You may be wondering about the ways in which your nephrology centre can become involved in  the education of international nephrology trainees. The CSN operates in partnership with ISN's Commission for the Global Advancement of Nephrology (COMGAN) which is ISN's trademark for capacity building efforts and global outreach programs, focused on continuing medical education throughout the world.

A major priority for the CSN International Health Committee is to leverage this existing partnership with COMGAN to help Canadian nephrologists respond to the global epidemic of non-communicable illnesses. This document outlines some existing mechanisms that may help to achieve this goal, as well as some practical tips on how to make the most of the ISN/COMGAN programs. Please direct questions to Dr. Tiina Podymow at  tiina.podymow@muhc.mcgill.ca

COMGAN's outreach and activities throughout the developing world include:

• Improving education of nephrologists, primary care doctors and other health professionals
• Raising public awareness about kidney disease in the context of cardiovascular disease and diabetes
• Training that focuses on the areas of epidemiology, clinical pharmacology and clinical trials
• Activating research projects on early screening for renal disease

ISN Sister Renal Centers Program

The ISN Sister Renal Centers program advances nephrology by linking renal units in the developing world with centers of excellence in the developed world. Note that this program is distinct from the CSN Sister Dialysis Center program which has a deadline of January 30, 2008 and is discussed below.

Any two renal centers/units can form an ISN Sister Renal Center pair provided that:

• At least one center is in the developing world — considered the Emerging Center
• Both centers are chaired by an ISN member.

The next deadline for new applications is 30 September 2008. The two centers must complete an online application (on the ISN website) for the SRC Program which includes a detailed plan of action in the form of a SWOT analysis (Strengths, Weaknesses, Opportunities, and Threats) and a clear plan on how their collaboration will upgrade the Emerging Center (EC) and positively reflect on the Supporting Center (SC). The application system is a dual online form that allows both centers to complete their own sections while being able to view the data filled in by their respective partners. More information is available at http://www.nature.com/isn/society/outreach/isn_20088.html

CSN Sister Dialysis Centers Program

At the September 1997 Annual Meeting of the Canadian Society of Nephrology, a motion was passed which committed $5000 per year to support Canadian renal programs who have joined the Sister Dialysis Program in fulfilling their objectives. It was agreed that a maximum of $2500 would be granted to any single unit on the condition that there would be evidence of equivalent support from the unit itself. Preference will be given to dialysis units that have recently joined the program and who have not received previous support from the CSN. Once Canadian renal programs have been confirmed as ISN Sister Renal Center pairs, they can apply to this CSN program. Deadline for applications is June 30, 2008. See http://www.csnscn.ca/local/files/guidelines/Sister%20Dialysis%20Application%20Dated%20Oct%202006.doc for details.

Fellowships

The ISN COMGAN Fellowship program provides nephrology training to physicians from emerging countries, with the ultimate goal of improving the standards in the Fellows' home countries upon their return. ISN Fellows receive hands-on training in advanced host institutions, allowing them to acquire state-of-the-art knowledge in basic and clinical nephrology, dialysis, transplantation, and epidemiology. The training focuses on providing the exact skills and knowledge specifically required by the home institution.

A complete Fellowship Program Guide is available on the ISN COMGAN website:  http://www.nature.com/isn/society/programs/full/isn_051027_4.html

CSN International Guide to Hosting a Foreign Learner

Candidates: The foreign applicant may learn of your center through the ISN COMGAN listing or a trusted international contact known to you may serve as a link. The foreign learner may have just completed their fellowship and be about to start in a new job in their country of origin, or they may have years of clinical experience and wish to have advanced continuing medical education. The upper age limit was 40; this was recently raised as those with more experience and with existing practices and experience have much to contribute to global nephrologic health.

Application: The application for an ISN COMGAN fellowship can be found at their website in the Fellowship section. Applicants are required to have completed nephrology fellowship training, and to have a position to which they will be returning after their experience at your center. The applicant should write a letter stating their educational background, fellowship rotations and learning goals for their experience abroad, for instance hemodialysis, peritoneal dialysis, transplant or clinical nephrology. They should also include a CV with their letter to you. The ISN application requires a form to be filled, and three letters of recommendation, one from their department head as well as from two faculty members. You may wish to review their application prior to submission, and will also have a portion of the application to fill, regarding your own center. ISN application deadlines are two times per year and processing of the application (to the time that they will hear if they have received the award) generally takes a few months.

Prerequisites, licensing, funding and logistics: Knowledge of English or French (depending on the working language of the center) is obviously required, but there are no formal requirements and a statement of knowledge plus correspondence with the individual are generally used to gauge proficiency. Generally, the foreign learner will be accepted into the hospital as an observer, and as such will not have any licensing, exams (such as LMCEE)  or malpractice insurance, they will not be permitted to examine patients independently or keep hospital chart notes. They will be responsible for obtaining a visa from their own country. ISN application deadlines are twice yearly and if accepted, the applicant will be awarded approximately $8000 USD from the ISN for a 3 month fellowship. The stipend is to cover costs of the flight, room and board while they are in Canada, for three months (although longer fellowships are also available).  Housing may or may not be inexpensively available e.g. a nurses residence, and the hosting faculty can help to arrange this if practical. It is essential that the applicant arrange for their own health insurance for the period that they are living in Canada, in advance of arrival.

Fellowship schedule: As an observer, the applicant will be expected to attend all formal and informal nephrology teaching rounds and lectures, and should be given a schedule of daily events. The specific rotation (i.e. consult service, dialysis, clinics, transplant, etc) should be determined in advance and an appropriately detailed schedule be drawn. Hosting faculty and existing fellows will need to be aware and receptive to the addition of the foreign learner to the nephrology team. The foreign learner may experience cultural challenges in taking initiative, and planning their own learning should be encouraged early on.

The Fellowship Matching Initiative helps potential applicants locate a renal center offering suitable training. Without a host institute a training plan cannot be established; this is a prerequisite for the submission of a Fellowship application. Candidates are encouraged to seek out relationships of their own accord and to benefit from relationships that their institution may already have with other well-established renal centers.

Applicants from the developing world can access 'The Fellowship Matcher' an online tool in the ISN website’s Fellowship Section, in order to locate an eventual training facility for those who do not have the adequate contacts. Canadian host institutions or nephrologists who are willing to offer training opportunities to fellows can be added to the Matching Initiative, by contacting ISN Global Headquarters by email:  info@isn-online.org.

May 2008