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The International Society of Nephrology (ISN) and the American Nephrologists of Indian Origin (ANIO) Online Clinical Nephropathology Certificate (CNC) program

2016; Elsevier BV; Volume: 89; Issue: 5 Linguagem: Inglês

10.1016/j.kint.2015.11.035

1523-1755

Vanesa Bijol, Youssef M.K. Farag, Sudhir V. Shah, John Feehally, Ajay Singh,

Gastrointestinal Bleeding Diagnosis and Treatment

Rapid advances in internet and communication technology have changed the face of the world and made globalization a reality. New information technologies play an important role in the education of new generations, and educators should capitalize on this new direction in learning and teaching.1Cook D.A. Levinson A.J. Garside S. et al.Internet-based learning in the health professions: a meta-analysis.JAMA. 2008; 300: 1181-1196Crossref PubMed Scopus (1029) Google Scholar, 2Cook D.A. Garside S. Levinson A.J. et al.What do we mean by web-based learning? A systematic review of the variability of interventions.Med Educ. 2010; 44: 765-774Crossref PubMed Scopus (160) Google Scholar, 3Elkind M.S.V. Teaching the next generation of neurologists.Neurology. 2009; 72: 657-663Crossref PubMed Scopus (27) Google Scholar This ever expanding innovative technology has enabled the development of new and exciting educational programs for worldwide professional communities. To this end, the International Society of Nephrology (ISN) and the American Nephrologists of Indian Origin (ANIO) collaboratively developed a year-long web-based Clinical Nephropathology Certificate (CNC) program for physicians seeking training in the principles and practice of nephropathology. Over the years, the ISN has led a number of initiatives and successful programs in developing countries, in response to the worldwide demographic trends of chronic kidney disease and growing demand for trained nephrologists.4Parker M.G. Ibrahim T. Shaffer R. et al.The future nephrology workforce: will there be one?.Clin J Am Soc Nephrol. 2011; 6: 1501-1506Crossref PubMed Scopus (93) Google Scholar, 5Jha V. Garcia-Garcia G. Iseki K. et al.Chronic kidney disease: global dimension and perspectives.Lancet. 2013; 382: 260-272Abstract Full Text Full Text PDF PubMed Scopus (2604) Google Scholar, 6Harris D.C.H. Dupuis S. Couser W.G. Feehally J. Training nephrologists from developing countries: does it have a positive impact?.Kidney Int Suppl (2011). 2012; 2: 275-278Abstract Full Text Full Text PDF PubMed Scopus (68) Google Scholar The CNC program too has been very successful in providing the nephropathology training in countries with limited nephropathology resources. In 2013, the CNC program was offered to physicians in India, and in 2014, this program was expanded and offered to the rest of the world, with priority given to applicants in-training from India and low- and middle-income countries, stratified on the basis of the World Bank Countries Classification. This expanded 2014 program included 113 students (age 36 ± 6 years; mean ± SD), from 31 countries of 6 continents (Figure 1a), and it continues to grow, with 211 students from 54 countries enrolled in 2015. The most represented country in this program continues to be India, followed by Nigeria and Egypt. We here describe the completed 2014 program in more detail. In this cohort, the enrolled students self-identified as practicing or in-training nephrologists (54%), pathologists (40%), and others (internists/pediatricians; 6%). The program offered over 35 prerecorded online lectures and 12 live webinars with recorded versions for later on-demand viewing. High-quality professionally recorded lectures from 12 experts in the field of nephrology and nephropathology were delivered online using a Microsoft Silverlight player (Microsoft, Redmond, WA), in a predetermined logical sequence to cover the main concepts in nephropathology. The lectures were kept concise and to the point, spanning from basic concepts to complex problems, new exciting discoveries, and controversial issues in the field. Live webinars were especially invigorating for both presenters and students. In these sessions, a nephrologist paired with a pathologist would present interesting cases using a webinar and online conference platform GoToWebinar (Citrix Systems, Ft. Lauderdale, FL). These live events included pertinent literature review relevant to the topic as well as detailed discussion of pathology findings, allowing students to actively participate by typing in their questions or comments. Several nonmandatory basic pathology webinars were also included in the repertoire, and they were particularly useful for trainees with limited exposure to immunofluorescence and electron microscopy techniques. Online quizzes created using Articulate Quiz-Maker’13 (Articulate Global, New York, NY) and delivered through a web-based Articulate Online system were also used in this program. The quiz questions had individualized feedback for each correct and incorrect answer; they often included kidney pathology images and ranged from morphological to clinical, sometimes with short case-based presentations. Some of the questions were more interactive, with “drag and drop” or “click on detail” features, which students found particularly useful for learning morphologic details; however, students overall preferred questions requiring clinicopathologic correlations and found them most useful in their learning process. Several challenges were faced at various stages of the program. The need for administrative support was greater than initially expected, with a large number of inquiries regarding content and administrative issues. Still, about 32% of candidates could not be considered in the application process due to incomplete documentation and various irregularities. The language barrier and difficulties with live webinar attendance due to actual webinar timing were a problem for some students, given the cultural and geographical diversity and time zone differences among participants. To receive the final certificate, students were required to attend the minimum of 75% of the live webinars and pass midterm and final exams; of 113 students in 2014, 99 (88%) satisfied the certification criteria. A pretest was administered before the beginning of the program, and these results were used to estimate the gain in knowledge and compare to a post-test score using a 2-tailed paired t-test. The students were not given the results or explanations for questions in the pretest and they were unable to record or save this test. The final CNC exam administered nearly a year later contained 15 questions identical to those in pretest, and the results of those were used for pretest–posttest analysis. All tests were timed and administered online through the EasyTestMaker application (Canton, OH), using links and passcodes. A total of 92 students completed both pretest and posttest exams, with average performance of 45% ± 4% and 82% ± 3% (mean ± 95% confidence interval), respectively; this difference between the pretest and posttest scores (37%) was statistically significant using a 2-tailed paired t-test, P < 0.001, suggesting a significant gain in knowledge over the course of the year (Figure 1b). Anonymous and voluntary surveys were conducted at midterm and end of the program through Survey Monkey (Palo Alto, CA) to evaluate students’ satisfaction with the program and the offered e-learning resources. In the midterm satisfaction survey (response rate 68%), the students rated all offered materials (prerecorded lectures, webinars, and quizzes) very highly, with excellent marks by >65% students in each category. More than 90% of surveyed students rated quizzes favorably, particularly interactive quiz questions and multiple choice questions requiring higher level comprehension of clinicopathologic correlations. On exit survey (response rate 72%), all respondents (100%) felt that the CNC program had a positive impact on their practice and 90% said they would have continued attending webinars, if this was a given option, regardless of the further certification. In these surveys, the criticisms were very few and revolved around the issues of internet connectivity and internet speed in some countries that sometimes interfered with the students’ ability to actively participate in live webinar sessions. Depending on their professional background, others have criticized the balance of the content and whether it should be more nephrology- or pathology-centered, but even so, 99% of surveyed students rated the program as overall excellent or very good. In summary, the CNC program has been very successful in connecting the global nephrology community and providing nephropathology training to trainees and physicians in countries with no or minimal nephropathology resources. Creative educational strategies and implementation of positive experience in learning and understanding of kidney disease will hopefully prove useful in improving and retaining general knowledge of kidney diseases among physicians and help stimulate interest in the fields of nephrology and nephropathology. Better understanding of kidney pathology and mechanisms of kidney injury is critical for early recognition, prevention, and treatment of kidney disease. As is evident from our surveys, the CNC attendees were very satisfied with this program and its resources. In addition, the improved performance of the 2014 CNC attendees shows that this kind of online training program is effective in improving their diagnostic nephropathology skills at the conclusion of the course, compared with baseline. This unique online format based on a blended structure of prerecorded lectures, live webinars, and formative assessments has a great potential to further expand and provide much needed nephropathology training worldwide. Importantly, this educational model may be useful for other areas of nephrology, including dialysis and transplantation. All the authors declared no competing interests. The authors would like to thank the faculty that participated in live webinars and those who provided high-quality recorded lectures for the CNC course, in alphabetical order: Gerald Appel, Jamil Azzi, Ibrahim Batal, Fernando Fervenza, Albert Lam, Martina McGrath, David Mount, Jai Radhakrishnan, Helmut Rennke, Leonardo Riella, David Salant, Sanjeev Sethi, Sushrut Waikar, and Astrid Weins.