Abstract: TH-PO0007
Differential Diagnosis Variation Among First-Year Nephrology Fellows for a Virtual Case of AKI
Session Information
- Educational Research Within and Across Disciplines
November 06, 2025 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Educational Research
- 1000 Educational Research
Authors
- Deutsch, Colin, Temple University, Philadelphia, Pennsylvania, United States
- Parsons, Andrew S., University of Virginia School of Medicine, Charlottesville, Virginia, United States
- Sozio, Stephen M., Johns Hopkins Medicine, Baltimore, Maryland, United States
- Warburton, Karen M., University of Virginia School of Medicine, Charlottesville, Virginia, United States
- Martindale, James R., University of Virginia School of Medicine, Charlottesville, Virginia, United States
- Boyle, Suzanne, Temple University, Philadelphia, Pennsylvania, United States
Background
Multiple choice exams are the standard for measuring nephrology fellows’ knowledge and reasoning, but they do not directly assess generation of a differential diagnosis. We analyzed first-year fellows’ free-text differential diagnoses for a case of acute kidney injury (AKI) for variation in length and content.
Methods
We analyzed deidentified, free-text differential diagnoses for a case of AKI, which was administered to 75 first-year nephrology fellows from 20 accredited U.S. programs in 2022 to validate a clinical reasoning assessment tool (https://sites.temple.edu/rene/). We coded diagnoses in four prespecified anatomical diagnostic categories (pre-renal, glomerular, tubulointerstitial, post-renal). A “miscellaneous” category included diagnoses that did not fit conventional nomenclature or did not specify an anatomical compartment. We evaluated the type and number of diagnoses per fellow, number of diagnoses per diagnostic category, and number of unique diagnoses in the entire cohort.
Results
Among 75 differential diagnoses, there were 60 unique diagnoses. The median (IQR) of diagnoses per fellow was 8 (6,11) and for the following categories: pre-renal, 1 (0, 2); glomerular, 3 (2,6); tubulointerstitial, 2 (1,2); post-renal, 1 (0,1); chronic kidney disease, 0 (0, 0.1); miscellaneous, 1 (1,2). The most common diagnoses were AIN/medication-induced (n=44); glomerulonephritis/not otherwise specified (NOS) (n=34); post-renal/NOS (n=34); nephrotic syndrome/NOS (n=32), and pre-renal/volume depletion (n=30). The expert differential diagnosis listed 15 plausible diagnoses (pre-renal, 2; glomerular, 7; tubulointerstitial, 5; post-renal, 1).
Conclusion
The differential diagnoses widely varied for a case of AKI by first-year nephrology fellows. Despite the breadth of diagnoses, the most common ones were non-specific, “NOS.” Also, there were 11 miscellaneous diagnoses. This suggests that patients could be receiving variable evaluation, management, and explanation of their disease. Potential explanations include differences in knowledge, clinical reasoning skills, and regional variations in documentation and practice. This underscores the complexity of nephrology, the inherent variability in human cognition, and a need for standardized curricula for knowledge and clinical reasoning.