Improving outcomes in CKD and ESRD patients: carrying the torch from training to practice.
Practicing nephrologists are spending more time caring for end-stage renal disease (ESRD) and chronic kidney disease (CKD) patients. Despite this focus, and considerable advances in the understanding of those aspects of care that impact on clinical outcomes, morbidity, mortality, and quality of life for these patients has not improved substantially over the past decade. One of the possible explanations for this lack of progress is the structure of current nephrology training programs, where ESRD and CKD patient care is not emphasized. To address this issue, we developed a short preceptorship for second-year nephrology fellows, including didactic lectures and workshops. Of 67 participating fellows, 50% were from programs offering 3 or fewer months of exposure to outpatient hemodialysis, and 25% reported no exposure to peritoneal dialysis. Of more concern, 25% reported no "official rounds" with an attending nephrologist on dialysis patients. If nephrologists are to take their appropriate place as leaders of the care delivery team, nephrology fellowships must be restructured with appropriate emphasis placed on the comprehensive care of ESRD and CKD patients.
Department of Medicine, Division of Nephrology, David Geffen School of Medicine, UCLA, Los Angeles, California 90095, USA. anissenson@mednet.ucla.edu
Allen R
AR
Nissenson
Rajiv
R
Agarwal
Michael
M
Allon
Alfred K
AK
Cheung
William
W
Clark
Tom
T
Depner
Jose A
JA
Diaz-Buxo
Carl
C
Kjellstrand
Alan
A
Kliger
Kevin J
KJ
Martin
Keith
K
Norris
Richard
R
Ward
Jay
J
Wish
D001291:Attitude of Health Personnel; D002908:Chronic Disease; D002983:Clinical Competence; D004502:Education, Medical, Continuing / Q000379:methods; D004503:Education, Medical, Graduate / Q000379:methods; D005260:Female; D006801:Humans; D007674:Kidney Diseases / Q000175:diagnosis / Q000628:therapy; D007676:Kidney Failure, Chronic / Q000175:diagnosis / Q000628:therapy*; D008297:Male; D009398:Nephrology / Q000193:education*; D005791:Patient Care / Q000592:standards / Q000639:trends; D010530:Peritoneal Dialysis / Q000379:methods; D010817:Physician-Patient Relations; D011787:Quality of Health Care; D006435:Renal Dialysis / Q000379:methods; D012720:Severity of Illness Index