The Kidney Disease Screening and Awareness Program (KDSAP): a novel translatable model for increasing interest in nephrology careers

Abstract

Despite the increasing prevalence of CKD in the United States, there is a declining interest among United States medical graduates in nephrology as a career choice. Effective programs are needed to generate interest at early educational stages when career choices can be influenced. The Kidney Disease Screening and Awareness Program (KDSAP) is a novel program initiated at Harvard College that increases student knowledge of and interest in kidney health and disease, interest in nephrology career paths, and participation in kidney disease research. This model, built on physician mentoring, kidney screening of underserved populations, direct interactions with kidney patients, and opportunities to participate in kidney research, can be reproduced and translated to other workforce-challenged subspecialties.

Keywords: educational model; health screening; mentoring; nephrology workforce; premedical training; service learning.

Figure 1.

Unique structure of KDSAP: bridging community outreach efforts and on-campus student career development activities. (A) Student career development: cultivation of interest in nephrology. KDSAP student members engage in activities that promote student career development contextualized by clinical exposure in underserved communities. This figure charts a sample flow of a student’s involvement with KDSAP from entry to graduation. (B) Health screening structure: KDSAP’s health screenings consist of eight stations. (1) Registration: KDSAP members greet clinic participants at the first station and provide an overview of the day. A questionnaire, in the appropriate language, is administered. (2) Participant questionnaire: students assist participants in filling out basic demographic information. Participants take questionnaires to each station where students collect and record screening data. (3) Health education: onsite physician presents an overview of basic determinants of kidney health, including basic nutrition. (4) Body mass index (BMI) and waist–hip circumference measurement: students measure height, weight, and waist circumference. (5) BP measurement: students who have attended BP training sessions take BP measurements. (6) Urinalysis: students perform the test on urine samples using urinalysis readers and test strips. (7) Blood glucose test: students perform finger-stick tests using lancets, glucose test strips, and glucometers. (8) Physician consultation: the physician reviews the questionnaire with participants, discusses results, and makes follow-up referrals to primary care physicians or nephrologists. The summary page of objective data is given to participants, whereas KDSAP retains the questionnaire. Participants complete a satisfaction survey.

Figure 1.

Unique structure of KDSAP: bridging community outreach efforts and on-campus student career development activities. (A) Student career development: cultivation of interest in nephrology. KDSAP student members engage in activities that promote student career development contextualized by clinical exposure in underserved communities. This figure charts a sample flow of a student’s involvement with KDSAP from entry to graduation. (B) Health screening structure: KDSAP’s health screenings consist of eight stations. (1) Registration: KDSAP members greet clinic participants at the first station and provide an overview of the day. A questionnaire, in the appropriate language, is administered. (2) Participant questionnaire: students assist participants in filling out basic demographic information. Participants take questionnaires to each station where students collect and record screening data. (3) Health education: onsite physician presents an overview of basic determinants of kidney health, including basic nutrition. (4) Body mass index (BMI) and waist–hip circumference measurement: students measure height, weight, and waist circumference. (5) BP measurement: students who have attended BP training sessions take BP measurements. (6) Urinalysis: students perform the test on urine samples using urinalysis readers and test strips. (7) Blood glucose test: students perform finger-stick tests using lancets, glucose test strips, and glucometers. (8) Physician consultation: the physician reviews the questionnaire with participants, discusses results, and makes follow-up referrals to primary care physicians or nephrologists. The summary page of objective data is given to participants, whereas KDSAP retains the questionnaire. Participants complete a satisfaction survey.

Figure 2.

KDSAP has a positive influence on students’ academic and career choices. Fifty-six undergraduate students evaluated KDSAP’s impact on their (1) interest in working with medically underserved communities (1.8% neutral, 44.6% somewhat positive, and 53.6% strongly positive), (2) interest in participation in public health-related projects (3.6% neutral, 33.9% somewhat positive, and 62.5% strongly positive), (3) interest in nephrology (14.3% neutral, 50.0% somewhat positive, and 35.7% strongly positive), (4) knowledge in nephrology (3.6% neutral, 39.3% somewhat positive, and 57.1% strongly positive), (5) interest in medical research (8.9% neutral, 37.5% somewhat positive, and 53.6% strongly positive), and (6) interest in a medical career (3.6% neutral, 19.6% somewhat positive, and 76.8% strongly positive). For each category of interest, students responded using a 1–5 Likert Item (exposure response set: 1, strongly negative; 2, somewhat negative; 3, neutral; 4, somewhat positive; 5, strongly positive). For all categories, there were no responses of strongly negative or somewhat negative. All students who joined KDSAP after April 30, 2009, were administered an entrance survey to assess their interest in nephrology and knowledge of kidney disease. Those students who joined before April 30, 2009, but had not yet graduated or departed from KDSAP were asked to complete the survey based on their recall of their interest and knowledge level before joining KDSAP. On graduation or departure from the organization, students were given an exit survey. On both surveys, students were asked to provide general demographic information and rate how participation in KDSAP impacted various aspects of their career development. The student survey was approved by Harvard College, Harvard Medical School, and the Partners Healthcare Institutional Research Boards. Analyses were performed using the statistical software package Stata, version 10.1 (StataCorp, College Station, TX).

Figure 3.

Career trajectories: KDSAP is a model to cultivate interest in nephrology. (A) Survey responses of 51 Harvard College KDSAP graduates revealed that 26 students enrolled in medical school and 1 student enrolled in dental school. The five students enrolled in graduate school are pursuing studies in health-related disciplines; five students work in health-related activities. Among alumni, three individuals have decided to pursue nephrology as a career. This number is expected to increase as students move further along their educational trajectories. (B) Since the establishment of KDSAP in 2008, 10 students have engaged in kidney-related research.