A Dialysis Medical Director Rotation for Nephrology Fellows: A Single Center’s 10-Year Experience

Rationale & Objective

Many nephrology fellows will eventually become dialysis unit medical directors, yet few receive formal training on the responsibilities of this position. This study reports on our 10-year experience conducting a dedicated medical director rotation for nephrology fellows.

Study Design

An observational longitudinal study of a month-long medical director rotation designed to prepare nephrology fellows for leadership roles in dialysis facilities.

Setting & Participants

From 2014 to 2023, 36 nephrology fellows at the Mayo Clinic in Rochester, MN completed the rotation.

Quality Improvement Activities

Fellows were surveyed before and immediately after the rotation. Postgraduation surveys assessed the rotation’s effect on the fellows’ clinical practice.

Outcomes

The study evaluated how well the rotation improved fellows’ understanding of the medical director role, its influence on their clinical practice, and the importance of incorporating this training into fellowship programs.

Analytic Approach

Quantitative and qualitative survey responses from fellows before and after the rotation and postgraduation were analyzed.

Results

Before the rotation, only 5% of fellows had a strong understanding of the medical director’s role, increasing to 100% after completion. None felt well prepared for the role before rotation, whereas 81% reported feeling well prepared afterward. Among graduated fellows, nearly half served as a dialysis facility medical director, 70% found the rotation valuable to their practice, and 30% found it somewhat valuable. Additionally, 85% considered it very important to include a medical director rotation in fellowship training.

Limitations

Single-center study.

Conclusions

A structured medical director rotation within a general nephrology fellowship effectively prepares fellows for leadership roles in dialysis facilities and could serve as a model for other institutions.

Plain Language Summary

The increasing prevalence of patients with kidney failure has expanded the role of dialysis facility medical directors, yet many nephrology fellows receive little formal training for this leadership position. To address this gap, our fellowship program introduced a dedicated medical director rotation in 2014. We surveyed current and graduated fellows to assess the rotation’s effect. Results showed that participation significantly improved fellows’ understanding and preparedness for the role. Graduates found the rotation highly beneficial, though they identified areas for improvement, such as financial management training. Our study highlights the importance of a structured medical director education in nephrology fellowships, demonstrating that such training enhances leadership, operational, and clinical skills, ultimately improving dialysis facility management and patient care.