Nephrology Fellowships Research Articles

A Survey of Pregnancy and Parenthood among Physician Trainees: How Do Nephrology Fellowships Compare?

A Survey of Pregnancy and Parenthood among Physician Trainees: How Do Nephrology Fellowships Compare?

Study preferences and exam outcomes in medical education: insights from renal physiology

BackgroundEfficient learning strategies and resource utilization are critical in medical education, especially for complex subjects like renal physiology. This is increasingly important given the rise in chronic renal diseases and the decline in nephrology fellowships. However, the correlations between study time, perceived utility of learning resources, and academic performance are not well-explored, which led to this study.MethodsA cross-sectional survey was conducted with second-year medical students at the University of Bergen, Norway, to assess their preferred learning resources and study time dedicated to renal physiology. Responses were correlated with end-of-term exam scores.ResultsThe study revealed no significant correlation between time spent studying and overall academic performance, highlighting the importance of study quality over quantity. Preferences for active learning resources, such as Team-Based Learning, interactive lessons and formative assignments, were positively correlated with better academic performance. A notable correlation was found between students’ valuation of teachers’ professional competence and their total academic scores. Conversely, perceived difficulty across the curriculum and reliance on self-found online resources in renal physiology correlated negatively with academic performance. ‘The Renal Pod’, a locally produced renal physiology podcast, was popular across grades. Interestingly, students who listened to all episodes once achieved higher exam scores compared to those who listened to only some episodes, reflecting a strategic approach to podcast use. Textbooks, while less popular, did not correlate with higher exam scores. Despite the specific focus on renal physiology, learning preferences are systematically correlated with broader academic outcomes, reflecting the interconnected nature of medical education.ConclusionThe study suggests that the quality and strategic approaches to learning significantly impact academic performance. Successful learners tend to be proactive, engaged, and strategic, valuing expert instruction and active participation. These findings support the integration of student-activating teaching methods and assignments that reward deep learning.

American Society of Nephrology Kidney Tutored Research and Education for Kidney Scholars (TREKS) Program: A 10-Year Interim Analysis.

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.

Pregnancy and Family Policies in Nephrology Fellowships.

Pregnancy and Family Policies in Nephrology Fellowships.

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.

Securing the future of kidney transplantation by addressing the challenges of transplant nephrology.

Kidney transplant is a life-changing procedure, and transplant nephrologists, as part of a larger transplant team, play an important role in the field by managing the complex medical needs of transplant patients. The subspecialty of transplant nephrology, however, faces structural challenges related to its workforce, reporting structures, compensation, research and innovation, and health care information technology. The position of transplant nephrology at the academic and operational intersection of medicine and surgery may limit its access to critical resources, hinder academic promotion, and contribute to physician burnout. The authors provide an overview of the subspecialty transplant nephrology and propose solutions. Collaborative efforts that fortify the subspecialty of transplant nephrology will ultimately improve the lives of patients suffering from kidney disease.

Home hemodialysis education during postdoctoral training: Challenges and innovations.

Inadequate education in home hemodialysis (HHD) fellowship training might contribute to underutilization of this modality in the United States. Most graduates of nephrology fellowships do not grade themselves as competent in HHD suggesting that fellowship training in HHD is inadequate. An essential component for fellow education is at least one faculty member with expertise in HHD who is passionate about promoting the use of this modality. At a minimum, fellow training should utilize a curriculum that includes both lectures about HHD and outpatient clinical exposure to this modality over a period of at least 6-12months. Fellows benefit from the opportunity to transition at least three patients to a home modality to gain experience with modality education, access placement, initial prescriptions, and home dialysis training. They should spend time with HHD training nurses to learn more about modality education, observe nurse intake interviews with patients in order to learn the criteria for entrance into the home dialysis program as well as recognize how to identify potential barriers to successful home dialysis therapy. To expose fellows to problems that do not occur during clinic visits fellows are encouraged to take first call during the day for HHD patients. There are many opportunities to do research and quality improvement projects which might also propel some fellows into an academic career as a home dialysis nephrologist.

Protocols for treating patients with end-stage renal disease: a survey of nephrology fellowships.

Approximately 14% of Americans are living with chronic kidney disease (CKD). The prevalence of end-stage renal disease (ESRD), the result of progressing CKD continues to rise by 21,000 per year. Currently, the only antibiotic prophylaxis guidelines for patients with ESRD undergoing dental treatment were published by the AHA in 2003. Presented in three parts, the first and second parts of this study found no consistent protocols amongst U.S. dental schools and U.S. GPRs and AEGDs, respectively. The goal of the third part of the project was to determine the current protocol being used to treat ESRD patients at U.S. nephrology fellowship programs. An 18 multiple-choice question survey was e-mailed to 130 directors of nephrology fellowships within the U.S. regarding renal treatment protocol details and antibiotic prophylaxis for patients with renal disease. Note that, 34.6% of respondents reported having an established renal treatment protocol. For programs with a protocol, 69% of programs reported following AHA guidelines. There is a lack of consistent, established protocols amongst U.S. nephrology fellowships. It is suggested that updated and evidence based guidelines for the safe treatment of patients be developed.

What Are We Doing? A Survey of United States Nephrology Fellowship Program Directors.

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.

Are There Any Solutions to the Problem of Declining Nephrology Enrolment? A Dialogue Between Two Practicing Nephrologists

Nephrology, the study of kidney diseases, took its birth as a separate specialty many decades ago, and has gradually more in importance, especially with the advent of renal replacement therapy and kidney transplantation. Nephrology also has a strong physiology foundation; indeed an understanding of renal physiology is crucial for dealing with electrolyte and acid-base problems that a physician commonly faces in day-to-day practice. Perhaps this is why it comes as a surprise that the interest in nephrology fellowships is declining - at least in North America. In this article, we present a dialogue between two practicing nephrologists, working at a tertiary care academic Canadian centre, on some potential solutions to this problem.

Training the Next Generation’s Nephrology Workforce

The subspecialty of nephrology faces several critical challenges, including declining interest among medical students and internal medicine residents and worrisome declines in the number of applicants for nephrology fellowships. There is an urgent need to more clearly define the subspecialty and its scope of practice, reinvigorate meaningful research training and activities among trainees, and ensure that fellows who complete training and enter the practice of nephrology are experts in the broad scope of nephrology. This need requires a critical look at fellowship training programs and training requirements. A new workforce analysis is also needed that is not focused on primarily meeting estimated future clinical needs but rather, ensuring that there is alignment of supply and demand for nephrology trainees, which will ensure that those entering nephrology fellowships are highly qualified and capable of becoming outstanding nephrologists and that there are desirable employment opportunities for them when they complete their training.

Alternative ideas to increase the percentage of filled seats in nephrology fellowships

Interest in nephrology has been decreasing for the last decade. In this opinion piece, the author provides four unconventional, outside-the-box strategies to increase the percentage of filled nephrology training positions.

Common sense ideas to increase the percentage of filled seats in nephrology fellowships

Interest in nephrology has been decreasing for the last decade. In this opinion piece, the author provides four unconventional, outside-the-box strategies to increase the percentage of filled nephrology training positions.

Growing a peritoneal dialysis program: A single‐center experience

Growing a peritoneal dialysis program: A single‐center experience

The D&T Report

The D&T Report

The D&T Report

The D&T Report

Procedures in Nephrology Fellowships

In this month's issue of CJASN , Berns and O'Neill describe the results of a survey of US adult nephrology training program directors (68% responded) on procedures performed by faculty and fellows at their institutions (1). The results are not surprising: The vast majority of programs require competence in performing native and transplant renal biopsies and placement of temporary hemodialysis access, whereas approximately 15 to 20% of programs perform tunneled catheter placement, peritoneal dialysis access placement, and/or therapy of stenosed/clotted vascular access. As one might expect given the lack of nationally mandated standards, there is no uniformity among programs on the required number of a given procedure. What is surprising is that such analysis of training program practices has not been done for 18 yr (2). Even more concerning is that there has been no analysis for 17 yr on the effectiveness of procedural training in preparing fellows to be practicing nephrologists (3). What, then, should renal fellowship programs be doing, and how do we make this determination? Certain procedures are generally accepted as being integral to nephrology practice; relinquishing them would potentially affect the timeliness, quality, and safety of patient care. Such procedures are appropriately mandated by the American College of Graduate Medical Education (ACGME): Renal biopsy and temporary hemodialysis access. The latter is obvious: Nephrologists should have the ability to place emergent access. With regard to renal biopsies, only nephrologists can make real-time decisions about adequacy of sample size given the suspected diagnosis. Nephrologist-obtained renal biopsies yield similar numbers of glomeruli but fewer severe complications, as compared with radiologists (4). Scheduling conflicts may preclude timely …

Interventional Care of the Hemodialysis Patient: It's About Quality

OVER the past two decades, Interventional Radiology has developed into an essential provider of percutaneous creation and management of access in hemodialysis patients. The role of interventional radiology in this patient population has developed into a broad range of procedures, including catheter placement and management, preoperative imaging for access, screening of and prophylactic intervention for failing hemodialysis conduits and fistulas, treatment of thrombosed conduits and fistulas, and salvage procedures designed to enhance the maturation of native fistulas. The development and proliferation of these interventions has been accomplished almost exclusively by interventional radiologists. These interventions are so integral to the care of the patient receiving hemodialysis treatment that they are strongly supported by the Dialysis Outcomes Quality Initiative (DOQI) Vascular Access Guidelines, published in 1997 (1) and updated in 2001 (2). Undoubtedly, the last thing interventional radiologists want to hear is the rumbling of another turf battle, but that is precisely what is happening in the area of hemodialysis access interventions. For many years, a very small group of nephrologists “borrowed” from our well-recognized name and began calling themselves “interventional nephrologists.” Until recently, the “interventional nephrology” movement was a small blip on the radar screen, but now, for a variety of reasons discussed herein, there is increased interest in this area from the nephrology community. Gradually, throughout the late 1990s, manuscripts published by “interventional nephrologists” became more frequent, billing for percutaneous procedures by the same specialists increased, and attention to this subject at nephrology meetings increased dramatically. In fact, there has been a hands-on course in “interventional nephrology” at the American Society of Nephrology meeting for the past three years. The year 2000 marked a turning point, and arguably the true onset of the “turf battle” over hemodialysis access interventions. In January of that year, the American Society of Nephrology and Renal Physicians Association published a document outlining training guidelines for nephrology fellowships, which include “interventional nephrology,” clearly defined and covering the entire spectrum of interventions currently performed by interventional radiologists in this patient population (3). Later in the year, the formation of the American Society of Interventional Nephrology was announced. Also during 2000, a proliferation of freestanding “interventional nephrology” centers, largely Baxter’s RMS Lifelines, allowed nephrologists to bypass hospital credentials committees by performing interventions outside of the hospital setting. Until this point, nephrologists had largely been unable to receive credentials for percutaneous interventions precisely because of their lack of training, which was obvious to even the most liberal credentials committee. “Training centers” are now available to nephrologists in several places throughout the country (4,5) where a 2-week course is considered “acceptable training” to allow performance of these procedures. The quote at the beginning of this Commentary reflects this sentiment. To make matters worse, medical device manufacturers are promoting the concept, offering 1and 2-day “training courses” to nephrologists, cardiologists, and surgeons; one of the authors of this article has been approached repeatedly to provide such “training.” If this sounds far-fetched, or if the reader is thinking, “this won’t happen here,” consider the following: Late this year, the Society of Cardiovascular & Interventional Radiology (SCVIR) From the Department of Radiology (S.O.T.), University of Pennsylvania Medical Center, Philadelphia, Pennsylvania; Department of Radiology (R.D.G.), Washington Hospital Center, Washington, DC; Department of Radiology (M.B.), Swedish Covenant Hospital, Chicago, Illinois, and Department of Radiology (S.A.), Open Access Vascular Access Center, Miami, Florida. Address correspondence to S.O.T., Department of Radiology, Hospital of the University of Pennsylvania, 1 Silverstein, 3400 Spruce St., Philadelphia, PA 19104; E-mail: streroto@uphs.upenn.edu