A 2008 research study found that Canadian medical residents were most likely to choose a specialty based on factors such as lifestyle, previous role models, experience of the resident with the specialty, and mentorship. The same study found that procedural based specialties were increasingly being chosen as opposed to non-procedural based specialties. Such findings are similar to those found among U.S. medical residents and are present even when looking at nephrology alone. To further understand the decline in interest in nephrology, the authors of a 2013 study used a survey targeting fellows who had chosen not to pursue a nephrology a career. They found that among non-nephrology fellows, 31% felt it was the most difficult physiology course during medical school. When asked about features they did not like during their experience with the field, the top two answers were the perceived complexity in taking care of patients on dialysis and no role model or mentorship in the field respectively.
Nephrology is often viewed as a non-procedural specialty (although this is a misconception) that is challenging and considered a difficult topic by medical students and residents – stacking the odds against us in terms of recruitment. However, if we look at the factors described in previously mentioned articles, we have material to work with to turn the current tide. Work is already underway by program directors all over the country to strengthen interest, but what are we as nephrology fellows doing to pitch in? Are we really too busy to be able to help? Of course not. As the old adage says: “Where there is a will, there is a way.” Here are two areas where I think nephrology fellows can shine:
- The resident’s nephrology experience
Some university systems already have robust nephrology programs that engage their residents and medical students. These can serve as a model for other renal fellows to develop their own programs. In a 2017 article published in the American Journal of Kidney Diseases, Gomez et al. successfully argue that curriculum changes can positively impact medical trainee experience. Their intervention focused on providing an interactive ambulatory nephrology curriculum that would include not only clinic visits, but also online interactive forums and small group discussions over select cases. They found 100% of trainees reported a positive didactic experience and 77% reported improved understanding of clinical nephrology. Here’s a visual abstract representing the effects on the intern experience after these curriculum changes.
So how can the nephrology fellow get involved?
Simply by coming up with ideas that will make a difference! At our institution, we have begun an initiative to work closely with our internal medicine residents to develop ways in which we can provide solutions to the main factors that impede interest in nephrology. Our proposed model will utilize question and answer sessions for the residents. These sessions will gauge their level of interest in nephrology as a potential career, determine sources of anxiety associated with the subject, and determine what topics residents feel they would like to learn more about. Identified topics will turn into small group interactive education and hopefully make for optimistic and confident residents.
Furthermore, although some may view nephrology as mostly non-procedure based, we as fellows can do more to expose our residents to the procedures we do. At least in our case, our residents have asked us to spend more teaching time on dialysis itself and its different modalities. Dialysis, kidney biopsies, and interventional nephrology are all areas we can use to highlight the actual abundance of procedures in this specialty.
In addition, see Figure 2 for a small list of other ways to get your program going.
- Mentorship and role models
Among medical students, mentorship is a key area that can determine career choice. The nephrology fellow can be a huge asset in this respect as they can mentor trainees. Residents who are interested in nephrology can benefit from inclusion in certain fellowship led activities. For example, a fellow or staff led journal club activity in which residents can join can foster and develop interest. It is important to remember that creativity breeds camaraderie. We live in a time where we can share ideas and information via media that have a global reach, like RFN. We can encourage medical students and residents to contribute to RFN, ASN, or other blogs and allow them to feel part of our collective team. Over time, these ideas and implementations may improve in-house recruitment and general recruitment into the nephrology applicant pool.
Other ideas to develop mentorship include becoming active in resident/fellow wellness programs. Wellness has become of central importance in medical training in recent times and often these programs include avenues to develop professional relationships and mentorship. ASN provides an excellent resource on mentorship.
I would encourage other nephrology fellows to be active participants in the education of residents and students. Every program can improve. If your program doesn’t have anything as described above, don’t be afraid to lead the charge. If we are passionate about what we do, we will inspire the same in others and that can only bode well for the future health of the profession. It is difficult to be interested in something that you find confusing or laborious, but easy to love something that you feel good about! Have any ideas or thoughts about how we can provide quality exposure of our field to our trainees? Please leave a comment below.
Posted by: Cristina E. Pinal, DO (@reins09)
Baylor Scott & White – Texas A&M