Early Medical Student Involvement Is Key to Bolstering Interest in Nephrology

Nephrology fellowship programs continue to face challenges in filling positions, with only 66% of positions filled for the appointment year 2024 National Resident Matching Program Medical Specialties Matching Program, including medicine and pediatric specialties (1). Although several strategies have been proposed to improve recruitment along the nephrology trainee continuum, there is growing concern that demand may soon surpass the supply of the existing nephrology workforce (2–6). Fostering interest in nephrology at the resident level may be too late; therefore, we urge medical education leaders to invest more resources in early nephrology experiences for medical students to combat these alarming trends. Here, we highlight how engaging with medical students as early as the second year of medical school can both spark and maintain interest in the subspecialty.

In his second year of medical school, one of the authors (T.S.) encountered a nephrology mentor who developed a project for him—to create patient-centered materials on glomerular diseases and emerging therapeutics for the Glomerular Disease Study and Trial Consortium (GlomCon). Creating these educational materials ignited a deeper curiosity in nephrology for T.S.; his involvement with patient education, especially concerning emerging therapeutics, highlighted nephrology as a field teeming with diagnostic and therapeutic innovations, challenging the misconception that nephrology is a specialty with limited future prospects.

The second author's (O.S.) interest in nephrology emerged from her personal experience with a loved one who received peritoneal dialysis for kidney failure. By the second year of medical school, O.S. discovered nephrology mentors who identified projects that suited both her interest in nephrology and science writing. She submitted a case report and literature review on fibrillary glomerulonephritis and now contributes editorials for the GlomCon newsletter, a weekly publication reaching over 6000 nephrology fellows and attendings worldwide. The author participated in a month-long nephrology Visiting Student Learning Opportunities program during her fourth year of medical school and continues to tutor students in the preclinical nephrology course.

Both authors attended ASN Kidney Week 2023, yet another opportunity to expel the unfair position that nephrology lacks in diagnostic or therapeutic advancement. The authors’ stories send a compelling message that is lacking in the current literature: Early engagement in medical education is essential to sow the seeds so that the next generation of nephrologists may grow.

These experiences need not be unique. Medical educators must act now to maintain and augment the nephrology workforce. Young trainees may express early interest in nephrology for a variety of reasons; attending nephrologists can play a key role in maintaining students’ interest, both through mentorship and identification of personalized, appropriate-level projects. Faculty, with strong teaching skills and a willingness to use new teaching methods, should lead the nephrology–physiology course, as this course tends to “make or break” a student's ability to envision a career in nephrology (7). They may also choose to advise a medical student nephrology interest group, effectively creating a “nephrology pipeline.” Medical students who rotate on a nephrology elective should be offered additional experiences in outpatient hemodialysis, peritoneal dialysis, glomerular disease, transplant, and other subspecialty clinics if available. The Table further outlines current opportunities for medical students interested in nephrology.

Table

Overview of medical student opportunities in nephrology

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Expanding the resident nephrology experience is important and should be continued; however, work must begin early and continue throughout a medical student's training to make a significant impact. Mentorship is the key agent in synthesizing specialists; the first two authors continue to engage in nephrology research, education, and patient outreach with encouragement from enthusiastic mentors. Practicing nephrologists know that nephrology does not just begin and end with hyperkalemia in patients with kidney failure; it is an exciting field that offers a wide breadth of pathology and opportunity to make a difference in patients’ lives. However, nephrologists alone will not be the ones to save their profession. Education leaders and faculty must recognize that to effectively combat the declining match rates, work must be done to engage medical students now so that they can envision a future career in nephrology.

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