Shaping an Early Nephrology Fellowship Curriculum

Background: The transition between residency and nephrology fellowship can be difficult for many trainees because of nephrology’s inherent complexity and high-intensity nature as well as the lack of standardization in internal medicine training. We aimed to assess self-perceived preparedness of nephrology fellows at the start of fellowship and explore learner preferences for educational methods and content for an early-fellowship curriculum. Methods: Data was collected using an instrument included in the 2025 American Society of Nephrology Fellow Survey. Results: Responses from 339 adult nephrology fellows were included in analysis. Most responding fellows (252 [74%]) reported feeling “extremely prepared”, “very prepared”, or “moderately prepared” when starting nephrology fellowship. Preparedness was associated with completing 3 or more weeks of nephrology rotations in residency (Chi-Squared test for independence, p = 0.004). Half of fellows (49%) reported participating in an early-fellowship curriculum prior to starting clinical rotations. Learner preferences for educational methods used in an early-fellowship curriculum were similar to those most commonly used in contemporary curricula (didactics, shadowing senior fellows, and case simulations), though there was a preference for small-group problem-based learning compared to procedural training. Fellows reported a preference for learning about common inpatient nephrology emergencies (acute kidney injury, dialysis prescriptions and complications, and electrolytes and acid/base) and executive functioning skills (workflow/efficiency and discussing dialysis and goals of care with patients) in their ideal early-fellowship curriculum. Conclusions: These results can help inform development of future early-fellowship curricula based on current fellows’ experiences and perceived needs to promote successful clinical training.