ASN plans to lead the kidney community in reconsidering “every aspect of the future of nephrology” over the next 8 months, ASN President Susan E. Quaggin, MD, said in a March letter to the American Board of Internal Medicine (ABIM) Nephrology Board and the Accreditation Council for Graduate Medical Education (ACGME).
Quaggin was responding to separate messages from the two organizations asking for ASN's input on major revisions of their certification and training program requirements.
In a letter to Quaggin in January, the ABIM Nephrology Board wrote, “For some time the nephrology community has grappled with whether or not certain procedures (temporary dialysis catheters and kidney biopsies) should remain a required procedure for nephrology fellows to learn to perform competently and whether other requirements should be strengthened like training for peritoneal and home hemodialysis.” The letter asked for ASN to share its views on these and other procedures by February 25.
On January 18, ACGME sent a message to program directors relaying that it was beginning “a major revision of the current program requirements” for many internal medicine subspecialties, including nephrology. It invited written “comments on specific topics” with a March 3 deadline.
Quaggin responded in March to both organizations with the same letter calling these invitations “exciting opportunities” but requesting an 8-month pause in the deadlines to provide time for ASN to facilitate a discussion in the kidney community on the future of nephrology. Quaggin committed to issue final recommendations by October and share them with “the entire kidney community during ASN Kidney Week” at the start of November.
ASN sees these requests as an opening to resolve several outstanding questions that have been nagging nephrologists for years, according to ASN Executive Vice President Tod Ibrahim. “Many of these conversations have been taking place for quite some time. There hasn't been any pressure to come to consensus, and, as a result, we haven't come to consensus as a community. Perhaps setting a deadline and saying, in the next 8 months we will reach agreement, is the only way we will,” he said.
But Ibrahim added that it was not possible to untangle the specific issues from the web without considering the whole. “Our feeling was, you can't reach consensus on procedures until you know what the overall specialty is going to look like. We are going to work from the big picture to the details,” Ibrahim said. “We have gone back and forth with ABIM and ACGME on these issues, and it is never clear what the first step is. It is a little bit of a circular process. So, part of what we are trying to do is to break that cycle. The experts in the specialty should determine what the future looks like and then work with the educational regulators to help ensure high-quality training and high-quality certification,” he said.
Quaggin's letter commits ASN to “convene the kidney community, representatives from ABIM and ACGME, and other stakeholders during the next 8 months” to carry out the following objectives:
Decide the core skills, knowledge, and experiences in kidney medicine that every nephrology fellow must learn during fellowship training
Evaluate whether all nephrology fellows should have the same training and initial certification examination (regardless of their clinical interests) or should have a way to differentiate themselves professionally through a standalone subspecialist certification by ABIM
Assess which subspecialties of nephrology have evolved to the point of requiring formal training and certification
Identify potential gaps in training of nephrology fellows who trained during the COVID-19 pandemic
Determine how to ensure that nephrology training, certification, and practice promote diversity, equity, and inclusion while pursuing health care justice
Begin to articulate how future nephrology training, certification, and practice can align with other members of the kidney health care team
Articulate the future expectations for nephrology fellowship training programs based on the above goals
ABIM and ACGME appear likely to embrace this process. Jerry Vasilias, PhD, executive director of the ACGME Review Committee for Internal Medicine, responded in early March that his committee's leadership has “no issue or concern with pausing the major revision of the program requirements for nephrology for approximately 8 months.”
The next ABIM nephrology board meeting was scheduled to be held after this edition of Kidney News went to press, but ABIM nephrology board member Matthew Sparks, MD, agreed that “the time is now” to reconsider the issues mentioned in Quaggin's letter: “I can't speak on behalf of the board, but I would support this process. We want to listen to the community and key stakeholders.”
