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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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Cheng SC, Pivert KA, Sozio SM. "Make Me a Match": All-In and Other Trends in the Nephrology Match. Clin J Am Soc Nephrol 2022; 17:1691-1693. [PMID: 35853729 PMCID: PMC9718053 DOI: 10.2215/cjn.04450422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Steven C. Cheng
- Division of Nephrology, Washington University School of Medicine in St. Louis, St. Louis, Missouri
| | - Kurtis A. Pivert
- Department of Information and Outreach, American Society of Nephrology, Washington, DC
| | - Stephen M. Sozio
- Department of Medicine, Division of Nephrology, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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Prasad C, Sanger S, Chanchlani R, Kirpalani A, Noone D. Engaging medical students and residents in nephrology education: an updated scoping review. J Nephrol 2021; 35:3-32. [PMID: 34351594 DOI: 10.1007/s40620-021-01135-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Accepted: 07/24/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND There is global recognition that interest in nephrology among pediatric and adult trainees is waning, while the burden of kidney disease continues to wax. There is a growing need to engage trainees in nephrology education. The objective of this study was to systematically review the literature on nephrology education for medical students and residents published in the last six years, collate the findings, and extract major themes in order to better define the gaps in this field. METHODS A systematic literature search was conducted on four major academic search engines including MEDLINE (OvidSP), ERIC, EMBASE and Web of Science until October 22, 2020, retrieving a total of 2,694 studies. Forty studies published after September 2014 met the inclusion and exclusion criteria. These studies were analyzed based on study focus, type of study design, and outcomes. RESULTS The studies fell into three main areas of focus: (a) factors that influence interest in nephrology careers (b) current gaps in nephrology knowledge and (c) innovative educational strategies. Barriers to engaging learners in nephrology include a lack of exposure, lack of mentorship, and perceived complexity of nephrology. Baseline awareness is deficient in the management of chronic kidney disease and acute kidney injury. Applying active learning strategies may reduce the perceived barriers to understanding nephrology. CONCLUSION The importance of engaging the future nephrology workforce is well-recognized. Nephrologist educators should focus their efforts in studying curriculum interventions and their impact not only on learner satisfaction, but also future behavior, career choices, and patient outcomes.
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Affiliation(s)
- Charushree Prasad
- Division of Nephrology, Department of Pediatrics, McMaster University, Hamilton, ON, Canada.
| | | | - Rahul Chanchlani
- Division of Nephrology, Department of Pediatrics, McMaster University, Hamilton, ON, Canada
| | - Amrit Kirpalani
- Division of Nephrology, Department of Pediatrics, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Damien Noone
- Division of Nephrology, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
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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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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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Boyle SM, Subedi K, Pivert KA, Harhay MN, Baynes-Fields J, Goldman J, Warburton KM. Nephrology Fellows' and Program Directors' Perceptions of Hospital Rounds in the United States. Clin J Am Soc Nephrol 2020; 15:474-483. [PMID: 32184295 PMCID: PMC7133138 DOI: 10.2215/cjn.10190819] [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: 08/29/2019] [Accepted: 02/18/2020] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND OBJECTIVES Hospital rounds are a traditional vehicle for patient-care delivery and experiential learning for trainees. We aimed to characterize practices and perceptions of rounds in United States nephrology training programs. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS We conducted a national survey of United States nephrology fellows and program directors. Fellows received the survey after completing the 2019 National Board of Medical Examiners Nephrology In-Training Exam. Program directors received the survey at the American Society of Nephrology's 2019 Nephrology Training Program Directors' Retreat. Surveys assessed the structure and perceptions of rounds, focusing on workload, workflow, value for patient care, and fellows' clinical skill-building. Directors were queried about their expectations for fellow prerounds and efficiency of rounds. Responses were quantified by proportions. RESULTS Fellow and program director response rates were 73% (n=621) and 70% (n=55). Most fellows (74%) report a patient census of >15, arrive at the hospital before 7:00 am (59%), and complete progress notes after 5:00 pm (46%). Among several rounding activities, fellows most valued bedside discussions for building their clinical skills (34%), but only 30% examine all patients with the attending at the bedside. Most directors (71%) expect fellows to both examine patients and collect data before attending-rounds. A majority (78%) of directors commonly complete their documentation after 5:00 pm, and for 36%, after 8:00 pm. Like fellows, directors most value bedside discussion for development of fellows' clinical skills (44%). Lack of preparedness for the rigors of nephrology fellowship was the most-cited barrier to efficient rounds (31%). CONCLUSIONS Hospital rounds in United States nephrology training programs are characterized by high patient volumes, early-morning starts, and late-evening clinical documentation. Fellows use a variety of prerounding styles and examine patients at the beside with their attendings at different frequencies. PODCAST This article contains a podcast at https://www.asn-online.org/media/podcast/CJASN/2020_03_17_CJN.10190819.mp3.
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Affiliation(s)
- Suzanne M Boyle
- Department of Medicine, Section of Nephrology, Hypertension and Kidney Transplantation, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania;
| | - Keshab Subedi
- Value Institute, Christiana Care Health System, Newark, Delaware
| | - Kurtis A Pivert
- Department of Workforce, Training, and Career Advancement, American Society of Nephrology, Alliance for Kidney Health, Washington, DC
| | - Meera Nair Harhay
- Department of Medicine, Drexel University College of Medicine, Philadelphia, Pennsylvania.,Tower Health Transplant Institute, Tower Health System, West Reading, Pennsylvania.,Department of Epidemiology and Biostatistics, Drexel University Dornsife School of Public Health, Philadelphia, Pennsylvania
| | - Jaime Baynes-Fields
- Department of Medicine, Drexel University College of Medicine, Philadelphia, Pennsylvania
| | - Jesse Goldman
- Division of Nephrology, Department of Medicine, Thomas Jefferson University, Philadelphia, Pennsylvania; and
| | - Karen M Warburton
- Division of Nephrology, Department of Medicine, University of Virginia School of Medicine, Charlottesville, Virginia
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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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Brown WW, Anderson S. Women in Nephrology Leadership. Adv Chronic Kidney Dis 2018; 25:519-522. [PMID: 30527552 DOI: 10.1053/j.ackd.2018.08.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2018] [Accepted: 08/16/2018] [Indexed: 11/11/2022]
Abstract
Women and men tend to take different paths to leadership, with men being more intentional. When women do undertake leadership activities, they tend to be surprised by how much they enjoy it. Women's leadership styles tend to be more collaborative and inclusive. Women are used to multitasking and tend to persist under difficult circumstances. The nephrology manpower crisis affects both men and women, although some of the drivers are different. There is a persistent and well-known pay disparity between men and women physicians that many have tried to address without consistent success. Strategies also need to be developed to support and encourage both men and women in nephrology.
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Affiliation(s)
- Michel Chonchol
- Division of Renal Diseases and Hypertension, University of Colorado Anschutz Medical Campus, Aurora, Colorado
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