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Challenges in Nephrology Education: Integration of the Preclinical Curriculum

      With the ongoing workforce crisis in nephrology, it is critically important to engage medical students early in their educational arc with continued touch points throughout the curriculum. Ideally, this begins with the preclinical learning experience as nephrology is notoriously one of the most difficult subjects in medicine to master. Over the last decade, medical schools have made a significant push toward shortening the preclinical experience from 2 years to less than 18 months to allow students earlier exposure to clinical medicine and a more deliberate integration of basic science concepts into the third- and fourth-year curriculum. This design allows for more longitudinal revisiting of basic science concepts in a clinically relevant way as well as more opportunities for clinical application of the materials. In the traditional 2 + 2 model, year 1 typically reviewed normal physiology, anatomy, and histology, and year 2 focused on pathology, pathophysiology, and pharmacology. Year 2 is where nephrologists did the bulk of their teaching. Now in this shortened preclerkship model, schools are moving toward an integrated systems-based approach to learning the material with a focus on clinical relevance for all basic science material. As such, nephrology educators have been tasked with the integration and consolidation of their subject matter into 1 systems-based module to maximize efficiency of the preclinical experience. This requires collaboration with PhD colleagues from anatomy, physiology, embryology, and histology and a team effort to focus and integrate the basic science concepts around clinically relevant topics. However, rather than a 1-pass systems-based approach, many schools (including ours) are deliberately revisiting the material through integrated clinical cases later in the preclerkship and clerkship phases to reinforce and build upon concepts taught in the systems-based modules so students can integrate and apply what they are learning across systems. In nephrology, such concepts include acid-base disorders, hyponatremia and hypernatremia, selection of intravenous fluids, acute kidney injury, chronic kidney disease, complex multisystem autoimmune syndromes, and multisystem organ failure requiring more sporadic teaching for nephrology educators.
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