The need to emphasize nephrology knowledge in residents-in-training

Abstract

Background:Chronic kidney disease is an increasingly prevalent health problem with the potential for poor outcome of end-stage renal disease. Hospitalized critically ill patients are prone to acute renal injury from numerous factors such as poor renal perfusion secondary to ischemia and hypotension, nephrotoxin exposure, and intravenous contrast exposure.Aims:We set to explore resident awareness and knowledge about chronic kidney disease management, timely nephrology referrals, preventing inadvertent acute kidney injury (AKI), and the understanding of basic electrolyte physiology.Materials and Methods:We conducted a cross-sectional study using an online questionnaire survey of internal medicine, Medicine/Pediatrics and Family Medicine residents in the United States to determine the knowledge of residents during their training about nephrology.Results:The survey questionnaire was sent out to 270 residents. Forty-seven (17%) respondents completed the survey. Out of them, 57% of the residents chose to refer a patient with an estimated glomerular filtration rate <30 mL/min/1.73 m2 to a nephrologist; 66% felt that it was safe to use aspirin in stage IV chronic kidney disease; 82% did not want to use metformin or Lovenox in stage IV chronic kidney disease; 87% answered that they would make the patient resume angiotensin converting enzyme inhibitor or angiotensin II receptor blockers (ARBs) about 48-72 h after contrast exposure. Only 7.5% decided to hold angiotensin converting enzyme inhibitors/ARBs before contrast exposure. Meanwhile, 70% correctly identified the efferent arteriole as the site of action of angiotensin converting enzyme inhibitors/ARBs and 76% identified nitrofurantoin as a contraindication in renal insufficiency.Conclusion:Residency offers a golden opportunity for resident physicians to create a strong foundation of concepts in medicine. There are several basic areas in the field of nephrology that need to be further emphasized during residency training to help improve patient care and potentially decrease the incidence of AKI.

An innovative nephrology elective enhances learning in internal medicine residents

“…An elective in a subspecialty helps internal medicine trainees improve their understanding in areas which may translate to their clinical practice (Akbar et al 2015, Shah et al 2015. Goldenberg et al (1983) were able to demonstrate this educational impact in a group of residents undergoing a rheumatology elective.…”

“…Despite the increasing burden of CKD, there is a declining interest in nephrology fellowships (Sharif et al 2016, Field 2008, Jhaveri et al 2013. The various reasons given include poor learning experiences with nephrology in medical school, nephrology not being a core rotation, the perception that work hours are very long, and exposure to very sick patients such as dialysis or transplant patients in a hospital setting (Jhaveri et al 2013, Akbar et al 2015, Shah et al 2015. As patients with acute kidney injury (AKI), CKD and fluid electrolyte imbalance are routinely admitted to medical wards, not only specialist nephrologists but also internal medicine (IM) physicians will need to be conversant in their management.…”

Knowledge and Needs of Resident Physicians Regarding Osteoporosis: A Nationwide Survey of Residents

“…For example, significant knowledge gaps regarding management of chronic kidney disease were identified in a survey of internal medicine, internal medicine/ pediatrics, and family medicine residents. (11) Similarly, internal medicine house-staff had poor awareness and knowledge for dose adjustment for common cardiovascular drugs in patients with chronic kidney disease, (12) and specific gaps in knowledge of chronic kidney disease guidelines. (13) Finally, a study investigating knowledge about menopause management among all levels of internal medicine, family medicine, and obstetrics and gynecology residents showed that despite the belief that training in menopause management was important, knowledge gaps were present, and a minority felt adequately prepared to manage women experiencing menopause.…”

Dose adjustment of antidiabetic medications in chronic kidney disease

“…Having additional nephrology education either in medical school or in residency is associated with improved level of awareness and knowledge among IMHS. [ 18 ] Both internal medicine residents and PCPs have gaps in their knowledge of CKD practice guidelines and treatment of CKD complications. [ 19 ] Improved education of CKD among training physicians can result in improved patient care and clinical outcomes.…”

“…[ 19 ] Improved education of CKD among training physicians can result in improved patient care and clinical outcomes. [ 18 ] This may come in the form of additional ambulatory Nephrology exposure as conditions such as CKD are best taught in the outpatient setting. [ 20 ]…”