Nephrology Training

The combined four-year residency and fellowship training program will be offered by training hospitals with both Internal Medicine and Nephrology accredited training programs and accepted by ACGME as a qualifying site for the IMNP. The host institution will determine the eligibility criteria. Please refer to each host's webpage for more details.

Interested candidates will apply to the IMNP program through ERAS. Each host institution will set up its own interview process during the Internal Medicine interview season. Acceptance into the IMNP track will occur based on the ERAS timeline for residency applicants. Programs may also choose to identify interested trainees during their intern year (PGY-1) and invite them to join the pilot.

As we have condensed the traditional five years of training (i.e., three years of Internal Medicine and two years of Nephrology) into four years of training, the rigor of training will inevitably increase. The proposed four-year combined residency and fellowship is intended to provide training that allows each learner the opportunity to achieve a high level of competence in all areas required for board certification in both specialties. Each institution may have a slightly different curriculum, which may change the required clinical duties (e.g., call, inpatient services, and elective services).

Amidst the rising tide of kidney disease, there is a concern about a shortage in the Nephrology workforce, threatening the access and quality of health care delivered to this vulnerable patient population. The intent of the IMNP program is to meet this demand with highly qualified and motivated individuals. Additionally, condensing the time commitment required for consecutive Internal Medicine and Nephrology training from five to four years could also increase interest in further sub-specialty training such as transplant nephrology, interventional nephrology, glomerular disease, home dialysis, onco-nephrology, and other emerging nephrology subspecialties.

Each candidate will be paired with a mentor and have periodic reviews conducted by the institution's IMNP Oversight Committee to gauge progress and interest, and to ensure that milestones are achieved. If the candidate at any point no longer wishes to pursue nephrology, they may choose to opt out of the pathway and revert to a traditional Internal Medicine pathway.

Amidst the rising tide of kidney disease, there is a concern about a shortage in the Nephrology workforce, threatening the access and quality of health care delivered to this vulnerable patient population. Interest in nephrology as a career choice has been steadily waning among internal medicine residents. This decline has been reflected in a significant increment in unfilled fellowship training spots for several years. Efforts to reverse the decline have been focused on increasing exposure of medical students and residents to Nephrology, redesigning preclinical and clinical educational approaches, and implementing and adapting new pedagogical activities that accommodate the current generation's learning needs. The IMNP establishes a combined four-year training program in Internal Medicine and Nephrology to be offered to medical students, leading to ABIM board eligibility in both specialties. This clinically focused training experience could meet ACGME guidelines within a shortened time frame, which might draw more attention and interest in Nephrology sub-specialization amongst students applying to Internal Medicine and improve the Nephrology workforce in general. Condensing the time commitment required for consecutive IM and Nephrology training from five to four years could also increase interest in further sub-specialty training such as transplant nephrology, interventional nephrology, glomerular disease, home dialysis, onco-nephrology, and other emerging nephrology subspecialties. This pilot aims to provide alternate training models for nephrology, at a time when the field recognizes the need for new training models and is expected to generate increased interest as the model appeals to some who would not otherwise enter the field.

The proposed four-year combined residency and fellowship is intended to provide training that allows each learner the opportunity to achieve a high level of competence in all areas required for board certification in both specialties. While the general outline of this training follows, some degree of flexibility will be necessary to account for specific institutional, program, and trainee characteristics. Candidates accepted to the IMNP program will spend approximately 30 months of training focused on Internal Medicine residency and approximately 18 months on Nephrology fellowship. There will be a designated number of months that can count toward both programs (dual counting). For example, in year three, the trainee will complete Nephrology rotations that count towards the 30 months of clinical requirements for IM training. Furthermore, the trainee will attend continuity clinic in both Internal Medicine and Nephrology throughout the third year.

Initial application and selection of the candidate will occur through the creation of a separate track for matching into Internal Medicine residency and Nephrology fellowship programs at the sponsoring institution through the NRMP. Each participating Internal Medicine and Nephrology fellowship program will create an "Internal Medicine-Nephrology Fellowship" track through their GME offices with a quota of one (which can be reverted to their standard clinical track if unfilled).

Trainees should be identified as participating in the AIRE pilot for the entire length of training. Please follow the instructions for managing the trainee's AIRE participation found here. For year one and year two of the pilot, participating trainees must be listed as "Active Full Time" only in the IM program's ADS resident roster. For year three of the pilot, participating trainees must be listed as "Active Part Time" in both the IM and Nephrology programs' ADS rosters. Identifying pilot trainees as "Active Part Time" in both programs and participating in the AIRE pilot will allow them to participate in both the IM and Nephrology programs' ACGME Survey. Both programs will also have to complete Milestones for the trainee during this year as well. For year four of the pilot, the trainee must have their status in the IM program updated to "Completed All Accredited Training". The trainee will stay on the Nephrology program's roster and have their status updated to "Active Full Time." After successful completion of the 4th year of pilot, the trainee's status must be updated to "Completed All Accreditation Training" in the Nephrology program.

The IMNP candidate will be part of the original complement of your Internal Medicine residency and not a new complement position. For example, if you have 15 Internal Medicine positions per year, being accepted as a pilot site by ACGME means you still have 15 candidate positions per year. The one IMNP candidate will become a full-time nephrology fellow after month 30.

A unique IMNP Oversight Committee involving faculty and program leadership in both internal medicine and nephrology will meet to discuss the trainee's progress and ability to stay on this accelerated path. Every six months, internal medicine and nephrology will meet with their respective Clinical Competency Committee (CCC) and review the trainee's progress and evaluations in these meetings. To ensure graduated responsibility as trainees progress through training, the CCC assesses trainee performance related to the program supervision policy, which details the degree of direct and indirect supervision as well as oversight expected at each level of training. The CCC uses aggregate assessment and evaluation data to determine whether the trainee possesses the degree of competence expected to progress in level of supervision and level of training. The evaluations and overall impression of the CCC will be communicated to the IMNP Oversight Committee every six months following completion of the CCC meeting. Even prior to the CCC evaluation process, each program reviews feedback regarding trainee performance during and after each rotation to ensure each trainee's performance is at the expected level. If areas of underperformance are identified in training based on evaluation data focused upon competency-based medical education or with training exams, this will be reviewed by both CCC and INMP Oversight Committee. If the trainee is deemed unable to proceed with training by the IM CCC and remediation is recommended, consideration will be made for the individual dropping the pilot program to focus on a traditional three-year Internal Medicine training pathway with the opportunity to match into two-year Nephrology training. If the trainee is deemed ok to proceed with training by Internal Medicine CCC but has areas of underperformance, the IMNP Oversight Committee may still consider the individual dropping the pilot program for traditional pathways. These reviews will occur every six months throughout training. If the learner has circumstances which may require leave of absence and extension of training, the IMNP Oversight Committee will include program leadership from Internal Medicine and Nephrology to review the trainee's continuation in the pilot program versus transition to the traditional pathway. All efforts will be made to keep this unique learner in the pilot program unless the trainee or program director, with support of the CCC, recommends the traditional pathway. As a contingency plan for trainee circumstances, at any point before completion of 36 months, the learner may request transition to the traditional three-year internal medicine pathway.

Please visit the ACGME website and find the hyperlink for "Access the form to request additional program participation in an AIRE pilot." As this pilot is already approved, you will not need to complete an original AIRE application; rather, you will complete an application to add a program to an approved AIRE. Contact the pilot lead, Dr. Webb, for details on the application process at jwebb2@uky.edu.