In July, three nephrology fellows were selected to join the ASN Kidney News Editorial Fellows Program for 2-year terms: Timothy M. Chow, MD, Johns Hopkins School of Medicine, Baltimore, MD; Annie Liu, DO, MS, MPH, Massachusetts General Hospital and Brigham and Women's Hospital, Boston, MA; and Jordy Salcedo-Giraldo, MD, Children's National Hospital, Washington, DC.
As part of the application process, they were asked to write a short editorial on the topic, Training in Nephrology 2024: What Can Be Changed? We welcome Drs. Chow, Liu, and Salcedo-Giraldo to the Kidney News editorial team and invite you to read their visionary editorials.
Training in Nephrology 2024: What Can Be Changed?
Nephrology today benefits from an unprecedented wealth of research efforts and findings that have given nephrologists more resources and tools in their mission to care for patients with kidney diseases. With this volume have come findings that may contradict previous ones, treatments that require complex statistical analyses, and a heterogeneity of quality of evidence. Each of these emphasizes a growing and significant need to be able to critically analyze and safely implement the literature to patient care. This need represents an area of improvement for current nephrology training.
Journal clubs, first started by Sir William Osler, MDCM, as a way to discuss and share costs of literature, have evolved to now also be a component of curriculum to teach critical analysis (1, 2). However, in addition to being inconsistent in implementation, reviews have found that this addition does not improve critical appraisal skills in trainees (3).
Further, while both internal medicine and nephrology trainees are assessed on “evidence-based and informed practice” as part of ACGME's [Accreditation Council for Graduate Medical Education's] milestones, the criteria for meeting this competency are not well described and are evaluated locally by the program (4, 5). Current ABIM [American Board of Internal Medicine] initial certification blueprints for internal medicine and nephrology allocate less than 2% of questions to “primarily epidemiology” and do not mention methods or statistical analyses (6, 7). This highlights that there are limited evaluation and structured standards for critical analysis and implementation.
Special attention must be made on critical analysis and implementation of the literature, as trainees will be responsible for evaluating literature on their own in practice. By empowering current educators, engaging national organizations, and collaborating with journals, the nephrology community can ensure trainee success and take the lead in medicine in creating formal teaching standards and evaluation of these essential skills.
As someone who once dabbled in becoming a philosophy major, it seems only fitting to borrow a quote from Socrates to describe the shifts occurring in modern medical practices: “The secret of change is to focus all your energy not on fighting the old, but on building the new.” Gone are the days when physicians solely dictated care; they now become part of the decision-making process and make recommendations alongside patients, their families, and professionals across various disciplines. With this shift comes heightened responsibilities for physicians, necessitating broad discussions to ensure informed decisions, despite varying levels of medical literacy.
It comes as no surprise that patients expect similar coordination and care delivery within nephrology. However, there exists a gap in how trainees navigate complex conversations and deliver patient-centered care aligned with individual goals. For instance, the intricacies involved in discussing and setting expectations for different dialysis modalities: in-center versus home hemodialysis versus peritoneal dialysis—or not pursuing dialysis altogether and opting for conservative kidney management—require careful consideration and communication. There is also an opportunity for improvement in the integration of artificial intelligence into nephrology training to enhance patient access and promote health equity. The recent 2023 Match cycle illustrated a looming concern: a decrease in trained nephrologists in a shrinking pool despite the growing number of individuals with kidney diseases in the United States. It emphasizes the urgency to incorporate artificial intelligence in training to expand patient access, improve care delivery, and hopefully mitigate physician burnout.
In this era, I feel hopeful about the future of nephrology due to the technologies that are constantly being developed, the cultural shift toward supporting care teams, and the recognition of the imperative need to embrace change and “build the new.”
Nephrology is often perceived as a complex and intimidating field, deterring many aspiring medical professionals from considering it as a possible career option. As we look toward nephrology training in 2024 and beyond, we must address these misconceptions and cultivate interest in the field of nephrology starting at earlier stages of medical education. By introducing students to nephrology concepts and career opportunities at earlier stages of training, such as during medical school or even in undergraduate studies, we can dispel myths and showcase the rewarding aspects of our specialty.
To bring this vision to life, organizations like ASN can play a pivotal role. ASN could actively engage with medical students at conferences, offering educational lectures and workshops on unique topics such as dialysis and kidney biopsies that trainees may not have the opportunity to experience otherwise. By participating in conferences hosted by organizations such as The Latino Medical Student Association and the Student National Medical Association, ASN can broaden its outreach efforts and enhance diversity within the field.
Moreover, targeting undergraduate students through specialized programs could further stimulate interest in nephrology. A summer initiative in which undergraduate students collaborate on research projects with their local hospitals or institutions’ nephrology departments would not only provide valuable research experience for the students but also expose students to the excitement and impact of nephrology research.
By embracing early education and outreach initiatives, we have the potential to transform the landscape of nephrology training. We can empower the next generation of nephrologists by making our field more accessible, inclusive, and inspiring from the start of their medical journeys.
Footnotes
References
- 2.↑
Green ML. Graduate medical education training in clinical epidemiology, critical appraisal, and evidence-based medicine: A critical review of curricula. Acad Med 1999; 74:686–694. doi: 10.1097/00001888-199906000-00017
- 3.↑
Ebbert J, et al. The journal club in postgraduate medical education: A systematic review. Med Teach 2001; 23:455–461. doi: 10.1080/01421590120075670
- 4.↑
Accreditation Council for Graduate Medical Education. Internal medicine milestones. November 2020. Accessed April 26, 2024. www.acgme.org/globalassets/pdfs/milestones/internalmedicinemilestones.pdf
- 5.↑
Accreditation Council for Graduate Medical Education. Nephrology milestones. March 2020. Accessed April 26, 2024. www.acgme.org/globalassets/pdfs/milestones/nephrologymilestones2.0.pdf
- 6.↑
American Board of Internal Medicine. Internal Medicine Blueprint. Certification Examination (CERT). July 2023. Accessed April 26, 2024. https://www.abim.org/Media/h5whkrfe/internal-medicine.pdf
- 7.↑
American Board of Internal Medicine. Nephrology Blueprint. Certification Examination (CERT). January 2024. Accessed April 26, 2024. www.abim.org/Media/iohh2ahg/nephrology.pdf
