Medical Education Research Can Improve the Future of Nephrology and Applies to All Types of Practice

An important task for all physicians is to educate. This may apply to those teaching the next generation of nephrologists, but it also goes far beyond that task. Medical education includes information provided to patients, colleagues, nursing staff, dieticians, and trainees about concepts concerning physiology or pathophysiology. For example, teaching a patient the reason to keep phosphorus levels controlled and noting the improvement in subsequent laboratory results is an effective educational intervention. In medical education research, the project must have a specific question with a measurable outcome to determine the success of the change.

Although it might seem that medical education research is meant for academic institutions, this type of research may be performed in all practice settings. The number of investigations linking medical education and quality of care or patient outcomes is minimal (1). Research is needed to determine whether the changes in medical education implemented are useful or wasted effort. An example is this could easily apply to fellowship training, where outcomes –based education has been implemented without strong evidence to back this change (2). Specifically, further investigation is necessary to determine whether the type of education given to the next generation will create nephrologists who provide higher-quality care with improved patient outcomes. The following examples will highlight some potential areas of practice where medical education research can be applied (Table 1).

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Quality improvement projects

Quality improvement is a recertification requirement for all nephrologists. This project could bring many members of a team together for collaboration on enhancing an educational aspect of practice (2). The Plan-Do-Study-Act method is a model for testing a change that is implemented (3). The four steps guide the thinking process and lead to an outcome that is measured for success.

Teaching at work

Sharing knowledge is a significant part of patient care delivery as well as trainee education. However, teaching without measuring effectiveness does not answer whether the methods used to relay information are as good as they can be. Taking the time to frame a deficiency, pose an intervention, and test the results over time can optimize best teaching practices.

Simulation

Medical simulation is a rapidly growing field, and credentialing organizations are requiring it as part of the training curriculum. Simulation can be used to perfect technical skills in performing procedures but also to assist in improving interactions with patients. Whichever skill is being practiced, simulation provides an opportunity for feedback to be given to participants. Repeating these sessions can provide a way to evaluate learning over time (4).

Novel ideas for delivering care

Innovation can come in many forms. Examine teaching techniques or delivery of care methods that are new to the field. For example, increase the time you spend with patients by grouping those with similar medical problems together, such as monthly peritoneal dialysis visits. This gives patients a way to connect with others in a similar situation, and it also allows teaching concepts of care only once to the group instead of repeatedly in separate patient visits. Assess whether this improves patients’ satisfaction with their care, their medical knowledge, or ultimately their outcomes.

Steps to educational research

No matter the practice model, there are ways to implement educational research. Innovation and energy for a project are important, but without the tools to accomplish the task, no project will be successful. The process of educational research should parallel the familiar scientific methods (5).

Step 1: Formulate the question

The research question should be specific, with a measurable outcome. For example, you might notice that dialysis patients go through multiple cannulations before starting their treatment. A research question could be this: Does staff education about cannulation improve successful needle placement rates?

Step 2: Measure the baseline

The measure used to determine success should be assessed before the intervention. This will validate that the perceived deficiency is truly present, and it will set the baseline for comparison after intervention. Determining the measure can be difficult. Traditional teaching has suggested quantitative findings to be the optimal assessment: “The proof is in the numbers.” Educational research may focus on qualitative findings as a better measure. Examples of measures can be found in Table 2.

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Step 3: Plan the intervention

The intervention must be planned to address the specific topic. Keep the difficulty of material at the level of the audience. Use teaching methods that provide information in a variety of ways to target the largest audience. Some people learn by hearing (lectures), seeing (written word), or doing (simulation or workshops); therefore, it is wise to focus on interventions that address multiple means of knowledge delivery (68).

Step 4: Implement the change

More is not always better. Focus on finding the most effective tool to deliver the information. It may take more than one session to have the learner retain the information. For example, it is advisable to give a lecture and then provide written language for review. Similarly, teaching patients and having them teach it back is another effective method to get repetition and check understanding.

Step 5: Measure the intervention

Not all changes improve the outcome; in fact, change might make it worse. Prove that the intervention is worth the extra effort, and make sure that the old way is not better. If the desired outcome is not met, reevaluate the intervention and try again.

Step 6: Share your findings

Most importantly, unless all concerned work together to share their successes and failures, progress in the field of nephrology education will be slow. Similar problems are seen in many practices, and if ideas for change can be shared with the community, improvement in the field will be enhanced (5). There has been a decline in the number of learners choosing nephrology as a career, which may be attributed to the style of presenting subject matter or to a lack of dedicated mentorship (9). Optimizing the delivery of curriculum material to enhance understanding might be one way we can lead more trainees to a career in the field.

An excellent avenue to share projects is through the ASN Kidney Week Educational Abstracts Category. This category was developed in 2008 and is a place for sharing changes in educational programs that can make a difference in patients’ lives. These projects can be initiated and submitted by any part of the care team. Take time to consider adding a submission to the category this year. More information can be found at the ASN website.

Notes

[1] Laura Maursetter, DO, is a member of the ASN Workforce Committee and assistant professor in the Division of Nephrology at the University of Wisconsin Madison, where she serves as the associate program director. She is a member of the ASN Workforce Committee that is focused on increasing interest in nephrology as a career for trainees.

[2] Mary K. Thompson is a PhD educator in the department of medicine at the University of Wisconsin-Madison. She works with fellowships across the department supporting education and curricular needs.

References

1.Chen F, Bauchner H, Burstin H. A call for outcomes research in medical education. Acad Med 2004: 79:955–960.

2.Parker MG. Nephrology training in the 21st century: toward outcomes-based education. Am J Kidney Dis 2010; 56:132–142.

3.Langley GL, Nolan KM, Nolan TW, et al. The Improvement Guide: A Practical Approach to Enhancing Organizational Performance, 2nd Ed. San Francisco, Jossey-Bass Publishers, 2009.

4.Cook DA, Hatala R, Brydges R, et al. Technology-enhanced simulation for health professions education: a systematic review and meta-analysis. JAMA 2011: 306:978988.

5.Armstrong G, Headrick L, Madigosky W, et al. Designing education to improve care. Jt Comm J Qual Patient Saf 2012; 38:5–14.

6.Swanwick, T, McKimm J. Clinical leadership development requires system-wide interventions not just courses. Clin Teach 2012; 9:89–93.

7.Sutherland R, Reid K, Kok D, et al. Teaching a fishbowl tutorial: sink or swim? Clin Teach 2012; 9:80–84.

8.Malik AS, Malik RH. Twelve tips for effective lecturing in a PBL curriculum. Med Teach 2012; 34:198–204.

9.Parker MG, Ibrahim T, Shaffer R, et al, The future of nephrology workforce: will there be one? Clin J Am Soc Nephrol 2011: 6:1501–1506.

May 2012 (Vol. 5, Number 4)​