Nephrology Fellows Research Articles

Current Trends and Challenges in Nephrology Fellowship Training: Expansion of Education in Home Dialysis, Palliative Care, and Point-of-Care Ultrasound.

Nephrology education has changed significantly since the first nephrology fellowship programs were established in the United States in the 1950s and 1960s. The past several years have seen increased opportunities for subspecialization in areas such as interventional nephrology, onconephrology, and glomerular disease. Notable trends in fellowship curricula include the expansion of education in home dialysis and palliative care, driven by policy changes and focus on patient-centered care. In addition, point-of-care ultrasound has garnered significant interest due to its potential to provide diagnostic information that improves patient care. An important area that remains largely unaddressed appears to be education about the business and administrative aspects of nephrology. Meanwhile, the importance of training in hemodialysis catheter placement and kidney biopsy has come into question due to the small proportion of nephrologists performing these procedures today. Nephrology fellowship programs should strive to tailor their curriculum to meet the interests and needs of individual fellows.

In Memoriam: Anil K. Bidani, MD.

In Memoriam: Anil K. Bidani, MD.

Evaluation Evolution: Designing Optimal Evaluations to Enhance Learning in Nephrology Fellowship.

Evaluations serve as the backbone of any educational program and can be broadly divided into formative and summative evaluations. Formative evaluations are "just in time" evaluations focused on informing the learning process, whereas summative evaluations compare fellows to a preset standard to determine their readiness for unsupervised practice. In the nephrology fellowship programs, evaluations assess competence in the framework of ACGME Milestones 2.0. A variety of learning venues, evaluators, and tools should be incorporated into the measurement process. It is important to determine which milestones can be best assessed in each education venue to decrease the burden of assessment fatigue. Additionally, programs can diversify the evaluators to include nurses, medical students, peers, and program coordinators in addition to faculty to provide a well-rounded assessment of the fellows and share the assessment burden. Lastly, the evaluation data should be presented to fellows in a format where it can inform goal setting. The evaluation system needs to evolve along with the changes being made in curriculum design. This will help to make fellowship learning effective and efficient.

National Survey: Point-of-Care Ultrasound Use Among Nephrology Program Directors, Fellows, and Graduates

National Survey: Point-of-Care Ultrasound Use Among Nephrology Program Directors, Fellows, and Graduates

"Make Me a Match": All-In and Other Trends in the Nephrology Match.

"Make Me a Match": All-In and Other Trends in the Nephrology Match.

Impact of a Simulation Dialysis Access Ultrasound Tutorial for Nephrology Fellows

Impact of a Simulation Dialysis Access Ultrasound Tutorial for Nephrology Fellows

Point-of-Care Ultrasound Training during Nephrology Fellowship: A National Survey of Fellows and Program Directors.

Point-of-care ultrasound (POCUS)-performed by a clinician during a patient encounter and used in patient assessment and care planning-has many potential applications in nephrology. Yet, US nephrologists have been slow to adopt POCUS, which may affect the training of nephrology fellows. This study sought to identify the current state of POCUS training and implementation in nephrology fellowships. Concise survey instruments measuring attitudes toward POCUS, its current use, fellow competence, and POCUS curricula were disseminated to (1) 912 US nephrology fellows taking the 2021 Nephrology In-Training Examination and (2) 229 nephrology training program directors and associate program directors. Fisher exact, chi-squared, and Wilcoxon rank sum tests were used to compare the frequencies of responses and the average responses between fellows and training program directors/associate program directors when possible. Fellow and training program directors/associate program directors response rates were 69% and 37%, respectively. Only 38% of fellows (240 respondents) reported receiving POCUS education during their fellowship, and just 33% of those who did receive POCUS training reported feeling competent to use POCUS independently. Similarly, just 23% of training program directors/associate program directors indicated that they had a POCUS curriculum in place, although 74% of training program directors and associate program directors indicated that a program was in development or that there was interest in creating a POCUS curriculum. Most fellow and faculty respondents rated commonly covered POCUS topics-including dialysis access imaging and kidney biopsy-as "important" or "very important," with the greatest interest in diagnostic kidney ultrasound. Guided scanning with an instructor was the highest-rated teaching strategy. The most frequently reported barrier to POCUS program development was the lack of available instructors. Despite high trainee and faculty interest in POCUS, the majority of current nephrology fellows are not receiving POCUS training. Hands-on training guided by an instructor is highly valued, yet availability of adequately trained instructors remains a barrier to program development. This article contains a podcast at https://www.asn-online.org/media/podcast/CJASN/2022_09_21_CJN01850222.mp3.

Nephrology Trainee Education Needs Assessment: Five Years and a Pandemic Later

Seventy-four percent of nephrology fellows reported exclusively receiving virtual didactics during the early part of the coronavirus disease 2019 (COVID-19) pandemic.1 In response to this rapid shift to online instruction, we sought to describe usage of novel digital educational resources, including free open access medical education (FOAMed; eg, online journal clubs, podcasts, and blogs), by current adult and pediatric nephrology fellows through a research survey. Observed utilization rates were compared with rates reported from a prepandemic study.

First Author Spotlight

AnnouncementFirst Author SpotlightPublished Online:09 Sep 2022https://doi.org/10.1152/ajprenal.2022.323.3.AUMoreSectionsPDF (285 KB)Download PDF ToolsExport citationAdd to favoritesGet permissionsTrack citations ShareShare onFacebookTwitterLinkedInWeChat RAWAN ALMUTLAQCardiorenal Physiology and Medicine, Division of Nephrology, Department of Medicine, University of Alabama at Birmingham, Birmingham, AlabamaFigure 1.Rawan AlmutlaqDownload figureDownload PowerPointRawan Almutlaq is a PhD student in the Department of Integrative Biology and Physiology at the University of Minnesota, mentored by Dr. Louise Evans. She earned her BS in Biochemistry from King Abdulaziz University and her MS in Biotechnology from the University of Alabama at Birmingham. Her research interest focuses on salt-sensitive hypertension. In her spare time, she likes to bake [Photo: Fig. 1].https://doi.org/10.1152/ajprenal.00055.2022DENISE C. HASSONDivision of Critical Care Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OhioFigure 2.Denise HassonDownload figureDownload PowerPointDenise Hasson was born and raised in a suburb of Los Angeles, CA. She graduated from Dartmouth College and then earned her medical degree at Keck School of Medicine at the University of Southern California. She completed an Internal Medicine-Pediatrics Residency at the University of Colorado Hospital/Children's Hospital Colorado. She moved to Cincinnati, OH, to pursue research mentorship from Dr. Steve Standage, Dr. Hector Wong, and Dr. Stuart Goldstein in the laboratory of Dr. Steve Standage at Cincinnati Children's Hospital Medical Center. She finished a Pediatrics Critical Care Fellowship and a Critical Care Nephrology Fellowship. Her research interests focus on the improvement of pediatric acute kidney injury outcomes with a translational approach to nutritional/metabolic optimization. She has accepted a position as a Clinical Assistant Professor in the Department of Pediatrics at NYU Langone Health/NYU Grossman School of Medicine. Denise enjoys traveling, biking, swimming, and she is a loyal Dodgers fan [Photo: Fig. 2].https://doi.org/10.1152/ajprenal.00033.2022SOPHIA M. SEARSDepartment of Pharmacology and Toxicology, University of Louisville, Louisville, KentuckyFigure 3.Sophia SearsDownload figureDownload PowerPointSophia Sears recently earned her PhD in Pharmacology and Toxicology from the University of Louisville. During her graduate studies, she was awarded an F31 predoctoral fellowship from the National Institute of Diabetes and Digestive and Kidney Diseases under the mentorship of Dr. Leah Siskind. She then became a postdoctoral associate in Dr. Siskind's laboratory. Her research interests include chronic kidney disease and inflammation. In her spare time, she enjoys exercising and playing with her dog [Photo: Fig. 3].https://doi.org/10.1152/ajprenal.00097.2022This article has no references to display. Download PDF Back to Top Next FiguresReferencesRelatedInformationRelated ArticlesAromatase inhibition increases blood pressure and markers of renal injury in female rats 23 Aug 2022American Journal of Physiology-Renal PhysiologyCholine supplementation attenuates experimental sepsis-associated acute kidney injury 17 Aug 2022American Journal of Physiology-Renal PhysiologyPharmacological inhibitors of autophagy have opposite effects in acute and chronic cisplatin-induced kidney injury 17 Aug 2022American Journal of Physiology-Renal Physiology More from this issue > Volume 323Issue 3September 2022Pages i-i Crossmark Copyright & PermissionsCopyright © 2022 the American Physiological Society.https://doi.org/10.1152/ajprenal.2022.323.3.AUHistory Published online 9 September 2022 Published in print 1 September 2022 Metrics

Improvement in Housestaff Knowledge of Novel Antihyperglycemic Agents Through a Cross-Specialty Beyond Diabetes“Educational Initiative”

Lead Author's Financial Disclosures Nothing to disclose. Study Funding AstraZeneca Pharmaceutical Industry Company. Background/Synopsis Novel antihyperglycemic agents, including sodium-glucose cotransporter-2 inhibitors (SGLT2i) and glucagon-like-peptide-1 receptor agonists (GLP1-RA), demonstrate significant benefits in select patients with and without diabetes (T2DM). These benefits include improvements in cardiovascular, kidney and metabolic outcomes. Despite these benefits, these medications remain underutilized, attributed in part to a lack of provider knowledge across specialties. Our "Beyond-Diabetes" initiative is a health system-wide, multidisciplinary collaboration to raise awareness and prescriber utilization of these medications through a variety of informatics and educational modalities. Objective/Purpose The goal of this component of our initiative was to assess whether lecture based (grand rounds) and case-based conferences delivered via a virtual platform could improve understanding of SGLT2i and GLP1-RA among residents and fellows as part of their core curriculum. Methods We administered a 6-question electronic survey to assess knowledge of SGLT2i and GLP1-RA before and after a 1-hour, virtual case-based education that highlighted clinical uses, contraindications, dosing, adverse effects, and prescribing barriers. The housestaff were previously offered a grand rounds on the topic. The lectures and pre/post surveys were provided to internal medicine residents, as well as cardiology, nephrology, and endocrinology fellows. Efficacy was measured by analyzing the percent correct between pre/post-test questionnaires by a paired, two-sided t-test. Results After evaluating the pre-test and post-test results of the trainees, we found that among all disciplines (n = 119 pre/63 post), the average increase was 15% correct between pre-test and post-test (p-value <0.01) using random pre-test sampling. Limitations of this data include a low response rate with 28% of trainees completing the pre-test (119/418) and 53% completing the post-test (63/119). Cardiology fellows showed the greatest improvement in their overall scores with a 17% change. Endocrinology fellows had the least improvement, with a difference of 6%, likely attributable to having the highest baseline pre-test questionnaire scores. Analysis of each question showed that there was an increase in the percentage answered correctly, with the exception of one question, which had no change after education. Conclusions Our intervention demonstrates that a 1-hour virtual lecture can improve the knowledge of trainees across four disciplines regarding novel antihyperglycemic medications. This data supports the use of virtual lecture and case-based didactics to enhance provider knowledge regarding SGLT2i and GLP1-RA medications. However, further research into the most effective educational initiatives is warranted. This knowledge is essential to increase the utilization of these effective medications, which have been demonstrated to improve clinical outcomes and reduce healthcare expenditures. Nothing to disclose.

Regional variations in nephrology trainee confidence with clinical skills may relate to the availability of local training opportunities in the UK: results from a national survey

BackgroundThe United Kingdom offers a standardised training program for nephrology fellows. However, local training opportunities vary resulting in mismatches between trainee interests and accessible opportunities. This may impact trainee confidence, satisfaction, and future service provision.MethodsA survey assessing confidence with key procedures and sub-specialities was disseminated. Associations with region of training were probed using Chi square tests, with significance set at p < 0.0008 following a Bonferroni correction. Results were compared to trainee views on available opportunities for development.Results139 responses were received (32% response rate, demographics representative of the UK nephrology trainee cohort). Procedural independence varied from 98% for temporary femoral vascular catheters to 5% for peritoneal dialysis catheters (PDIs). Independence with inserting tunnelled vascular catheters varied with region (p < 0.0001). Trainees expressed a desire for formal training in kidney ultrasound scanning and PDIs, corresponding with procedures they had least opportunity to become independent with. Trainees felt least confident managing kidney disease in pregnancy. Suggestions for improving training included protected time for garnering sub-speciality knowledge, developing procedural skills and for experiencing practice in other nephrology units.ConclusionsA mismatch between trainee interests and professional development opportunities exists, which may threaten trainee autonomy and impact patient care particularly with regards to peritoneal dialysis. Provisions to facilitate trainee directed development need to be made while balancing the rigors of service provision. Such measures could prove critical to promoting trainee well-being and preventing attrition within the nephrology workforce.

SARS-CoV-2 Infection Evolution Among Nephrologists During the Pandemic: Clinical Features and Impact of Vaccination

SARS-CoV-2 Infection Evolution Among Nephrologists During the Pandemic: Clinical Features and Impact of Vaccination

Burnout in Pediatric Nephrology Fellows and Faculty: Lessons From the Sustainable Pediatric Nephrology Workforce Project (SUPERPOWER).

Physician well-being is an important contributor to both job satisfaction and patient outcomes. Rates of burnout among physicians vary by specialty, ranging from 35 to 70%. Among pediatric residents, longitudinal data demonstrates consistent rates of burnout around 50-60%, although little is known about burnout among pediatric subspecialty fellows. Specifically, the degree of burnout among pediatric nephrologists remains unknown, as does the impact faculty burnout may have on trainee burnout. We sought to evaluate prevalence and predictors of burnout among US pediatric nephrology fellows and faculty, and assess for interactions between groups. In this multi-center pilot survey of all United States pediatric nephrology training programs from February to April 2020, burnout was assessed through abbreviated Maslach Burnout Inventory and predictors were explored through survey items devoted to demographic, personal characteristics, and job and career satisfaction questions. A total of 30/34 available fellows and 86/102 faculty from 11 institutions completed the survey (overall response rate 85%). The prevalence of burnout was 13% among fellows and 16% among faculty. Demographic (age, gender, year of training, faculty rank, marital status) and program factors (fellowship size, faculty size, current block/rotation, vacation or weekend off timing) were not significantly associated with burnout. Faculty and fellows with burnout reported significantly lower quality of life (5.3 vs. 7.9, p < 0.05), higher perceived stress (2.4 vs. 1.4, p < 0.05) and lower satisfaction with career choice (66 vs. 22%) and work life balance (28 vs. 0%), compared to those without burnout (p < 0.05 for all). Other important factors positively associated with burnout included lower institutional support for wellness programs and lower satisfaction with both colleague and faculty support. Larger studies are needed to explore if burnout is truly less prevalent among pediatric nephrology fellows and faculty compared to pediatric residents and graduate physicians. A larger sample size is also necessary to determine whether any interactions exist between the faculty and trainee roles in the developments of burnout. Future studies should also explore how to promote well-being through addressing key factors such as overall learning/working environment, stress reduction, and building personal resilience.

Barriers to Peritoneal Dialysis Utilization among End Stage Kidney Disease Patients in Kenya

Aim: barriers to peritoneal dialysis utilization among end stage kidney disease patients in Kenya. Background: Peritoneal Dialysis (PD) is the use of the capillary rich peritoneal membrane as a dialyzer whereby waste products diffuse from the capillaries into the dialysate during dwell time. Peritoneal Dialysis is a proven viable treatment for Kidney failure (KF) but it is not popularly utilized in Kenya. However, the uptake of PD in Kenya has been shown to be low owing to various barriers that have created a hindrance to utilization of the procedure among patients suffering from end stage kidney disease (ESRD). Methodology: A descriptive – analytical cross sectional study was conducted in 6 government dialysis centres in Kenya purposively selected. The study targeted 346 patients with ESKD, 6 nephrologists, 19 general physicians, 125 nurses in six government owned dialysis centers in Kenya. The targeted policy makers were 6 from each hospital, 4 from the county governments, 2 from the national hospital insurance fund (NHIF) and 2 from the ministry of health (MOH). The nurses and patient participants were sampled through simple random sampling while the doctors and policy makers were sampled by census based on their specialization and/or deployment in dialysis units and their positions respectively. The study sought to establish barriers to utilization of PD among patients with ESKD. The study entailed mixed methods where both quantitative and qualitative data collection methods were employed. Both structured and unstructured questions were utilized in a self-administered / research assisted questionnaire. Quantitative data was analyzed using SPSS Version 22.0. Qualitative data was organized, shared, and managed using N Vivo 11 software and was analyzed using thematic areas. Hypothesis testing was done using chi- squared test whereby P-values of less than 0.05 were considered statistically significant with a 95% confidence interval (CI). Data presentation was done using tables, charts and in narrative form. Results: The research revealed low utilization of PD in the selected Hospitals where only 0.2% (1) was on PD. Chi-square tests of associations revealed that patients who had been educated on PD and patients who were educated on the equipment required for PD were more likely to utilize the PD modality of dialysis (p&lt;0.01 and p=0.01603, respectively). Results from the multivariate logistic regression showed that only patients who had been educated on PD were more likely to choose the PD modality (p= 0.01222). Various barriers to PD utilization were identified. From the research findings, the Cost of PD fluids seems to be a major constraint given that many countries in Africa do not have the capacity to manufacture fluids but instead rely heavily on fluids imported from developed countries. Low patient education and motivation was also found to be a major barrier with a huge population unaware of PD. There was lack of expertise/experience for catheter insertion with insufficient PD training for nephrology fellows, which has been a barrier to PD initiation and retention. Some nurses also lacked training and experience in conducting PD procedure. The policy makers in the National Hospital Insurance Fund also confirmed that PD services were not among the services covered by the fund hence patients had to pay for themselves. Additionally, there was no sound policy or a standard Model to guide utilization of PD in Kenya unlike in other countries. The barriers were categorized as patient related, healthcare related as well as policy related. Conclusions and Recommendations Despite similar clinical and humanistic outcomes between HD and PD, PD may be the more convenient and resource-conscious option of dialytic kidney replacement therapy (DKRT). Underutilization of PD is mainly related to lack of PD dianeal solutions, accessories, dearth of trained personnel, social-economic factors, and lack of advocacy to project PD as the first option for Kidney replacement therapy (KRT). In order to address the identified barriers, the development of a functional PD team is essential for a successful patient outcome. There is also need to develop a policy on management of PD services as well as a standard Model to guide PD utilization.

The Kidney Diet Challenge: An Experiential Educational Experience.

Health care providers who care for patients with CKD must be able to provide effective counseling about a kidney-friendly diet. Nutrition is underemphasized in medical curricula, and the kidney diet is one of the most challenging diets. We hypothesized that participation in an experiential educational program in kidney diet would result in improved knowledge of the underlying principles behind it and provide concrete examples of how to explain this diet to patients. The first part of this study was a knowledge assessment administered to all US nephrology fellows during the 2020 National Board of Medical Examiners Nephrology In-Training Examination. We later opened the assessment to a broader, global audience via social media. Respondents included trainees, practicing nephrologists, dieticians, and other health professionals. Participants self-identified willingness to participate in the second part of the study, the Kidney Diet Challenge (KDC). The 5-day challenge included daily webinars by experts in nutrition. Daily surveys captured self-reported adherence to the diet. Social media was used to engage with participants. All participants received a follow-up knowledge assessment. Among the nephrology fellows (n=317), the median pretest score was 2 out of 5 (40%) questions correct, and results did not differ by year of training (P=0.31). Of the participants (n=70) who completed the 5-day challenge and responded to the post-challenge survey, the distribution of the number of correct answers improved after the KDC (median [25th, 75th percentile]: 3 [2, 3] versus 3 [2, 4]; P<0.001). Statistics from our official hashtag for this study (#kidneydietchallenge) showed that we achieved 406,241 reaches and 1,004,799 impressions, with a total of 974 posts using this hashtag. The KDC is an immersive, experiential educational tool that enabled a global population to learn how to counsel their patients better about adherence to a complex kidney diet.

Nephrology Fellowship Clinician-Performed Ultrasound Curriculum.

Fluid overload (FO) contributes significantly to the development of cardiovascular disease among patients with end-stage kidney disease (ESKD) on hemodialysis (HD), yet remains underappreciated due to limitations of the physical exam [1]. Lung ultrasound (US) is an established tool for quantification of FO [2]. Previous validation of quantitative lung US among nephrology attendings using a remote web-based lung ultrasound training has been demonstrated [3]. Interest in ultrasound education among nephrology fellows is high [4]. Clinician-performed ultrasound curricula for nephrology fellows have been described previously, however fellows’ competency in quantitative lung US has not been described [5]. In the present study we aimed to assess the current level of knowledge among nephrology fellows as well as the efficacy of a brief training course in quantitative lung US.

POS-984 Impact of covid-19 pandemic on Malaysian nephrology fellow training and well-being

Corona virus disease 2019 (covid-19) pandemic has alarming implications on an individual's health, and emotional and social well-being. This survey explores such impact on the nephrology fellows’ training programmes and their emotional welfare.

Integrating Point of Care Ultrasound into Nephrology Fellowship Training: Insights from a Pilot Program.

In nephrology, point-of-care ultrasound (POCUS) has multiple applications including the rapid evaluation of acute kidney injury, enhancing the initial evaluation of chronic kidney disease, direct evaluation of vascular access, and improved fluid balance management in acute and chronic settings [1, 2]. Recently, the role of POCUS has been formally acknowledged by the American College of Physicians and curricula specific to nephrology have been proposed [3, 4]. However, the integration of a novel clinical skill into a field comes with its unique set of challenges. Above all, most nephrologists in leadership roles within fellowship training programs lack POCUS experience, which represent a significant barrier for adequate exposure and teaching. Although educational curriculum centered on nephrology have been proposed, the optimal model to ensure adequate POCUS exposure considering the scarcity of expertise among educators is not known.

Advancing Discovery Research in Nephrology in Canada: A Conference Report From the 2021 Molecules and Mechanisms Mediating Kidney Health and Disease (M3K) Scientific Meeting and Investigator Summit.

New discoveries arising from investigations into fundamental aspects of kidney development and function in health and disease are critical to advancing kidney care. Scientific meetings focused specifically on fundamental biology of the kidney can facilitate interactions, support the development of collaborative groups, and accelerate translation of key findings. The Canadian fundamental kidney researcher community has lacked such a forum. On December 3 to 4, 2021, the first Molecules and Mechanisms Mediating Kidney Health and Disease (M3K) Scientific Meeting and Investigator Summit was held to address this gap with the goal of advancing fundamental kidney research nationally. The meeting was held virtually and was supported by a planning and dissemination grant from the Canadian Institutes of Health Research. Attendees included PhD scientists, nephrology clinician scientists, engineers, industry representatives, graduate students, medical residents, and fellows. This report was prepared from the scientific program, registration numbers, and details obtained from the online platform WHOVA, and summaries written by organizers and participants of the 2021 meeting. A 21-person team, consisting of the organizing committee members and participants from the meeting, was assembled. Key highlights of the meeting and future directions were identified and the team jointly assembled this report. Participation in the meeting was strong, with more than 140 attendees across a range of disciplines. The program featured state-of-the-art presentations on diabetic nephropathy, the immune system, kidney development, and fibrosis, and was heavily focused on trainee presentations. The moderated "Investigator Summit" identified key barriers to research advancement and discussed strategies for overcoming them. These included establishment of a pan-Canadian fundamental kidney research network, development of key resources, cross-pollination with clinical nephrology, better reintegration into the Canadian Society of Nephrology, and further establishment of identity and knowledge translation. The 2021 M3K meeting represented a key first step in uniting fundamental kidney researchers in Canada. However, it was universally agreed that regular meetings were necessary to sustain this momentum. The proceedings of this meeting and future actions to sustain the M3K Scientific Meeting and Investigator Summit are presented in this article.

Glomerular Disease Education Experience across Nephrology Fellowship Programs: An International Survey

Introduction: Glomerulonephritis (GN) education is an important, albeit a challenging, component of nephrology fellowship training. We hypothesized that trainee experience varies widely across programs, leading to differences in self-reported competency levels in the diagnosis and management of glomerular diseases. Methods: The Glomerular Disease Study & Trial Consortium (GlomCon) conducted an anonymous online survey to determine the educational experience of nephrology trainees. We used multiple-choice questions to obtain data about (a) curriculum-based education, (b) dedicated specialty clinic, and (c) exposure to pathology. We leveraged a visual analog scale of 1–100 (with a higher number indicating a higher comfort level) to assess self-reported levels of clinical competency. The survey was disseminated via email to the subscribing members of GlomCon and through Twitter. Results: In total, there were 109 respondents to our survey, and 56% were from training programs in the USA. Exposure to a specialized GN clinic was reported by 45%, while 77% reported the presence of an onsite nephropathologist at their training program. Self-reported competency scores were 59 ± 25 and 52 ± 25 for diagnosis and treatment of glomerular diseases, respectively. Days spent in a GN clinic per year, years of fellowship, and dedicated nephropathology didactics were associated with higher diagnosis and treatment competency scores. Conclusion: Trainees report a wide variation in glomerular disease education across fellowship programs. A lack of nephropathology exposure and a dedicated GN curriculum was associated with lower scores in self-reported clinical competency in caring for patients with glomerular disease.