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Research Article
Georges Nakhoul
Cleveland Clinic
Corresponding Author
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This work is licensed under a CC BY 4.0 License. Read Full License
Background
Interest in nephrology has been declining among residents but the reasons behind this observation are not well characterized. Our objective was to evaluate factors influencing internal medicine residents’ choice of subspecialty.
Methods
This is a mixed-method QUAL-QUAN design study that used the results of our previously published qualitative analysis on residents’ perception of nephrology to create and pilot a questionnaire of 60 questions. The questionnaire was distributed to 26 programs across the United States and a total of 1992 residents. We calculated response rates and tabulated participant characteristics and percentage of participant responses. We categorized choice of fellowship into 2 medical categories (Highly Desirable vs. Less Desirable) and fitted a logistic regression model of choosing a highly vs. less desirable fellowship.
Results
415 out of 1992 (21%) US residents responded to the survey. Of the 268 residents planning to pursue fellowship training, 67 (25%) selected a less desirable fellowship. Female sex was associated with significantly higher odds of selecting a less desirable fellowship (OR = 2.64, 95% CI: 1.47, 4.74). Major factors deterring residents from pursuing nephrology were perception of inadequate financial compensation, broad scope of clinical practice and complexity of patient population. We observed a decline in exposure to nephrology during the clinical years of medical school with only 35.4% of respondents rotating in nephrology versus 76.8% in residency. The quality of nephrology education was rated less positively during clinical medical school years (median of 50 on a 0-100 point scale) compared to the pre-clinical years (median 60) and residency (median 75).
Conclusion
Our study attempts to explain the declining interest in nephrology. Results suggest potential targets for improvement: diversified trainee exposure, sub-specialization of nephrology, and increased involvement of nephrologists in the education of trainees.
Keywords
Nephrology Fellowship, Specialty training, Education
Figure 1
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Figure 3
No competing interests reported.
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CURRENT STATUS: Under Review
Version 1
Posted 10 Feb, 2021
No community comments so far
Editorial decision: Major revision
On 31 Mar, 2021
Reviews received
Received 29 Mar, 2021
Reviewers agreed
On 01 Mar, 2021
Reviews received
Received 01 Mar, 2021
Reviewers agreed
On 14 Feb, 2021
Reviewers invited
Invitations sent on 09 Feb, 2021
Editor assigned
On 08 Feb, 2021
Editor invited
On 08 Feb, 2021
Submission checks complete
On 08 Feb, 2021
First submitted
On 22 Jan, 2021
Metrics
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Subject Areas
Urology & Nephrology
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A new preprint design is coming!
We have improved readability, clarity, accessibility, and opportunities for engagement.
This preprint is under consideration at BMC Nephrology. A preprint is a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.
Learn more about In Review
Research Article
Georges Nakhoul
Cleveland Clinic
Corresponding Author
Badges
Prescreen
This manuscript passed our Prescreen assessment
Complete author information
Appropriate declaration statements
Potential risks to human health
Prescreen
Peer Review Timeline
CURRENT STATUS: Under Review
Version 1
Posted 10 Feb, 2021
No community comments so far
Editorial decision: Major revision
On 31 Mar, 2021
Reviews received
Received 29 Mar, 2021
Reviewers agreed
On 01 Mar, 2021
Reviews received
Received 01 Mar, 2021
Reviewers agreed
On 14 Feb, 2021
Reviewers invited
Invitations sent on 09 Feb, 2021
Editor assigned
On 08 Feb, 2021
Editor invited
On 08 Feb, 2021
Submission checks complete
On 08 Feb, 2021
First submitted
On 22 Jan, 2021
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
Subject Areas
Urology & Nephrology
License:
This work is licensed under a CC BY 4.0 License. Read Full License
Background
Interest in nephrology has been declining among residents but the reasons behind this observation are not well characterized. Our objective was to evaluate factors influencing internal medicine residents’ choice of subspecialty.
Methods
This is a mixed-method QUAL-QUAN design study that used the results of our previously published qualitative analysis on residents’ perception of nephrology to create and pilot a questionnaire of 60 questions. The questionnaire was distributed to 26 programs across the United States and a total of 1992 residents. We calculated response rates and tabulated participant characteristics and percentage of participant responses. We categorized choice of fellowship into 2 medical categories (Highly Desirable vs. Less Desirable) and fitted a logistic regression model of choosing a highly vs. less desirable fellowship.
Results
415 out of 1992 (21%) US residents responded to the survey. Of the 268 residents planning to pursue fellowship training, 67 (25%) selected a less desirable fellowship. Female sex was associated with significantly higher odds of selecting a less desirable fellowship (OR = 2.64, 95% CI: 1.47, 4.74). Major factors deterring residents from pursuing nephrology were perception of inadequate financial compensation, broad scope of clinical practice and complexity of patient population. We observed a decline in exposure to nephrology during the clinical years of medical school with only 35.4% of respondents rotating in nephrology versus 76.8% in residency. The quality of nephrology education was rated less positively during clinical medical school years (median of 50 on a 0-100 point scale) compared to the pre-clinical years (median 60) and residency (median 75).
Conclusion
Our study attempts to explain the declining interest in nephrology. Results suggest potential targets for improvement: diversified trainee exposure, sub-specialization of nephrology, and increased involvement of nephrologists in the education of trainees.
Figure 1
Figure 2
Figure 3
No competing interests reported.
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