• 1.

    Santhosh L, Babik JM. Trends in racial and ethnic diversity in internal medicine subspecialty fellowships from 2006 to 2018. JAMA Netw Open 2020; 3:e1920482. doi: 10.1001/jamanetworkopen.2019.20482

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Putting Fellows First

  • 1 Paul M. Palevsky, National Kidney Foundation President, is Deputy National Program Director, Veterans Health Administration (VHA) Nephrology Program; Chief, Kidney Medicine Section, VA Pittsburgh Healthcare System; and Professor of Medicine and Clinical and Translational Science, Renal-Electrolyte Division, University of Pittsburgh School of Medicine, Pittsburgh, PA. Susan E. Quaggin, ASN President, is Charles Horace Mayo Professor and Chief, Division of Nephrology and Hypertension, and Director, Feinberg Cardiovascular and Renal Research Institute, Northwestern University Feinberg School of Medicine, Chicago, IL.
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Our favorite time of the year is fellowship interview season. Mornings and afternoons spent with talented, young physicians who exhibit unbridled enthusiasm for our specialty. For most nephrologists, that passion never wanes. The future of our specialty depends upon recruiting, teaching, and mentoring exceptional and diverse trainees. Nephrology is uniquely diverse on every possible level, which makes every aspect of the specialty richer and more fulfilling.

We are proud that our specialty can boast a higher proportion of traditionally underrepresented-in-medicine (URiM) trainees compared to our internal medicine counterparts in cardiology, gastroenterology, pulmonary and critical care, hematology/oncology, and rheumatology (1). However, there is still much more to do, and it is unacceptable that Black or African American and Hispanic or Latinx students represented only 6.2% and 5.3%, respectively, of graduating medical school classes in 2019.

At the end of each academic year, it is a privilege to recognize and thank our incredible nephrology fellows. They are the backbone and future of our specialty, and they will go on to make great discoveries that will transform our field, help dismantle systemic racism, and tear down barriers to healthcare while providing expert care to millions of people living with kidney diseases.

Like other members of the kidney community, both the National Kidney Foundation (NKF) and American Society of Nephrology (ASN) support and enhance fellowship training through multiple activities and initiatives. First and foremost, both organizations provide free membership to fellows along with subscriptions to our scientific journals, including the Journal of the American Society of Nephrology (JASN), Clinical Journal of the American Society of Nephrology (CJASN), American Journal of Kidney Diseases (AJKD), Kidney Medicine, and Kidney360. ASN's Kidney Week and NKF's Spring Clinical Meeting represent our respective major educational activities, with multiple programs in both meetings targeting fellows and other trainees. ASN's Board Review Course and Update, held each summer, provides an additional forum to prepare trainees for the American Board of Internal Medicine (ABIM) nephrology board exam. Nearly every fellow takes the Nephrology In-Training Examination, which is cosponsored by ASN and the National Board of Medical Examiners.

Beyond these more traditional training venues, NKF and ASN have developed and supported a variety of other opportunities to promote and enhance the trainee experience. The journals of both organizations—AJKD and JASN—have developed editorial fellowship programs to permit trainees and early career investigators to get “under the hood” and learn about the editorial processes of research journals. CJASN has a trainee peer-review program to give fellows experience in providing peer review of scientific submissions and gives a Trainee of the Year award to recognize outstanding work based on the editors' selection of the best manuscript during the year submitted with a trainee as first author.

NephMadness has become one of our favorite annual traditions in nephrology, providing an educational diversion during the long days of late winter. Supported by the NKF, AJKD, and AJKD Blog, NephMadness pits themes in nephrology against each other—taking an initial round of 32 meticulously researched topics through a series of elimination rounds until a final “winner,” selected by a panel of experts, is crowned, generating passionate debate over various nephrology topics on Twitter and other social media outlets and, inevitably, tweets about #blueribbon-fails.

Local NKF offices support a variety of educational opportunities for trainees that vary from city to city including intra-city and even intra-state conferences, permitting fellows across institutions to meet. NKF sponsors regional and national Young Investigator Forums, providing an opportunity to recognize the best clinical and basic science research by nephrology trainees.

Increasingly, today's fellows participated in ASN's Kidney TREKS (Tutored Research and Education for Kidney Scholars) and Kidney STARS (Students and Residents) programs when they were students and residents. TREKS is a summer program to encourage interest and a love of kidney physiology and medicine among medical students and graduate students, whereas the STARS program coincides with the annual ASN Kidney Week, providing a mentored experience for medical students, graduate students, and residents to experience the very best of nephrology.

Many nephrology and PhD postdoctoral fellows apply to participate in ASN's Karen L. Campbell, PhD, Trainee Support Program for Fellows, which provides travel support to serve as mentors for Kidney STARS during ASN Kidney Week. ASN travel grants permit eligible fellows to attend the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) Network of Minority Health Research Investigators Annual Workshop.

The commitment of both NKF and ASN to trainee education runs deep. Both organizations provide grant and funding opportunities to support and encourage fellows, early career scientists, and clinician-educators to pursue research that will transform kidney care.

ASN also supports the Harold Amos Medical Faculty Development Program, a partnership with the Robert Wood Johnson Foundation to increase diversity among future leaders in nephrology by supporting the research and career development of a kidney scholar and future healthcare leader from a historically disadvantaged background. This year, ASN launched a $2.7 million loan-mitigation pilot program targeting residents interested in nephrology, reflecting the vital importance of fellows to advancing treatment, research, and education. The first year of the program targets residents who self-identify as underrepresented in medicine.

These programs are designed to support the nephrology fellows who enrich the work of those of us who interact with them and who do so much to advance care of those with kidney diseases. Moreover, we are personally incredibly grateful to many other members of our community who are also committed to supporting the next generation of nephrologists, scientists, and other health professionals focused on advancing kidney health. We challenge all in the community to continue to put “fellows first” in all that you do.

Nephrology fellows are the backbone and future of our specialty.

Reference

1.

Santhosh L, Babik JM. Trends in racial and ethnic diversity in internal medicine subspecialty fellowships from 2006 to 2018. JAMA Netw Open 2020; 3:e1920482. doi: 10.1001/jamanetworkopen.2019.20482

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