Restructuring the Nephrology Elective: Can It Help Increase Interest in Nephrology?

In a recent article in the American Journal of Kidney Diseases, Jhaveri and colleagues from the Division of Kidney Diseases and Hypertension at the Hofstra North Shore-LIJ School of Medicine in New York report how implementing a restructured nephrology subspecialty rotation improved interest in nephrology training. Given the topic, Dr. Matthew Sparks, eAJKD Advisory Board Member, recruited Dr. Romita Mukerjee (eAJKD), Nephrology Fellow at Duke University Medical Center, to interview author Dr. Joseph Mattana (JM), Chief of the Division at North Shore-LIJ, about this project.

eAJKD: What prompted you to develop this project?

JM: My interest in nephrology education goes back a number of years. I’ve had a very strong interest in medical education, and was inspired to pursue nephrology as a career thanks to the influence of some extraordinary teachers I had as a medical student. We looked at the structure of residency and fellowship training and began to feel that the methods that we were using may not be optimal for providing trainees a robust exposure. We were trying to create educational experiences that would provide a different method of education and a better exposure to each of the fields that residents are supposed to learn about during their training. While the usual 1-month nephrology consultation rotation provided very interesting patient exposure, it was restricted to acutely ill hospitalized patients. While this is a very strong learning experience, it doesn’t allow a trainee to develop a good appreciation for the other aspects of the field of nephrology.

eAJKD: Can you describe how you restructured your nephrology elective rotation?

JM: Our nephrology group took the traditional 1-month inpatient elective rotation and rebuild it in a very different way. Now internal medicine residents round in our outpatient dialysis unit and are exposed to both chronic hemodialysis and peritoneal dialysis patients. They also spend time at our kidney transplant center and get to see how potential recipients and donors are evaluated. They see how both the immediate and post—kidney transplant process works. The trainee also gets an opportunity to interact with faculty who are conducting laboratory, educational, and clinical-based nephrology research. A more detailed description of the rotation can be found in Box 1 of the article. In addition, we customize the rotation to the needs of the resident (our learner) in terms of the focus on teaching topics.

eAJKD: Did you have any difficulty in managing inpatient service coverage in the restructured nephrology elective rotation?

JM: We consider it a luxury and a privilege to have residents with us, and there was no service impact at all. We were able to function in terms of service needs seamlessly in the absence of residents and students on the inpatient team.

eAJKD: Did you get any feedback from the nephrology fellows or faculty members after this project was implemented? Did it affect their experience with residents?

JM: Fellows and faculty have been very pleased with this new rotation. Many more faculty members now have time to interact with residents. There is a much broader faculty and fellow exposure as captured in our study. By enhancing exposure to many different elements of nephrology we may encourage residents to pursue a particular field. Our feeling is that this innovative rotation may give the trainee a more representative exposure to the entire discipline.

eAJKD: You mentioned in your article about the potential problems with the medical school curriculum related to teaching renal pathophysiology. Do you have any thoughts on how that might be improved?

JM: Nephrologists need to contribute to the medical school and residency curriculum. In addition to learning about the things that nephrologists do on a daily basis, we want the material to be exciting. I think the way that nephrology is taught is extraordinarily important, and we have to make the material exciting to successfully engage the learner. We have to make it interactive and meaningful, and this hopefully will translate into more students pursuing a career in this field. Certainly in our division, we’re taking a number of very innovative approaches to how we educate. This is an ongoing conversation, and we’re constantly brainstorming new approaches to enhance medical education. We hope this will inspire many more motivated trainees to consider nephrology.

Note: Another interview on this article is available here.

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