KI's new president Annika Östman Wernerson - Kidney specialist with a passion for education

Text: Cecilia Odlind

How can we create the optimal learning conditions? Feeling good is an important start, according to KI’s new president Annika Östman Wernerson.

She has been engaged in student wellbeing, both in her previous role as academic vice president for higher education at KI and as a researcher of medical pedagogy. One of her objectives as she enters her new office is to make sure more space is given to higher education.

While teaching as a doctoral student early in her career, Annika Östman Wernerson noticed that her pupils became more interested when she based her lessons on genuine patient cases.

“If you’re curious about something, you want to understand it. And if you understand it, you’ll retain your knowledge about it, and you don’t have to cram it in,” she says.

It isn’t so easy in the beginning

Emotions can also influence learning, as an interview and survey study of students who attended autopsies showed. Some of the group thought it was fascinating and highly instructive.

“But another group stood pressed up against the wall,” says Professor Östman Wernerson. “Maybe they’d never seen a dead body before and were tense and unable to concentrate. That group didn’t learn much at all.”

She and her research group found this interesting and they wanted to understand more about the kinds of situation that medical students consider distressing. Interview studies showed that clinical placements that involved working with serious disease and death and ethical dilemmas were emotionally difficult, as were the occasions when colleagues focused too much on the diagnosis and didn’t really acknowledge the patient.

“It takes energy and time to come to terms with all the thoughts that such things arouse, and there’s little support, if any, for  dealing with them,” she continues. “I have no quick fix but I think it’s vital that space is created for reflection with others in the same situation.”

She also believes that more senior colleagues need to remember that it isn’t so easy in the beginning.

“We must take care of our younger colleagues and show some empathy,” she says. “This is easily forgotten.”

An as-yet unpublished study by Professor Östman Wernerson et al shows that over half of all medical students are worried about burnout.

“Surveys of medical students show us that many are insecure and lacking in confidence. Female students were particularly unconfident and more susceptible to mental heath problems. They need more support, especially from colleagues.”

Was an assisting nurse before becoming a doctor

She was herself highly motivated when she first began to study medicine.

“As soon as I left school, I spent a few years working as an assisting nurse, and it never crossed my mind to be a doctor,” she recalls. “Neither of my parents are academics and I thought you had to be superhuman to become a doctor.”

But with time she realised that doctors are normal people too, and the profession could be something for her.

“As a student I already felt at home in the medical environment and had many questions I wanted answering. But I definitely remember also feeling insecure and anxious.”

She specialised in pathology with a focus on kidney and transplant pathology, and it is in renal medicine where Professor Östman Wernerson has her other research interest. She is passionate about bringing kidney diseases, which she believes to be relatively overlooked, to the fore.

“At least ten per cent of people in Sweden and around the world are affected, and the problem is growing,” she says. “But it’s relatively unknown as it is often concomitant with other known diseases such as diabetes and cardiovascular disease. We need more specific treatments and suppressants.”

Took off to El Salvador

Professor Östman Wernerson has also taken an interest in CKDu (chronic kidney disease of unknown cause), which affects many young men who do physically demanding labour in hot countries, such as plantation workers in Central America. She travelled with a doctoral student to El Salvador and conducted a minor kidney biopsy study to understand more about the damage done to the kidneys of these people. They have also since taken samples from patients in Nicaragua, Sri Lanka and India and seen similar damage.

“It’s been speculated that pesticides could be part of the aetiology, but this isn’t backed up by epidemiological research and other studies. Instead, we think that the disease is attributable to repeated damage caused by poor oxygenation due too excessive physical labour in a hot climate.” 

It was an eye-opening experience for her to meet people in these low and middle-income countries. Access to dialysis and kidney transplants is nothing like that in Sweden, and disease-related fatalities are high.

“There are villages where there are hardly any able-bodied men left,” she says.

Another research group in Gothenburg has conducted intervention studies showing that the damage can be prevented by sharpening billhooks, introducing rest periods and ensuring access to water.

“It doesn’t take much to make great improvements.”

Conditions for people with kidney diseases are very different in Sweden, where, unlike in many poor parts of the world, advanced treatments are widely available. Despite this, much still remains to be learned – the prognosis for common kidney diseases such as IgA nephropathy and diabetic nephropathy, for example. To address this, professor Östman Wernerson has started a biobank project in which tissue, urine and blood samples from patients with kidney disease are stored in order to ascertain how gene and protein expression and other variables can be linked to the onset, prognosis and progress of the diseases.

“It’s quite risky to take tissue samples from the kidneys, so you can only take a tiny amount. It’s only now that we have the technology to make qualitative analyses on such small samples.”

The aim is to understand why some patients fare better than others. A third arm of her kidney research involves transplants.

“Patients with kidney transplants generally do very well. But sooner or later problems can arise, such as immunological damage resulting from rejection. We monitor these patients accordingly to identify risk and success factors.”

Different research fields complement each other

Professor Östman Wernerson finds researching two so very different fields rewarding, as it gives insight into different types of research and how they can complement each other.

“Studies in medical education are often qualitative and involve fewer individuals, which is uncommon in medical research and therefore occasionally contested. But interviews can be used to identify interesting questions that can then be interrogated by surveying larger groups. It seems to me that the field has a lower status, which is problematic, not least because it makes it harder to get grants for this kind of research. I think we have to recognise differences in methodology, for example, and pedagogy research is needed if we’re to engage in evidence-based education.”

The knowledge generated can also feed into other contexts.

“We talk about lifelong learning,” she says. “It’s also good to know how best to communicate at scientific conferences and other learning situations.”

She also thinks we are in a particularly interesting and instructive situation right now.

“The pandemic forced us to do much of our teaching remotely for a long time,” she explains. “There are today two student camps, one that thinks remote teaching is the best thing since sliced bread and one that thinks it’s the pits. But how does it affect learning? We need to find this out so that in future we’ll be able to choose the setup that works best, which might be different for different subjects and different parts of a programme. The most important thing is that our students are well-prepared for their future careers.”

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