| Abstract Objective: To explore and implement a structured training pathway for professional master''s degree students in nephrology under the "Four-Certificates-in-One" model, aiming to address the challenge of integrating clinical rotations with scientific research training within the limited three-year timeframe. Methods: Based on national policies and institutional training programs, the Department of Nephrology at the Affiliated Hospital of Jiangnan University designed and implemented a stepwise progressive training pathway guided by the core principle of "Clinical Priming, Research Advancement". This pathway conceptualizes the three-year training period as a continuum, divided into three stages to guide students in constructing a holistic disease cognition system integrating "Clinical Phenotype – Pathological Alteration – Molecular Mechanism". Specific measures included: 1) establishing problem-oriented "Clinical Phenotype Profiles" during initial rotations; 2) bridging clinical phenotypes with pathological manifestations via pathology reading sessions in the mid-phase, facilitating the initial translation of clinical uncertainties into scientific questions; and 3) delving into molecular mechanisms in the final stage to form a multi-dimensional disease perspective. Research training commenced with a literature review focused on solving clinical problems, fostering a closed-loop process for topic selection and protocol design. A "Time Gridding" management strategy was employed to efficiently utilize non-clinical hours for research tasks without compromising clinical duties. In addition, process-oriented evaluation indicators were established around clinical competency, clinical–research integration, research translation, and fulfillment of the four-certificate requirements. Results: This pathway helped promote a shift from "time segmentation" to "cognitive integration" between clinical practice and research training. By embedding research training organically into clinical competency development, scientific inquiry became a natural extension for deepening clinical understanding, thereby alleviating, to some extent, the temporal conflict between clinical work and research. Based on the process evaluation, students were able to establish phenotype profiles indexed by real cases, conduct clinical–pathological integrated case reports, and advance literature review, proposal development, and phased project implementation around clinical questions. Practice demonstrated that this approach cultivates students'' ability to think like "clinical scientists", enabling them to establish a cross-hierarchical framework for disease interpretation and equipping them with the core competencies needed to navigate the complexity and rapid evolution of nephrology. Conclusion: The stepwise progressive training pathway represents a practical implementation of the "Four-Certificates-in-One" policy''s principles. Through a meticulously designed cognitive ladder, it forges clinical practice and research training into an organic whole, providing a feasible reference for cultivating high-level, versatile nephrology specialists. The continuous optimization and wider adoption of this pathway rely on a high-caliber faculty team, innovation in formative assessment systems, and synergistic support from the broader training ecosystem. |
