and depressive symptoms. Further exploration of burnout-especially that reported by female physicians, as well as burnout associated with poor work-life balance or a disruptive work environment-is warranted to develop targeted efforts that may enhance the educational experience and emotional well being of nephrology fellows.
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Affiliation(s)
- Varun Agrawal
- Division of Nephrology and Hypertension, University of Vermont, Burlington, Vermont;
| | | | - Khaled Abdel-Kader
- Division of Nephrology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Kurtis Pivert
- Workforce, Training, and Career Advancement Department, American Society of Nephrology, Washington, DC
| | | | - Sandeep Soman
- Division of Nephrology and Hypertension, Henry Ford Hospital, Detroit, Michigan
| | - Michael J Choi
- Division of Nephrology and Hypertension, Medstar Georgetown University Hospital, Washington, DC
| | - Bernard G Jaar
- Department of Medicine, Division of Nephrology, Johns Hopkins University, Baltimore, Maryland.,Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health Welch Center for Prevention, Epidemiology, and Clinical Research, Baltimore, Maryland; and.,Nephrology Center of Maryland, Baltimore, Maryland
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Nair D, Pivert KA, Baudy A, Thakar CV. Perceptions of nephrology among medical students and internal medicine residents: a national survey among institutions with nephrology exposure. BMC Nephrol 2019; 20:146. [PMID: 31035944 PMCID: PMC6489240 DOI: 10.1186/s12882-019-1289-y] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Accepted: 03/10/2019] [Indexed: 12/28/2022] Open
Abstract
Background Fewer trainees are choosing to pursue nephrology. Only 60.1% of positions filled in the 2018 fellowship Match, which is concerning given the rising prevalence of end-stage kidney disease. Identifying factors influential in career choices is critical to inform focused approaches to recruit qualified applicants. Methods To understand perceptions of nephrology and assess factors influential in specialty choice among early career trainees, an anonymous survey was distributed to upper-level medical students and internal medicine residents at programs identified through the American Association of Medical Colleges (AAMC) and American Medical Association’s Fellowship and Residency Electronic Interactive Database (FREIDA). Results Of 4199 recipients, 644 (15.3%) participants responded, including 315 upper-level medical students, 308 residents, and three chief residents from 30 institutions. An interest in the subject was the most critical factor in selecting a specialty (92%). Other key factors included a suitable work-life balance (73%), access to mentors (70%), and subject exposure (66%). Lack of interest was the most frequently-cited reason to forgo a nephrology fellowship (79%), followed by concerns regarding remuneration (43%), work-life balance (39%), and subject exposure (32%). In free-text responses, several participants described frustration with managing patients on hemodialysis and desired combined training with specialties such as critical care. Respondents who had considered nephrology at any point cited an interest in physiology or interface with a mentor as key driving factors. Conclusions A lack of interest in and exposure to the subject, perceptions of poor earning potential and patient nonadherence, and concerns regarding work-life balance were influential in participants’ decisions to forgo nephrology training. Incorporating novel educational tools and broadening the scope of the nephrology elective, highlighting ongoing areas of clinical and research innovation, expanding opportunities for interdisciplinary collaboration and procedural skills, and cultivating strategies to reduce burnout may be useful areas on which to focus future recruitment efforts. Electronic supplementary material The online version of this article (10.1186/s12882-019-1289-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Devika Nair
- Division of Nephrology and Hypertension, Vanderbilt University Medical Center, 1161 21st Avenue South, Medical Center North S-3223, Nashville, TN, 37232-2372, USA.
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Affiliation(s)
- W Charles O'Neill
- Renal Division, Emory University School of Medicine, Atlanta, Georgia; and
| | - Daniel W Ross
- Division of Kidney Diseases and Hypertension, Donald and Barbara Zucker School of Medicine at Hofstra Northwell, Great Neck, New York
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Yang Y, Li J, Wu X, Wang J, Li W, Zhu Y, Chen C, Lin H. Factors influencing subspecialty choice among medical students: a systematic review and meta-analysis. BMJ Open 2019; 9:e022097. [PMID: 30850399 PMCID: PMC6429728 DOI: 10.1136/bmjopen-2018-022097] [Citation(s) in RCA: 79] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
OBJECTIVE To characterise the contributing factors that affect medical students' subspecialty choice and to estimate the extent of influence of individual factors on the students' decision-making process. DESIGN Systematic review and meta-analysis. METHODS A systematic search of the Cochrane Library, ERIC, Web of Science, CNKI and PubMed databases was conducted for studies published between January 1977 and June 2018. Information concerning study characteristics, influential factors and the extent of their influence (EOI) was extracted independently by two trained investigators. EOI is the percentage level that describes how much each of the factors influenced students' choice of subspecialty. The recruited medical students include students in medical school, internship, residency training and fellowship, who are about to or have just made a specialty choice. The estimates were pooled using a random-effects meta-analysis model due to the between-study heterogeneity. RESULTS Data were extracted from 75 studies (882 209 individuals). Overall, the factors influencing medical students' choice of subspecialty training mainly included academic interests (75.29%), competencies (55.15%), controllable lifestyles or flexible work schedules (53.00%), patient service orientation (50.04%), medical teachers or mentors (46.93%), career opportunities (44.00%), workload or working hours (37.99%), income (34.70%), length of training (32.30%), prestige (31.17%), advice from others (28.24%) and student debt (15.33%), with significant between-study heterogeneity (p<0.0001). Subgroup analyses revealed that the EOI of academic interests was higher in developed countries than that in developing countries (79.66% [95% CI 70.73% to 86.39%] vs 60.41% [95% CI 43.44% to 75.19%]; Q=3.51, p=0.02). The EOI value of prestige was lower in developed countries than that in developing countries (23.96% [95% CI 19.20% to 29.47%] vs 47.65% [95% CI 34.41% to 61.24%]; Q=4.71, p=0.01). CONCLUSIONS This systematic review and meta-analysis provided a quantitative evaluation of the top 12 influencing factors associated with medical students' choice of subspecialty. Our findings provide the basis for the development of specific, effective strategies to optimise the distribution of physicians among different departments by modifying these influencing factors.
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Affiliation(s)
- Yahan Yang
- State Key Laboratory of Ophthalmology, Sun Yat-Sen University Zhongshan Ophthalmic Center, Guangzhou, China
- Zhongshan School of Medicine, Sun Yat-Sen University, Guangzhou, China
| | - Jiawei Li
- Zhongshan School of Mathematics, Sun Yat-Sen University, Guangzhou, China
| | - Xiaohang Wu
- State Key Laboratory of Ophthalmology, Sun Yat-Sen University Zhongshan Ophthalmic Center, Guangzhou, China
| | - Jinghui Wang
- State Key Laboratory of Ophthalmology, Sun Yat-Sen University Zhongshan Ophthalmic Center, Guangzhou, China
| | - Wangting Li
- State Key Laboratory of Ophthalmology, Sun Yat-Sen University Zhongshan Ophthalmic Center, Guangzhou, China
| | - Yi Zhu
- Department of Molecular and Cellular Pharmacology, University of Miami School of Medicine, Miami, Florida, USA
- Cataract, Sun Yat-Sen University Zhongshan Ophthalmic Center, Guangzhou, China
| | - Chuan Chen
- Department of Molecular and Cellular Pharmacology, University of Miami School of Medicine, Miami, Florida, USA
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Haotian Lin
- Cataract, State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
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16
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Affiliation(s)
- Samira Farouk
- Division of Nephrology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Matthew A. Sparks
- Division of Nephrology, Department of Medicine, Duke University Medical Center, Durham, North Carolina; and
- Renal Section, Durham Veterans Affairs Medical Center, Durham, North Carolina
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17
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Beckwith H, Kingsbury M, Horsburgh J. Why do people choose nephrology? Identifying positive motivators to aid recruitment and retention. Clin Kidney J 2018; 11:599-604. [PMID: 30288258 PMCID: PMC6165757 DOI: 10.1093/ckj/sfy076] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Accepted: 07/15/2018] [Indexed: 11/14/2022] Open
Abstract
Increasing concerns about recruitment and retention of junior doctors have led to renewed interest in how and when trainees choose their specialties. To our knowledge, no study has yet reported what attracts UK applicants to nephrology nor how clinicians develop vocational interests or make occupational choices. With this in mind, we sought to explore the motivation behind current nephrologist's career choices in the UK. We interviewed 11 nephrologists using a semi-structured face-to-face approach and used interpretative phenomenological analysis to conduct and analyse the interviews. We found role models were pivotal in encouraging specialization in nephrology, particularly those encountered in early postgraduate training. The diversity, diagnostic challenge and cross-specialty knowledge was highlighted as well as the ability to 'make a difference to patients' lives'. Nephrologists enjoyed the challenge of managing very sick, acutely unwell patients as well as the holistic continuity of long-term care offered to dialysis patients and their families. Academic and procedural components were attractive motivators to the specialty and the flexibility to have multiple interests was noted, with many nephrologists having 'portfolio' careers. Based on these results, we suggest strategies the specialty can use to aid policy decision making, promote recruitment and improve educational experiences within current training programmes.
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Affiliation(s)
- Hannah Beckwith
- Nephrology Registrar, MRC London Institute of Medical Science, Imperial College London, London, UK
- Centre for Higher Education Research and Scholarship, Imperial College London, London, UK
- Renal and Transplant Centre, Imperial College Healthcare NHS Trust, London, UK
| | - Martyn Kingsbury
- Centre for Higher Education Research and Scholarship, Imperial College London, London, UK
| | - Jo Horsburgh
- Centre for Higher Education Research and Scholarship, Imperial College London, London, UK
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Barat A, Goldacre MJ, Lambert TW. Career choices for nephrology and factors influencing them: surveys of UK medical graduates. JRSM Open 2018; 9:2054270418793024. [PMID: 30181891 PMCID: PMC6111404 DOI: 10.1177/2054270418793024] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Objectives To study early and eventual career choices for nephrology among UK medical
graduates and investigate factors which influenced career preferences. Design Self-completed survey questionnaires mailed to medical graduates 1, 3, 5 and
10 years after graduation. Setting United Kingdom. Participants UK medical graduates in 15 year-of-qualification cohorts between 1974 and
2015. Main outcome measures Early career specialty choices, career specialty destinations at 10 years and
ratings of factors affecting career choices. Results Around 0.4%–1.1% of these junior doctors expressed a career preference for
nephrology, varying by year of qualification and years after qualification.
Among all graduates of 1993–2002 combined, 0.4% expressed a career
preference for nephrology 1 year after qualification rising to 1.0% in year
5. Among graduates of 2005–2008, the corresponding figures were 1.0% in year
1 falling to 0.7% in year 5. Only 18% of doctors who chose nephrology in
year 1 eventually became nephrologists. Of doctors who were practising as
nephrologists for 10 years and more after qualification, 74% of the women
and 56% of the men had decided to pursue a career in nephrology by year 5
after qualification. ‘Enthusiasm/commitment’ had a great deal of influence
on those who chose nephrology, for all cohorts and all years studied. Conclusions The most recent data suggest that the proportion of young doctors who sustain
an interest in nephrology through the early postgraduate training years may
be lower than among their predecessors. Efforts are needed to reverse the
declining trend and increase interest in nephrology.
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Affiliation(s)
- Atena Barat
- UK Medical Careers Research Group, Unit of Health-Care Epidemiology, Nuffield Department of Population Health, University of Oxford, Oxford OX3 7LF, UK
| | - Michael J Goldacre
- UK Medical Careers Research Group, Unit of Health-Care Epidemiology, Nuffield Department of Population Health, University of Oxford, Oxford OX3 7LF, UK
| | - Trevor W Lambert
- UK Medical Careers Research Group, Unit of Health-Care Epidemiology, Nuffield Department of Population Health, University of Oxford, Oxford OX3 7LF, UK
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19
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Affiliation(s)
- Mitchell H. Rosner
- Division of Nephrology, University of Virginia Health System, Charlottesville, Virginia; and
| | - Jeffrey S. Berns
- Renal, Electrolyte, and Hypertension Division, Perelman School of Medicine at the University of Pennsylvania, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
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20
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Affiliation(s)
- John K Roberts
- Division of Nephrology, Duke Department of Medicine, Durham, North Carolina
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21
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Safety and adequacy of percutaneous kidney biopsy performed by nephrology trainees. BMC Nephrol 2018; 19:14. [PMID: 29334930 PMCID: PMC5769494 DOI: 10.1186/s12882-017-0796-y] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2017] [Accepted: 12/12/2017] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Recently there has been a progressive loss of specialty related skills for nephrologists. Among the skills we find the kidney biopsy that has a central role in diagnosis of renal parenchymal disease. One of the causes might be the belief that the kidney biopsy should be performed only in larger Centers which can rely on the presence of a renal pathologist and on nephrologists with a large experience. This trend may increase in the short term procedural safety but may limit the chance of in training nephrologists to become confident with the technique. METHODS We evaluated renal biopsies performed from May 2002 to October 2016 in our Hospital, a mid-sized facility to determine whether the occurrence of complications would be comparable to those reported in literature and whether the increase in the number of biopsy performing physicians including nephrology fellows which took place since January 2012, after our Nephrology Unit became academic, would be associated to an increase of complications or a reduction of diagnostic power of renal biopsies. Three hundred thirty seven biopsies were evaluated. Patients underwent ultrasound guided percutaneous renal biopsy using a 14 G core needle loaded on a biopsy gun. Observation lasted for 24 h, we evaluated hemoglobin levels 6 and 24 h and kidney ultrasound 24 h after the biopsy. RESULTS Complications occurred in 18.7% of patients, of these only 1,2% were major complications. Complications were more common in female (28%) compared to male patients (14,8%) (p = 0.004). We found no correlation between diagnosis, kidney function and complication rates; hypertension was not associated to a higher risk in complications. The increase of biopsy performing personnel was not associated to an increase in complication rates (18,7% both pre and post 2012) or with an increase of major complications (1.2% vs 1,2%). CONCLUSIONS Kidney biopsy can be safely performed in mid-sized hospitals. Safety and adequacy are guaranteed even if the procedure is performed by a larger number of less experienced nephrologists as long as under tutor supervision, thus kidney biopsy should become an integral part of a nephrology fellow training allowing more widespread diffusion of this technique.
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Brasme R, Larceneux F, Delion A, Aubert O, Bertocchio JP. [French teaching in nephrology: What is the residents' feeling? Results from the first national survey]. Nephrol Ther 2017; 13:485-494. [PMID: 28571694 DOI: 10.1016/j.nephro.2016.11.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2016] [Revised: 07/25/2016] [Accepted: 11/15/2016] [Indexed: 11/17/2022]
Affiliation(s)
- Rémi Brasme
- Service de néphrologie, CHU d'Amiens-Picardie, site sud, D408, 80054 Amiens, France; Club des jeunes néphrologues, 11, rue Auguste-Mourcou, 59000 Lille, France
| | - Fabrice Larceneux
- Université Paris-Dauphine, PSL research university, CNRS, UMR 7088, DRM [Ermes], 75016 Paris, France
| | - Alexandra Delion
- Club des jeunes néphrologues, 11, rue Auguste-Mourcou, 59000 Lille, France; Service de néphrologie, CHU de Nancy, site des hôpitaux de Brabois, 29, avenue du Maréchal-de-Lattre-de-Tassigny, 54000 Nancy, France
| | - Olivier Aubert
- Club des jeunes néphrologues, 11, rue Auguste-Mourcou, 59000 Lille, France; Inserm U970 équipe 4, Paris centre de recherche cardiovasculaire (Parcc), 15, rue Leblanc, 75015 Paris, France
| | - Jean-Philippe Bertocchio
- Club des jeunes néphrologues, 11, rue Auguste-Mourcou, 59000 Lille, France; Service d'explorations fonctionnelles rénales et métaboliques, hôpital européen Georges-Pompidou, 20, rue Leblanc, 75908 Paris, France; Université Paris Descartes, faculté de médecine, 15, rue de l'École-de-Médecine, 75006 Paris, France.
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23
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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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24
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Agrawal V, Jhaveri KD, Shah HH. Enhancing outpatient nephrology experience for internal medicine residents. Clin Kidney J 2017; 10:429-436. [PMID: 29479427 PMCID: PMC5815570 DOI: 10.1093/ckj/sfx019] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2017] [Accepted: 02/24/2017] [Indexed: 11/12/2022] Open
Abstract
Interest in nephrology careers continues to remain low in the USA. Educational innovations that enhance interest in nephrology among medical trainees are being actively studied. While internal medicine (IM) residency programs commonly offer the inpatient nephrology elective to the resident, outpatient nephrology experience is lacking. Understanding the provision of care in outpatient and home dialysis and management of patients with glomerular diseases, chronic kidney disease and kidney transplantation are vital components of an outpatient nephrology rotation. In this review article, we share our experiences in incorporating outpatient nephrology to the IM resident's elective time. We also present the structure of the nephrology rotations at our programs and suggest several learning opportunities in outpatient nephrology that the training community can provide to medical residents. Strategies to effectively set up an outpatient nephrology rotation are also described. While more educational research on the impact of outpatient nephrology on resident learning and career choices are needed, we encourage a collaborative effort between faculty members in nephrology and the medicine residency programs to provide this unique learning opportunity to IM residents.
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Affiliation(s)
- Varun Agrawal
- Division of Nephrology and Hypertension, University of Vermont, Burlington, VT, USA
| | - Kenar D Jhaveri
- Division of Kidney Diseases and Hypertension, North Shore University Hospital and Long Island Jewish Medical Center, Hofstra Northwell School of Medicine, Great Neck, NY, USA
| | - Hitesh H Shah
- Division of Kidney Diseases and Hypertension, North Shore University Hospital and Long Island Jewish Medical Center, Hofstra Northwell School of Medicine, Great Neck, NY, USA
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25
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Liebman SE, Moore CA, Monk RD, Rizvi MS. What Are We Doing? A Survey of United States Nephrology Fellowship Program Directors. Clin J Am Soc Nephrol 2017; 12:518-523. [PMID: 27920031 PMCID: PMC5338709 DOI: 10.2215/cjn.06530616] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Interest in nephrology has been declining in recent years. Long work hours and a poor work/life balance may be partially responsible, and may also affect a fellowship's educational mission. We surveyed nephrology program directors using a web-based survey in order to define current clinical and educational practice patterns and identify areas for improvement. Our survey explored fellowship program demographics, fellows' workload, call structure, and education. Program directors were asked to estimate the average and maximum number of patients on each of their inpatient services, the number of patients seen by fellows in clinic, and to provide details regarding their overnight and weekend call. In addition, we asked about number of and composition of didactic conferences. Sixty-eight out of 148 program directors responded to the survey (46%). The average number of fellows per program was approximately seven. The busiest inpatient services had a mean of 21.5±5.9 patients on average and 33.8±10.7 at their maximum. The second busiest services had an average and maximum of 15.6±6.0 and 24.5±10.8 patients, respectively. Transplant-only services had fewer patients than other service compositions. A minority of services (14.5%) employed physician extenders. Fellows most commonly see patients during a single weekly continuity clinic, with a typical fellow-to-faculty ratio of 2:1. The majority of programs do not alter outpatient responsibilities during inpatient service time. Most programs (approximately 75%) divided overnight and weekend call responsibilities equally between first year and more senior fellows. Educational practices varied widely between programs. Our survey underscores the large variety in workload, practice patterns, and didactics at different institutions and provides a framework to help improve the service/education balance in nephrology fellowships.
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Affiliation(s)
- Scott E Liebman
- Department of Medicine, Division of Nephrology, University of Rochester Medical Center, Rochester, New York
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26
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Daniels MN, Maynard S, Porter I, Kincaid H, Jain D, Aslam N. Career interest and perceptions of nephrology: A repeated cross-sectional survey of internal medicine residents. PLoS One 2017; 12:e0172167. [PMID: 28207893 PMCID: PMC5313227 DOI: 10.1371/journal.pone.0172167] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Accepted: 01/28/2017] [Indexed: 11/19/2022] Open
Abstract
Background Interest in nephrology careers among internal medicine residents in the United States is declining. Our objective was to assess the impact of the presence of a nephrology fellowship training program on perceptions and career interest in nephrology among internal medicine residents. A secondary objective was to identify commonly endorsed negative perceptions of nephrology among internal medicine residents. Methods This was a repeated cross-sectional survey of internal medicine residents before (Group 1) and 3 years after (Group 2) the establishment of nephrology fellowship programs at two institutions. The primary outcome was the percentage of residents indicating nephrology as a career interest in Group 1 vs. Group 2. Secondary outcomes included the frequency that residents agreed with negative statements about nephrology. Results 131 (80.9%) of 162 residents completed the survey. 19 (14.8%) residents indicated interest in a nephrology career, with 8 (6.3%) indicating nephrology as their first choice. There was no difference in career interest in nephrology between residents who were exposed to nephrology fellows during residency training (Group 2) and residents who were not (Group 1). The most commonly endorsed negative perceptions of nephrology were: nephrology fellows have long hours/burdensome call (36 [28.1%] of residents agreed or strongly agreed), practicing nephrologists must take frequent/difficult call (35 [27.6%] agreed or strongly agreed), and nephrology has few opportunities for procedures (35 [27.3%] agreed or strongly agreed). More residents in Group 2 agreed that nephrology is poorly paid (8.9% in Group 1 vs. 20.8% in Group 2, P = 0.04), whereas more residents in Group 1 agreed that nephrologists must take frequent/difficult call (40.0% in Group 1 vs. 18.1% in Group 2, P = 0.02). Conclusions The initiation of a nephrology fellowship program was not associated with an increase in internal medicine residents’ interest in nephrology careers. Residents endorsed several negative perceptions of nephrology, which may affect career choice.
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Affiliation(s)
- Michael N. Daniels
- Department of Medicine, Lehigh Valley Health Network, Allentown, Pennsylvania, United States of America
| | - Sharon Maynard
- Department of Medicine, Lehigh Valley Health Network, Allentown, Pennsylvania, United States of America
| | - Ivan Porter
- Department of Medicine, Mayo Clinic College of Medicine, Mayo Clinic Florida, Jacksonville, Florida, United States of America
| | - Hope Kincaid
- Network Office of Research & Innovation, Lehigh Valley Health Network, Allentown, Pennsylvania, United States of America
| | - Deepika Jain
- Department of Medicine, Lehigh Valley Health Network, Allentown, Pennsylvania, United States of America
| | - Nabeel Aslam
- Department of Medicine, Mayo Clinic College of Medicine, Mayo Clinic Florida, Jacksonville, Florida, United States of America
- * E-mail:
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Roberts JK, Sparks MA, Lehrich RW. Medical student attitudes toward kidney physiology and nephrology: a qualitative study. Ren Fail 2016; 38:1683-1693. [PMID: 27758129 DOI: 10.1080/0886022x.2016.1230459] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
Interest in nephrology among trainees is waning in the USA. Early perceptions and attitudes to subject matter can be linked to the quality of pre-clinical curricula. We wanted to explore these attitudes in the setting of modern curriculum redesign. We utilized Q methodology to understand first-year medical student attitudes after an innovative kidney physiology curriculum redesign that focuses on blending multiple learning methods. First-year medical students were invited to take a Q sort survey at the conclusion of a kidney physiology course. Students prioritized statements related to their understanding of kidney physiology, learning preferences, preferred course characteristics, perceived clinical relevance of kidney physiology, and interest in nephrology as a career. Factor analysis was performed to identify different student viewpoints. At the conclusion of our modified course, all students (n = 108) were invited to take the survey and 44 (41%) Q sorts were returned. Two dominant viewpoints were defined according to interest in nephrology. The Potentials are students who understand kidney physiology, perceive kidney physiology as clinically relevant, attend class sessions, utilize videos, and are willing to shadow a nephrologist. The Uninterested are students who are less satisfied with their kidney physiology knowledge, prefer to study alone with a textbook, avoid lectures, and are not interested in learning about nephrology. In an updated renal physiology course, students that use multiple learning methods also have favorable attitudes toward learning kidney physiology. Thus, modern curriculum changes that accommodate a variety of learning styles may promote positive attitudes toward nephrology.
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Affiliation(s)
- John K Roberts
- a Department of Medicine, Division of Nephrology , Duke University Medical Center , Durham , NC , USA
| | | | - Ruediger W Lehrich
- a Department of Medicine, Division of Nephrology , Duke University Medical Center , Durham , NC , USA
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28
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Bayefsky SD, Shah HH, Jhaveri KD. Nephrology education for medical students: a narrative review. Ren Fail 2016; 38:1151-9. [PMID: 27197981 DOI: 10.1080/0886022x.2016.1185352] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
BACKGROUND Strategies used to teach nephrology to medical students are not well studied. This study assesses the published literature on medical student education in nephrology. METHODS A review of the published literature on nephrology education for medical students was conducted on two major online search engines (PubMed and ERIC). In addition, references of the manuscripts discovered in these searches were reviewed. The empirical studies were categorized by subject within nephrology and research design. RESULTS We found 26 original studies in which a method of teaching nephrology to medical students was described. The studies dated from 1977 to 2015. The focus of these nephrology teaching experiences was as follows: anatomy (6.5%), physiology (22.6%), pathophysiology (29.0%), pathology (6.5%), treatment (25.8%), and general nephrology (9.7%). The studies were also categorized into various types of research design. 6.9% had either no assessment of the educational experience or had a description too vague to categorize it; 3.4% involved a survey about the existing educational approach before a curriculum change was implemented; 55.2% used surveys or tests after an educational course was carried out; 10.3% sought feedback from students before and after the educational experience; 13.8% were case studies; and 10.3% included a randomized controlled trial. The randomized controlled trials involved teaching techniques focused on the pathophysiology of renal disease. CONCLUSIONS Rigor was lacking in most empirical studies on medical student education in nephrology. Well-designed randomized controlled studies are needed to accurately assess the effectiveness of the educational techniques introduced into medical school curricula.
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Affiliation(s)
| | - Hitesh H Shah
- a Hofstra Northwell School of Medicine , Hempstead , NY , USA ;,b Division of Kidney Diseases and Hypertension, Department of Medicine , North Shore University Hospital and Long Island Jewish Medical Center, Northwell Health , Great Neck , NY , USA
| | - Kenar D Jhaveri
- a Hofstra Northwell School of Medicine , Hempstead , NY , USA ;,b Division of Kidney Diseases and Hypertension, Department of Medicine , North Shore University Hospital and Long Island Jewish Medical Center, Northwell Health , Great Neck , NY , USA
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29
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Ward DR, Manns B, Gil S, Au F, Kappel JE. Results of the 2014-2015 Canadian Society of Nephrology workforce survey. Can J Kidney Health Dis 2016; 3:25. [PMID: 27175290 PMCID: PMC4864912 DOI: 10.1186/s40697-016-0117-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2016] [Accepted: 04/15/2016] [Indexed: 11/21/2022] Open
Abstract
Background Nephrology was previously identified as a subspecialty with few Canadian employment opportunities, and in recent years, fewer trainees are choosing nephrology. Objective The objective of this study is to better understand the current Canadian adult nephrology workforce and the expected workforce trends over the next 5 years. Design This is an online self-administered survey. Setting This study is set in Canada. Survey participants Survey participants are Canadian adult nephrologists, including self-identified division heads. Measurements The measurements of this study are demographics, training, current practice characteristics, work hours, and projected workforce needs. Methods Survey questions were based on previous workforce surveys. Ethics approval was obtained through the University of Saskatchewan. The survey was piloted in both English and French and modified based on the feedback to ensure that responses accurately reflected the information desired. It was circulated to all identified Canadian nephrologists via an anonymous e-mail link for self-administration. Categorical data was aggregated, and free-text answers were thematically analyzed. Additional descriptive analysis was conducted by all authors. Results Five hundred ninety-two Canadian nephrologists were contacted and 48 % responded, with representation from all Canadian provinces. One third of the respondents were female, and the largest age cohort was 41–50 years. Most nephrologists are trained in Canada and 61 % completed additional training. The majority of the respondents (69.1 %) began working as a nephrologist immediately upon completion of fellowship training. Younger nephrologists reported more challenges in finding a job. Eighty percent of responding nephrologists were satisfied with their current work hours, 13.1 % will reduce work hours within 3 years, an additional 8.2 % will reduce work hours within 5 years, and a further 14.2 % will reduce work hours within 10 years. Nephrology division heads forecasted the number of clinical and academic nephrologists needed for the next 3 and 5 years. Limitations The response rate was 48 %. Forecasted workforce needs are not indicative of guaranteed future positions. Conclusions This Canadian Society of Nephrology workforce survey demonstrated the current workforce demographics, individual nephrologist future workforce plans, and projected nephrology division requirements for the next 3 and 5 years. Further work will need to be done to refine Canadian nephrology workforce planning with the development of a robust strategy that encompasses both societal and nephrologists’ needs with the realities of employment. Electronic supplementary material The online version of this article (doi:10.1186/s40697-016-0117-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- David R Ward
- Department of Medicine, University of Calgary, Calgary, Alberta Canada
| | - Braden Manns
- Department of Medicine, University of Calgary, Calgary, Alberta Canada
| | - Sarah Gil
- Department of Medicine, University of Calgary, Calgary, Alberta Canada
| | - Flora Au
- Department of Medicine, University of Calgary, Calgary, Alberta Canada
| | - Joanne E Kappel
- Division of Nephrology, Department of Medicine, University of Saskatchewan, Rm 434- 230 Avenue R South, Saskatoon, SK S7M 2Z1, Saskatchewan Canada
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Maursetter LJ, Stern LD, Sozio SM, Patel AB, Rao R, Shah HH, Leight K, Okusa MD, Zeidel ML, Parker MG. Enhancing Nephrology Career Interest through the ASN Kidney TREKS Program. J Am Soc Nephrol 2016; 27:1604-7. [PMID: 27026364 DOI: 10.1681/asn.2015101086] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
The Kidney Tutored Research and Education for Kidney Students (TREKS) Program is a product of the American Society of Nephrology (ASN) Workforce Committee that seeks to connect medical and graduate students to nephrology. This program starts with a weeklong camp-like course introducing participants to renal physiology through classic and modern experiments. Next, each student is matched with a nephrology mentor at his or her home institution to foster a better understanding of a nephrology career. Lastly, the students are encouraged to participate in scholarly activities and attend the ASN Kidney Week. Now in its third year, with a total of 84 participants, survey data suggest early success of the program, with a self-reported 40% increased interest in nephrology fellowship and/or research careers. In addition, students give high ratings to the course components and mentorship pairings. Continued student tracking will be necessary to determine the long-term program effect.
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Affiliation(s)
- Laura J Maursetter
- Division of Nephrology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin;
| | - Lauren D Stern
- Department of Nephrology, Boston University School of Medicine
| | - Stephen M Sozio
- Division of Nephrology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Ankit B Patel
- Division of Renal Medicine, Brigham and Women's Hospital, and
| | - Reena Rao
- Division of Nephrology and Hypertension, University of Kansas Medical Center, Kansas City, Missouri
| | - Hitesh H Shah
- Division of Nephrology, Hofstra Northwell School of Medicine, Hempstead, New York
| | - Katlyn Leight
- American Society of Nephrology, Workforce and Career Development, Washington, DC
| | - Mark D Okusa
- Division of Nephrology, University of Virginia, Charlottesville, Virginia; and
| | - Mark L Zeidel
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachesetts
| | - Mark G Parker
- Division of Nephrology, Maine Medical Center and Tufts University School of Medicine, Portland, Maine
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Leehey DJ, Daugirdas JT. Teaching renal physiology in the 21st century: focus on acid-base physiology. Clin Kidney J 2015; 9:330-3. [PMID: 26985388 PMCID: PMC4792613 DOI: 10.1093/ckj/sfv138] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2015] [Accepted: 11/13/2015] [Indexed: 12/31/2022] Open
Abstract
A thorough understanding of renal physiology, and in particular acid–base physiology, is essential for an understanding of nephrology. Difficulties in both teaching and learning this material are major impediments to attracting medical trainees into nephrology. Approaches to teaching renal physiology include collaborative learning, computer-based learning and laboratory-based learning. Computer-based learning applications are becoming increasingly popular and can be useful, but are most successful when they incorporate interactive components. Students also note that the presence of a live instructor remains desirable. Some concepts of renal and in particular acid–base physiology can be taught using structured self-experimentation, a practice with a long tradition that possibly should be revitalized.
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Affiliation(s)
- David J Leehey
- Hines VA Hospital, Hines, IL, USA; Loyola University Stritch School of Medicine, Maywood, IL, USA
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Koyner JL, Heung M. Nephrohepatology: Managing the Nexus of Liver and Kidney Interactions. Adv Chronic Kidney Dis 2015; 22:335-6. [PMID: 26311593 DOI: 10.1053/j.ackd.2015.06.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
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Roberts JK, Hargett CW, Nagler A, Jakoi E, Lehrich RW. Exploring student preferences with a Q-sort: the development of an individualized renal physiology curriculum. ADVANCES IN PHYSIOLOGY EDUCATION 2015; 39:149-157. [PMID: 26330030 PMCID: PMC4747902 DOI: 10.1152/advan.00028.2015] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/13/2015] [Accepted: 05/04/2015] [Indexed: 06/05/2023]
Abstract
Medical education reform is underway, but the optimal course for change has yet to be seen. While planning for the redesign of a renal physiology course at the Duke School of Medicine, the authors used a Q-sort survey to assess students' attitudes and learning preferences to inform curricular change. The authors invited first-year medical students at the Duke School of Medicine to take a Q-sort survey on the first day of renal physiology. Students prioritized statements related to their understanding of renal physiology, learning preferences, preferred course characteristics, perceived clinical relevance of renal physiology, and interest in nephrology as a career. By-person factor analysis was performed using the centroid method. Three dominant factors were strongly defined by learning preferences: "readers" prefer using notes, a textbook, and avoid lectures; "social-auditory learners" prefer attending lectures, interactivity, and working with peers; and "visual learners" prefer studying images, diagrams, and viewing materials online. A smaller, fourth factor represented a small group of students with a strong predisposition against renal physiology and nephrology. In conclusion, the Q-sort survey identified and then described in detail the dominant viewpoints of our students. Learning style preferences better classified first-year students rather than any of the other domains. A more individualized curriculum would simultaneously cater to the different types of learners in the classroom.
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Affiliation(s)
- John K Roberts
- Department of Medicine, Duke University Medical Center, Durham, North Carolina
| | - Charles W Hargett
- Department of Medicine, Duke University Medical Center, Durham, North Carolina
| | - Alisa Nagler
- Graduate Medical Education, Duke University School of Medicine, Durham, Durham, North Carolina; and
| | - Emma Jakoi
- Department of Cell Biology, Duke University School of Medicine, Durham, Durham, North Carolina
| | - Ruediger W Lehrich
- Department of Medicine, Duke University Medical Center, Durham, North Carolina;
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Jhaveri KD, Perazella MA. Nephrologists as Educators: Clarifying Roles, Seizing Opportunities. Clin J Am Soc Nephrol 2015; 11:176-89. [PMID: 26276141 DOI: 10.2215/cjn.12151214] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Nephrologists play an important role in providing medical education in a variety of settings, including the medical school classroom, nephrology consult service, outpatient clinic, and dialysis unit. Therefore, nephrologists interact with a variety of learners. In this article the current state of published literature in medical education in nephrology is reviewed. Eight attending roles are identified of the nephrologist as a medical educator in the academic settings: inpatient internal medicine service, nephrology inpatient consult service, inpatient ESRD service, outpatient nephrology clinic, kidney transplantation, dialysis unit, classroom teacher, and research mentor. Defining each of these distinct settings could help to promote positive faculty development and encourage more rigorous education scholarship in nephrology.
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Affiliation(s)
- Kenar D Jhaveri
- Division of Nephrology, North Shore University Hospital and Long Island Jewish Medical Center, Hofstra North Shore LIJ School of Medicine, Great Neck, New York; and
| | - Mark A Perazella
- Section of Nephrology, Yale University School of Medicine, New Haven, Connecticut
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Shah HH, Adams ND, Mattana J, Kadiyala A, Jhaveri KD. Nephrology elective experience during medical residency: a national survey of US nephrology fellowship training program directors. Ren Fail 2015; 37:999-1006. [DOI: 10.3109/0886022x.2015.1055693] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Sparks MA, Lerma EV, Kupin W, Phelan PJ, Jhaveri KD, Topf J. NephMadness 2015: nephrology as a cornerstone of medicine. Am J Kidney Dis 2015; 65:375-7. [PMID: 25704043 DOI: 10.1053/j.ajkd.2014.12.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2014] [Accepted: 12/03/2014] [Indexed: 11/11/2022]
Affiliation(s)
- Matthew A Sparks
- Duke University and Durham VA Medical Centers, Durham, North Carolina
| | - Edgar V Lerma
- University of Illinois at Chicago College of Medicine/Advocate Christ Medical Center, Oak Lawn, Illinois
| | - Warren Kupin
- Miami Transplant Institute, University of Miami Miller School of Medicine, Miami, Florida
| | | | - Kenar D Jhaveri
- North Shore University Hospital and Long Island Jewish Medical Center, Hofstra North Shore LIJ School of Medicine, Great Neck, New York
| | - Joel Topf
- St. John Hospital and Medical Center, Detroit, Michigan.
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Sandal S, Singh J, Liebman SE. Prospective analysis of after-hour pages to nephrology fellows. Am J Kidney Dis 2014; 64:158-9. [PMID: 24797523 DOI: 10.1053/j.ajkd.2014.04.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2014] [Accepted: 04/03/2014] [Indexed: 11/11/2022]
Affiliation(s)
- Shaifali Sandal
- University of Rochester Medical Center, Rochester, New York.
| | - Jagmeet Singh
- University of Rochester Medical Center, Rochester, New York
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Hernandez RG, Cowden JD, Moon M, Brands CK, Sisson SD, Thompson DA. Predictors of resident satisfaction in caring for limited English proficient families: a multisite study. Acad Pediatr 2014; 14:173-80. [PMID: 24602581 DOI: 10.1016/j.acap.2013.12.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2013] [Revised: 12/16/2013] [Accepted: 12/17/2013] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To assess residents' self-efficacy, satisfaction and frustration in the care of limited English proficient (LEP) families and to identify individual and programmatic factors associated with the above outcomes. METHODS A multisite cross-sectional survey of pediatric residents currently in training and caring for LEP families was conducted. Resident self-efficacy scores in specific skill domains were assessed. Clustered multivariate logistic regression analyses were used to identify individual and programmatic factors associated with increased satisfaction and frustration. Qualitative analyses were also utilized to identify themes related to frustrating aspects of care. RESULTS A total of 271 of 449 eligible residents representing 7 US pediatric residency programs participated in our study (60% response rate). A majority of residents (51%) rated their self-efficacy in the overall care of LEP families as low. Satisfaction was associated with a high self-efficacy score (odds ratio [OR] 4.7, 95% confidence interval [CI] 1.8-12.6), increasing year in training (OR 3.2, 95% CI 1.01-10.2), frequent non-English language use (OR 3.1, 95% CI 1.1-8.8), and instruction on the use of interpreters (OR 1.9, 95% CI 1.02-3.64). Satisfaction was inversely associated with increased LEP patient volumes (OR 0.40, 95% CI 0.18-0.91). Clinical inefficiency related to interpreter use and distrust of interpreter skills were frequently cited as aspects that contribute to overall frustration. CONCLUSIONS A majority of residents reported lacking self-efficacy in their ability to deliver care to LEP patients, which may influence overall satisfaction with such encounters. Strategies that promote resident self-efficacy and assess non-English language proficiency should be included in future training curricula. Exposing trainees to best practices in interpreter-based encounters may further promote resident satisfaction.
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Affiliation(s)
- Raquel G Hernandez
- Children's Hospital, Johns Hopkins Medicine, St Petersburg, Fla; Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Md.
| | - John D Cowden
- Children's Mercy Hospitals and Clinics, Kansas City, Mo
| | - Margaret Moon
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Md
| | - Chad K Brands
- Children's Hospital, Johns Hopkins Medicine, St Petersburg, Fla; Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Md
| | - Stephen D Sisson
- Department of Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, Md
| | - Darcy A Thompson
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colo
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Arroyo D, Dominguez P, Panizo N, Quiroga B, Calvo M, Álvarez L, Macias N, Menendez D, Blazquez L, Galan I, Reque J. A Spanish multicentric study to evaluate the clinical activity of nephrology fellows during in-hospital on-call shifts. Clin Kidney J 2013; 6:556-60. [PMID: 26064520 PMCID: PMC4438395 DOI: 10.1093/ckj/sft080] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2013] [Accepted: 06/21/2013] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Nephrologists develop their work in diverse scenarios. A training programme must qualify trainees to assist different kinds of problems. The aim of this study was to characterize patients and pathologies that Spanish nephrology fellows face while on-call. METHODS This is a descriptive study with clinical and demographic data gathered with a form by 10 nephrology fellows of five university hospitals of Madrid (Spain), throughout their in-hospital 24 h on-call shifts in February and March 2013. RESULTS We collected 409 episodes over 338 patients, through 72 shifts. Among these, 16.7% had previous normal renal function, 24.6% chronic kidney disease, 39.5% were on dialysis and 18.2% had a kidney transplant. Most of the consults came from the emergency room (35.9%) or the previous on-call team (13.7%). Afterwards, the most usual destiny was admittance to a nephrology department (32.8%) or discharge (20.5%). The most frequent reason for consulting was a decline in renal function (31.6%) and the second motive an infection. Thirty-four episodes (8.3%) were related to dialysis access problems. Medical treatment was prescribed in 79.2% of the cases, primarily fluids (47.2%) and antibiotics (42.2%). The fellow had to place a central venous catheter in 24 cases (5.9%). Renal replacement therapy was prescribed in 19.8% of the episodes. CONCLUSIONS Specific renal reasons for consulting nephrologists are common, such as acute kidney injury or dialysis access complications. These patients benefit from a specialized approach to their problems. Clinical activities during in-hospital out-of-hours shifts are a priceless tool as part of the training programme of nephrology fellows.
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Affiliation(s)
- David Arroyo
- Hospital General Universitario Gregorio Marañón , Madrid , Spain
| | | | - Nayara Panizo
- Hospital General Universitario Gregorio Marañón , Madrid , Spain
| | - Borja Quiroga
- Hospital General Universitario Gregorio Marañón , Madrid , Spain
| | - Marta Calvo
- Hospital Clínico San Carlos , Madrid , Spain
| | | | - Nicolás Macias
- Hospital General Universitario Gregorio Marañón , Madrid , Spain
| | | | - Luis Blazquez
- Hospital Universitario de La Princesa , Madrid , Spain
| | - Isabel Galan
- Hospital General Universitario Gregorio Marañón , Madrid , Spain
| | - Javier Reque
- Hospital General Universitario Gregorio Marañón , Madrid , Spain
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Shah HH, Monga D, Caperna A, Jhaveri KD. Palliative care experience of US adult nephrology fellows: a national survey. Ren Fail 2013; 36:39-45. [PMID: 24059838 DOI: 10.3109/0886022x.2013.831718] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Palliative care (PC) training and experience of United States (US) adult nephrology fellows was not known. It was also not clear whether nephrology fellows in the US undergo formal training in PC medicine during fellowship. To gain a better understanding of the clinical training and experience of US adult nephrology fellows in PC medicine, we conducted a national survey in March 2012. An anonymous on-line survey was sent to US adult nephrology fellows via nephrology fellowship training program directors. Fellows were asked several PC medicine experience and training questions. A total of 105 US adult nephrology fellows responded to our survey (11% response rate). Majority of the respondents (94%) were from university-based fellowship programs. Over two-thirds (72%) of the fellows had no formal PC medicine rotation during their medical school. Half (53%) of the respondents had no formal PC elective experience during residency. Although nearly 90% of the fellows had a division or department of PC medicine at their institution, only 46.9% had formal didactic PC medicine experience. Over 80% of the respondent's program did not offer formal clinical training or rotation in PC medicine during fellowship. While 90% of the responding fellows felt most comfortable with either writing dialysis orders in the chronic outpatient unit, seeing an ICU consult or writing continuous dialysis orders in the ICU, only 35% of them felt most comfortable "not offering" dialysis to a patient in the ICU with multi-organ failure. Nearly one out of five fellows surveyed felt obligated to offer dialysis to every patient regardless of benefit. Over two-thirds (67%) of the respondents thought that a formal rotation in PC medicine during fellowship would be helpful to them. To enhance clinical competency and confidence in PC medicine, a formal PC rotation during fellowship should be highly considered by nephrology training community.
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Affiliation(s)
- Hitesh H Shah
- Division of Kidney Diseases and Hypertension, Department of Medicine, North Shore University Hospital and Long Island Jewish Medical Center, Hofstra North Shore-LlJ School of Medicine , Great Neck, NY , USA and
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Jhaveri KD, Sparks MA, Shah HH. Novel educational approaches to enhance learning and interest in nephrology. Adv Chronic Kidney Dis 2013; 20:336-46. [PMID: 23809286 DOI: 10.1053/j.ackd.2013.03.006] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2013] [Revised: 03/16/2013] [Accepted: 03/26/2013] [Indexed: 11/11/2022]
Abstract
The number of U.S. medical graduates pursuing careers in nephrology has declined over the last several years. Some of the proposed reasons for this declining interest include difficult-to-understand or unstimulating kidney pathophysiology courses in medical school; disheartening inpatient elective experiences; and few opportunities to experience the other aspects of nephrology careers such as outpatient nephrology clinics, outpatient dialysis, and kidney transplantation. Novel and alternative educational approaches should be considered by the nephrology training community to enhance the understanding of nephrology from medical school to fellowship training. Newer teaching methods and styles should also be incorporated to adapt to today's learner. These innovative educational approaches may not only increase interest in nephrology careers, but they may also enhance and maintain interest during nephrology fellowship. In this article, we will review several educational approaches that may enhance teaching and learning in nephrology.
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Bhasin B, Estrella MM, Choi MJ. Online CKD education for medical students, residents, and fellows: training in a new era. Adv Chronic Kidney Dis 2013; 20:347-56. [PMID: 23809287 DOI: 10.1053/j.ackd.2013.04.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2013] [Revised: 03/30/2013] [Accepted: 04/12/2013] [Indexed: 01/05/2023]
Abstract
CKD and its complications are associated with substantial morbidity and mortality. Studies have highlighted significant deficiencies in resident knowledge and awareness of CKD and its complications. There is a need to improve CKD education through medical school and residency. There is also a need to provide alternatives to traditional teaching methods to meet the challenges of learning in the context of work-hour restrictions and increasing workload among residents and fellows. Internet-based learning resources offer various educational tools, including websites, kidney blogs, online modules, and smartphone applications, which could potentially and efficiently advance CKD knowledge among medical trainees. In this review, we describe several online resources for CKD education that could be useful for medical students, residents, and fellows. Increased awareness of these tools and their utilization may significantly influence and hopefully improve the recognition and management of patients with CKD. Future studies may help evaluate the effectiveness of these online learning methods and their effect on CKD patient outcomes. In addition, in light of increased concern about nephrology workforce issues, the potential for these online tools to augment interest in nephrology careers should be investigated.
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Jhaveri KD, Sparks MA, Shah HH, Khan S, Chawla A, Desai T, Iglesia E, Ferris M, Parker MG, Kohan DE. Why not nephrology? A survey of US internal medicine subspecialty fellows. Am J Kidney Dis 2013; 61:540-6. [PMID: 23332603 PMCID: PMC4164433 DOI: 10.1053/j.ajkd.2012.10.025] [Citation(s) in RCA: 90] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2012] [Accepted: 10/19/2012] [Indexed: 11/11/2022]
Abstract
BACKGROUND There is a decreased interest in nephrology such that the number of trainees likely will not meet the upcoming workforce demands posed by the projected number of patients with kidney disease. We conducted a survey of US internal medicine subspecialty fellows in fields other than nephrology to determine why they did not choose nephrology. METHODS A web-based survey with multiple choice, yes/no, and open-ended questions was sent in summer 2011 to trainees reached through internal medicine subspecialty program directors. RESULTS 714 fellows responded to the survey (11% response rate). All non-nephrology internal medicine subspecialties were represented, and 90% of respondents were from university-based programs. Of the respondents, 31% indicated that nephrology was the most difficult physiology course taught in medical school, and 26% had considered nephrology as a career choice. Nearly one-fourth of the respondents said they would have considered nephrology if the field had higher income or the subject were taught well during medical school and residency training. The top reasons for not choosing nephrology were the belief that patients with end-stage renal disease were too complicated, the lack of a mentor, and that there were insufficient procedures in nephrology. CONCLUSIONS Most non-nephrology internal medicine subspecialty fellows never considered nephrology as a career choice. A significant proportion were dissuaded by factors such as the challenges of the patient population, lack of role models, lack of procedures, and perceived difficulty of the subject matter. Addressing these factors will require the concerted effort of nephrologists throughout the training community.
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Affiliation(s)
- Kenar D Jhaveri
- Division of Kidney Diseases and Hypertension, Department of Medicine, North Shore University Hospital and Long Island Jewish Medical Center, Hofstra North Shore-LlJ School of Medicine, Great Neck, NY 11021, USA.
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Adams ND. Choosing nephrology--or not. Am J Kidney Dis 2013; 61:529-31. [PMID: 23497766 DOI: 10.1053/j.ajkd.2013.02.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2013] [Accepted: 02/08/2013] [Indexed: 11/11/2022]
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Hoenig MP, Shapiro E, Hladik GA. Lessons learned from the ASN Renal Educator Listserv and survey. Clin J Am Soc Nephrol 2013; 8:1054-60. [PMID: 23293124 DOI: 10.2215/cjn.07410712] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Nephrology ranks next to last in career choices among US medical school graduates. The American Society of Nephrology established a Workforce Committee to help address this issue. Surveys of US medical students indicate that experiences during kidney pathophysiology courses in the preclerkship years may impact their decision to consider a career in nephrology. In October of 2011, preclinical kidney physiology and pathophysiology course directors at US medical schools were surveyed about teaching methods, curricular content, resources, and institutional support for teaching to identify what worked well and what impairs their teaching efforts. A Listserv of these educators, the American Society of Nephrology Renal Educators Listserv, was used to electronically administer the survey. Course leaders from 62 of 114 (54.4%) surveyed medical schools responded. Most of these educators are nephrologists, but physiologists and other clinicians also lead courses; 60% of course directors noted that lectures are videotaped, resulting in decreased attendance. A range of resources is used: 68% use audience response systems, 16% use the simulation center, and none of the educators indicated use of social media (such as Twitter or Facebook); 50% of respondents receive no remuneration, and 68% receive no full-time equivalent for their efforts. Audience response systems, virtual microscopy, and flash animations were identified as valuable teaching tools. Course directors, during subsequent dialogue on the American Society of Nephrology Renal Educators Listserv, have cited incorporation of case scenarios and integration of clinical exposure during preclinical years as methods that inspired interest. Hopefully, adoption of such approaches will ultimately serve to stimulate interest in nephrology.
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Affiliation(s)
- Melanie P Hoenig
- Division of Nephrology, Joslin Clinic and Beth Israel Deaconess Medical Center, Boston, Massachusetts 02215, USA.
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