Nephrology Fellows Research Articles

Artificial intelligence in nephrology education: a multicenter survey of fellowship trainees at Mayo Clinic.

Artificial intelligence (AI) is increasingly recognized for its potential to enhance nephrology training and practice. However, the integration of AI into fellowship training remains inadequately explored. This study aimed to assess current AI utilization, perceptions, and educational needs among nephrology fellows at Mayo Clinic. A structured online survey was administered to 23 fellows-including those specializing in kidney transplantation and onco-nephrology-across three Mayo Clinic sites (Minnesota, Arizona, and Florida). The survey addressed domains such as current AI usage, perceived relevance of AI in clinical practice, interest in formal AI training, self-assessed comfort with AI integration, and barriers to adopting AI technologies in nephrology education. A total of 21 fellows (91% response rate) participated in the survey. 76% of respondents rated AI as moderately to highly relevant to nephrology. Similarly, 76% indicated a moderate to very high interest in receiving targeted AI training. Despite these favorable perceptions, 76% had rarely or never used AI in their clinical or research activities, and none reported any formal AI education. Interactive workshops emerged as the preferred modality for AI training (52%), with limited knowledge cited as the primary barrier to adoption. Optimism was especially high regarding AI applications in predictive modeling (86%) and diagnostic imaging (81%), while confidence in AI for direct clinical decision-making remained cautious. There is significant interest among nephrology fellows in AI, along with a critical need for formal education and training. The enthusiasm for AI's potential contrasts with a cautious perspective towards its current use in clinical decision-making. Our study highlights the necessity for educational initiatives that bridge the knowledge gap and foster confidence in the appropriate use of AI technologies in Nephrology fellowship.

The Emerging Nephrology Physician Workforce in the United States: Defining an Impending Shortfall.

Given projected inadequacies in the United States (US) nephrologist workforce, we sought to define the annual number of training positions, applicants, and unmatched training positions for US nephrology fellowship training. The National Resident Matching Program provided match data for this retrospective study of US nephrology fellowship applicants (2009-2024). Annual trends were analyzed with linear regression. The annual number of nephrology fellowship programs (142 to 180, 26.8% higher, P<0.001) and training positions (367 to 488, 33.0% higher, P<0.001) were higher over the study period. In contrast, the annual number of applicants were lower (578 to 362, 37.4% lower, P<0.001). The annual applicant-to-training position ratio was lower (1.6 to 0.7, P<0.001) while the annual match rate was higher (60.2% to 89.4%, P=0.004). The annual rate of unmatched training positions were higher (5.2% to 34.2%, P<0.001) and the percentage of applicants that matched at their first-choice ranked fellowship were higher (37.2% to 60.4%, P=0.02). The annual representation of US allopathic graduates were lower (37.9% to 25.5%, P=0.05 while the annual representation of US osteopathic graduates were higher (4.9% to 16.5%, P<0.001). The annual representation of international medical graduates remained similar (57.2% to 57.9%, P=0.15). The annual number of training positions in nephrology have been higher without commensurate growth in the number of applicants. The rate of unmatched training positions is becoming higher with potential deleterious consequences to future US nephrologist workforce adequacy. Accelerated efforts are needed to emphasize the attractiveness of the specialty and stimulate interest among applicants. Surveillance of future nephrology match outcomes is warranted.

Why Not Transplant Nephrology? A Survey of US Nephrology Fellows.

Why Not Transplant Nephrology? A Survey of US Nephrology Fellows.

Nephrology-Oriented Point of Care Ultrasound Education and Subsequence: Clinical Usefulness for Nephrology Fellows From a Japanese Teaching Hospital.

Point-of-care ultrasound (POCUS) is an essential bedside tool in nephrology for evaluation of fluid volume, acute kidney injury (AKI), and vascular access. In Japan, nephrology-oriented POCUS education remains underdeveloped, despite its clinical significance. This study aimed to evaluate the effects of a POCUS educational programme on POCUS implementation in clinical nephrology. This single-centre observational study was conducted between 2022 and 2024 and comprised 162 patients with AKI. We compared POCUS use, including the checking of the inferior vena cava diameter, urinary obstruction, and venous excess ultrasound (VExUS) grading system, before and after lectures and hands-on training in 2023. There was a significant increase in POCUS implementation for AKI evaluation, including VExUS for assessing congestion. Post-training, the procedure implementation of VExUS for patients with congestion (N = 29) increased from 0% in 2022 to 66.7% in 2023 and 56.3% in 2024. Severe congestion by VExUS might be related to poor outcomes, including higher rates of haemodialysis and mortality. Despite technical difficulties in visualising renal interlobular veins using pulse-wave Doppler in VExUS, the visualisation rate improved over time, increasing from 50% in 2023 to 66.7% in 2024. These results underscore the importance of developing comprehensive nephrology-oriented POCUS training programmes, even at the facility level, coupled with on-the-job training to improve clinical use. However, the procedure implementation of VExUS plateaued in years when the lectures were not conducted. Thus, regularly conducted lectures, the development of supervising physicians' teaching skills, and the implementation of a robust training system would be necessary.

Demographic variations and temporal trends in the United States nephrology fellowship match: An analysis of the National Resident Matching Program from 2010 to 2024.

Each year, the National Resident Matching Program (NRMP) releases match outcomes data, highlighting trends, match rates, and competitiveness for each specialty. However, research on the demographics, temporal trends, and disparities among Nephrology applicants remains limited. This retrospective study analyzed data from the NRMP for Nephrology fellowships from 2016 to 2024, including applicant demographics and match outcomes. Chi-square tests were used to assess differences and temporal trends were evaluated with Mann-Kendall tests, and statistical significance was set at p < 0.05. Although the total number of training programs (p < 0.001) and fellowship positions (p < 0.001) increased from 2010 to 2024, the percentage of filled positions significantly declined from 94.1% in 2010 to 65.8% in 2024 (p = 0.047). Females were less likely to apply for Nephrology compared to other fellowships (p = 0.002) and had a lower match rate (p< 0.001). White applicants were less likely to apply for Nephrology than for other fellowships (p < 0.001). US MD graduates had a significantly higher match rate than non-US MD graduates over the study period (p < 0.001). In conclusion, despite the annual increase in Nephrology training positions, declining applicant numbers have reduced fellowship competitiveness. Males, Asians, and non-US international medical graduates comprised the majority of trainees. Addressing pay, job opportunities, and gender disparities is crucial to sustaining the future Nephrology workforce in the United States.

Consensus development and validation of entrustable professional activities for nephrology fellowship training in Saudi.

This study aimed to develop and validate entrustable professional activities (EPAs) for the nephrology fellowship program in Saudi Arabia. This study utilized a two-round modified Delphi design involving nephrology consultants across Saudi Arabia. The initial list of 39 EPAs was created through a literature review and expert input, followed by a piloting process that refined these activities based on feedback. A target sample of 26 nephrology consultants was invited, achieving an 80% response rate in the first round with 21 participants. Descriptive statistics, including means and percentages, summarized demographic characteristics and group responses. Participants rated the relevance of each EPA using a 5-point Likert scale. Consensus was defined as at least 75% agreement among participants, which guided the refinement of EPAs across the Delphi rounds. The study was approved by the institutional review board at Umm Al-Qura University, Makkah, Saudi Arabia. In the first round, consensus was achieved for 34 EPAs, while 5 were excluded for lack of relevance and 6 were modified. The second round confirmed full consensus on the revised 34 EPAs, with an 81% response rate among the 21 experts. This study successfully developed and validated EPAs for the nephrology fellowship program in Saudi Arabia. Implementing these EPAs is expected to enhance training, assessment, and clinical competence for nephrology fellows. Future studies should explore the long-term impact of these EPAs on training outcomes and consider adapting them for other specialties.

A Home Hemodialysis Objective Structured Clinical Examination for Formative Assessment of Nephrology Fellows.

Key Points Because of low patient numbers and uneven geographical distribution, nephrology fellows may not have experience caring for home hemodialysis (HHD) patients.We developed and preliminarily validated a formative HHD objective structured clinical examination.The objective structured clinical examination may be used to assess HHD curriculum and basic HHD clinical skills in individual fellows. Background The Accreditation Council for Graduate Medical Education requires graduating nephrology fellows demonstrate competence in home hemodialysis (HHD). Because low patient numbers may lead to training gaps, clinical experience may be enhanced using simulation. We designed and preliminarily validated a formative objective structured clinical examination (OSCE) assessing clinical care of an uncomplicated patient initiating HHD, using a unified model of construct validity. Methods The OSCE was developed by a nephrology fellow and five faculty (three practicing HHD). The nine-member test committee (five in HHD practice; one HHD care partner) assessed test item difficulty/relevance and determined passing scores. The final test consisted of 27 items (31 possible points); seven were evidence-based/standard-of-care questions (9.5 possible points). Passing score was 20 of 31 points (65%). Median relevance for all items was “important” or “essential.” Content validity index was 0.84. On preliminary validation by 11 board-certified volunteers (four practicing HHD), overall mean±SD score was 27.5±2 (100% passing), kappa=0.83 (95% confidence interval, 0.67 to 0.99). Validator evidence-based question score was 9.0±0.6. Results Thirty-eight fellows (9 programs, 21 first-year; 17 second-year) were tested. Seventy-one percent passed (Cronbach α=0.70). Fellows' mean±SD scores were lower than validators: 21.5±4.0 versus 27.5±2, P &lt; 0.001, as were their scores on evidence-based questions: 7.4±1.4 versus 9.0±0.6, P &lt; 0.001. Eighty-eight percent of evidence-based/standard-of-care questions were answered correctly by validators versus 62% by fellows (P &lt; 0.001). Forty-two percent of fellows were able to name four potential benefits and two risks associated with HHD; 79% recognized that the primary risk of buttonhole cannulation was infection. Seventy-four percent correctly identified minimum single pool Kt/V for thrice-weekly hemodialysis, and 29% knew the minimum standard weekly Kt/V target. Eighty-eight percent of fellows surveyed (22 of 25) agreed/strongly agreed that the OSCE was useful in self-assessing proficiency. Conclusions The OSCE may be used as a formative assessment of fellow proficiency in prescribing HHD.

G-549 Pioneering Hands-On Kidney Biopsy Training for Nephrology Fellowship

G-549 Pioneering Hands-On Kidney Biopsy Training for Nephrology Fellowship

G-554 Scholarly Activities in Nephrology Fellowship Training

G-554 Scholarly Activities in Nephrology Fellowship Training

Knowledge, attitudes, and practices toward training of vascular access in chronic hemodialysis patients among nephrology fellows in Southwest China

This cross-sectional study examined the knowledge, attitudes, and practice (KAP) of training of vascular access in chronic hemodialysis patients among nephrology fellows in Southwest China. Nephrology fellows in Southwest China were recruited from June 1st to 10th, 2024. The demographic characteristics and KAP scores were determined using a self-designed questionnaire. Finally, 210 valid questionnaires were included. Among the participants, 37.6% were 36–40 years old, and 54.3% were females. The median knowledge, attitude, and practice scores were 19 (IQR: 17–20) (possible maximum of 20), 36 (IQR: 35–37) (possible maximum of 50), and 46 (IQR: 38–60) (possible maximum of 80), respectively. Knowledge and attitudes were correlated (Pearson’s r = 0.439, P < 0.001), as well as knowledge and practice (r = 0.645, P < 0.001) and attitudes and practice (r = 0.560, P < 0.001). Mediation analysis showed that the knowledge scores (β = 0.266, P < 0.001), attitude scores (β = 0.268, P < 0.001), gender (β=-0.149, P = 0.001), nephrology experience (β = 0.135, P = 0.005), and experience of leading a vascular access-related surgery or procedure (β=-0.374, P < 0.001) had direct influences on practice, while the knowledge scores (β = 0.130, P < 0.001), professional background (β=-0.186, P < 0.001), and experience of leading a vascular access-related surgery or procedure (β=-0.070, P = 0.006) had indirect influences on practice. The study indicated that nephrology fellows in Southwest China had good vascular access knowledge but moderate attitudes and practices. Specific areas would require training to improve the practice of vascular access for patients requiring maintenance hemodialysis.

Digital transformation of nephrology POCUS education-Integrating a multiagent, artificial intelligence, and human collaboration-enhanced curriculum with expert feedback.

The digital transformation in medical education is reshaping how clinical skills, such as point-of-care ultrasound (POCUS), are taught. In nephrology fellowship programs, POCUS is essential for enhancing diagnostic accuracy, guiding procedures, and optimizing patient management. To address these evolving demands, we developed an artificial intelligence (AI)-driven POCUS curriculum using a multiagent approach that integrates human expertise with advanced AI models, thereby elevating educational standards and better preparing fellows for contemporary clinical practice. In April 2024, the Mayo Clinic Minnesota Nephrology Fellowship Program initiated a novel AI-assisted process to design a comprehensive POCUS curriculum. This process integrated multiple advanced AI models-including GPT-4.0, Claude 3.0 Opus, Gemini Advanced, and Meta AI with Llama 3-to generate initial drafts and iteratively refine content. A panel of blinded nephrology POCUS experts subsequently reviewed and modified the AI-generated material to ensure both clinical relevance and educational rigor. The curriculum underwent 12 iterative revisions, incorporating feedback from 29 communications across AI models. Key features of the final curriculum included expanded core topics, diversified teaching methods, enhanced assessment tools, and integration into inpatient and outpatient nephrology rotations. The curriculum emphasized quality assurance, POCUS limitations, and essential clinical applications, such as fistula/graft evaluation and software integration. Alignment with certification standards further strengthened its utility. AI models contributed significantly to the curriculum's foundational structure, while human experts provided critical clinical insights. This curriculum, enhanced through a multiagent approach that combines AI and human collaboration, exemplifies the transformative potential of digital tools in nephrology education. The innovative framework seamlessly integrates advanced AI models with expert clinical insights, providing a scalable model for medical curriculum development that is responsive to evolving educational demands. The synergy between technological innovation and human expertise holds promising implications for advancing fellowship training. Future studies should evaluate its impact on clinical competencies and patient outcomes across diverse practice environments.

Current State and Future Direction of Vascular Access Training in the United States.

This study seeks to provide insights into the current state of vascular access education in adult nephrology fellowship programs in the United States and to identify areas for improvement. A total of 63 adult nephrology programs and 71 second-year adult nephrology fellows were randomly selected for participation in a roundtable. Virtual roundtable discussions preceded by a survey were conducted to gather information on the delivery of vascular access education. Descriptive statistics were employed for analysis. Among the respondents invited to the roundtable discussions, 42 individuals (30 faculty, 12 fellows) completed the survey, while 21 individuals (13 faculty, 8 fellows) also participated in the roundtable discussion. Of these respondents, a majority (67%) of didactic lectures on vascular access in fellowship programs were delivered by general nephrologists, with 57% provided by interventional nephrologists, 36% by surgeons and 17% by interventional radiologists (respondents were able to select multiple disciplines). The respondents reported limited exposure to proceduralists, including interventional nephrologists and vascular access surgeons during fellowship training. Faculty and fellows were less comfortable with physical examination skills related to vascular access, particularly in using point-of-care ultrasound and interpreting vascular imaging as compared to naming and identification of vascular access. Both groups emphasized the importance of hands-on modalities in vascular access education. Roundtable discussions highlighted the need for enhanced hands-on training, multidisciplinary collaboration, and standardized curricula in vascular access education. Recommendations were formulated in alignment with the three levels of competency outlined by the American Society of Nephrology (ASN) Task Force on the Future of Nephrology, aiming to address gaps and improve the quality of vascular access education in nephrology fellowship programs. This study underscores the importance and need for a comprehensive vascular access education in nephrology fellowship training. By implementing the identified recommendations, programs can better prepare fellows to manage vascular access-related challenges in clinical practice.

Assessing Current Nephrology Fellows' Perceptions of Future Earnings as Attending Physicians.

Assessing Current Nephrology Fellows' Perceptions of Future Earnings as Attending Physicians.

Challenges encountered to creating a renal biopsy program at a tertiary care academic institution in the United States

Biopsy is the gold standard for diagnosing renal pathology and the procedure is required to be learned per ACGME guidelines for Nephrology Fellowship graduation. We describe the process for the planning and development of a new Nephrologist directed native renal biopsy program to increase the opportunity to train Nephrology fellows in this procedure. The article outlines the barriers, complications and lessons learned to developing the program, highlighting the key challenges and progress that has been made within a single American tertiary academic medical center.

Barriers and Constraints in Scientific Manuscript Preparation Among Nephrologists: Insights From India.

Introduction: Medical research shapes public health actions, emphasising the need for greater investments in health. Despite a surge in scientific publications, disparities exist in authorship from low-income countries and among female researchers. Addressing these gaps is vital for studying real-world health outcomes and promoting universal healthcare delivery. Methods: A descriptive quantitative study using an online questionnaire to gather data from Indian nephrologists and nephrology fellows was conducted by members of Women in Nephrology, India, from September 2023 to December 2023. The survey collected data on demographics, publication experience and challenges in scientific paper writing. Statistical analyses were performed using SPSS Version 25.0, with significance at p < 0.05. Results: The survey included 156 participants, with a mean age of 35.55 ± 8.91 years. The majority were males (55.8%) and practicing nephrologists (69.9%). Most respondents practiced in medical institutions (45.5%) and metropolitan cities (60.3%), with an average practice duration of 12.29 ± 9.12 years. Only 44.9% published their thesis work, and 52.6% preferred writing case reports. Key challenges included time constraints (82.1%), funding (67.9%), limited access to research articles (65.4%), lack of statistical analysis knowledge (64.7%) and limited access to research software (60.2%). Younger nephrologists faced more funding (68.9%) and knowledge-related barriers (74.4%). Discussion: Multiple challenges exist in scientific paper writing among Indian nephrologists, emphasising the need for targeted interventions. Funding for research, burnout and article processing charges are significant barriers. Addressing these challenges is crucial for enhancing research output and improving healthcare outcomes in resource-limited countries.

Dialysis Jeopardy!

Dialysis Jeopardy! was a fun and innovative dialysis quiz for conference attendees at the Annual Dialysis Conference 2024 held in San Diego. The event saw active participation from nephrology fellows, faculty, and allied health care professionals. The event provided an excellent opportunity for nephrology fellows to interact with faculty in a nonformal setting.

Enhancing Apheresis Knowledge: An Educational Intervention for Non-Apheresis Medical Providers.

A knowledge gap exists between apheresis medicine (AM) physicians and providers who request the service, presenting challenges when coordinating care. We investigated an educational intervention consisting of a 40-min in-person evidence-based lecture for neurology residents, neurology attending physicians, and nephrology fellows. Pre-/post-testing demonstrated substantially improved understanding of apheresis mechanics, indications, complications, and patient consent. We advocate for more educational sessions about AM for the non-apheresis providers to increase awareness about apheresis and foster collaborative interdisciplinary efforts.

Program Director and Nephrology Fellow's Perceptions of Home Hemodialysis Education in the United States.

Background: Public policy focuses on increasing the prevalence of home dialysis. Home hemodialysis (HHD) education and comfort with the procedure are significant barriers to increasing prevalence. This study examines nephrology fellowship didactic curriculum, training program infrastructure and barriers identified by both program directors and trainees Methods: The anonymous, on-line survey was developed to assess HHD curriculum in US nephrology fellowship programs. During academic year 2023-24, all US nephrology program directors (n=150) were surveyed and asked to forward survey link to their fellows, and to indicate the number to whom they forwarded the link. Results: Fifty-five (55/150; 37%) US nephrology program directors responded to the survey; 80% completed it. Thirty-seven (37/55, 67%) forwarded the link to their fellows. Fellow response rate was 53/237 (22%); 50/53 completed it (94%). 75% of the program directors reported either having an HHD curriculum or were developing one. Program directors reported that didactic lectures (87%) were the most frequently available curriculum component, whereas fellows report education on counselling (72%) was most frequent. 60% of fellows and 86% of program directors reported fellow attendance at HHD longitudinal/continuity clinic (routinely or as part of a block rotation). Both PDs and fellows identified insufficient patients as a key barrier to implementing HHD curriculum. Fellows who attended outpatient HHD clinic felt more confident and prepared in HHD-related competencies. Conclusions: The HHD curriculum exists as didactic lectures, attendance at outside HHD courses, and ESKD-shared decision-making at training programs. Most programs also have continuity clinics. Our findings highlight the presence of curriculum although inconsistent. Fellows who worked in clinic were more likely to be confident and more prepared to manage HHD patients. Additionally, fellows with longitudinal clinic felt better prepared than those attending block rotations. Training programs should consider incorporating HHD longitudinal clinical rotations, although this may require creativity to achieve.

Navigating Nephrology's Decline Through a GPT-4 Analysis of Internal Medicine Specialties in the United States: Qualitative Study.

The 2024 Nephrology fellowship match data show the declining interest in nephrology in the United States, with an 11% drop in candidates and a mere 66% (321/488) of positions filled. The study aims to discern the factors influencing this trend using ChatGPT, a leading chatbot model, for insights into the comparative appeal of nephrology versus other internal medicine specialties. Using the GPT-4 model, the study compared nephrology with 13 other internal medicine specialties, evaluating each on 7 criteria including intellectual complexity, work-life balance, procedural involvement, research opportunities, patient relationships, career demand, and financial compensation. Each criterion was assigned scores from 1 to 10, with the cumulative score determining the ranking. The approach included counteracting potential bias by instructing GPT-4 to favor other specialties over nephrology in reverse scenarios. GPT-4 ranked nephrology only above sleep medicine. While nephrology scored higher than hospice and palliative medicine, it fell short in key criteria such as work-life balance, patient relationships, and career demand. When examining the percentage of filled positions in the 2024 appointment year match, nephrology's filled rate was 66%, only higher than the 45% (155/348) filled rate of geriatric medicine. Nephrology's score decreased by 4%-14% in 5 criteria including intellectual challenge and complexity, procedural involvement, career opportunity and demand, research and academic opportunities, and financial compensation. ChatGPT does not favor nephrology over most internal medicine specialties, highlighting its diminishing appeal as a career choice. This trend raises significant concerns, especially considering the overall physician shortage, and prompts a reevaluation of factors affecting specialty choice among medical residents.

Racial and Gender Disparities among Nephrology Fellowship Trainees: Trends over a Decade and the Impact of COVID-19

Racial and Gender Disparities among Nephrology Fellowship Trainees: Trends over a Decade and the Impact of COVID-19