Assessing university nephrology training as preparation for community consultative practice

The authors gathered information about the consultative practice of nephrology in a community environment and used this information to speculate about improvements that could be made in the training of nephrologists in academic medical centers, based on their knowledge of such training. Data were gathered on the specialty affiliations of the physicians who requested 211 consecutive consultations, on the clinical problems encountered, and on the most likely diagnosis for each problem. In some instances the referral patterns, patient mixes, and clinical diagnoses observed in the community-based practice differed significantly from those often emphasized in training programs in academic medical centers. Such differences may be unintentionally reinforced, because the clinical literature in which new findings are reported and validated largely arises from university-type clinical practices. Specific examples of the differences observed and some suggestions for change are given. Although additional research is needed to confirm the findings of this study, and although these findings may not be applicable to other settings or other internal medicine subspecialties, these findings raise questions about the appropriateness of completely university-based training in preparing physicians for practice in a community setting. The authors suggest that cooperation between community hospitals and established university programs could bring about the best opportunities for clinical training.