How I Find Time to Educate as a First Year Nephrology Fellow

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I’m a first-year nephrology fellow who is very passionate about medical education. As a fellow at a large academic center, I have the opportunity to work closely with trainees from multiple levels and play an integral role in shaping their academic future. Just imagine, medical students must decide on a career specialty by spending just a few weeks on a rotation!

However, teaching can be a difficult feat while simultaneously learning a new curriculum, adjusting to the hospitals/city, and balancing a busy service. So, how can a fellow manage a dynamic inpatient service and still make time to teach students or residents? With this post, I plan to answer this question and provide you with tips that to help facilitate this balance.

As a medical student and later as a resident, I was often tasked with calling consultants for their input around the clock. Initially, I found calling a consult can be intimidating as a trainee. As time went on, I realized this could be an opportune time for constructive exchange with some consultants who took an interest in understanding my patient and reason for consult in greater detail. In fact, I feel that those attendings and fellows who took time to teach in these moments, even in the wee hours of the morning, had a positive impact on me for which I am grateful. As I transitioned into fellowship, I feel a responsibility to pay-it-forward and create a positive learning environment for those whom I interact with. With this being said, let’s dive into some teaching tips

1.Behind every consult, there’s a teaching opportunity

Taking the time to teach when you are being called for a consult has proven to be an effective teaching tactic. The trainees will improve their presentations, perform a more thorough work-up, and improve patient care; furthermore, the consulting physician often exhibits a genuine interest in discussing the case during the call. I have developed great working relationships from these interactions, which have led to great collaborations. However, it is important to keep in mind a couple details when responding to consults.

2. Tailor teaching to your audience

Customize teaching based on the consultants’ level of knowledge and interest by determining who is calling the consult. If it’s a medical student, take the time to determine their understanding what is going on, explain how to call a consult, what additional information you need and why you need it. If it’s an Emergency Medicine resident, provide input on emergency management of a condition and be clear on the disposition. If it’s a Hospitalist, level up the conversation. For surgical subspecialties (Urology, ENT, Orthopedics) answer any questions they may have, however, avoid giving them a super-nerdy renal physiology lesson and focus more on management.

3. Take a deep breath

Keep your emotions in check when speaking to consultants. You are a renal fellow and you will be called for consults (good and bad) at all hours of the day, the sooner you accept this the easier it will be. Avoid being angry, sarcastic and condescending when answering the phone. Welcome all questions/consults as a learning opportunity. Many times, your recommendations will not be accepted, even though it might be backed by the highest level of evidence! Don’t be dissuaded.

4. Medical literature/guidelines > Your experience

Stick to guidelines and medical literature when teaching. Avoid teaching based off of experience as our experience maybe limited/not proven at this time. I always try to avoid using the phrase “based on my experience”. To be honest, I do not think we are experienced enough yet. The best guidelines are the Kidney Disease Improving Global Outcomes (KDIGO). These are free, easy to read, and I have even directed consulting physicians to these documents.

5. There good times to teach but there are bad times too…

Don’t feel obligated to teach if you are not able to. Sometimes we get 5 pages in a row or are speaking on two phones at the same time; other times we are in conference or post-call. It’s okay to keep your interactions short and teach at a later time. I always try to let them know that we can set up a time to discuss about this as I need to take care of a patient right now.

6. Take some time to teach pre-rounds

If you are rounding with medical residents, interns and/or students, have them present their patient to you before rounds. It is important to run the list prior to rounds to better understand their knowledge base, presentation style and how you can improve upon it. While in depth teaching cannot occur prior to rounds, stick to succinct lessons regarding the management in the morning and reserve thorough lesson later in the day.

7. Avoid ‘homework’- Be Honest if you Don’t Know

It is common to assign ‘homework’ to trainees when you do not know the answer to a question, or you do not have enough time to discuss it. The famous “why don’t you read up on it and we can talk about it tomorrow.” Personally, I believe this method obstructs the learning process as some trainees may avoid asking you questions in the future in an effort to avoid this assignment.  Instead, be honest. I think it is completely fine to say that ‘I need to read up on this’. ‘Let’s talk about it tomorrow’. If you are a fellow and you don’t know the answer to a pertinent question; you have to read about it anyway.

    8. Social media can be your teacher

Nephrology has a very active social media presence which has led to a number of free open access medical education (FOAMed) resources. A great way to become a part of the conversation and learn more is by joining Twitter. You can follow Nephrologists like:

@kidneyboy and @hswapnil whom co-founded a Nephrology online journal club (#NephJC) which happens on Twitter which is open to all.

@edgarvlermamd who posts tutorial and pearls on various papers and nephrology topics.

@Nephro_Sparks who posts about upcoming conferences and learning opportunities.

In addition, you can take advantage of the number of Twitter pages dedicated to FOAMed:

NephSIM: A Twitter profile for the nephrology mobile teaching tool

Kidney Zone: A Twitter profile for nephrology pearls for students and trainees

NephJC: A online Nephrology journal club

Landmark Nephrology: dedicated to discussing landmark nephrology trials

If you see content that is relevant you can save, send or tag your trainees in the tweet so they can benefit as well.

Over the last year, I have found teaching to be a rewarding experience. Since I have implemented the tips above, I have found a number of individuals reach out to me about nephrology related questions during the week. I look forward to these questions and find joy in finding the answers to them. I hope these teaching tips will be as helpful for you as they were for me. Please feel free to reach out to me on Twitter to let me know your thoughts on this post.

Sayna Norouzi, MD
First year Nephrology Fellow
Baylor College of Medicine, Houston, TX

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