Nephrology elective experience during medical residency: a national survey of US nephrology fellowship training program directors

Figures & data

Table 1. Nephrology elective experience during medical residency: survey questions.

1. Which best describes your internal medicine residency program? (100%)
a. Small to medium-sized tertiary academic center program (fewer than 30 residents per intern class)
b. Large tertiary academic center program (more than 30 residents per intern class)
c. Small to medium-sized community hospital based program (fewer than 30 residents per intern class)
d. Large community hospital based program (more than 30 residents per intern class)
2. Please describe the location of your training program (choose one answer) (100%)
a. Northeast
b. West
c. Southeast
d. Midwest
e. Hawaii or Alaska
3. Which of the following clinical services are available at your institution? (choose all that apply) (100%)
a. Outpatient hemodialysis
b. Home hemodialysis
c. Peritoneal dialysis
d. Kidney transplant
e. Interventional radiology
f. Interventional nephrology
g. Critical care
h. None of the above
4. How involved are the nephrology faculty in internal medicine program leadership (e.g., chair or vice-chair of medicine, IM program directors, IM clerkship directors, etc.) at your institution? (100%)
a. Not at all involved
b. Infrequently involved
c. Sometimes involved
d. Frequently involved
e. Very involved
5. With regard to internal medicine residents’ exposure to clinical nephrology, which of the following apply to your institution? (choose all that apply) (100%)
a. Dedicated inpatient nephrology ward
b. Nephrology faculty teach and supervise as general IM wards attending
c. Nephrology/renal elective experience
d. Nephrology faculty participate in resident conferences, including resident report
e. Other (please specify)
6. Duration of nephrology/renal electives currently offered at your institution is: (choose all that apply) (100%)
a. <2 weeks
b. 2 weeks
c. 3 weeks
d. 4 weeks
e. >4 weeks
7. Duration of nephrology/renal electives most commonly chosen by residents at your institution is: (100%)
a. <2 weeks
b. 2 weeks
c. 3 weeks
d. 4 weeks
e. >4 weeks
8. Which of the following characterize the nephrology elective experience for residents at your institution? (choose all that apply) (100%)
a. Inpatient general nephrology consultative service
b. Inpatient ESRD (dialysis) service
c. Outpatient general nephrology experience
d. Inpatient renal transplant experience
e. Outpatient renal transplant experience
f. Outpatient hemodialysis experience
g. Outpatient peritoneal dialysis experience
h. Interventional radiology/nephrology experience
i. Other (please specify)
9. On a typical 4-week nephrology elective, how would you best describe the elective experience for most of your residents at your institution? (choose one answer) (100%)
a. Inpatient nephrology consult experience
b. Inpatient nephrology consult and inpatient ESRD (dialysis) experiences
c. Inpatient experiences with few renal clinic experiences (on average ≤1 clinic per week)
d. Inpatient experiences with several renal clinic experiences (on average >1 or = to 2 clinics per week)
e. Inpatient experiences with many renal clinic experiences (on average >2 clinics per week)
f. Two weeks (50%) of inpatient and 2 weeks (50%) of outpatient nephrology experiences (including renal clinics, dialysis unit rounding, outpatient transplant center experiences)
g. Outpatient nephrology experiences only
h. Other (please specify)
10. On a typical 2-week nephrology elective, how would you best describe the elective experience for most of your residents at your institution? (choose one answer) (100%)
a. Inpatient nephrology consult experience
b. Inpatient nephrology consult and inpatient ESRD (dialysis) experiences
c. Inpatient experiences with few renal clinic experiences (on average ≤1 clinic per week)
d. Inpatient experiences with several renal clinic experiences (on average >1 or = to 2 clinics per week)
e. Inpatient experiences with many renal clinic experiences (on average >2 clinics per week)
f. One week (50%) of inpatient and 1 week (50%) of outpatient nephrology experiences (including renal clinics, dialysis unit rounding, outpatient transplant center experiences)
g. Outpatient nephrology experiences only
h. Other (please specify)
11. How involved are your fellows in teaching and supervising your medical residents during their elective time? (100%)
a. Not at all involved
b. Infrequently involved
c. Sometimes involved
d. Frequently involved
e. Very involved
12. Do your residents participate in nephrology conferences during their elective time? (100%)
a. Never
b. Sometimes
c. Frequently
d. Always
13. Number of faculty members each resident interacts in a clinical setting during a typical 4-week nephrology elective at your institution: (100%)
a. 1
b. 2
c. 3
d. 4
e. >4
14. Do your residents rotate through your outpatient hemodialysis unit during their nephrology elective? (100%)
a. Yes
b. No
15. Do your residents rotate through your peritoneal dialysis program/clinic during their nephrology elective? (100%)
a. Yes
b. No
16. Do your residents rotate through your outpatient kidney transplant program/clinic during their nephrology elective? (100%)
a. Yes
b. No
c. No, as there is no outpatient kidney transplant program in my institution
d. No, but kidney transplant patients integrated in (general) ambulatory nephrology experience
17. Do your residents rotate through your interventional radiology/nephrology program during their nephrology elective? (100%)
a. Yes
b. No
c. No, as there is no interventional program in my institution
18. What are some of the most effective ways in fostering interest in nephrology careers? (choose all that apply) (100%)
a. Dedicated inpatient nephrology ward
b. Nephrology elective experiences
c. Nephrology conferences for residents
d. Research opportunities in nephrology
e. Formal mentoring program with nephrology point person
f. Exposure to nephrology fellows
g. Other (please specify)
19. In your opinion as a program director, the duration of nephrology elective needed to have adequate exposure to nephrology during medical residency is: (choose single best answer) (100%)
a. <2 weeks
b. 2 weeks
c. 3 weeks
d. 4 weeks
e. >4 weeks
20. In your opinion as a program director, the ideal nephrology elective experience for medical residents should consist of: (choose single best answer) (100%):
a. Pure inpatient consultative experience
b. Pure inpatient consultative and inpatient ESRD (dialysis) experience
c. Pure outpatient experience
d. Combined inpatient and outpatient experiences (including outpatient dialysis and transplantation)
21. What are some of the reasons that medical residents have no or limited outpatient nephrology experience at your institution? (choose all that apply) (100%)
a. Inpatient service needs
b. Lack of resources to rotate medical residents in outpatient renal clinics
c. Lack of peritoneal dialysis program
d. Lack of resources to rotate medical residents in outpatient hemodialysis unit
e. No outpatient transplant program available
f. No access to interventional radiology/nephrology program
g. Residents do not want any outpatient nephrology exposure
h. Too much work to coordinate various outpatient nephrology experiences
i. Not applicable as most of our residents undergo all the above mentioned experiences during their nephrology elective
j. Other (please specify)
22. Does your program offer research opportunities in nephrology to your medical residents? (100%)
a. Yes, mainly clinical research opportunities
b. Yes, mainly basic research opportunities
c. Yes, both basic and clinical research opportunities
d. No
e. Other (please specify)
23. Does your current nephrology elective structure at your institution provide your medical residents with a realistic insight into the professional life of a practicing nephrologist? (100%)
a. Yes
b. No

Response rate is indicated in parentheses.

Table 2. Characteristics of nephrology elective experience during medical residency (in percentage).

US N-TPDs’ responses	Response (%)
Inpatient experiences
Inpatient general nephrology consultative service	98.9
Inpatient ESRD/dialysis service	42.9
Inpatient renal transplant experience	34.1
Inpatient critical care nephrology	1.1
Inpatient onco-nephrology service	1.1
Ambulatory experiences
Outpatient general nephrology experience	58.2
Outpatient renal transplant experience	22.0
Outpatient hemodialysis experience	12.1
Outpatient peritoneal dialysis experience	11.0
Other experiences
Interventional radiology/nephrology experience	5.5

Table 3. Types of 4- and 2-week nephrology elective experience of US internal medicine residents (in percentage).

Four-week nephrology elective experience	Percent response	Two-week nephrology elective experience	Percent response
Pure inpatient elective
a. Inpatient nephrology consult experience	29.7	a. Inpatient nephrology consult experience	34.1
b. Inpatient nephrology consult and inpatient ESRD/dialysis experience	23.1	b. Inpatient nephrology consult and inpatient ESRD/dialysis experience	23.1
Inpatient elective with ambulatory experience
c. Inpatient experience with few renal clinic experiences (on average ≤1 clinic per week)	22.0	c. Inpatient experience with few renal clinic experiences (on average ≤1 clinic per week)	15.4
d. Inpatient experience with several renal clinic experiences (on average >1 or =2 clinics per week)	11.0	d. Inpatient experience with several renal clinic experiences (on average >1 or =2 clinics per week)	8.8
e. Inpatient experience with many renal clinic experiences (on average >2 clinics per week)	0.0	e. Inpatient experience with many renal clinic experiences (on average >2 clinics per week)	0.0
f. Two weeks (50%) of inpatient and 2 weeks (50%) of outpatient nephrology experiences (including renal clinics, dialysis unit rounding, outpatient transplant center experiences)	4.4	f. One week (50%) of inpatient and one week (50%) of outpatient nephrology experiences (including renal clinics, dialysis unit rounding, outpatient transplant center experiences)	3.3
Pure outpatient elective and other experiences
g. Outpatient nephrology experiences only	1.1	g. Outpatient nephrology experiences only	2.2
h. Other experiences^a	8.8	h. Other experiences^a	13.2

^aOther experiences (free responses) are reviewed in the “Results” section.

Figure 1. Do your medical residents rotate through your outpatient hemodialysis, peritoneal dialysis, transplant and interventional radiology/nephrology programs during their nephrology elective?

Figure 2. Most effective measures in fostering interest in nephrology careers as perceived by US adult N-TPDs.

Figure 3. Top four reasons why US internal medicine residents have no or limited outpatient nephrology elective experience.