Training of surgeons in peritoneal dialysis catheter placement in the United States: a national survey.
OBJECTIVE
Peritoneal dialysis (PD) depends on timely and skilled placement of a PD catheter (PDC). Most PDCs are placed surgically, but little is known about the residency training of surgeons in this procedure. Inadequate residency training could limit surgical expertise in PDCs, resulting in high complication rates that discourage PD use. This study assessed surgical PDC training in the United States to explore this issue.


METHODS
A survey was sent to program directors of 248 U.S. surgery residency programs regarding the amount of PDC training, attitudes toward PDCs, and barriers to PDC training. Results were compared between academic and private centers.


RESULTS
Ninety-three surgery programs (38%) responded: 82% provided training in PDC and 69% were academic centers. Most surgeons placed 2 to <or=5 catheters during residency. Forty-eight percent of program directors felt that PDC training was important, 61% felt PDC training affected outcomes and increased the likelihood surgeons would place PDCs in practice, and 62% of programs expressed willingness to provide more PDC training. Lack of referrals from nephrology was the most frequently cited barrier to PDC training.


CONCLUSIONS
Although many U.S. surgery residency programs provide PDC training, this training appears inadequate. Low PD use and lack of referrals limits surgical training at most centers. Nephrologists need to develop initiatives with surgeons to improve PDC training and outcomes.
Wong
Leslie P
LP
Northwest Kidney Centers, Seattle, Washington 98122, USA. Lpw919@u.washington.edu
Liebman
Scott E
SE
Wakefield
Katherine A
KA
Messing
Susan
S
D000046:Academic Medical Centers; D001291:Attitude of Health Personnel; D002404:Catheterization; D016009:Chi-Square Distribution; D002983:Clinical Competence; D003479:Curriculum; D004503:Education, Medical, Graduate; D019538:Health Care Surveys; D007722:Health Knowledge, Attitudes, Practice; D006772:Hospitals, Military; D016304:Hospitals, Private; D006801:Humans; D007396:Internship and Residency; D016015:Logistic Models; D009398:Nephrology / Q000193:education*; D016017:Odds Ratio; D010530:Peritoneal Dialysis; D010818:Practice Patterns, Physicians'; D014481:United States; D013520:Urologic Surgical Procedures / Q000193:education*