Performance of procedures by nephrologists and nephrology fellows at U.S. nephrology training programs.
OBJECTIVE
Some procedures (e.g., placement of temporary hemodialysis catheters and kidney biopsies) are required in nephrology fellowship training. Others (e.g., placement of tunneled hemodialysis catheters, ultrasonography, and hemodialysis access interventions) are not required but are performed at some centers. To assess the procedures performed by nephrologists and nephrology fellows at U.S. adult nephrology training programs and the number of procedures required for fellow competency, a survey was conducted of all such training programs.


METHODS
An on-line survey was e-mailed to the directors of all U.S. adult nephrology fellowship programs in October to November 2007.


RESULTS
Responses were received from 93 of 136 programs. Nephrologists and nephrology trainees perform native and transplant kidney biopsies in 98% to 99% of programs and, in about half of programs, also perform the ultrasound guidance. Diagnostic ultrasounds are performed at fewer programs. Temporary dialysis catheters are inserted at nearly all programs. Tunneled hemodialysis catheters and peritoneal dialysis catheters are placed at < or =20% of programs. Interventional procedures on hemodialysis access are performed at 13% to 21% of programs. Continuous renal replacement therapy is performed at 99% of programs, plasmapheresis at 40%. Many programs either do not specify a minimum number of supervised procedures that need to be performed to demonstrate competence or require a very limited number.


CONCLUSIONS
Core procedures are performed at almost all programs. Experience and training in other procedures are variable. Many programs have limited requirements for the number of procedures trainees need to perform to demonstrate competence.
Berns
Jeffrey S
JS
University of Pennsylvania School of Medicine, Hospital of the University of Pennsylvania, 3400 Spruce Street, 1 Founders Pavilion, Philadelphia, PA 19104, USA. bernsj@uphs.upenn.edu
O'Neill
W Charles
WC
D000328:Adult; D017130:Angioplasty / Q000193:education; D001706:Biopsy; D002404:Catheterization; D002568:Certification; D002983:Clinical Competence; D004503:Education, Medical, Graduate; D005257:Fellowships and Scholarships; D006801:Humans; D020407:Internet; D007674:Kidney Diseases / Q000000981:diagnostic imaging / Q000473:pathology / Q000628:therapy; D009398:Nephrology / Q000193:education* / Q000379:methods; D010956:Plasmapheresis; D015397:Program Evaluation; D017582:Renal Replacement Therapy; D011795:Surveys and Questionnaires; D013647:Task Performance and Analysis; D017131:Thrombectomy / Q000193:education; D014463:Ultrasonography; D014481:United States