By Saphia Suarez
As part of our “Meet Yale Internal Medicine” series, today’s feature is on Namrata Krishnan, MBBS, assistant professor of internal medicine (nephrology).
For Namrata Krishnan, MBBS, the key to enhancing academic interest in nephrology and addressing the notable decline in internal medicine residents applying to the specialty lies in developing innovative ways of delivering nephrology education. In the last three years, Krishnan has focused on ‘E-learning’ and developed two online, interactive learning modules in Hemodialysis. Krishnan developed these modules with the help of Belinda Platt, associate director of digital education at the Yale Poorvu Center for Teaching and Learning.
The E-modules are designed to have a ‘concept learning’ section that utilizes audio-visual animated videos to teach the topics. Krishnan believes that animation can be a powerful teaching tool in medical education and especially in nephrology. “I think the visualization of nephrology concepts can be difficult,” said Krishnan, assistant professor of internal medicine (nephrology). “The kidney works at a microscopic level, so the functional units of the kidney are not visible to the naked eye. Complex nephron functions occur at a cellular level, which is often difficult for students and residents to visualize. Animation can allow better visualization of these concepts and break down information into ‘chunks’ or ‘cognitive load’ in a visually simplified manner upon which knowledge can be built. The simultaneous narration helps to divide the cognitive load into visual and auditory cues which allows easier processing of information, making it easier to understand and retain information.”
The second section of the module is the knowledge testing section which promotes active learning and concept reinforcement. “This section uses interactive, simulated cases to actively engage the learner and allow knowledge assessment. It makes learning fun while assessing and reinforcing concepts learnt in the first part of the module. The learners get immediate feedback on their responses, which helps solidify what they’ve learned,” said Krishnan.
One of Krishnan’s modules, which focused on hemodialysis access, won an Innovations in Medical Education Award in 2018, through the American Society of Nephrology (ASN). The ASN then published that module, helping spread the word throughout the nephrology community. Her modules have also been shared on Twitter and posted on the Renal Fellow Network; a website run by nephrology fellows. They have been incorporated into the curriculum of several US nephrology training programs and have also been used by other medical practitioners such as dialysis nurses, vascular surgeons, and interventional radiology residents. “Our Yale fellows use them all the time,” said Krishnan. “I use it to teach our fellows, and I know some of my former fellows that have moved onto academic positions use it to teach their fellows.”
Krishnan has begun to incorporate these modules into a blended hemodialysis curriculum which combines e-learning with face-to-face learning. “When fellows rotate with me through the VA, they review these modules independently, and then we do a small didactic session and clarify questions on the topic. I think they enjoy this format of teaching as it allows them flexibility and control of their own learning,” said Krishnan. “The advantage of this ‘flipped learning’ format over E-learning alone, is it still allows the face to face collaborative discussion which is so valuable for student learning. I think this combination helps to reinforce their self-directed learning, so I am using it very actively.”
Krishnan recently published a perspective paper in the Journal of Nephrology about her experiences developing the blended hemodialysis curriculum for Yale nephrology fellows.
Krishnan has conducted a pilot study to describe the experience among nephrology trainees of using her hemodialysis E-curriculum and examine its impact on learner knowledge and satisfaction. She conducted interviews and collected survey data using Qualtrics from 25 nephrology fellows across 4 training programs including Yale. The results showed there was 100% agreement to the ease of use and clinical applicability of the modules. 100% of the users found the animated videos and self-assessment section helpful in understanding and retaining concepts respectively. Perceived level of knowledge in 6 key Accreditation Council of Graduate Medical Education (ACGME) competency areas improved upon module completion. She presented the data from her study during Medical Education Day at Yale as well as at the American Society of Nephrology in 2020. She is hoping to publish her findings. “I think e-learning has tremendous potential,” said Krishnan. “The fellows find it effective and learner-centric. My next steps are to understand where the limitations of E-learning lie and to try interventions to overcome those.”
Krishnan believes e-learning is particularly important now, when today’s students are so digitally inclined. “If we can tap into that interest and learn to use technology to develop effective, well-designed E-curricula that promote active learning and have features that appeal to all learner types, I think that can be an extremely powerful way to teach medicine,” said Krishnan. “We need to change with the times. Classroom lectures are great, and face-to-face, bedside teaching is certainly the best way to teach. However, with the heavy clinical load and time constraints that our trainees and faculty face, e-learning can be a powerful adjunct to traditional forms of teaching.” Though Krishnan began developing these modules long before COVID-19, she adds that the pandemic has further increased the relevance of E-learning in medical education. Her modules have been particularly helpful in nephrology training during the pandemic.
Looking forward, Krishnan is collaborating with the National Kidney foundation to develop a comprehensive online curricula in nephrology and is planning to study animation and develop her own technology skills in order to make these modules independently. “The ultimate goal is to teach nephrology to medical professionals at all levels of training, using technology-based, learner-centric and innovative approaches, so they can appreciate how wonderful the kidneys are and how fascinating renal physiology is,” said Krishnan. “That would be a dream come true.”
Almost 100 years after John Peters, MD, founded the metabolism section at YSM, the Section of Nephrology continues to thrive and grow. Focused on excellence in patient care, research, and education, the section’s faculty members are national and international leaders in the field. Learn more at Nephrology.