Abstract

Medical residency is a crucial experience in the life of physicians during their training as specialists, in which various aspects converge, such as clinical workload, knowledge acquisition, and the development of clinical competencies. In Mexico, one of the challenges faced by the medical residency system is balancing these aspects within a hospital environment with high clinical demand, especially in the public sector. This study aimed to describe the perception of Nephrology residents regarding their training process, exploring axes such as teaching methodologies, available resources, clinical supervision, evaluation methods, research work, and psychological well-being. A cross-sectional, observational, and descriptive study was conducted through electronic forms distributed to Nephrology residents from various hospital sites across the country via instant messaging. The results demonstrate considerable variability among these sites, a predominance of traditional teaching strategies, and a reliance on self-directed learning. The findings shed light on different areas of opportunity such as supervision, feedback, research, and attention to well-being. The opinion of most study participants supports the need for a reform of the educational system of medical residencies in Mexico.

Keywords

Medical education; Medical residencies; Nephrology; Competency-based training; Clinical teaching

Introduction

Medical residency represents a critical training period in the trajectory of the specialist physician. It is during this stage that knowledge acquisition, development of clinical skills, and the construction of a professional identity converge, all within a hospital environment whose main characteristic is a high clinical workload. In Mexico, this scenario poses a permanent challenge: ensuring that, within the resident’s training process, teaching is the central objective.

Nephrology is a specialty with high demands due to the complexity of patients’ conditions and the need to integrate broad knowledge of pathophysiological and anatomical issues for the performance of different procedures and the ability to make decisions in various clinical scenarios; unfortunately, the educational experience in training centers shows high variability that depends on factors such as the availability of trained faculty, availability of resources, institutional educational culture, and internal organization.

Clinical excellence does not necessarily translate into teaching skills; this is not new. Ponce-De León [1] pointed out that “medical teaching requires specific attitudes and competencies that are not acquired automatically.” In the last century, the integration of different educational models, beginning with the Flexner Report and progressing to the incorporation of Problem-Based Learning and competency-based education, has sought to respond to this need [2-4].

It is because of this problem that exploring residents’ perceptions allows an approach to the real functioning of the educational system. This research will also make it possible to identify strengths and areas of opportunity from the point of view of those who experience this training process daily

Materials and Methods

A cross-sectional, observational, and descriptive study was conducted, with the main objective of exploring the perception of Nephrology residents regarding different components of the educational process during medical residency. For this purpose, an electronic questionnaire was designed using Google Forms and distributed via instant messaging to Nephrology residents from different training hospital centers throughout the country; participation was not limited to a specific level of training. Participation was anonymous and voluntary. The descriptive statistical analysis primarily included frequencies and percentages. According to national regulations, this study is considered low-risk research. Confidentiality and data security were ensured through the implementation of personal data protection protocols. Based on current regulations, explicit approval by an ethics committee was not required.

Results

A total of 77 responses were obtained from residents from 28 hospital sites across the country. Sixty-one percent of participants were male. Regarding level of training, 31.2% were first-year residents, 28.6% second-year residents, and 40.3% third-year residents.

Most residents reported a predominance of monographic lectures supported by digital presentations (96.1%). Among teaching methodologies, Problem-Based Learning was reported by 62.3% of participants, Gamification by 23.4%, the Flipped Classroom by 10.4%, and Project-Based Learning by a smaller percentage (5.2%).

When exploring available educational resources, 74% reported not having simulators and only 24.7% had plastic models useful for practicing procedures. Almost universally (97.4%), the use of digital material for learning purposes was reported. Among the most used complementary tools were the social network X (80.5%), webinars (64.9%), YouTube tutorials (63.6%), and instant messaging groups for the dissemination of scientific articles from scientific journals that require a subscription to access them (57.1%). Half of the residents do not have an ultrasound device exclusively for the Nephrology service (50.5%).

Constant supervision during clinical practice was by far the aspect reported by the fewest participants, being indicated by only 9.1%. Regarding the number of classes received per week, 54.6% indicated a total of five classes; however, most were taught by the residents themselves (98.7%), only 41.5% mentioned being involved in external academic sessions, clinical case discussions, and seminars; in addition, 49.25% of residents reported support and incentives to undertake training stays abroad. The most used evaluation method was the multiple-choice exam (87%).

More than half of the residents (57.1%) attributed their learning to being self-taught. A total of 62.4% expressed not having adequate preparation in research, and awareness of the existence of institutional programs focused on the detection and management of professional burnout syndrome was reported by only 7.8% of residents. Despite these data, 77.9% indicated that they would choose their training site again. Almost universally (96.1%), participants indicated that they consider an educational reform of the medical residency system in Mexico to be necessary.

Discussion

This study demonstrates that the training experience during medical residency in Mexico within the specialty of Nephrology is highly heterogeneous and is conditioned by the aspects of each training site. Nephrology residents perceive deficiencies in the use of active teaching methodologies, in clinical supervision by attending physicians, and in timely feedback. In addition, the lack of availability of didactic and technological resources affects central elements of the training process. The reality of medical residencies in Mexico is that the acquisition of different theoretical and practical knowledge does not follow a logical and sequential process as expected and as outlined in the operational program, resulting directly in the impossibility of segregating competencies by year of residency, considerably limiting objective evaluation.

The predominance of traditional classes and peer teaching translates into formal teaching sustained by the initiative of medical residents rather than by a solid institutional educational structure. The findings of this research coincide with what has been reported in previous studies conducted in the country, where the resident-as-teacher model emerges as an adaptive strategy in response to the limited availability of faculty with formal pedagogical training [5].

Although Problem-Based Learning is present in a significant percentage of residents, its implementation appears uneven and conditioned by the individual interest of faculty at training sites, despite evidence supporting its use and demonstrating benefits such as the development of clinical reasoning and collaborative learning [2,3]. In line with this information, previous studies on the clinical learning environment in Mexico have indicated that the implementation of active educational strategies does not usually respond to clearly defined institutional policies [6,7].

Regarding competency-based education, the results demonstrate a gap between the objectives established in the specialty’s graduate profile and actual evaluation practices. The widespread use of multiplechoice exams limits the assessment of clinical performance and the ability to apply knowledge and skills in real situations, aspects that are fundamental during professional practice [4,8].

Although a significant proportion of residents attributing their learning to self-study may be interpreted as an indicator of autonomy, it also points to insufficient faculty mentorship. This has been previously described in national studies on clinical learning environments [6]. This self-learning limits the acquisition and development of soft skills (empathy, ethics, professionalism) in addition to perpetuating the inability to transmit knowledge to undergraduate students and lowerlevel residents.

Finally, minimal awareness of programs oriented toward well-being contrasts with extensive evidence documenting a high prevalence of professional burnout syndrome among medical residents and the limited response of residency training hospitals [9,10]. There is an urgent need to critically analyze current residency conditions even though the majority expressed they would choose their training site again.

Limitations

Not having the participation of all Nephrology residents in the country represents the main limitation of this study, as it prevents generalization of the findings and introduces selection bias, since it is possible that residents who participated were those with greater interest in teaching or a more critical assessment. The cross-sectional design does not allow for the establishment of causal relationships between the different variables analyzed. The information expressed is based on the participants’ subjective perceptions, and the electronic questionnaire limits qualitative exploration of individual experiences. In the future, the use of a mixed methodology and broad national coverage will provide valuable information to address the identified areas of opportunity.

References

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Article Information

Article Type: RESEARCH ARTICLE

Citation: Villegas Gutierrez LY, Cedillo Monreal MM, García Vera AL, Morales Guillen ML, Jauregui Navarro SG, et al. (2025) Perspective on Teaching in the Medical Residency of Nephrology in Mexico. Int J Nephrol Kidney Fail 12(1): dx.doi.org/10.16966/2380-5498.262

Copyright: ©2025 Villegas Gutierrez LY, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Publication history: 

Received date: 20 Dec, 2025

Accepted date: 30 Dec, 2025

Published date: 31 Dec, 2025