When Li-Li Hsiao, MD, PhD, moved to Boston to start her nephrology training, she began receiving phone calls, sometimes at home, from Chinese Bostonians seeking medical advice. Fellow doctors told her that she was one of the only physicians in the area who spoke Mandarin.
“They don't feel comfortable seeing a physician because of the language barrier or because they believed they would self-treat with Chinese herbal medicine,” said Dr. Hsiao, now Instructor at Harvard Medical School. “That's when I decided I needed to go into the community and reach out to those people instead of waiting for those people to come in.”
She proposed creating and directing an Asian Renal Clinic, which was subsequently approved by Brigham and Women's Hospital. Under the umbrella of this clinic, she created a community outreach program that provides free kidney disease screenings and health education to underserved communities.
The program became known as the Kidney Disease Screening and Awareness Program (KDSAP), and it morphed from including student volunteers to becoming a completely student-run organization at Harvard. Dr. Hsiao serves as advisor.
Since 2008, the program has enabled student volunteers to learn from nephrologists about the renal profession, while helping the community at the same time.
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Working with the Community
Members of KDSAP initially assess the community to see what the organization can do for residents. They then offer education to increase the overall awareness of chronic kidney disease (CKD).
“Working with community leaders, nephrologists go into the community and give a talk about CKD and treatment options,” Dr. Hsiao said. “Our KDSAP student volunteers also help develop a CKD brochure, which is translated into the language of the community. The brochure is used in the community and given out during the screening activity.”
The health screenings are provided monthly. In order to be qualified to perform renal screenings, students must attend training.
“I created a program called Universal Precaution and Professionalism (UPP),” Dr. Hsiao said. “Every individual who wants to volunteer in KDSAP must attend UPP. This is an annual event, and every year we remind them and teach them the correct attitude and how to be a professional.
“During this, we have an overall training session to train volunteers to be proficient in each station. We have a nephrologist teach them why each station is important. The volunteer is not just doing what they are doing; they understand why they are doing it.”
A biennial blood pressure training session was also created for students who want to work at that station at the community screenings.
After each screening, a volunteer nephrologist chooses a topic of the day to discuss with students, who range from college participants to even high school volunteers getting a taste of community service and nephrology.
“There are many areas where high school students can be involved,” Dr. Hsiao said. “At the beginning, they only helped direct traffic, and gradually they were given more responsibilities. They are the most reliable volunteers. I'm very lucky and proud that I have a chance to work with these students.”
Since 2008, the program has grown rapidly, expanding beyond Boston.
“Every time we go into the community, we average about 25 to 30 student volunteers,” Dr. Hsiao said. “We have two local high schools involved—one in Brookline, MA, and the other in North Quincy, MA. We went to Toronto this past February because a group of University of Toronto students wanted to start this program at their university, and 45 students came out to be trained. We have expanded to New Jersey, and we work with medical students from the University of Medicine and Dentistry of New Jersey.”
When bright college and high school students are provided with a chance to participate in hands-on renal-related community service and learn from current nephrologists, there is the potential to inspire these students to pursue the specialty later in their education.
“There is no doubt about it; early exposure to students is very important and impactful,” said Mitchell Rosner, MD, Professor of Medicine and Chair of the Department of Medicine at the University of Virginia School of Medicine. “They get direct mentorship from people who are passionate about treating people with CKD, and that kind of mentorship is incredibly invaluable.”
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Mark G. Parker, MD, Program Director of the Nephrology Fellowship Program at Maine Medical Center, agreed that the possible benefits are intriguing.
“If we could involve college students directly with nephrologists not only as an entrée into the medical field in general but as a potential way of igniting interest in nephrology, that is great.”
The Nephrology Workforce
The past several years have seen a noticeable decline in the nephrology workforce that the field is working diligently to address.
“It largely comes down to mentorship and exciting people at early stages,” Dr. Parker said. “I think the more we have one-on-one opportunities with people who show a flicker of interest, the more that we can show them what the field in general is all about and why there are so many exciting reasons to get involved with the field.”
Dr. Parker is Chair of the American Society of Nephrology (ASN) Workforce Committee, which is in talks with Dr. Hsiao about potentially partnering in the future to support the organization's goals, Dr. Parker noted. The hope is that similar efforts can be used to influence the young generation of future doctors to pursue the specialty.
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Another possible force behind the workforce challenges is lifestyle concerns.
“A nephrologist works very hard,” said Beth Piraino, MD, Associate Dean of Admissions and Financial Aid at the University of Pittsburgh School of Medicine. “Medical students now are more balanced in their approach to life in general. Trainees look at these things. They look at work hours and on-call and factor that into their decision.”
The KDSAP program gives college students a chance to witness nephrology through the lens of an outpatient experience, setting it apart from the common nephrology elective during medical residency, which focuses much attention on inpatient treatment.
“With inpatient nephrology, you are only seeing intensive care unit patients, many of whom are dying,” Dr. Piraino said. “Some people like this type of care, but I certainly most prefer outpatient care. I would like to see a much more balanced view of nephrology.”
The Student Experience
In the Kidney Disease Screening and Awareness Program, the emphasis on mentorship and outpatient experience is key to shaping the student volunteers' view of nephrology.
“KDSAP has allowed me to explore nephrology in more depth,” said Eric Shieh, KDSAP cofounder and a second-year medical student at Harvard Medical School. “I knew very little about the kidney when I started with KDSAP, and volunteering at KDSAP's health screenings showed me firsthand how public awareness of kidney disease is lacking. I have become more passionate about educating people about the kidney.”
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Laura Polding, Secretary of the KDSAP Executive Board at Harvard, has had a similar experience.
“My time with KDSAP has provided me with an exceptionally diverse array of experiences relating to nephrology and instilled in me an interest in this specialty that was not present when I first started,” Ms. Polding said. “The experience has motivated a number of students to engage in kidney research and to think earnestly about pursuing the nephrology specialty in medical school and beyond.”
This knowledge and interest in the renal specialty has extended to high school students volunteering in KDSAP, like Jake Cohen, Copresident of the Brookline High School Chapter.
“I have gained so much from this program,” Mr. Cohen said. “Not only have I been trained to screen patients for CKD, but I have attained immense knowledge of the disease. I've had the privilege of learning information that I would not receive anywhere else.”
Mr. Shieh helped develop the health screening program in Boston, and he has been inspired by its progress.
“It's been very rewarding to see KDSAP achieve its mission of bringing kidney disease to the forefront,” Mr. Shieh said. “We have been able to catch disease early, recommend lifestyle changes, and refer patients to clinics that can provide the appropriate care.”
Ms. Polding, who is studying neurobiology and global health and health policy, with a language citation in Mandarin, recognizes the planning of screenings to be one of the challenges in the organization.
“Community outreach volunteers research the unique characteristics and needs of a population prior to organizing a health talk and screening so that volunteers gain insight into how best to serve the members of the community,” she said.
“For example, in planning screenings on a community-by-community basis, we must ensure that we have a sufficient number of volunteer translators for each of the main languages in a given community in order to facilitate the accessibility of chronic kidney disease screenings for every individual interested in participating.”
Once the screenings start, the ardor of the students is palpable.
“If you observe a CKD kidney health screening in progress, you'll witness that all of our volunteers—physicians, nurses, medical students, and college and high school students alike—exude a distinctive enthusiasm and spirit that is telling of our passion for making a positive impact in the health of underprivileged communities,” Ms. Polding said.
This excitement has inspired Mr. Cohen to rethink his plan for the future.
“I was set on pursuing a career in business; however, my involvement with KDSAP has altered my perspective,” Mr. Cohen said. “I have a newfound passion for science and medicine, and these new interests will undoubtedly influence my future profession.”
Dr. Hsiao considers herself lucky to not only help serve the community but also mentor and inspire students.
“It's a privilege to work with this group of students,” Dr. Hsiao said. “They are talented, courteous, and humble. They do this because they believe this is something they want to do, and they believe this is a good thing to do. This is every teacher's dream to be able to work with students like this.”
© 2012 Lippincott Williams & Wilkins, Inc.