Design, Dissemination, and Assessment of NephSIM: A Mobile-Optimized Nephrology Teaching Tool

Simulation-based learning in nephrology

Simulation is a technique to replace and amplify real experiences with guided ones that evoke or replicate substantial aspects of the real world in a fully interactive fashion. In nephrology (a particularly complex specialty), simulation can be used by patients, nurses, residents, and attending physicians alike. It allows one to learn techniques outside the stressful environment of care such as central venous catheter placement, arteriovenous fistula management, learning about peritoneal dialysis, or performing a kidney biopsy. Serious games and virtual reality are emerging methods that show promise. Simulation could also be important in relational aspects of working in a team or with the patient. The development of simulation as a teaching tool in nephrology allows for maintaining high-quality training for residents, tailored to their future practice, and minimizing risks for patients. Additionally, this education helps nephrologists maintain mastery of technical procedures, making the specialty attractive to younger generations. Unfortunately, the inclusion of simulation training programmes faces occasional logistical or funding limitations that universities must overcome with the assistance and innovation of teaching nephrologists. The impact of simulation-based teaching on clinical outcomes needs to be investigated in clinical studies.

RheumMadness: Creating an Online Community of Inquiry in Rheumatology

OBJECTIVE

To evaluate the educational impact of RheumMadness, an online tournament of rheumatology concepts grounded in social constructivist theory, as viewed through the community of inquiry (CoI) framework.

METHODS

The curricular scaffold of RheumMadness was a bracket of 16 rheumatology concepts competing as "teams" in a tournament. Participants could create and review "scouting reports" about each team, listen to a RheumMadness podcast, discuss on social media, and submit a bracket predicting tournament outcomes according to the perceived importance of each team. Engagement was measured with direct analytics and through self-report on a survey. The survey also assessed participants' educational experience using an adapted 34-item CoI survey, which describes the cognitive, social, and teaching presences in a learning activity.

RESULTS

One hundred brackets were submitted. On average, each scouting report was viewed 92 times, each podcast episode was downloaded 163 times, and 486 tweets were sent about #RheumMadness from 105 users. The survey received 58 of 107 responses (54%). Respondent agreement with prompts related to each CoI presence was: 70.3% cognitive, 61.7% social, 84.9% teaching. Reported engagement in RheumMadness correlated strongly with overall CoI survey scores (r = 0.72, P < 0.001).

CONCLUSION

RheumMadness created an online CoI that fostered social constructivist learning about rheumatology.

Trainee Love and Breakup Letters to NephSIM: A Free, Mobile-Optimized, Nephrology Teaching Tool

BACKGROUND

It is not known how learners feel about free open access medical education (FOAMed) as they progress through their training from medical school to fellowship. Love and breakup letter methodology (LBM) is a technique that has been used extensively in user experience technology-based research but has not previously been used in evaluating medical education tools. LBM asks participants to creatively write a "love" or "breakup" letter to a product under study to capture their thoughts and emotions when engaging with it. We conducted qualitative analysis of data from focus groups to explore how attitudes toward a learning platform change at various training stages and to broaden our understanding of how we meet learners' needs through a nephrology FOAMed tool, NephSIM.

METHODS

Three virtual, recorded focus groups were conducted with second-year medical students, internal medicine residents, and nephrology fellows ( N =18). At the start of the focus group, participants composed and read their love and breakup letters. Semistructured discussions were then led by facilitator-driven questions and peer comments. After transcription, inductive data analysis was conducted using Braun and Clarke's six-step thematic analysis.

RESULTS

Four main themes were seen across all groups: attitudes toward teaching tool, perception of nephrology, learning needs and approach, and application to practice. Preclinical students positively viewed the opportunity to simulate the clinical setting and unanimously wrote love letters. Reactions from residents and fellows were mixed. Residents were interested in brevity and speed of learning, preferring algorithms and succinct approaches to meet their practice-based learning needs. Fellows' learning needs were driven by a desire to prepare for the nephrology board examination and review cases uncommonly seen in practice.

CONCLUSIONS

LBM provided a valuable methodology through which to identify trainee reactions to a FOAMed tool and highlighted the challenges of meeting learning needs of a continuum of trainees with a single learning platform.

Harnessing Social Media to Enhance Nephrology Academia

The process of learning has been confined to the realms of educational institutions. Over the last ten years, the semantics of social media networks have evolved with the use of mobile gadgets. Consequently, nephrologists have realised the potential benefits of using these platforms for their educational and career development. Social media can change the horizon of nephrology education. The concept of bedside examination, teaching and sharing experiences have changed with the advent of Facebook, YouTube, Instagram and X (former Twitter). Other networking portals, such as WhatsApp, Telegram, X (former Twitter), and Pinterest, have also amassed the attention of selected users. Despite split opinions on the utility of social media, it is undeniable that it has influenced interaction between students and mentors. Resources ranging from online networks, blogs, visual aids, podcasts, online journal clubs, videos, live conference coverages, and tutorials have made it possible for nephrologists to stay informed and educated with recent updates. In this review, we discuss how social media can enrich nephrology academia, facilitate the sharing of research and access to fellowships and mentorship programs, provide career prospects to trainees, and broadcast scientific conferences while bringing nephrology societies together.

Keywords

education; nephrology; social media.

Creating ophthalmology experiences in undergraduate medical education: pilot of a cased-based learning ophthalmology tool

PURPOSE

To evaluate medical student perceptions of a novel ophthalmology resource delivered through facilitated workshops in the core clerkship curriculum.

METHODS

We created www.2020sim.com, a free case-based learning (CBL) ophthalmology tool, adapted from NephSIM (www.nephsim.com). The tool was first piloted with the internal medicine (IM) residents. After confirming a need, we focused on undergraduate medical education (UME) by expanding the 20/20 SIM content and partnering with the neurology (pilot academic year [AY] 2020-2021) and pediatric clerkships (pilot AY 2021-2022) to deliver a facilitated one-hour ophthalmology workshop within each clerkship's didactic curriculum. We evaluated the tool using pre- and post-surveys and knowledge assessments.

RESULTS

Of 80 IM residents, 33 (41.3%) completed the needs assessment. Of the 25 residents who attended the workshop, 23 (92.0%) completed the exit survey. IM residents reported discomfort in several ophthalmology domains (9 of 14 rated mean score < 3.0), confirming a need. Most (n = 21/23, 91.3%) rated the tool as good/excellent. Of 145 neurology clerkship students, 125 (86.2%) and at least 88 (60.7%) students completed the pre- and post-test/exit surveys, respectively. On average, participants highly rated the tool, perceiving 20/20 SIM to be relevant to their education [4.1 (0.8)]. Mean pre- to post-test knowledge scores increased from 7.5 to 8.5/10.0 points (p < 0.001). Of the 136 pediatric clerkship students, 67 (49.3%) and 51 (37.5%) completed the pre- and post-surveys, respectively. Respondents perceived increased comfort with ophthalmology topics after the facilitated workshop [3.8 (0.8)]. Mean pre- to post-test knowledge scores trended from 1.8 to 2.0/5.0 points (p = 0.30). Collectively, 20/139 (14.4%) of exit survey respondents visited www.2020sim.com within 1 month after the workshop.

CONCLUSION

After identifying areas of greatest need with residents, we partnered with core clerkships to deliver cross-disciplinary ophthalmology content in UME. We found high engagement with 20/20 SIM, with trends toward increased knowledge.

Developing a Novel Case-Based Gastroenterology/Hepatology Online Resource for Enhanced Education During and After the COVID-19 Pandemic

BACKGROUND

The COVID-19 pandemic reshaped the delivery of medical education, necessitating novel modes of instruction to facilitate distance learning. Online medical education resources provide opportunities for self-directed and asynchronous learning. GISIM is a free, open access educational website dedicated to gastroenterology (GI)/hepatology, which teaches pathophysiology and disease management, and supports clinical reasoning skill development through interactive, dynamic, case presentation-based journeys.

AIMS

(1) To describe the creation of a mobile-optimized, GI/hepatology educational resource for medical trainees, and (2) to report on trainee feedback on completing and authoring GISIM cases.

METHODS

GISIM was created on WordPress and modeled after NephSIM, an e-learning platform dedicated to Nephrology. Content was developed by internal medicine residents and GI/hepatology fellows and attendings. Cases are interactive, prompting users to select differential diagnoses and management plans, with immediate feedback provided on response. Self-reported user demographics and website feedback were collected with an embedded survey. A separate survey evaluated case authors' experiences.

RESULTS

GISIM launched in February 2021 and received 12,184 website views and 2003 unique visitors between February 1 2021 and February 28 2022. New cases are disseminated bimonthly. Sixty-one user surveys were collected, with a majority completed by fellows (38%) and residents (26%). All users found the website easy to use and most reported enhanced understanding of case topic areas. Nine author surveys were collected. Authors reported significant learning on chosen topics and improved clinical knowledge through their participation.

CONCLUSIONS

We developed a novel GI/hepatology case-based resource that enables distance learning and was perceived as a valuable educational tool by users and authors.

Engagement in Free Open Access Medical Education by US Nephrology Fellows

BACKGROUND

As free open access medical education (FOAMed) use increases, it is important to characterize how and why learners are using this educational material in nephrology. We describe the frequency, purpose, and type of FOAMed usage across US nephrology fellows.

METHODS

In this cross-sectional survey, items were emailed to all US adult and pediatric nephrology fellows via the American Society of Nephrology (ASN) Fellow Survey in May 2022. The eight-item survey, developed to measure FOAMed engagement, had previously undergone instrument validation. The results were analyzed by descriptive statistics.

RESULTS

In total, 43% (359/842) adult nephrology fellows and 51% (45/88) pediatric nephrology fellows completed the survey. Seventy-four percent (300/404) of fellows reported using FOAMed, and 72% (215/300) started using FOAMed within the past 2 years. Of FOAMed users, 41% (122/300) reported viewing FOAMed and 33% (99/300) reported applying knowledge gained from these resources daily or weekly. Common purposes for FOAMed engagement included searching Twitter to learn about others' opinions in the field (43%; 130/300), reading blogs to answer clinical questions (35%; 105/300), and listening to podcasts for the most up-to-date information (39%; 116/300). Compared with traditional educational resources, fellows preferred using FOAMed for staying up to date on nephrology topics (75%) and answering clinical questions (37%). Among all fellows, the greatest barriers to FOAMed use were unfamiliarity with FOAMed (27%; 111/404), validity concerns (22%; 90/404), and a lack of a local community of FOAMed users (22%; 87/404).

CONCLUSIONS

Seventy-four percent of nephrology fellows used FOAMed resources in a variety of ways, and of them, 33% of fellows clinically applied knowledge gained from these resources. Reasons for engaging with FOAMed varied across resources.

The evolution of social media in nephrology education: A mini-review

Social media is defined as "a group of Internet-based applications that build on the ideological and technological foundations of Web 2.0, that allow the creation and exchange of user-generated content". Social media can be used in medical education to enhance knowledge sharing among peer groups and the public in general. The internet revolutionized learning by allowing easier dissemination of knowledge that did not depend on printing and physical distribution of books, journals, or magazines. According to a report from 2018, 95% of students have access to smartphones and 45% are online at any given time. Social media platforms are powerful tools to spread knowledge by the way of stories, videos, and educational games. Both formal and informal learning can be achieved with the use of social media. The microblogging website Twitter has become a popular social media platform by many in medical education including the nephrology community. Twitter, for example, is used to build communities, discuss journal articles, inform the community of conferences, share infographics and visual abstracts of original research work. As an example, it can be difficult for women in nephrology to connect and travel to make a physical presence. The use of social media allows women to connect via webinars and Women in Nephrology (WIN) India live Twitter chats. Thus, social media can help facilitate networking and collaboration with nephrologists all over the world. Social media has limitations as well. Insensitive posts can have a detrimental effect on one's career. A survey has shown that increased use of social media can contribute to addiction, anxiety, diminished self-esteem, and even depression. Hence, in order to effectively use social media to contribute positively to one's career, we recommend considering the positive and negative aspects of social media.This review will discuss the various social media platforms and how they have been applied to nephrology education.

The changing landscape in nephrology education in India

Digital tools have revolutionized education in nephrology in India. All forms of in-person learning are moving online. Social media have taken over the world, with clinicians learning and promoting multidirectional education methods. E-learning is better equipped to keep up with the rapid pace of new knowledge generation and dissemination. The use of digital multimedia tools to enhance rapid learning is backed by science, viz., dual-coding theory. Digital tools such as Twitter, blogs, podcasts, YouTube, and Nephrology Simulator (NephSIM) have had an impact in facilitating nephrology education among medical professionals and the general public. Digital tools, such as NephMadness, have resulted in the gamification of nephrology learning. Social media usage by the nephrology community in India is growing at a rapid pace. Everyday Cases in Nephrology (#ECNeph), a monthly Twitter-based discussion focused on academically challenging clinical cases, has its origins in India. The Women in Nephrology, India (WIN-India) initiative is very active in facilitating digital education in India and has, in a short space of time, created phenomenal momentum. Furthermore, non-governmental organizations in India, such as the Kidney Warriors Foundation and the Multi Organ Harvesting Aid Network (MOHAN) Foundation, have successfully tapped into social media to educate and aid kidney disease patients. All technologies come with some drawbacks. Despite their acceptance and validation, digital tools have their own pitfalls. These relate to (1) accessibility and connectivity, (2) accuracy of the scientific information, (3) social media noise, and (4) patient privacy. All pitfalls of digital education can be addressed by avoiding excessive social media overload and adopting an appropriate peer-review process. It is advisable to seek written consent from patients whenever patient data are posted online, to avoid privacy issues.

Kidney Pathology Education for Nephrology Fellows: Past, Present, and Future

Kidney pathology education is a critical component in training of nephrology fellows, as well as for continuing medical education for practicing nephrologists. Kidney pathology images are included on nephrology fellow board exams, and clinicopathologic correlation of kidney biopsy findings is critical in everyday clinical practice. Nephropathology training is a requirement by the American College of Graduate Medical Education within nephrology fellowship curricula. However, greater than one-third of fellowship program directors believe that nephropathology training for their fellows is not sufficient. During the Coronavirus Disease-19 pandemic, the use of digital learning has become commonplace with virtual conferences (local, national, and international) and online meetings becoming the norm for education. Nephrology has become a leader in free open-access online medical education, both prior to and, to even a greater extent, during the pandemic. Here, we review available resources to nephrology fellows and other learners to supplement nephropathology training, which includes medical blogs, journal clubs, interactive quizzes and games, online conferences, podcasts, and mentorship opportunities. These resources are archived and provide durable content to learners of all stages of training, even beyond the pandemic.

Engendering a Love of Nephrology Among Medicine Residents: Education Over Recruitment

Dwindling interest in nephrology amid a growing prevalence of kidney disease has inspired nephrologists to create educational initiatives for trainees. Engagement at all levels is crucial to fostering interest in the field, and experience for internal medicine residents has been a significant area for growth. In this article, we review the literature on available educational programs at the residency level. These interventions were largely met with high trainee satisfaction and positive feedback, particularly when designed with the goal to create superb internists rather than future nephrologists. Based on the available literature and our own experience at the University of Pennsylvania, we propose that such approaches will be better-received and engender a greater love for nephrology.

Quality Appraisal and Assurance Techniques for Free Open Access Medical Education (FOAM) Resources: A Rapid Review

Free open access medical education (FOAM) has disrupted traditional modes of knowledge translation and dissemination. These are popular resources with a wide educational reach. Nephrology has been a leader in FOAM, but many skeptics still question the accuracy and reliability of this content. Recently, quality-assurance techniques have been developed to address these concerns. These techniques may be helpful for readers to appraise the online literature and for institutions to reward the production of high-quality open educational resources. We performed a rapid review of the literature. A medical librarian conducted a systematic search of the Medline and Cumulative Index of Nursing and Allied Health Literature databases. Two independent assessors screened and selected articles, performed a hand-search of reference lists, and scored articles on their quality using the Medical Education Research Study Quality Instrument. Thirteen reports were included for the final descriptive analysis. We identified 10 quality-assessment techniques, and 4 of them having been validated. The quality of the reports was fairly high, with an average Medical Education Research Study Quality Instrument score of 11.5 of 18 (SD, 2.3; range, 7.25-14.25). The calculated Cronbach α was 0.85. There is burgeoning literature on the topic of critical appraisal of open educational resources, and, more specifically, FOAM resources. Many of the techniques used are of varying quality and developed with different intended uses and audiences. By continuing to refine these tools, we can continue not only to support and legitimize the FOAM movement, but also foster individual critical appraisal skills that increasingly are necessary in this age of information.

Great nephrologists begin with great teachers: update on the nephrology curriculum

PURPOSE OF REVIEW

The purpose of this review is to highlight developments and opportunities in the nephrology curriculum from the basic science foundation years through teaching medical students, residents and fellows in the clinical realm.

RECENT FINDINGS

Teaching skills are a vital tool for nephrologists both to promote excellent patient care and attract talented learners to the field. Exposure to dynamic and inspiring nephrologists is one of the main factors given by students and residents for selecting a career in nephrology. Nephrology teaching, including case discussions, problem-based learning, team-based learning and flipped classrooms, provides motivating active learning for medical students and is equally effective for didactics in graduate medical education. Avenues for teaching in the clinical realm include the microskills framework, bedside teaching and grounding in evidence-based medicine. Areas of growth include blended nephrology/subspecialty fields as well as social media applications.

SUMMARY

Medical education is a satisfying and exciting area of growth in the field of nephrology. The recent literature provides a framework for best practices in active learning as well as providing numerous examples of educational interventions and innovations. In addition, this field is ripe for further development and scholarly activity.

Tackling acid-base disorders, one Twitter poll at a time

Understanding and interpretation of acid-base disorders is an important clinical skill that is applicable to the majority of physicians. Although this topic is taught early in medical school, acid-base disturbances have been described as challenging by postgraduate trainees. We describe the use of Twitter, an online microblogging platform, to augment education in acid-base disturbances by using polls in which the user is shown laboratory values and then asked to select the most likely etiology of the disorder. The answer and a brief explanation are then shared in a subsequent tweet. Both polling questions and answers are shared from the account for the online, mobile-optimized, nephrology teaching tool NephSIM (https://www.nephsim.com/). An anonymous survey was administered to assess attitudes toward these polls. Using Twitter as an approach to enhance teaching of acid-base disturbances was both feasible and an engaging way to teach a challenging topic for trainees and physicians. Moreover, the coronavirus disease 2019 (COVID-19) pandemic has demonstrated the importance of incorporating virtual learning opportunities in all levels of medical education.

'I hear and I forget. I see and I remember. I do and I understand.'- incorporating high-fidelity medical simulation into the undergraduate nephrology course

Background

Medical simulation is a teaching method, which enables the development of clinical skills by implementing a simulation scenario in a true-to-life environment, but without exposing patients to any risk. So far, there has been no information on the use of high-fidelity simulation in undergraduate clinical nephrology teaching. Aim of this study was to analyze students' opinions and reactions to the simulation module in nephrology.

Methods

The survey consisting of the Satisfaction with Simulation Experience Scale (SSES) and open-ended question concerning the overall impression of classes was conducted among 103 5^th year medical students, who took part in the simulation training in nephrology. SSES consisted of three parts (debriefing, reasoning, education). Statements from the open-ended question were interpreted by means of the Atlas.ti software for qualitative data analysis.

Results

The overall score for simulation classes was 4.39 ± 0.69 points. Students rated debriefing, reasoning and education at 4.43 ± 0.78, 4.32 ± 0.7 and 4.39 ± 0.73 points, respectively. 87.4% and 84.5% of participants agreed that simulation developed their 'clinical reasoning' and 'decision-making' skills in nephrology, respectively.

Thematic analysis revealed that students evaluated the module as 'interesting', 'useful' and 'informative', but they found number of classes significantly insufficient. Students pointed out that due to the small emphasis placed on practical aspects in the existing curriculum e.g. routes of drug administration and conversion of doses, they could not fully benefit from simulation.

Conclusion

Medical simulation is a valuable constituent of the nephrology course. Putting greater emphasis on practical aspects from the beginning of training may enable students to benefit more from simulation modules.

Medical Education During the Coronavirus Disease-2019 Pandemic: Learning From a Distance

As paradigms of clinical care delivery have been significantly impacted by the novel coronavirus disease-2019 pandemic, so has the structure, delivery, and future of medical education. Both undergraduate and graduate medical education have seen disruptions ranging from fully virtual delivery of educational content and limited clinical care for medical students to increased clinical demands with redeployment for residents and fellows. Adherence to social distancing has led to the adoption and implementation of already available technologies in medical education, including video conferencing softwares and social media platforms. Efficient and effective use of these technologies requires an understanding not only of these platforms and their features but also of their inherent limitations. During a time of uncertainty and increased clinical demands, the approach to medical education must be thoughtful with attention to wellness of both the educator and learner. In this review, we discuss the influence of the pandemic on the existing medical education landscape, outline existing and proposed adaptations to social distancing, and describe challenges that lie ahead.

The Nephrology Clinician Educator: Pathway and Future

In the medical profession, teaching has always been a routine expectation for practicing physicians. While this remains true today, in recent years, we have seen the emergence of a well-defined career pathway for those practicing physicians who want to focus on education: the clinician educator. This is a physician who is highly active in the practice of teaching, science of learning, service as a role model for young physicians, and leading educational programs. In nephrology, one can have a fruitful and fulfilling career as a lifelong clinician educator. As career interest in our specialty wanes, the clinician educator is the professional well suited to reverse this trend. In this article, we will further define the clinician educator and map out a pathway of skills needed to thrive in this rewarding career. We also provide recommendations to both educators and leaders to ensure the clinician educator pathway continues to grow.

An introduction and guide to becoming a social media savvy nephrologist

The use of social media has increased over the last several decades, with ∼72% of the US adult population indicating the use of social networking platforms. Expansion of social media use beyond personal reasons now includes professional uses. This growth is especially true in medicine—and specifically nephrology. An enhanced online presence has the potential to make positive contributions to professional development, education and collaborations, potentially opening doors to academic opportunities. With a growing number of online platforms, resources and conversations, it is natural for one to feel overwhelmed and ultimately avoid social media. We discuss the benefits of social media engagement for nephrologists and provide a practical guide on how they can harness social media professionally and effectively. With an understanding of the basics, existing resources and avoidance of potential pitfalls, physicians can learn to use social media and join the global nephrology community.