Nephrology: Educating Patients, Internists and Trainees

Dr. Rachel Sturdivant

Educating patients about kidney diseases is an area that is of utmost importance and several recent studies have focused on this topic. Furthermore, educating primary care physicians (internists and pediatricians) about CKD care is a valuable effort in this time of decreasing interest in nephrology. Finally, novel and improved educational techniques for our trainees in nephrology are necessary in the era of social media, internet, and challenges faced by our learners and teachers. The Advances in Chronic Kidney Disease (ACKD) had a special issue on nephrology education. One of the Guest Editors of this issue, Dr. Rachael Sturdivant (RS) from Medical University of South Carolina, discusses this topic with Kenar Jhaveri (eAJKD), eAJKD Editor.

eAJKD: What prompted an entire issue of ACKD on the topic of nephrology education?

RS: The idea was proposed by our co-editor, Dr. Michael Ullian. We felt that it was a topic that needed the attention of the nephrology community. Once the broad topic was approved, we were faced with the challenges on how to focus the conversation. Should we focus on fellowship education, patient education, or a combination of both topics? Does educating primary care physicians fit in this edition? Finally, we decided that a combination of all three would serve multiple needs and summarize the current status of the field. Drs. Ruth Campbell, Michael Ullian, and myself then embarked on this very fun and challenging journey of reviewing articles that would shed light on education in chronic kidney disease.

eAJKD: The issue was divided into three parts: patient education, trainee education, and primary care provider education. Do you think that nephrologists are doing a sub optimal job of educating internists about kidney disease, and the need for timely referral to nephrology?

RS: I think we could do more. The education of the primary care audience is crucial so that we get to these patients in a timely manner. CKD guideline development takes time, and then processing it within the nephrology community takes even longer. Distributing the recommendations and educating the referring physician is even more challenging. With the advent of electronic medical records and increased collaboration in medical care, we’re trying to make sure that we are doing our part in educating the primary care provider as to how best care for the patient in their office and in ours. The articles towards the end of the ACKD issue highlight this very important topic.

eAJKD: Similar to nephrology, geriatrics is also facing a major workforce shortage. If residents and medical students are not choosing geriatrics as a career and fellowships are left vacant, then perhaps energy and resources should be redirected towards teaching non geriatricians to be better geriatricians. Will there ever be a point in time when general internists might have to do some basic nephrology care given lack of experts in the field?

RS: I think they already are doing some basic nephrology care in their offices by managing blood pressures, using ace-inhibitors and checking for albuminuria. Certainly we have been expanding our workforce to advanced practitioners during this time as we try to accomodate the enlarging CKD population that is referred to nephrologists. I think historically, patients were referred very late to nephrologists, unless they had something very overt like severe proteinuria or hematuria or when their creatinine was quite elevated. Now, patients are being referred quite early because of our efforts in educating primary care providers, we’re finding this really large group of patients that may be relatively stable or progressing very slowly but needs somebody to monitor them closely. Certainly engaging the primary care physicians in that endeavor is really important, and that’s where the education of the primary care provider, and collaboration with them, is so important. As far as never referring them to the nephrologists, I don’t think that is likely with the need for dialysis services and advanced nephrology care.

eAJKD: What changes do you anticipate in fellowship training in nephrology?

RS: I think our training programs now have a vested interest in making sure we are paying attention to new trends in electronic media and how we teach nephrology differently. Directors of medical school and residency curriculums are experimenting with social media in the classroom and in the clinical settings. When I am on inpatient service next month, I will try to direct trainees to certain nephrology websites such as the National Kidney Disease Education Program website for dialysis education pamphlets or perhaps even try out a polling app for questions on rounds. I think we should all try to experiment with some of these great suggestions that authors have offered in our ACKD issue.

eAJKD: Educating the “renal patient” can be very challenging. In the current health care system, how do you think it is going to be possible to provide complex information to our patients?

RS: There were some great articles on how patients learn and the literacy levels of patients. Making sure that we disseminate the information to the patient with a reasonable time span for the patient to understand is critical to achieving nephrology health goals. Certainly as we increase efforts for education, we’re going to need some help. It’s very hard to be a “renal patient”. You go to the nephrologist and have a conversation with your doctor about your declining glomerular filtration rate; the risks and benefits of the use of erythropoietin; managing phosphorus in your diet; what secondary hyperparathyroidism is. These are all tough topics to discuss with a lay patient as they are extremely complex and confusing. It is also complicated for the medical student. Dedicated nephrology educators who understand the complexity of literacy and decision making of patients really augments our ability to take care of patients well.

Please visit ACKD‘s website, ackdjournal.org, for more on the ACKD education issue.

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