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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Financial Disclosure: The authors declare that they have no relevant financial interests.
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