Achieving Procedural Competence during Nephrology Fellowship Training: Current Requirements and Educational Research.
Concerns have previously been raised as to whether training programs are ensuring that nephrology fellows achieve competence in the procedural skills required for independent practice. We sought to review the current requirements for procedural training as well as educational research pertaining to achieving competence in the core nephrology procedures of nontunneled (temporary) hemodialysis catheter insertion and percutaneous kidney biopsy. At this time, there is no universal approach to procedural training and assessment during nephrology fellowship. Nonetheless, simulation-based mastery learning programs have been shown to be effective in improving fellows' skills in nontunneled (temporary) hemodialysis catheter insertion and should be provided by all nephrology training programs. For percutaneous kidney biopsy, the development and evaluation of inexpensive simulators are a promising starting point for future study. Current practice with respect to procedural training during nephrology fellowship remains imperfect; however, the ongoing shift toward competency-based evaluation provides opportunities to refocus on improvement.
Division of Nephrology, Department of Medicine and Kidney Research Centre, Ottawa Hospital Research Institute, The University of Ottawa, Ottawa, Ontario, Canada.
Edward
E
Clark
Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois; and.
Jeffrey H
JH
Barsuk
Division of Nephrology, Department of Medicine and Kidney Research Centre, Ottawa Hospital Research Institute, The University of Ottawa, Ottawa, Ontario, Canada.
Jolanta
J
Karpinski
Division of Nephrology, University Health Network and The University of Toronto, Toronto, Ontario, Canada.
Rory
R
McQuillan
D001706:Biopsy / Q000592:standards; D002406:Catheterization, Peripheral / Q000592:standards*; D002408:Catheters, Indwelling; D002983:Clinical Competence / Q000592:standards*; D004503:Education, Medical, Graduate / Q000379:methods / Q000592:standards*; D005257:Fellowships and Scholarships; D006801:Humans; D007668:Kidney / Q000473:pathology*; D009398:Nephrology / Q000193:education*; D012106:Research; D013514:Surgical Procedures, Operative / Q000193:education
Catheterization; Fellowships and Scholarships; Research; kidney biopsy; medical education; nephrology; non-tunneled hemodialysis catheter; procedures; renal dialysis