Kidney Week

Abstract: SA-PO0981

Educational Gaps Among Family Medicine Residents in Diabetic Kidney Disease: A Mixed-Methods Needs Assessment

Session Information

• Educational Research
  October 24, 2026 | Location: Exhibit Hall A, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Educational Research

• 1000 Educational Research

Authors

• Humar, Sapna, University of Toronto Temerty Faculty of Medicine, Toronto, Ontario, Canada

Sapna Humar, MD

• Sivashanmugathas, Varunaavee, University of Toronto Temerty Faculty of Medicine, Toronto, Ontario, Canada

Varunaavee Sivashanmugathas, MD

• Dogadova, Ekaterina, University of Toronto Temerty Faculty of Medicine, Toronto, Ontario, Canada

Ekaterina Dogadova, MD

• Shapiro, Joshua, University Health Network, Toronto, Ontario, Canada

Joshua Shapiro, MD

• Singwi, Amita, University Health Network, Toronto, Ontario, Canada

Amita Singwi, MD

• Cherney, David, University Health Network, Toronto, Ontario, Canada

David Cherney, MD, PhD

• Ye, Wendy WQ, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada

Wendy WQ Ye, MD, MEd, MS

Background

Family Medicine (FM) physicians play a key role in diabetic kidney disease (DKD) management, yet educational and practice gaps among residents remain poorly characterized. This study aims to identify these gaps and determine preferred learning strategies to inform targeted educational interventions.

Methods

We conducted a mixed-methods needs assessment among University of Toronto FM residents. Semi-structured focus groups explored experiences with DKD management, barriers to care, referral practices, and educational needs. Data was analyzed using reflective thematic analysis with sensitizing concepts. Residents also completed a REDCap survey assessing confidence, challenges, and preferred educational modalities, analyzed using descriptive analysis.

Results

Three focus groups were completed with 11 total participants, alongside 25 REDCap surveys (64% PGY1, 36% PGY2). Four focus group themes emerged: (1) Residents conceptualized DKD within diabetes care rather than as a distinct disease, (2) Residents expressed discomfort advancing DKD management beyond first-line therapies, (3) Residents relied heavily on built-in EMR triggers and specialist guidance, with rationale for treatment decisions often unclear, and (4) Residents identified inconsistent formal teaching, fragmented guideline exposure, and lacked knowledge application to clinical practice, with preferences for concise, case-based learning. Survey findings aligned with qualitative themes. Most residents managed DKD patients weekly (52%) or monthly (32%). Common challenges included navigating system-level barriers (64%), managing medication side effects (62.5%), adjusting medications (54.2%), and deciding when to refer to nephrology (44%) Most referrals to nephrology are triggered with rapid decline in kidney function (96%), significant albuminuria (88%), or eGFR<30 (76%). Preferred educational formats included self-paced modules (76%) and interactive case-based learning (64%)

Conclusion

FM residents, despite managing DKD frequently, do not see DKD as its own distinct disease identity, with significant knowledge gaps in clinical monitoring and therapeutic decision making, contributing to missed opportunities for medication optimization and reliance on external supports. Practical, case-based educational interventions may improve confidence and preparedness for longitudinal DKD care.

Acknowledgment

Thank you for all the resident physicians who participated in focus groups and completed surveys.