Learning Continuum

Rapid changes are occurring in the healthcare environment, with greater emphasis placed on the care experience, its value/cost, and health outcomes. These changes are outpacing educational reforms, leading to growing gaps between medical education and clinical practice. Particularly concerning is trainee readiness for such gap areas as systems redesign, quality improvement and patient safety, population health, and interprofessional practice.

Type 1 diabetics’ risk of developing impaired glomerular filtration decreased 50 percent when they were given intensive diabetes therapy, according to late-breaking clinical trial results presented at Kidney Week. Other late-breaking findings pointed to the promising clinical potential of sitagliptin for patients with type 2 diabetes who have moderate or severe chronic renal insufficiency.

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.

Milagros Samaniego


For more than 20 years, the Membership and Professional Standards Committee of the Organ Procurement Transplant Network (OPTN) and the United Network for Organ Sharing (UNOS) have defined the training requirements for UNOS-certified transplant physicians.

The U.S. Department of Veterans Affairs (VA) established the VA Center for Innovation (VACI) to identify, fund, and test new health care system proposals. During the second annual innovation initiative (VAi2) competition a total of four VAi2 proposals pertaining to kidney disease were selected. Two of these focused on the implementation of telemedicine in nephrology—creation of a virtual kidney clinic and development of clinical home-based video technology.

It took only about 5 years after the discovery of the endothelin (ET) peptide to develop potent and selective endothelin receptor antagonists (ETRAs) (7). This was about 20 years ago, and there are now two antagonists currently approved for use in pulmonary hypertension. Other targets have demonstrated tremendous promise in preclinical studies, but patent expirations and failures in several clinical studies have discouraged most of the big pharmaceutical companies from further investigation of these drugs as therapies.


Adapted from Ronald J. Falk, et al., Clin J Am Soc Nephrol 3: 1238-1241, 2008. doi: 10.2215/CJN.02980608, September 2008

For people who choose to become physicians, continually improving their knowledge is a hallmark of their profession and essential to improving patient care.

Like almost all working adults, doctors learn most, and most effectively, through informal (incidental) learning opportunities: knowledge gained on the job (1). Unlike most other working adults, physicians must regularly, and formally, demonstrate their knowledge to retain their ability to practice, admit patients, receive payor reimbursements, and hold academic positions.

Recently, a substantial decline in interest in the field of nephrology has occurred, not only among medical graduates in the US (USMGs) but also among international medical graduates (IMGs) (1). Factors such as lifestyle, income potential, job opportunities, and others have been discussed (2), but little is known about the declining interest of IMGs. This article is a personal narrative of the first author on why he chose nephrology as a career.