The optimal manner in which to train nephrologists has not been studied. The objectives of this research were to determine:- 1. The educational and historical basis underpinning the Australian nephrology training program. 2. The drivers surrounding a career choice in nephrology. 3. What constitutes an ???ideal??? nephrologist and how nephrologists spend their work time, thereby identifying skills and attributes to be fostered in training. 4. Impediments to training, including examination of the available workforce. Five sub studies were undertaken, utilising a combined quantitative and qualitative approach (mixed methods): 1) A national Basic Physician Trainee (BPT) questionnaire, 2) a national nephrology workforce study, and in-depth interviews of: 3) nephrology patients, 4) nephrology trainees and 5) practicing nephrologists. New findings arising from this research reveal: doctors choose nephrology as a career if exposed to the specialty in a positive manner with good role models, however, there are a range of modifiable factors that make nephrology unattractive to many BPTs; workload is high, impacting negatively on training and trainee recruitment; Nephrologists spend most time in the management of dialysis and transplant patients but have a range of other roles in day to day practice, essential information to develop a competency based training program; availability of nephrologists for training is suboptimal and will likely worsen; Patients and doctors apply and weight parameters differently when defining an ???ideal nephrologist???. Both groups believed that specialist knowledge remains an essential requirement but patients focused more on good communication skills. This research provides evidence that the training program should incorporate training in advanced communication and basic research skills and promotion of an holistic approach to patient care. There is no formal alignment of training with assessment. Trainees and nephrologists believe that feedback is critical to learning, yet the assessment process is not underpinned by sound educational principles. This can be rectified using the findings of this research in conjunction with curriculum development and performance assessment. This research should provide an approach to the examination of training that is applicable to many internal medicine specialties. Importantly, nephrology training can now be improved with sound educational principles, underpinned by the findings of this research.