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Donald E. Kohan, MD, FASN, Chair of the ASN Training Program Directors Executive Committee Dr. Kohan—Professor of Medicine, Chief of the
Division of Nephrology
and Director of the Nephrology Training Program at the University of
Utah School of Medicine—is a member of the ASN Board of Advisors,
has served on several ASN committees, and is currently the Chair of the
Training Program Directors Executive Committee. He is also the
Assistant Dean for Graduate Medical Education at the University of
Utah, serves on the editorial board and/or as an Associate Editor of
several journals, and, until recently, served as the Chair of the VA
Nephrology Merit Review Subcommittee. Recognized for his many
contributions to the field of nephrology and author of over 80
publications, Dr. Kohan recently took a break from his busy schedule to
answer 10 questions for this edition of Renal Express.You recently completed your first year as Chair of the Training Program Directors (TPD) Executive Committee. Can you tell our readers what this group does and what the group is working on currently? The TPD Executive Committee represents U.S. nephrology training programs. Our mission is to help promote improvements in the quality of all aspects of nephrology training. Our current direction was largely defined during the Nephrology TPD Retreat held last year in Chicago. In addition to instituting the Match, we are involved in the following activities: 1) Development of an in-training examination for all renal fellows. This effort was spearheaded by Mark Rosenberg and is now under the leadership of Mitch Rosner. The questions will be developed by a panel of volunteer experts in nephrology working closely with the National Board of Medical Examiners. The first test should be available in 2009 or 2010 and will be administered electronically. 2) Establishment of new RRC guidelines. We have a TPD subcommittee working with the ACGME to create revisions to the current RRC guidelines. We are greatly interested in simplifying the requirements, while insuring that they adequately address training needs. 3) Creation of a toolkit to assist in fellow teaching. This TPD subcommittee is collecting teaching material from as many training programs as will contribute, then sorting through and arranging this material in a way that will facilitate nephrology teaching. In addition, new teaching techniques, evaluation methodologies, and standardized curricula are being addressed. We greatly welcome participation by TPDs - there is more than enough work for all of us to do! 4) Improved use of web-based methods to facilitate fellow training and TPD communication. 5) Creating a session or sessions at ASN Renal Week devoted to improvements in nephrology fellow education. The goal is to have abstracts on educational instruments and advances submitted, reviewed, presented at the meeting, and ultimately published. There will be other activities as well, but these are the major initiatives for now. The overwhelming majority of training programs have agreed to take part in the National Resident Matching Program (NRMP) Specialties Matching Service (SMS), which will begin in 2009. What is SMS and how will it benefit training programs? The SMS administers the match that is used by almost all school of medicine departments; it also administers the match for 12 internal medicine subspecialties. The principle of the nephrology match is essentially the same as that for other matches. Applicants and programs rank their selections, followed by a formal Match Day on June 18, 2008, for positions starting July 1, 2009. There are many advantages to the match, including creation of an impartial venue for matching programs' and applicants' preferences, permitting applicants to choose programs without undue pressure, allowing increased time to decide (rank order lists are not due until June 4, 2008), and establishment of a uniform offer/acceptance date. I think a testament to the benefits of the match is that greater than 90% voted in favor of the match by nephrology training programs. Your ambitious agenda and intrepid leadership have impressed Fellowship Training Program Directors from across the country. What’s the secret of your success? What drives your desire to “get things done?” I'm not sure about intrepid leadership, but I think the key to success is getting as many people as possible involved, giving them ownership, and making sure that all discussions are held, and decisions made, in an open forum that involves as many people as possible. What we do as TPDs is very difficult with all of the rules and regulations, however, many of the solutions to our current challenges are out there. It mainly requires getting people to freely share their ideas and experiences, as well as seeking input even from those outside of nephrology. As for motivation, I have yet to meet a nephrology TPD who wasn't motivated, as I am, to make fellowship training a great educational experience for faculty and trainees alike. You completed your fellowship training at the Washington University School of Medicine in St. Louis, Missouri. What is your most memorable educational experience? It wasn't classical medical knowledge, but I most remember my former Division Chief, Dr. Saulo Klahr, one of the smartest individuals I've ever met, sitting me down in his office and asking me about career plans. I was a bit nervous about succeeding in research even though I had a number of research ideas that interested me. Dr. Klahr asked "Do you want to be a bricklayer or an architect?" I don't think he meant anything derogatory about making contributions while working in the background; rather, he was saying that if you have potential, don't be afraid to try to reach for something greater. I would give the same advice to many trainees and junior faculty intimidated by a research career, but clearly with a strong curiosity and intrinsic ability. Why did you decide to be a nephrologist? I originally did a PhD in physiology and wound up studying the nephron sites responsible for escape from the sodium-retaining effects of mineralocorticoids. After I got my MD, it was a natural progression to do nephrology. What are your research interests? Can you give us a lay account of your research? My laboratory studies the regulation of renal collecting duct Na and water transport. We utilize gene targeting strategies whereby we disrupt target genes selectively within the collecting duct in order to determine their role in normal renal physiology and in pathologic conditions. We are particularly interested in the role of the endothelin and nitric oxide systems in hypertension and have found that mice lacking collecting duct endothelin are markedly hypertensive, and that the endothelin effect is mediated by nitric oxide. In collaboration with Drs. Matt Breyer's and Tianxin Yang's laboratories, we have determined that collecting duct PPARgamma is responsible for the edema due to thiazolidinedione treatment. We are currently examining the role of individual adenylyl cyclases in regulating collecting duct, as well as whole nephron, function. What advice would you give a young scientist in your field regarding his/her future career? Would it be different for male as opposed to female students? I think they should focus on the optimal way to get EMS, regardless of gender—environment, mentorship and support. Several great articles have been written by prominent scientists, including Nobel laureates and members of the National Academy of Sciences, about what is required to be successful as a physician scientist. A scientifically-nourishing environment is critical at all stages, but particularly early in one's career. Adequate protected time and financial support goes without saying. However, the biggest piece that is most often missing, and the one repeatedly emphasized by visionaries in science, is mentoring. This can be done by any number of people; the key is having a mentor who provides guidance on applying for grants, strategizing on how to operate your research program, identification of potential collaborators or just good scientists to learn from, etc. The mentorship should continue for many years, not just having someone point you in the right direction and let you go. What might be done to increase the interest of medical students in pursuing careers in nephrology? This is a very difficult question. Fewer medical students are going into internal medicine because of perceived issues with lifestyle, income and the evolution of the general internist/hospitalist schism. Many students are intimidated by the complexity of nephrology. I think the major thing I would work on is stimulating an interest in nephrology through exposure to renal-related research. Summer programs, such as the one Dr. Mark Zeidel is working on to expose renal fellows to renal research techniques, could be applied to medical students. Why not have medical students participate in renal camp, doing an experiment examining ion transport using a patch clamp apparatus or a Ussing chamber, studying renal clearance in a rat, or doing other renal studies? While recruiting more nephrologists is important, I think focusing on getting more MDs interested in renal research is really the key to the future of our subspecialty. I also think that we should extend these activities to the undergraduate and high school level—in effect, "imprinting" Nephrology research! Other than being a successful nephrologist, what would you most like to be remembered for? Other than the obvious things (a good husband, father, son and friend), I care the most about education. I think the contributions of the clinicians and scientists whose training I impact will be far greater than any individual clinical or research accomplishments of my own. How do you spend your free time? I am a bit of an adventurer. I enjoy, along with my family, scuba diving (particularly cave or cenote-diving in the Yucatan), white-water rafting through deep canyons in the West, kayaking in the Sea of Cortez, alpine skiing (Utah snow is the best), and traveling abroad. |
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Senate Finance
Committee discusses Medicare Bill To discuss
provisions of a Senate Medicare bill that is forthcoming this spring,
the Senate Finance Committee held a meeting with the physician
community and other clinical groups on Friday, April 11, 2008. The meeting gave Committee Chair Max Baucus (D-MT) an opportunity to relay his priorities for the Senate Medicare bill and explore ways that
his office and health care practitioners can work together to achieve
the best possible outcomes for Medicare beneficiaries. ASN
- represented by Paul Smedberg, Director, Policy & Public Affairs -
attended the meeting along with 35 other
representatives.Senator Baucus plans to have a Medicare bill to the Senate floor by mid-May 2008, and hopes of passage by June 30, 2008. The bill's major provision is a sustainable growth rate (SGR) fix for 18 months. His draft SGR proposal would increase physician reimbursement by 1.1 percent at a minimum and cost approximately $8 billion over five years. Ultimately, the senator wants to re-formulate SGR so the Senate Finance Committee does not need to replicate this exercise every year. In addition to the SGR fix, the senator's Medicare bill will likely include (but is not limited to) physician quality initiatives, provisions to address the current state of primary care medicine, enhancements to a Medical-Home demonstration project, and possible reform to payments for end-stage renal disease (ESRD). Senior committee staff who joined Senator Baucus for the meeting indicated that the ESRD reform provisions are comprehensive and will likely include a phase-in of an expanded ESRD bundled payment. According to Senator Baucus, any Senate Medicare bill will need 60 votes if it is to have any chance of passage. He also stated that negotiations are currently underway with the House of Representatives to draft a Medicare bill both chambers of Congress can support. In addition to keeping its members informed about this legislation, ASN plans to work with the rest of the renal community concerning these issues. Clinical Research Forum Focuses on Decline in Physician-Scientist Workforce The Clinical Research Forum (CRF)—a consortium of 47 medical schools and teaching hospitals dedicated to sharing best practices in clinical research and advocating for support of the broader interests and needs of clinical research—held its annual meeting Thursday and Friday, April 10-11, 2008, in Washington, DC. Presenting on behalf of the Association of Professors of Medicine (APM) Physician-Scientist Initiative, Andrew I. Schafer, MD, proposed four recommendations for revitalizing the physician-scientist workforce. APM suggests allocating resources to repair the “leaking” physician-scientist pipeline, enhancing mentoring programs, promoting the advancement of female investigators, and strengthening efforts to support investigators with a “more enduring commitment to research careers.” The APM Physician-Scientist Initiative—which was partially funded by the American Society of Nephrology—is a “long-term initiative to identify, develop, and implement substantive and practical solutions that will ensure the survival, growth, and diversity of the physician-scientist workforce. ASN Research Policy Coordinator Allison Haupt represented the Society at the CRF Annual Meeting, where participants also discussed the viability of creating a clinical trials curriculum, efforts by BlueCross BlueShield to support comparative effectiveness research, the decline in interest in primary care, and ways to advocate for increased funding for the National Institutes of Health's Clinical and Translational Research Awards. For more information on the meeting, the Clinical Research Forum, and its activities, please visit www.clinicalresearchforum.org. |
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ASN Committee Report The Dialysis
Advisory Group (DAG) focuses on the practical provision of care to
patients with ESRD as well as the methods to support nephrologists
caring for those patients. Recently, DAG published a series of articles in the Clinical Journal of the American Society of Nephrology (CJASN). DAG polled the ASN membership to identify key areas of primary care that the membership provides to their dialysis patients. Leaders in the each of these areas (which included cancer screening, mental health, and hormone replacement) were then invited to submit review articles related to their area of expertise, with a practical focus on how to provide care for the patient with concurrent kidney disease. In 2008, DAG turned its attention to two different areas: education and facilitation of research. Recognizing that there are certain core components to the teaching of the logistics and physiology of the provision of dialysis, DAG will assist the Fellowship Training Program Directors Executive Committee in drafting educational material that may be utilized to meet individual teacher needs. Further, DAG seeks to understand the logistics of initiating a research project in patients with end-stage renal disease and facilitating efficiencies that can be found at a national level. Lynda A. Szczech, MD, FASN Duke University Medical Center Chair, Dialysis Advisory Group |
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JASN Donor
Age Linked to Aortic StiffeningTransplantation of kidneys from older donors is followed by increased stiffening of the recipient's aorta - which may help to explain the higher rates of cardiovascular disease and death in patients receiving kidneys from "expanded criteria" donors. TOC; Full Study NephSAP  NephSAP Core Knowledge QuestionsNephSAP provides a new program to help trainees and others prepare for ABIM certification and maintenance of certification. |
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| ASN Reminders
International Society of Nephrology (ISN) Nexus Symposium on Transplantation and the KidneyAbstract submission deadline extended to April 30, 2008This symposium will take place September 25-28, 2008, in Rome, Italy. Among the list of topics to be considered and discussed: Immunopathogenesis of CAD, Risk Factors, Pathology, Immunosuppression, and Novel Strategies for Management.To learn more about the program and submit your abstract before April 30, click here. |
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| Retirements Jack W. Strandhoy, PhD, will retire as Professor Emeritus of Physiology and Pharmacology from the Wake Forest University School of Medicine on July 1, 2008. He has been an ASN member of 30 years. Hans Erik Hansen, MD, DMSc, Chief Physician in Nephrology, Associate Professor in Medicine at Skejby University Hospital, Aarhus, Denmark, retired on December 31, 2007. Employment/Appointments Josephine P. Briggs, MD, was named Director of the National Institutes of Health’s National Center for Complementary and Alternative Medicine (NCCAM). Joel Topf, MD, has joined the medical staff at Botsford Hospital. Aubrey R. Morrison, MD, FASN, became Program Director of the Washington University Renal Training Program. John W. O'Bell, MD, has been hired as Associate Fellowship Director at Rhode Island Hospital. Jochen Reiser, MD, PhD, has been hired as chief of the Division of Nephrology at the University of Miami Leonard M. Miller School of Medicine. David Altshuler, MD, PhD, an Associate Professor of Genetics and Medicine at the Harvard University Medical School and a member of the Diabetes Unit and Department of Molecular Biology at Massachusetts General Hospital was appointed to the Advisory Council of the National Institute of Diabetes and Digestive Kidney Diseases. Honors Wendy Hoy, MD, of the University of Queensland has been awarded the United States National Kidney Foundation (NKF) International Distinguished Medal for 2008. The Medal was established to honor the achievement of individuals who have made significant contributions to the field of kidney and related chronic disease. David J. Salant, MD, Chief of Nephrology at Boston Medical Center and a professor of medicine, pathology and laboratory medicine at Boston University School of Medicine, has received the 2008 Outstanding Physician in Nephrology Award from the National Kidney Foundation of Massachusetts, Rhode Island, New Hampshire and Vermont. Please send ASN Member News to bcarver@asn-online.org |
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