fellowships, and academic programs such as Department of Medicine, Division of Nephrology, University of Connecticut Health Center, Farmington, Connecticut Correspondence: Dr. Nancy D. Adams, Department of Medicine, Division of Nephrology, University of Connecticut Health Center, 263 Farmington Avenue, Farmington, CT 06030-1405. Email: adams@nso.uchc.edu 1382 Copyright © 2012 by the American Society of Nephrology www.cjasn.org Vol 7 September, 2012 master’s degree programs in public health or clinical research, will serve to further the development of the next generation of academic nephrologists and increase fellow satisfaction during training. Mentorship is often cited as important in career selection and satisfaction. Clinical faculty, whether full-time or voluntary, in contact with students and trainees, must extol the broad nature of the practice of nephrology. We need to share our enthusiasm for the challenge of chronic dialysis, critical care consultations, acid-base or complex electrolyte disorders, and emphasize outcomes for these patients. The care of transplant patients is often an aspect of nephrology practice unseen by students and residents (9). These patients have excellent outcomes and the clinical science is challenging. Interventional nephrology is new, reverses the assignment of nephrology as a nonprocedural subspecialty (7), and may be particularly attractive to some trainees interested in performing procedures (6). We need to expose them to ambulatory patients such as those with polycystic kidney diseases, kidney stones, and glomerular diseases (10). Complaints by nephrology faculty and fellows to medical students and house staff do not help recruit them to our field (11). Our frustrations and dissatisfactions (12) with funding, regulations, and paperwork need to be directed toward local administrators, national organizations (such as ASN for their public policy work), and our government representatives (for regulatory and legislative change), but not to students and residents. Fellows’ dissatisfaction is comparable across all IM subspecialties (7). Shah et al. help to unravel specific components of dissatisfaction among nephrology fellows. Long work hours are something we should be able to modify. (In most instances, nephrology fellows do not have in-house call, so these are not work-hours impacted by ACGME rules.) Solutions to our systemic inadequacies in patient transitions (dialysis unit to hospital, vascular access repairs to dialysis unit) need to be addressed (11). Perhaps the current national push to reduce readmissions will facilitate more cohesive systems for our patients. Solutions to dialysis workforce issues need continued efforts (13). Proposals to Improve Recruiting into Nephrology Shah et al. suggest a revised nephrology elective including ambulatory exposure. Alternative rotations need to be explored (9,10). Nephrology Needs to Continue Developing New Strategies to Educate UpToDate was started by a nephrologist with nephrology topics. Current efforts to blog and to develop puzzles and games for teaching complex subjects seem equally novel now (14). Nomograms, biomedical ethics, and decision analysis were applied early to nephrology problems. The use of innovative strategies can simplify difficult concepts and aid in review of more traditional teaching, but can also permit students and trainees to see the discipline as forward thinking. Enhancing the Teaching of Nephrology The education category for abstracts at the ASN annual meeting is an attempt to engage the nephrology community in reaching this goal. Additional examples include the renal physiology educators’ listserv, an initiative of the ASN Workforce Committee, and the development of an educational symposium at the annual meeting in November 2012, a combined initiative of several groups. We need to partner with education specialists and monitor these efforts to gain evidence of their effect (15–17). What We Need to Learn Some considerable work remains. We have gaps in knowledge about how renal physiology and pathophysiology are taught and by whom. Do we have data on how many students are exposed to the economic, ethical, and sociocultural questions that arise in nephrology and with the ESRD program, subjects that can be taught in courses addressing those foundations of the practice of medicine? Rosner et al. (18) presented data from five medical schools. Seventy percent of fourth-year students had no exposure to nephrology. In residency, what really is the exposure? Do residents participate in consolidated nephrology services, combined medicine/surgery transplant experiences, or nephrology clinics with private and Medicaid patients? With the change in duty hours for residents, time for electives may be reduced. Taken together, these data suggest that some residents finishing IM or pediatrics training have never been involved with nephrology as a clinical discipline. Shah et al. note that many fellows “enjoy intensive care nephrology” and the “association of nephrology with general internal medicine.” These qualities seem to mirror the description of Lane and Brown (16) of “focus toward patient well-being,” which they went on to summarize as a “holistic as opposed to organ-in-isolation approach.” Can we tease out the particular characteristics of these attractors and emphasize and teach toward