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Current Paradigms and Emerging Opportunities in Nephrology Training

      Nephrology is facing a period of remarkable and unprecedented change. The pipeline of device and therapeutic drug development, the growing success of clinical trials, and the emergence of novel clinical practice and training pathways each hold the promise of transforming patient care. Nephrology is also at the forefront of health policy in the United States, given the recent Advancing American Kidney Health initiative. Despite these developments, significant barriers exist to ensure a robust pipeline of well-qualified nephrologists, including but not limited to trainees’ declining trainee interest in the specialty, lower board pass rates, and a perceived erosion in stature of the subspecialty. There is a lack of consensus among training program directors regarding procedural training requirements, the number of fellowship positions needed, and the value of the match. There is widespread agreement, however, that any initiative to reassert the value of nephrology must include significant focus on reinvigorating the trainee experience before and during fellowship. We discuss the current state of education in nephrology (from medical school to beyond fellowship) and highlight ways to increase interest in nephrology to reinvigorate the specialty.

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      References

      1. (US Department of Health & Human Services. HHS launches President Trump's ‘Advancing American Kidney Health’ initiative. Available at:) (Accessed May 8, 2020)
      2. (Kirchhoff SM. Medicare Coverage of End-Stage Renal Disease (ESRD). Congressional Research Service. Published August 16, 2018. Available at:) (Accessed May 2, 2020)
        • Eknoyan G.
        Nephrology: as it was then, but is not Now.
        Am J Kidney Dis Jan. 2017; 69: 129-135
        • Ross M.J.
        • Braden G.
        • Committee A.S.N.M.
        Perspectives on the nephrology Match for fellowship applicants.
        Clin J Am Soc Nephrol. 2017; 12: 1715-1717
      3. (American Board of Internal Medicine, Initial certification pass rates. Available at:) (Accessed May 8, 2020)
        • Beathard G.A.
        Role of interventional nephrology in the multidisciplinary approach to hemodialysis vascular access care.
        Kidney Res Clin Pract Sep. 2015; 34: 125-131
        • Trachtman H.
        • Benzing T.
        • Sever S.
        • Harris R.C.
        • Reiser J.
        The grand challenge of nephrology.
        Front Med (Lausanne). 2014 Sep 18; 1 (eCollection 2014): 28https://doi.org/10.3389/fmed.2014.00028
        • Shah H.H.
        • Jhaveri K.D.
        • Sparks M.A.
        • Mattana J.
        Career choice selection and satisfaction among US adult nephrology fellows.
        Clin J Am Soc Nephrol Sep. 2012; 7: 1513-1520
        • Norton J.M.
        • Ketchum C.J.
        • Rankin T.L.
        • Star R.A.
        Rebuilding the pipeline of Investigators in nephrology research in the United States.
        Clin J Am Soc Nephrol. 2018; 13: 1285-1287
        • Nair D.
        • Pivert K.A.
        • Baudy A.T.
        • Thakar C.V.
        Perceptions of nephrology among medical students and internal medicine residents: a national survey among institutions with nephrology exposure.
        BMC Nephrol Apr 29. 2019; 20: 146
        • Jhaveri K.D.
        • Sparks M.A.
        • Shah H.H.
        • et al.
        Why not nephrology? A survey of US internal medicine subspecialty fellows.
        Am J Kidney Dis Apr. 2013; 61: 540-546
        • Nakhoul G.N.
        • Mehdi A.
        • Taliercio J.J.
        • et al.
        Residents' perception of the nephrology specialty.
        Kidney Int Rep Jan. 2020; 5: 94-99
        • Daniels M.N.
        • Maynard S.
        • Porter I.
        • Kincaid H.
        • Jain D.
        • Aslam N.
        Career interest and perceptions of nephrology: a repeated cross-sectional survey of internal medicine residents.
        PLoS One. 2017; 12: e0172167
        • Pivert K.
        • Boyle S.
        • Chan L.
        • et al.
        2019 Nephrology Fellow SurveyResults and Insights. Washington, DC: ASN Alliance for Kidney Health.
        2019 (Available at: https://www.asn-online.org/education/training/workforce/Nephrology_Fellow_Survey_Report_2019.pdf. Accessed September 16, 2020.)
        • Maursetter L.J.
        • Stern L.D.
        • Sozio S.M.
        • et al.
        Enhancing nephrology career interest through the ASN kidney TREKS program.
        J Am Soc Nephrol Jun. 2016; 27: 1604-1607
      4. KIDNEYcon: an innovative conference for nephrologists and trainees. Available at: http://kidneycon.org. Accessed May 8, 2020.

        • Topf J.M.
        • Sparks M.A.
        • Phelan P.J.
        • et al.
        The Evolution of the journal Club: from Osler to Twitter.
        Am J Kidney Dis Jun. 2017; 69: 827-836
        • Poyan Mehr A.
        • Sadeghi-Najafabadi M.
        • Chau K.
        • et al.
        The glomerular disease study and trial Consortium: a Grassroots initiative to foster collaboration and innovation.
        Kidney Int Rep Jan. 2019; 4: 20-29
      5. Topf JM, Burgner A, Farouk S, Yau T, Sparks MA. NephMadness: lessons from seven years on the leading edge of social media medical education. Available at: https://emj.emg-health.com/wp-content/uploads/sites/2/2019/07/NephMadness-Lessons-from-Seven-Years-on-the-Leading-Edge-of-Social-Media-Medical-Education.pdf. Accessed May 7, 2020.

        • Breu A.C.
        Why is a Cow? Curiosity, Tweetorials, and the Return to Why.
        N Engl J Med. 2019; 381: 1097-1098
        • West D.C.
        • Pomeroy J.R.
        • Park J.K.
        • Gerstenberger E.A.
        • Sandoval J.
        Critical thinking in graduate medical education: a role for concept mapping assessment?.
        JAMA. 2000; 284: 1105-1110
        • Jhaveri K.D.
        • Sparks M.A.
        • Shah H.H.
        Novel educational approaches to enhance learning and interest in nephrology.
        Adv Chronic Kidney Dis Jul. 2013; 20: 336-346
        • Roberts J.K.
        • Chudgar S.M.
        • Engle D.
        • et al.
        Digital chalk-talk videos improve knowledge and satisfaction in renal physiology.
        Adv Physiol Educ Mar 1. 2018; 42: 146-151
      6. (American Society of Nephrology, Innovations in Kidney Education Contest. Available at:) (Accessed May 5, 2020)
        • Roberts J.K.
        • Sparks M.A.
        • Lehrich R.W.
        Medical student attitudes toward kidney physiology and nephrology: a qualitative study.
        Ren Fail Nov. 2016; 38: 1683-1693
        • Bayliss G.P.
        • Cobb J.
        • Decker B.
        • et al.
        Kidney Mentoring and Assessment Program for Students: a guide for engaging medical students in nephrology.
        Clin Kidney J Dec. 2019; 12: 761-766
        • Xie Y.
        • Bowe B.
        • Mokdad A.H.
        • et al.
        Analysis of the Global Burden of Disease study highlights the global, regional, and national trends of chronic kidney disease epidemiology from 1990 to 2016.
        Kidney Int Sep. 2018; 94: 567-581
        • Crews D.C.
        • Campbell K.N.
        • Liu Y.
        • Bussue O.
        • Dawkins I.
        • Young B.A.
        Chronic kidney disease and risk factor prevalence in Saint Kitts and Nevis: a cross-sectional study.
        BMC Nephrol Jan 5. 2017; 18: 7
        • Weening J.J.
        • Brenner B.M.
        • Dirks J.H.
        • Schrier R.W.
        Toward global advancement of medicine: the International Society of Nephrology experience.
        Kidney Int Sep. 1998; 54: 1017-1021
        • Feehally J.
        • Brusselmans A.
        • Finkelstein F.O.
        • et al.
        Improving global health: measuring the success of capacity building outreach programs: a view from the International Society of Nephrology.
        Kidney Int Suppl (2011). 2016; 6: 42-51
        • Peluso M.J.
        • Forrestel A.K.
        • Hafler J.P.
        • Rohrbaugh R.M.
        Structured global health programs in U.S. medical schools: a web-based review of certificates, tracks, and concentrations.
        Acad Med Jan. 2013; 88: 124-130
        • Melamed M.L.
        • Campbell K.N.
        • Nickolas T.L.
        Resizing nephrology training programs: a call to action.
        Clin J Am Soc Nephrol. 2017; 12: 1718-1720
        • Easom A.
        • Allbritton G.
        Advanced practice nurses in nephrology.
        Adv Ren Replace Ther Jul. 2000; 7: 247-260
        • Easom A.
        Advanced practice nurses in nephrology: collaborative solutions to manpower shortages.
        Nephrol News Issues Apr. 2001; 15: 25-28
        • Bolton W.K.
        Nephrology nurse practitioners in a collaborative care model.
        Am J Kidney Dis May. 1998; 31: 786-793
        • Berns J.S.
        Training nephrology fellows in temporary hemodialysis catheter placement and kidney biopsies is needed and should be required.
        Clin J Am Soc Nephrol. 2018; 13: 1099-1101
        • Shankland S.J.
        Training nephrology fellows in temporary hemodialysis catheters and kidney biopsies is not needed and should not Be required.
        Clin J Am Soc Nephrol. 2018; 13: 1102-1104
        • Norby S.M.
        Requirements for procedural Skills in nephrology training programs: Framing the conversation.
        Clin J Am Soc Nephrol. 2018; 13: 1096-1098
        • Yuan C.M.
        • Nee R.
        • Little D.J.
        • et al.
        Survey of kidney biopsy clinical practice and training in the United States.
        Clin J Am Soc Nephrol. 2018; 13: 718-725
        • Yuan C.M.
        • Oliver 3rd, J.D.
        • Little D.J.
        • et al.
        Survey of non-tunneled temporary hemodialysis catheter clinical practice and training.
        J Vasc Access Sep. 2019; 20: 507-515
        • Herrmann F.E.
        • Lenski M.
        • Steffen J.
        • et al.
        A survey study on student preferences regarding pathology teaching in Germany: a call for curricular modernization.
        BMC Med Educ Jun 2. 2015; 15: 94
        • Huisman A.
        Digital pathology for education.
        Stud Health Technol Inform. 2012; 179: 68-71
        • Huisman A.
        • Looijen A.
        • van den Brink S.M.
        • van Diest P.J.
        Creation of a fully digital pathology slide archive by high-volume tissue slide scanning.
        Hum Pathol. 2010; 41: 751-757
      7. (NBLU - Nephrology Business Leadership. Available at:) (Accessed May 6, 2020)
        • Roberts J.K.
        Burnout in nephrology: Implications on recruitment and the workforce.
        Clin J Am Soc Nephrol Feb 7. 2018; 13: 328-330
        • Tonelli M.
        • Wiebe N.
        • Manns B.J.
        • et al.
        Comparison of the complexity of patients seen by Different medical Subspecialists in a Universal health care system.
        JAMA Netw Open Nov 2. 2018; 1: e184852
        • Hoenig M.P.
        • Shapiro E.
        • Hladik G.A.
        Lessons learned from the ASN renal educator Listserv and survey.
        Clin J Am Soc Nephrol Jun. 2013; 8: 1054-1060