Nephrology is currently undergoing a renaissance in education. These are exciting times to be involved in nephrology. We are beginning to see multiple stakeholders invest in education at both the local and national level. Clinicians, researchers, and organizations are all heeding the call to innovate, invigorate, and implement projects focusing on education. It is also refreshing to see multiple nephrology journals publish articles focusing on education.
In a recent AJKD article, Gomez et al sought to redesign the internal medicine intern rotation in nephrology. As a result of duty hours restrictions, many internal medicine residency programs have started to shift away from inpatient medicine and are now investing in meaningful outpatient clinical experiences. Accordingly, the Penn internal medicine residency program assigned every single categorical and preliminary intern to the 2-week nephrology rotation. 43 interns were included and the curriculum spanned an 8-week period.
The 2-week nephrology rotation was right on the tail end of a 6-week inpatient rotation (gen med, etc). The group wanted a varied experience spanning multiple areas of clinical nephrology as well as exposure to didactics and an interactive online forum. The interns were assigned to 4-8 half-day clinics (in addition to their own continuity clinics) over the 2-week period. Examples included PD clinic, in-center HD rounding, pre/post transplant clinic, stone clinic, CKD clinic, home hemodialysis, and GN clinic. The didactics were delivered during 3 half-day sessions throughout the 2-week module. Multiple faculty members and fellows took part in the didactic sessions and they were encouraged not only to use PowerPoint presentations, but also to utilize case-based “chalk-talks.” Finally, an interactive online forum was woven into the 2-week module. This was a way for the participants to interact both online (using Canvas as their Learning Management System) and in person. They split assigned readings between the SPRINT trial, the Minority viewpoint, and JNC8. This exercise was used to debate these differing viewpoints. Residents were also assigned 2 ambulatory clinic cases to discuss as well. Altogether, this jam packed 2-week schedule gave a broad overview of nephrology and presented a variety of educational offerings.
At the end of the block, interns completed a post-survey in a 7-point Likert scale. Amazingly, they had a 100% response rate (43/43). Both the didactics and interactive forum received a score of 6/7. Interestingly the clinical part of the 2-week module was favorably viewed based on qualitative feedback, but only scored a 5/7. I think this shows the difficulty in providing an effective outpatient experience when the exposure is fragmented and in an observer role. This view was reiterated in the write-in comments. A participant noted, “Lots of follow-up visits looking at creatinines without much discussion/explanation.” Nephrology educators need to think about how we can integrate early learners (medical students, interns, and residents) into the clinic as real participants and not just as observers. However, a majority of the comments were quite positive. Overall, the interns felt like their knowledge of nephrology improved from a score of 4/7 to 6/7.
This was a great initiative and it is refreshing to see so much emphasis on delivering nephrology education to interns. I would comment that the time commitment for faculty and fellows to deliver 3 half-day lectures every 2 weeks over 8 weeks could prove burdensome. However, since this is all condensed over an 8-week period, efforts to deliver lectures only occur 2 months out of the year. The group plans to measure how participation in the experience leads to interest in pursuing a nephrology fellowship. Hopefully, over time, we will see if this effort translates into increased career interest. Congrats to the authors on a well-executed curriculum.
Title: An Interactive Ambulatory Nephrology Curriculum for Internal Medicine Interns: Design, Implementation, and Participant Feedback
Authors: A.C. Gomez, K.M. Warburton, R.K. Miller, D. Negoianu, and J.B. Cohen