Another ASN Kidney Week has concluded, and it was an amazing week full of learning and meeting new individuals. I took a tour through the education research posters on Saturday, October 27, 2018. It is definitely an exciting time in education research! There were so many amazing projects that it was difficult for me to decide which one to blog about. After much deliberation, I bring to you 3 projects from budding nephrologists/educators. When I talked to each presenter, their enthusiasm for their projects and education was contagious and I imagine we will see great things from them in the future!
My first stop was to see Caitlynn Cooper, a second-year medical student at University of Utah School of Medicine, to chat with her on her project entitled “Examining Medical Student Educational Outcomes in a Focused Nephrology Ultrasound Training Initiative.” Her team incorporated interactive ultrasound sessions for fourth-year medical students on their ‘Transition to Internship’ clerkship at the University of Utah. Students were taught the basics of ultrasound physics as well as the basic skills for point-of care-ultrasound examination in the setting of AKI, including to assess for hydronephrosis, kidney size, echogenicity, and assessment of volume status by visualizing the inferior vena cava. Students were surveyed after completion of the curriculum. Sixty-four students completed the survey and 98% felt that it enhanced their medical education! What’s more intriguing is that 96% of students wanted more ultrasound incorporated in their curriculum and that 93% would like to use point-of-care ultrasound in their clinical practice.
Although it was not studied in this project, I hope to see that in the future they add assessment of the interest in nephrology as a career pre- and post-ultrasound session. Point-of-care ultrasound is relatively in its infancy. As ultrasound machines get smaller, more portable, and less expensive, they may transform our daily practice and exam of patients. Students in this study clearly want more ultrasound training and if nephrologists are relatively quick to adopt point-of-care ultrasound in our daily practice, we may be able to increase interest in nephrology!
On to my next stop where I had a lively conversation with Manasi Bapat (@manasib33), a second-year nephrology fellow at Icahn School of Medicine at Mount Sinai. Her team assessed the safety of kidney biopsies as performed by nephrology fellows versus those performed by interventional radiology. They retrospectively reviewed the outcomes of 251 kidney biopsies from 2013-2017 at two hospitals. At one hospital, all biopsies were done by nephrology fellows and were supervised by nephrology faculty (n = 149). At the other hospital, all biopsies were completed by interventional radiology (n = 102). Diagnostic yield did not differ between the two groups. Patients undergoing a biopsy by interventional radiology had a higher rate of post-biopsy transfusions; other complications did not vary between the two groups. Patients in the nephrology trainee group were more likely to receive DDAVP.
As an educator, I was intrigued by these findings. While kidney biopsies were initially exclusively performed by nephrologists, more and more radiologists are now performing biopsies. One theory for the increase in radiologists performing the procedure is the thought that these procedures may be more safely completed by radiologists. Dr. Bapat’s study results are similar to those of a previous study which found that kidney biopsies performed by nephrologists had similar adequacy and complication rates to those completed by radiologists. Interestingly, Dr. Bapat’s study found a much higher rate of DDAVP use by nephrologists performing kidney biopsies. This is a potential explanation for the decrease transfusion rate in nephrology trainee performed kidney biopsies. I would argue that nephrologists are likely better versed to consider treatment and/or prevention of uremic bleeding using agents like DDAVP than radiologists, which is why we should continue to train our nephrology fellows in the procedure of kidney biopsy instead of continuing to hand them over to radiologists!
Last but not least, I stopped to chat with Sayna Norouzi (@SaynaNorouzi), a first-year fellow at Baylor College of Medicine. Dr. Norouzi and her team harnessed the power of social media in this project to augment traditional medical education in nephrology. While Dr. Norouzi was an internal medicine resident at St. Louis University, she implemented this education project on their inpatient nephrology ward team. Every 5 days, Dr Norouzi posted Twitter polls asking questions on important topics in nephrology for the residents and students on the team to answer. This was then followed by either a 5-10 minute in-person lecture and/or a 2-3 minute animated YouTube video. Trainees (n = 73) were surveyed 2 months after completing the educational experience. 96% of respondents found the experience either somewhat or very educational. 97% planned to watch future educational videos on YouTube.
Social media can connect us easily with other individuals around the globe. In addition, it can be a great tool for use when implementing asynchronous learning tools like these. I expect with time we will continue to see more and more growth in the area of utilizing social media for asynchronous learning!
So, there you have it – 3 very different but interesting education research studies from 3 budding nephrologists!