Peer Reviews

Desai T, Ferris M, Christiano C, Fang X. Predicting the Number of US Medical Graduates Entering Adult Nephrology Fellowships Using Search Term Analysis. American Journal of Kidney Diseases 2012, Vol. 59, pp. 467-9

REVIEWER COMMENTS Reviewer #1: The literature provides examples of behavior prediction via analysis of one's search strategy. Consequently, Desai and colleagues hypothesize that an analysis of search term frequencies for the keyword "nephrology" is an accurate predictor USMGs entering adult nephrology fellowship programs. They provide a fairly robust search term strategy regarding this hypothesis but only "nephrology" is significant in the forecasting model. They determine this conclusion with statistical significance of their STIL analysis, and contend that currently utilized methods to determine the nephrology workforce are by their very nature always "late" and thus less useful. For example, the authors maintain that an educational intervention to bolster nephrology fellowship enrollment would be delayed by 2 years, at the default level. No educational interventions were proposed, but successful ones were alluded too. Reviewer #2: This paper by Desai, et al., is provocative and innovative in applying webbased "forecasting" to the problem of predicting USMG interest and entry into fellowships. The effort to use this as real time information to assess recruiting efforts is a step forward. I have a few concerns: 1. It is hard to believe that a correlation of 0.96 means what the authors think it means without at least giving consideration to other reasons why the search term "nephrology" could decline in use over the same period of time. For example, some organizations have relied in more recent years on the use of the word "kidney" or "kidney disease" to make reference to nephrology issues, as this is more recognizable to the general public maybe that is an entirely different reason why "nephrology" appeared less frequently recently. I'm sure one could think of other reasons. It would have been more reassuring if the inclusion of the words "training" or "fellowship" had appeared frequently enough to do analysis from these specific modifiers. 2. This is an association from one period of downward trend. It may be a leap to say it is "predictive." Having data from trends in both directions might be more supportive of the use of the word "predictive." There was an upward trend of USMG entry into nephrology prior to the period referenced in the paper, but perhaps there is not adequate internet search data from that time. Nephrology On-Demand ! http://www.myNOD.org

Peer Reviews

Desai T, Ferris M, Christiano C, Fang X. Predicting the Number of US Medical Graduates Entering Adult Nephrology Fellowships Using Search Term Analysis. American Journal of Kidney Diseases 2012, Vol. 59, pp. 467-9

3. I believe the match data from 2010 and 2011 is indeed available through contacting the ASN TPD Executive Committee Chair (Don Kohan) and/or NRMP. I would request this data for completeness before considering publication

Nephrology On-Demand !

http://www.myNOD.org