Improvements in training for glomerular diseases can attract more fellows to nephrology
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In April 2022, the American Society of Nephrology established an expert task force to examine training requirements in nephrology.
In its final report, the task force developed 10 recommendations focused on strategies needed to promote nephrology, which included the following:
- just, equitable and high-quality care for patients with kidney diseases;
- promote the value of nephrology as a specialty to nephrologists, the future nephrology workforce, health care system, the public and government; and
- innovation and personalization of nephrology education across the scope of medical training.
One of the key recommendations of the task force was that “nephrology must establish individualized pathways to provide opportunities for fellows to explore advanced specialized care and other career goals in more depth.”
There is a strong assertion that the second year of nephrology fellowship training must be leveraged to establish individualized pathways, according to the task force. The idea was to allow the second year of training to be used for greater flexibility, individualization and subspecialty exploration.
Glomerular disease
Glomerular disease is one such pathway. Specialized training can be provided using a track model within a general nephrology fellowship if the training and academic center have nephrology and pathology faculty with expertise in glomerular disease and enough patient volume.
In a recently published study in Kidney International Reports, we joined colleagues in investigating the importance of specialized training in the management of glomerular diseases. We conducted a qualitative descriptive study involving an online survey of 16 programs worldwide that offer advanced training in glomerular disease.
The study presents the status of glomerular disease fellowships internationally by evaluating the reasons for success and challenges faced by these programs. The study also identifies potential areas of improvement.
Most of the programs (10 of 14 responses) were in the United States, with the remainder in Europe. Notably, 11 of the 14 programs reported that its graduates primarily entered academia. Key factors of success for these programs included departmental resources, multidisciplinary teams, local expertise in glomerular diseases and protected time for research. Challenges included lack of funding, declining interest in nephrology, visa issues for international fellows and limited resources for patient education in glomerular diseases.
Program funding
Institutional and departmental support, along with the presence of nephropathologists, rheumatologists and other physicians, were crucial for the success of these programs. The study identified a few challenges, including funding. Some centers have been struggling to recruit fellows for several years due to financial constraints. The study suggests government funding, philanthropic funding or institutional support could help, and larger society-based grants might be a potential solution.
One broader challenge is the overall lack of interest in nephrology fellowships, which extends to glomerular disease training. Visa-related concerns were reported as another challenge for graduates, hindering their long-term prospects in the United States. Addressing immigration policy reform could attract promising candidates for glomerular disease fellowship programs.
The study also notes the lack of specific pediatric training courses for glomerular disease, emphasizing the need for dedicated training opportunities in this area. Managing patients with glomerular disease requires knowledge of disease pathogenesis, clinical presentations, comorbid conditions and experience with immunosuppression. Specialized training can enhance graduates’ prospects for careers in academia and encourage their active participation in research and literature interpretation.
Interpreting kidney pathology and balancing the risks and benefits of immunosuppression are crucial skills, and having in-house nephropathologists for training programs is essential. However, the study reveals that many programs lack a formal fellowship curriculum, indicating a gap in structured education.
Specialized training
The study highlights the need for specialized training in glomerular diseases due to the complexity of these diseases and the variability in exposure during general nephrology fellowship. An additional year of training is essential for fellows interested in treatment and management of these diseases, as it enhances their clinical experience, knowledge and ability to contribute to the scientific understanding of glomerular diseases. The study also highlights the need for patient education, access to subspecialty care and increased patient referrals to specialists in glomerular diseases.
The rarity of glomerular diseases presents a challenge, but specialists can be invaluable for nephrology divisions and practices. An extra year of training can improve reimbursement of institutions and lead to potential faculty hiring. Networking with other specialties and participating in international observational cohort studies can also enhance research and collaboration. Specialized training in glomerular diseases can be achieved by either a track method or an additional year in training. There are key factors for success and challenges faced by fellowship programs. Our research offers insights into potential improvements and the development of guidelines and educational curricula to foster international collaborations and advance research into glomerular diseases.
- References:
- Jhaveri KD, et al. Kidney Int Reports. 2023;doi:10.1016/j.ekir.2023.08.023.
- Rosenberg ME, et al. Clin J Am Soc Nephrol. 2023;doi:10.2215/CJN.0000000000000133.
- Shah HH, et al. Am J Kidney Dis. 2023;doi:10.1053/j.ajkd.2023.05.006.
- For more information:
- Koyal Jain, MD, MPH, FASN, is an associate professor of medicine in the division of nephrology and hypertension and program director of the nephrology fellowship and the glomerulonephritis and vasculitis fellowship program at the University of North Carolina Chapel Hill. She can be reached at koyal_jain@med.unc.edu.
- Kenar D. Jhaveri, MD, is professor of medicine and associate chief in the division of kidney diseases and hypertension at Northwell Health and Zucker School of Medicine at Hofstra/Northwell. He can be reached at kjhaveri@northwell.edu.
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