Analysis of Performance Trends from 2010-2019 on the American Board of Internal Medicine Nephrology Certifying Exam.

BACKGROUND: The pass rate on the American Board of Internal Medicine (ABIM) nephrology certifying exam has declined and is among the lowest of all internal medicine (IM) subspecialties. In recent years, there have also been fewer applicants for the nephrology fellowship match. METHODS: This retrospective observational study assessed how changes between 2010 and 2019 in characteristics of 4094 graduates of US ACGME-accredited nephrology fellowship programs taking the ABIM nephrology certifying exam for the first time, and how characteristics of their fellowship programs were associated with exam performance. The primary outcome measure was performance on the nephrology certifying exam. Fellowship program pass rates over the decade were also studied. RESULTS: Lower IM certifying exam score, older age, female sex, international medical graduate (IMG) status, and having trained at a smaller nephrology fellowship program were associated with poorer nephrology certifying exam performance. The mean IM certifying exam percentile score among those who subsequently took the nephrology certifying exam decreased from 56.7 (SD, 27.9) to 46.1 (SD, 28.7) from 2010 to 2019. When examining individuals with comparable IM certifying exam performance, IMGs performed less well than United States medical graduates (USMGs) on the nephrology certifying exam. In 2019, only 57% of nephrology fellowship programs had aggregate 3-year certifying exam pass rates ≥80% among their graduates. CONCLUSIONS: Changes in IM certifying exam performance, certain trainee demographics, and poorer performance among those from smaller fellowship programs explain much of the decline in nephrology certifying exam performance. IM certifying exam performance was the dominant determinant.

The Pioneers of Nephrology - Professor Gabriel Richet: "I will maintain".

Gabriel Richet was one of the great pioneers of European Nephrology. After a pivotal period of work with Jean Hamburger, whom we owe the name of our discipline, Nephrology, he contributed to all aspects of this specialty and was, in particular, a forerunner in dialysis and in the study of interstitial nephropathies.In this passionate and lucid interview, recorded in Paris in 2010, he describes himself as a "lucky man", able to transform folly in happiness. He does not describe himself as an intellectual, but as a warrior, and closes a detailed history of the early days of European Nephrology with a strong statement of the moral stature a physician should have: he underlines, in line with his strong personality, that a physician is a man able to decide, to give orders and to assume their consequences. However, science and care of human beings cannot exist without a heart. "A doctor is someone who decides; when he writes a prescription, this means he prescribes and takes responsibility. Is it possible to give a prescription and decide regardless of compassion?". In his interview, he commented that this last statement is probably not uniformly agreed, but that he'll always defend it, adds freedom as a moral value that a physician should proudly defend: "Unfortunately I know that many do not share my idea, but that's life... I am like the Queen of Holland, whose motto is: I will maintain!".