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Abstract: PO1065

Development and Implementation of an Immune Suppression Toolkit to Guide Nephrology Fellow Medication Prescribing and Monitoring

Session Information

  • Educational Research
    November 04, 2021 | Location: On-Demand, Virtual Only
    Abstract Time: 10:00 AM - 12:00 PM

Category: Educational Research

  • 800 Educational Research


  • Lamie, Lauren, University of Michigan, Ann Arbor, Michigan, United States
  • Rao, Panduranga S., University of Michigan, Ann Arbor, Michigan, United States
  • Mariani, Laura H., University of Michigan, Ann Arbor, Michigan, United States
  • Oliverio, Andrea L., University of Michigan, Ann Arbor, Michigan, United States
  • Wright Nunes, Julie A., University of Michigan, Ann Arbor, Michigan, United States
  • Bitzer, Markus, University of Michigan, Ann Arbor, Michigan, United States

There are many important considerations when prescribing high risk medications like immune suppression (IS). Informed by surveys administered to nephrology faculty and fellows, we developed a training curriculum and a concise, clinically applicable guide for IS prescription and monitoring.


A cross sectional survey was administered to nephrology faculty and fellows in November 2017 to assess perceptions, self-efficacy, and knowledge about prescribing, monitoring, and adjusting IS (12 questions with item-responses from 1=strongly agree to 4=strongly disagree). Informed by this survey we developed and implemented a toolkit (one-time training curriculum and IS reference guide) for fellows and assessed their perceptions of the toolkit using pre-and post-surveys. Results are reported using mean (SD) or N (%), with associations examined using linear regression.


Twenty-eight nephrology faculty and fellows completed the baseline survey; 19 (68%) were attending physicians and 9 (32%) fellows. Twenty (71%) were men, 16 (59%) Caucasian, 11 (41%) Asian. Collectively, 19 (77%) reported prescribing IS ranging from 1 to 40 times yearly.

Attending physicians exhibited higher self-efficacy in prescribing IS (1.7 (0.6) compared to 3.3 (0.8) p=0.02) and both attendings and fellows strongly agreed there was a need for IS guides 1.4 (0.8) and would use them if available 1.4 (0.6). In particular, fellows strongly disagreed they understood all steps needed to use IS (3.3 (0.8) compared to 2.3 (.07) for attending physicians).

In May 2021, 5 nephrology fellows received the IS toolkit and completed the surveys. Self-efficacy improved post intervention from mean (SD) 3.0 (1.2) to 2.2 (1.6). All 5 fellows (100%) strongly agreed that the toolkit added value to training, provided a guide they would use and recommended the toolkit for future fellows.


Nephrology faculty and fellows strongly agreed that there is a need for guides and protocols for prescribing and monitoring IS medications. Our pilot IS toolkit incorporated into nephrology fellow training was well received and improved fellow self-efficacy.


  • Veterans Affairs Support