Reimagining Nephrology Fellowship Education to Meet the Future Needs of Nephrology

Abstract

The American Society of Nephrology (ASN) Task Force on the Future of Nephrology was established in April 2022 in response to requests from the American Board of Internal Medicine and the Accreditation Council for Graduate Medical Education regarding training requirements in nephrology. Given recent changes in kidney care, ASN also charged the task force with reconsidering all aspects of the specialty's future to ensure that nephrologists are prepared to provide high-quality care for people with kidney diseases. The task force engaged multiple stakeholders to develop 10 recommendations focused on strategies needed to promote: (1) just, equitable, and high-quality care for people living with kidney diseases; (2) the value of nephrology as a specialty to nephrologists, the future nephrology workforce, the health care system, the public, and government; and (3) innovation and personalization of nephrology education across the scope of medical training. This report reviews the process, rationale, and details (the “why” and the “what”) of these recommendations. In the future, ASN will summarize the “how” of implementing the final report and its 10 recommendations.

Protected Time for Program Administration among Nephrology Program Leadership in the United States

“…Lack of time may be a barrier to implementing the recommendations of the American Society of Nephrology Taskforce on the Future of Nephrology (reflected in proposed updates to the ACGME Nephrology program requirements). 15,16 Concurrent with protected time decreases, there are new curriculum stipulations for diversity/equity/inclusion and health care disparities and increasing emphasis on fellow wellness. 17 An effective curriculum in these areas is likely to increase administrative time burdens on program leaders, and faculty will need developmental training.…”

Time is Money

“…8 If compensation systems evolve to incentivize physician performance that are outcome-based, as advised by Rosner and Falk, this commitment of the ASN will dovetail well with its goal to realign nephrology training to be more congruent with the needs of society. 9 This realignment in nephrology practice, which was articulated in the 2019 Executive Order on Advancing Kidney Health, would transform nephrology from a dialysis-centric specialty to one that prioritizes the preservation of kidney function through better diagnosis, treatment and preventive care; provides patient-centric options for renal replacement, such as home dialytic therapies and transplantation; and increases public awareness. 9 An ASN task force was established in 2022 at the request of the American Board of Internal Medicine and ACGME to identify gaps in training that must be filled to prepare fellows as the specialty changes to one focused on kidney health rather than merely kidney failure and to provide high-quality care in an equitable fashion.…”

“…9 This realignment in nephrology practice, which was articulated in the 2019 Executive Order on Advancing Kidney Health, would transform nephrology from a dialysis-centric specialty to one that prioritizes the preservation of kidney function through better diagnosis, treatment and preventive care; provides patient-centric options for renal replacement, such as home dialytic therapies and transplantation; and increases public awareness. 9 An ASN task force was established in 2022 at the request of the American Board of Internal Medicine and ACGME to identify gaps in training that must be filled to prepare fellows as the specialty changes to one focused on kidney health rather than merely kidney failure and to provide high-quality care in an equitable fashion. 9 The task force recommended sweeping changes that require changes in curriculum, identification, and development of robust patient cohorts (as an example, for home hemodialysis) and harnessing of available faculty expertise to address high priority gaps.…”

“…9 An ASN task force was established in 2022 at the request of the American Board of Internal Medicine and ACGME to identify gaps in training that must be filled to prepare fellows as the specialty changes to one focused on kidney health rather than merely kidney failure and to provide high-quality care in an equitable fashion. 9 The task force recommended sweeping changes that require changes in curriculum, identification, and development of robust patient cohorts (as an example, for home hemodialysis) and harnessing of available faculty expertise to address high priority gaps. These initiatives require the investment of time and money and are critically important for the future of nephrology.…”

“…9 This realignment in nephrology practice, which was articulated in the 2019 Executive Order on Advancing Kidney Health, would transform nephrology from a dialysis-centric specialty to one that prioritizes the preservation of kidney function through better diagnosis, treatment and preventive care; provides patient-centric options for renal replacement, such as home dialytic therapies and transplantation; and increases public awareness. 9…”