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Fellowship Education: What to Watch (and from Where)

Matthew A. Sparks Matthew A. Sparks, MD, is Assistant Professor of Medicine; Associate Program Director of Nephrology Fellowship; and Director of Medical Student Research, Department of Medicine, Duke University, and Staff Physician, Durham Health Care System, Durham, NC.

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2020 was a challenging year in nephrology education. In-person annual meetings shifted virtual, and many of us learned firsthand the concept of “Zoom fatigue,” as our institutional meetings and conferences moved virtually. The National Institutes of Health (NIH) made a big announcement that will likely have a long-lasting impact on research training. Home dialysis education was front and center. How will the nephrology education landscape continue to evolve in 2021?

Virtual conferences are here to stay

There is no denying that virtual education is here to stay. Coronavirus infectious disease 2019 (COVID-19) resulted in an almost complete shift to the use of virtual platforms to host local, national, and international conferences (1). The nephrology community worked hard to adapt, with major conferences, like ASN Kidney Week and the National Kidney Foundation (NKF) Spring Clinical Meeting, among others, moving virtual.

Fellows, who were looking forward to a break in a new city from busy clinical work, in-person education, and networking, were instead faced with several days of screen time. How would they be able to network effectively? This was especially concerning given that fellows are just getting started in nephrology and have more limited collaborator, mentor, and sponsor networks than more established nephrologists. The nephrology conference landscape for fellows was impressive leading up to 2020 and COVID-19 with offerings for private practice (National Business Leadership University), education (KIDNEYcon), home modalities (Home Dialysis University), critical care (CRRT Academy), and cardio-nephrology (Cardio Renal Connections), among many others. Many of these conferences provided funding for travel and lodging to trainees. Thankfully, most of these important educational offerings are trying to make the most of video-conferencing platforms as well.

The online nephrology space has one of the most well-developed communities in medicine, with educational programming in a variety of modalities from websites to Twitter, to podcasts, to videos (2). In addition, year-long programs for trainees include the Nephrology Social Media Collective (NSMC) Internship, the American Journal of Kidney Diseases (AJKD) Editorial Internship, the newly established GlomCon Virtual Glomerular Disease Fellowship, and NephSIM Nephrons mentoring program. We will be watching to see how the nephrology community continues to adapt in the virtual space during 2021. Even if in-person meetings return in 2021 and beyond, it is becoming clear that at least some virtual component is here to stay.

Changes in NIH’s National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) T32 Program

NIH’s National Research Service Award (NRSA) T32 Program has been a mainstay of funding for fellowship programs to secure protected academic time for fellows interested in pursuing careers as physician scientists (3). In spring 2020, the NIDDK’s Division of Kidney, Urologic, & Hematologic Diseases (KUH) announced an unexpected and sudden end to the T32 program. The KUH T32 programs will now be replaced by an Institutional Network Award for Research Training (U2C/TL1) mechanism. This announcement has led to considerable concerns from the nephrology research community. So how is the U2C/TL1 mechanism different? Following are some of the differences:

  • ■ An emphasis on fostering a community of trainees

  • ■ One application that supports at least five trainees across kidney, urology, and hematology research areas

  • ■ Encouragement for multiple institutions within the same metropolitan area to submit a single, joint application

American Society of Nephrology (ASN) Senior Policy Specialist Ryan Murray reviewed this change in Kidney News Online (July 2020), due to concern about how the change will affect funding for nephrology fellows (4). Some concerns noted are the diminished number of overall awards available, the even smaller proportion of training slots that go to nephrology fellows, and the potential to favor larger institutions. Time will tell how this policy change will impact the overall number and long-term success of our trainees wishing to pursue research careers in nephrology.

More emphasis on home dialysis modalities in fellowship

Under the Advancing American Kidney Health (AAKH) Initiative (5), use of home dialysis modalities by patients with kidney failure is expected to increase. Will nephrologists be able to care for this growing population of patients?

A survey of US nephrology fellows in 2017 showed that almost one-half of all respondents indicated they had little or no training in peritoneal dialysis or home hemodialysis (6). It is incumbent upon our fellowship programs to ensure that fellows are adequately prepared. A recent survey of 76 US nephrology fellows who attended Home Dialysis University courses in 2019 showed that a majority were moderately confident in administering peritoneal dialysis, but most had low confidence in home dialysis (7). These findings underscore the importance of including more training in home dialysis modalities in fellowship programs. Educational curricula should include both didactic sessions and a focus on longitudinal care of patients using these modalities during the two-year Accreditation Council for Graduate Medical Education (ACGME) fellowship. Additionally, select fellows can enroll in an additional year of training.