Article Figures & Data
Figures
- Figure 1.
Fellows have positive perceptions of the overall quality of their training. Bars indicate the percentages of respondents for each assessment class.
- Figure 2.
A majority of second-year fellows report moderate or full preparedness for independent practice.
Tables
Demographic Respondents ACGME Fellows (AY 2015)a Total N 320 863 Sex, % (differences between respondents and ACGME fellows were not statistically significant [P=0.43]) Women 34 36 Men 66 63 Age, yr Mean (PGY-4) 32.9 33.7 Median 32 — Range 28–62 — Race/ethnicity, % (differences between respondents and ACGME fellows were not statistically significant [P=0.21])b Asian/Pacific Islander 36 41 Black 7 7 White 32 23 Other 14 12 Hispanic/Latino 9 8 Unknown — 10 Medical education, % (MD/DO and USMG/IMG comparisons between respondents and ACGME fellows were borderline statistically significant [P=0.05] and statistically significant [P=0.03], respectively) Allopathic (MD) 89 92 Osteopathic (DO) 11 8 USMG 40 34 IMG 60 65 Fellowship year (%) First year 122 (38) 434 (50.2) Second year 155 (48) 429 (49.7) No response 43 (13) — Percentages may not total 100% due to rounding. P values for comparison are from chi-squared tests for independence; α=0.05. AY, academic year; PGY-4, post-graduate year 4; —, not applicable; MD, Doctor of Medicine; DO, Doctor of Osteopathic Medicine; USMG, United States medical graduate; IMG, international medical graduate.
↵a ACGME data for first- and second-year fellows AY 2015–2016.46
↵b Comparison for differences between white, black, Asian/Pacific Islander, and other. Differing data collection methods between ASN/George Washington University and ACGME obviate the ability to determine unknown responses or perform further comparisons.
Which of the Following Are Used in Your Fellowship Curriculum? (Select All That Apply) N (%) Journal clubs—led by fellows 243 (90) Curriculum lectures—led by attendings 240 (89) Renal pathology conferences 239 (88) Grand rounds—presented by attendings 193 (72) Grand rounds—presented by fellows 171 (64) Curriculum lectures—led by fellows 159 (59) Fellow-led case reports 142 (53) Journal clubs—led by attendings 135 (50) Key articles or reading lists/collections 121 (45) Temporary dialysis catheter simulation training 111 (41) Morbidity and mortality conferences 111 (41) Kidney biopsy simulation training 80 (30) Uninterrupted protected time for renal physiology, pathophysiology, and/or clinical nephrology review (separate from core curriculum lectures) 73 (27) Communications training for end of life care and dialysis decision making 69 (26) Online audio/video recordings of presentations (e.g., grand rounds, lectures) 68 (25) Interventional nephrology training 44 (16) Formal ultrasound training 32 (12) Online collaborative learning forum where fellows can post questions, cases, resources, and presentations 24 (9) Which of the Following Educational Tools Have You Used in the Last 3 mo? N (%) UpToDate 261 (96) CJASN articles 181 (67) ASN NephSAP 171 (63) JASN articles 160 (59) Textbooks 156 (58) KDIGO/KDOQI clinical practice guidelines 128 (47) AJKD articles 126 (47) Journal articles in general 113 (42) Renal fellow network blog 93 (34) ASN KSAP 74 (27) AJKD kidney core curriculum 30 (11) NephJC (Twitter-based journal club) 19 (7) AJKD Blog 18 (7) ASN online dialysis curriculum 7 (3) ASN online geriatrics curriculum 4 (2) CJASN, Clinical Journal of the American Society of Nephrology; NephSAP, Nephrology Self-Assessment Program; JASN, Journal of the American Society of Nephrology; KDIGO, Kidney Disease Improving Global Outcomes; KDOQI, Kidney Disease Outcomes Quality Initiative; KSAP, Kidney Self-Assessment Program; NephJC, Nephrology Journal Club.
Which Topics Would You Most Like to Receive Additional Instruction in during Fellowship? N (%) HHD 136 (51) PD 119 (45) Kidney ultrasound interpretation 118 (44) Acute GN diagnosis/management 101 (38) Obstetric nephrology 95 (36) Toxicology 89 (33) Renal pathology interpretation 85 (32) Nephrolithiasis 69 (26) Hemodialysis 67 (25) Care of adults with pediatric renal disease 62 (23) Renal pharmacology 61 (23) Genetic renal diseases 59 (22) Conservative/palliative management of ESRD 53 (20) Electrolyte disorders/acid-base disorders 53 (20) Secondary hypertension diagnosis/management 52 (19) Nutrition 45 (17) Kidney biopsy 44 (16) Temporary dialysis catheter placement 42 (16) Mineral and bone disease management 40 (15) Nephrotic syndrome 32 (12) Urinalysis 31 (12) Post-transplant outpatient management 30 (11) Geriatric nephrology 28 (11) Inpatient general AKI diagnosis/management 26 (10) Post-transplant acute inpatient management 25 (9) Outpatient CKD diagnosis/management 24 (9) Diabetic nephropathy 18 (7) Anemia of renal disease management 14 (5) Others specified by respondents: interventional nephrology, renal physiology N/A N/A, not applicable.
Theme Sample Quotations Structural changes desired “Protected teaching time not interrupted by pages” “Allow ‘pager free’ time so that focus can be given to lectures” “More core lecture series and board question–based conferences” “More time emphasized on education over service” “Reduce patient load/clinical responsibilities … [to] provide more dedicated time for study” “More attending involvement in planning a cohesive curriculum” “Structured curriculum with readings in textbook and/or key articles to go with lectures/cases” “Providing fellows with their own panel of patients rather than those designated to an attending” Educational content desired “Introductory lectures during the first 3 months on basic nephrology topics” “[Establish] specific … electives in second year for either US or IR” “Provide protected time for simulations programs, i.e., reading US, dialysis catheter placement” “More opportunity to do kidney [biopsies] and [for] training in performing ultrasound” “Dedicated renal physiology lectures and training” “More stress on home dialysis therapies/outpatient therapies and less in-hospital training Qualitative responses were reviewed by the first author (R.W.R.), who selected 14 representative quotes from 13 respondents. US, Ultrasound; IR, interventional radiology.
How Likely Are You to Participate in the Following Educational Strategies as a Fellow? (1–5 Likert Scale, with 1 Indicating Very Unlikely, 3 Indicating Neither Unlikely nor Likely, and 5 Indicating Very Likely) Mean (SD) Likelihood of Participation Renal pathology conferences 4.30 (0.86) Dedicated time for renal physiology, pathophysiology, and/or clinical nephrology review 4.03 (1.03) Training in performing ultrasound 3.75 (1.26) Fellow-led in-person case-based pathophysiology/management discussions (“morning report style”) 3.73 (1.16) Formal teaching opportunities (e.g., medical school, IM residency lectures) 3.67 (1.14) Formalized “pre-tending” as a fellow (acting as an attending during consultation rotations with minimized formal attending supervision) 3.65 (1.22) Key article reading list with fellow-authored article summaries 3.64 (1.17) Computer simulation exercises of HD/PD cases where you can alter prescriptions and follow results 3.62 (1.27) Watching online recordings of lectures, grand rounds, or journal clubs 3.50 (1.27) Simulated renal biopsy training 3.50 (1.28) Communications training for end of life care and dialysis decision making 3.49 (1.20) Conferences between local fellowships (e.g., in New England) targeted at fellows 3.45 (1.27) Simulated catheter placement training 3.44 (1.29) Fellow-led online case-based pathophysiology/management discussions where fellows share and contribute to cases on a regular basis 3.41 (1.24) Interventional nephrology training 3.41 (1.33) Case-based debates between specialties (e.g., rheumatology and nephrology fellows) 3.39 (1.26) Problem sets (“homework”) on various topics 3.37 (1.16) Formal education in “how to teach” 3.34 (1.26) IM, internal medicine; HD, hemodialysis.
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Education in Nephrology Fellowship: A Survey-Based Needs Assessment
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