Medicine has become ever more complex. We deal with ever-increasing patient workloads and convoluted medical systems (1). As a result, medical education can sometimes take a back seat in the face of these challenges. Does this sound like a familiar scenario to you? Perhaps it’s time to change the paradigm of medical education.
I am a second-year nephrology fellow with a great passion for teaching. I strongly believe that we as fellows can continue to facilitate change in the medical education paradigm. We are in house every day, working closely with residents and medical students. We
I recently started practicing nephrology and wish to share a few reflections.
To start, when I am going about my duties during the week, I often begin thinking about my fellowship. My heart beats faster and I can’t keep myself from looking at the time. This is exactly what I used to do while on consult service as I tried to budget the time I had with the work yet to be done.
I also remember the dark, small room, nestled between just a few other rooms on the bottom floor of the old hospital building, where we
Despite many advances in the care of patients with chronic kidney disease (CKD) and ESKD, cardiovascular (CV) disease remains the leading cause of death in the kidney disease patient population. One of the factors explaining this excess mortality risk is vascular calcification, which predisposes patients to myocardial ischemia, left ventricular hypertrophy, and stroke (1).
The pathophysiology of vascular calcification in patients with CKD and ESKD is distinct from that in the general population. In the general population, vascular calcifications form in the intima of vessels and are linked to traditionally modifiable risk factors, including smoking, age,
POCUS, or point-of-care ultrasonography, is a limited ultrasound examination performed by the clinician at the patient’s bedside. As opposed to a radiographic examination of an anatomic area, POCUS is intended to answer focused questions, mostly “yes” or “no” questions, and is performed by the same physician examining the patient. It is a valuable adjunct to physical examination, and some authors describe POCUS as a fifth pillar to bedside physical examination in addition to inspection, palpation, percussion, and auscultation (1). In specialties such as emergency medicine, POCUS training has been well established,
The past two decades have seen a surge in kidney disease with a significant impact on morbidity and mortality worldwide. An estimated 5 million to 10 million deaths are attributable to kidney disease annually (1–3). This has economic repercussions worldwide, with a larger estimated impact on low- and middle-income countries.
Multiple organizations have developed campaigns to increase awareness among both physicians and the public. For example, the International Society of Nephrology’s (ISN) “0 by 25” program aims to prevent avoidable death from acute kidney injury by 2025 in low- and middle-income
Blood pressure (BP) is a dynamic entity and, just like many other orders in nature, is affected by variability. Studies have shown variability in an individual’s BP over seconds, minutes, and days. This variability has been found to correlate with morbidity and mortality events. This review is intended to highlight some basic concepts of this entity with a focus on measures of variability and outcomes. The types of BP variability are shown in Table 1 (1).
Indices for measurement of short-term variability
Short-term variation is measured by 24-hour ambulatory BP monitoring (ABPM) through the
By my second year of internal medicine residency, I knew I wanted to be a nephrologist. Like many others who choose nephrology as a specialty, I enjoyed the challenge of solving complex acid–base problems or working up suspected glomerulonephritis. At the same time, I had grown to love procedures. My residency program was relatively small, and internal medicine residents performed nearly all of the bedside procedures in the ICU. It was satisfying to have a direct impact on the care of my patients through my ability to place a central line or endotracheal tube and deliver the
The percentage of international medical graduates (IMGs) is higher in nephrology than in any other major subspecialty in internal medicine. IMGs accounted for 62% of nephrology fellows in 2017, compared with a nearly even split with American medical graduates (AMGs) in 2007.
Thirty-one percent of nephrology fellows, or half of IMGs in nephrology, are dependent on visas. This means that 1 in every 3 nephrology fellows requires an employer who can sponsor a work visa, either H1b or J1. Thus, the issues outlined here are not limited to a handful of nephrologists, and they have a
Twenty years ago, a young newlywed senior nephrology fellow set out on a job interview. She sat down with the practice’s senior partners, who asked her general interview questions, including, “Why are you interested in joining our practice?” and “Where do you see yourself in five years?”
The interview was going well, and she began to feel the practice was right for her. As the interview came to a close, one male partner asked, “When do you plan on having children, and how many do you plan to have?”
As my fellowship inches toward completion, a new path is on the horizon. With anticipation, I am ready to embark on a new academic career in nephrology.
I often reflect on the factors that have brought me to this point, including years of education and training. I know one thing for certain: I could not have arrived here without my mentors and their guidance.
I feel fortunate to have had several mentors, including family members, friends, and teachers. These extraordinary people entered my life at various points and shaped me into the person I am today. All my