ASN News

You recently completed your first year as chair of the TPD Executive Committee; can you tell our readers what this group does and what the group is working on currently?

The TPD Executive Committee represents nephrology training programs in the United States. Our mission is to help promote improvements in the quality of all aspects of nephrology training. Our current direction was largely defined during the Nephrology TPD Retreat, which took place last year in Chicago, IL. In addition to instituting the “Match,” we are

1. Developing an in-training examination for all renal fellows. This effort was spearheaded by Mark E. Rosenberg, MD, and is now under the leadership of Mitch Rosner, MD. The questions will be developed by a panel of volunteer experts in nephrology working closely with the National Board of Medical Examiners. The first test should be available in 2009 or 2010 and will be administered electronically.

2. Helping to establish new guidelines from the Accreditation Council for Graduate Medical Education (ACGME). We have a TPD subcommittee working with the ACGME and the Residency Review Committee for Internal Medicine to create revisions to the current guidelines for nephrology fellowships. We are greatly interested in simplifying the requirements while ensuring that they adequately address training needs.

3. Creating a toolkit to assist in fellow teaching. This TPD subcommittee is collecting teaching material from as many training programs as will contribute, then sorting through and arranging this material in a way that will facilitate nephrology teaching. In addition, new teaching techniques, evaluation methodologies, and standardized curricula are being addressed. We greatly welcome participation by TPD—there is more than enough work for all of us to do!

4. Improving use of web-based methods to facilitate fellow training and TPD communication.

5. Creating a session or sessions at ASN Renal Week 2008 devoted to improvements in nephrology fellow education. The goal is to have abstracts on educational instruments and advances submitted, reviewed, presented at the meeting, and ultimately published.

There will be other activities as well, but the aforementioned are the major initiatives for now.

The overwhelming majority of training programs have agreed to take part in the National Resident Matching Program Specialties Matching Service (SMS), which will begin in 2009. What is SMS, and how will it benefit training programs?

The SMS administers the match that is used by almost all residency and fellowship programs accredited by ACGME; it also administers the match for 12 internal medicine subspecialties. The principle of the nephrology match is essentially the same as that for other matches. Applicants and programs rank their selections, followed by a formal Match Day on June 18, 2008, for positions starting July 1, 2009. There are many advantages to the match, including the creation of an impartial venue for matching the preferences of programs and applicants, the ability to allow applicants to choose programs without undue pressure, increased time to decide (rank-order lists are not due until June 4, 2008), and establishment of a uniform offer/acceptance date. I think a testament to the benefits of the match is that greater than 90% of accredited programs voted in favor of the match by nephrology training programs.

Your ambitious agenda and intrepid leadership have impressed fellowship training program directors from across the country. What's the secret of your success? What drives your desire to “get things done”?

I’m not sure about intrepid leadership, but I think the key to success is getting as many people as possible involved, giving them ownership, and making sure that all discussions are held and decisions made in an open forum that involves as many people as possible. What we do as TPD is very difficult with all of the rules and regulations; however, many of the solutions to our current challenges are out there. It mainly requires getting people to freely share their ideas and experiences, as well as seeking input even from those outside nephrology. As for motivation, I have yet to meet a nephrology TPD who wasn’t motivated, as I am, to make fellowship training a great educational experience for faculty and trainees alike.

You completed your fellowship training at the Washington University School of Medicine in St. Louis, MO. What is your most memorable educational experience?

It wasn’t classical medical knowledge, but I most remember my former division chief, Saulo Klahr, MD, one of the smartest individuals I’ve ever met, sitting me down in his office and asking me about career plans. I was a bit nervous about succeeding in research, even though I had a number of research ideas that interested me. Dr. Klahr asked, “Do you want to be a bricklayer or an architect?” I don’t think he meant anything derogatory about making contributions while working in the background; rather, he was saying that if you have potential, don’t be afraid to try to reach for something greater. I would give the same advice to many trainees and junior faculty intimidated by a research career but clearly with a strong curiosity and intrinsic ability.

Why did you decide to be a nephrologist?

Originally, I completed a PhD in physiology and wound up studying the nephron sites responsible for escape from the sodium-retaining effects of mineralocorticoids. After I earned my MD, it was a natural progression to pursue nephrology.

What are your research interests? Can you give us a lay account of your research?

My laboratory studies the regulation of renal collecting duct Na and water transport. We utilize gene targeting strategies whereby we disrupt target genes selectively within the collecting duct to determine their role in normal renal physiology and in pathologic conditions. We are particularly interested in the role of the endothelin and nitric oxide systems in hypertension and have found that mice lacking collecting duct endothelin are markedly hypertensive and that the endothelin effect is mediated by nitric oxide. In collaboration with the laboratories of Matt Breyer, MD, and Tianxin Yang, MD, we have determined that collecting duct peroxisome proliferator–activated receptor-γ is responsible for the edema due to thiazolidinedione treatment. We are currently examining the role of individual adenylyl cyclases in regulating collecting duct, as well as whole nephron, function.

What advice would you give a young scientist in your field regarding his or her future career? Would it be different for male as opposed to female students?

I think they should focus on the optimal way to get environment/mentorship/support, regardless of gender or environment, mentorship, or support. Several great articles have been written by prominent scientists, including Nobel laureates and members of the National Academy of Sciences, about what is required to be successful as a physician scientist. A scientifically nourishing environment is critical at all stages but particularly early in one's career. Adequate protected time and financial support goes without saying; however, the biggest piece that is most often missing and the one repeatedly emphasized by visionaries in science is mentoring. This can be done by any number of people; the key is having a mentor who provides guidance on applying for grants, strategizing on how to operate your research program, identifying potential collaborators or just good scientists to learn from, etc. The mentorship should continue for many years, not just having someone point you in the right direction and let you go.

What might be done to increase the interest of medical students in pursuing careers in nephrology?

This is a very difficult question. Fewer medical students are going into internal medicine because of perceived issues with lifestyle, income, and the evolution of the general internist/hospitalist schism. Many students are intimidated by the complexity of nephrology. I think the major thing I would work on is stimulating an interest in nephrology through exposure to renal-related research. Summer programs, such as the one Mark L. Zeidel, MD, is planning to expose renal fellows to renal research techniques, could be applied to medical students. Why not have medical students participate in renal camp, doing an experiment examining ion transport using a patch-clamp apparatus or a Ussing chamber, studying renal clearance in a rat, or doing other renal studies? While recruiting more nephrologists is important, I think focusing on getting more physicians-in-training interested in renal research is really the key to the future of our subspecialty. I also think that we should extend these activities to the undergraduate and high school level, in effect, “imprinting” nephrology research!

Other than being a successful nephrologist, for what would you most like to be remembered?

Other than the obvious things (a good husband, father, son, and friend), I care the most about education. I think the contributions of the clinicians and scientists whose training I impact will be far greater than any individual clinical or research accomplishments of my own.

How do you spend your free time?

I am a bit of an adventurer. I enjoy, along with my family, scuba diving (particularly cave or cenote diving in the Yucatan), white-water rafting through deep canyons in the West, kayaking in the Sea of Cortez, alpine skiing (Utah snow is the best), and traveling abroad.