RESUMO
BACKGROUND: In Italy, nephrology residency is available in twenty-one nephrology schools, each with its own strengths and weaknesses. The present study is aimed at exploring the residents' satisfaction with their training programs. METHODS: Between April 20th and May 19th, 2021, a questionnaire on residency satisfaction consisting of 49 items was sent to 586 residents and 175 recently certified specialists (qualified to practice as nephrologists in 2019 and 2020), with a response rate of 81% and 51%, respectively. The teaching organization was contextualized with a survey involving 13 European nephrology schools. RESULTS: Most residency fellowship programs received a good rating with regard to "satisfaction", in particular for the following items: number of hospitalizations followed-up, chronic hemodialysis training, follow-up of transplanted patients, diagnosis and treatment of glomerulonephritis. The teachings that were identified as being of lower quality or insufficient intensity included vascular access management, ultrasound diagnostics and renal nutrition. The need for improvement in formal teaching programs was underlined. Young nephrologists were rather satisfied with their salary and with the quality of the work they were doing, but only few were interested in an academic career since it was generally held that it is "too difficult" to obtain a university position. Many young nephrologists who filled in the questionnaire felt that lack of experience in peritoneal dialysis and vascular access management was a barrier to finding an ideal job. Compared to other European training programs, the Italian program differs with regard to longer exposure to nephrology (as compared to internal medicine), and greater flexibility for internships in different settings, including abroad. CONCLUSIONS: This first nationwide survey on the satisfaction of residents in nephrology indicates that, despite rather good overall satisfaction, there is room for improvement to make nephrology a more appealing choice and to fulfill the needs of a growing number of renal disease patients.
Assuntos
Internato e Residência , Nefrologia , Nefrologia/educação , Humanos , Itália , Inquéritos e Questionários , Europa (Continente) , Masculino , Feminino , Satisfação Pessoal , Nefrologistas/educação , Adulto , Satisfação no EmpregoRESUMO
Kidney transplant is not only the best treatment for patients with advanced kidney disease but it also reduces health care expenditure. The management of transplant patients is complex as they require special care by transplant nephrologists who have expertise in assessing transplant candidates, understand immunology and organ rejection, have familiarity with perioperative complications, and have the ability to manage the long-term effects of chronic immunosuppression. This skill set at the intersection of multiple disciplines necessitates additional training in Transplant Nephrology. Currently, there are more than 250,000 patients with a functioning kidney allograft and over 100,000 waitlisted patients awaiting kidney transplant, with a burgeoning number added to the kidney transplant wait list every year. In 2022, more than 40,000 patients were added to the kidney wait list and more than 25,000 received a kidney transplant. The Advancing American Kidney Health Initiative, passed in 2019, is aiming to double the number of kidney transplants by 2030 creating a need for additional transplant nephrologists to help care for them. Over the past decade, there has been a decline in the Nephrology-as well Transplant Nephrology-workforce due to a multitude of reasons. The American Society of Transplantation Kidney Pancreas Community of Practice created a workgroup to discuss the Transplant Nephrology workforce shortage. In this article, we discuss the scope of the problem and how the Accreditation Council for Graduate Medical Education recognition of Transplant Nephrology Fellowship could at least partly mitigate the Transplant Nephrology work force crisis.
Assuntos
Acreditação , Educação de Pós-Graduação em Medicina , Transplante de Rim , Nefrologia , Humanos , Nefrologia/educação , Nefrologistas/educação , Estados Unidos , Bolsas de EstudoRESUMO
Home dialysis therapies are flexible kidney replacement strategies with documented clinical benefits. While the incidence of end-stage kidney disease continues to increase globally, the use of home dialysis remains low in most developed countries. Multiple barriers to providing home dialysis have been noted in the published literature. Among known challenges, gaps in clinician knowledge are potentially addressable with a focused education strategy. Recent national surveys in the United States and Australia have highlighted the need for enhanced home dialysis knowledge especially among nephrologists who have recently completed training. Traditional in-person continuing professional educational programmes have had modest success in promoting home dialysis and are limited by scale and the present global COVID-19 pandemic. We hypothesize that the use of a 'Hub and Spoke' model of virtual home dialysis mentorship for nephrologists based on project ECHO would support home dialysis growth. We review the home dialysis literature, known educational gaps and plausible educational interventions to address current limitations in physician education.
Assuntos
Hemodiálise no Domicílio/educação , Falência Renal Crônica/terapia , Nefrologistas/educação , Ensino , COVID-19/epidemiologia , COVID-19/prevenção & controle , Educação Médica Continuada/métodos , Hemodiálise no Domicílio/métodos , Humanos , SARS-CoV-2 , Interface Usuário-ComputadorRESUMO
The attractiveness of a career in nephrology has diminished over the past decades, leading to global concerns about the future of the specialty's workforce. The reasons physicians choose (and do not choose) a career in the field must be identified in order to boost recruitment of new nephrologists. In this article, a multilevel strategy is proposed to deal with the declining interest in the specialty: (1) increasing contact and providing early exposure to nephrology; (2) promoting mentoring and role models in medical schools; (3) improving the experience of trainees and medical students; (4) incorporating procedural skills and combined fellowship training with critical care in nephrology; (5) facilitating exchanges between trainees and young and senior nephrologists; (6) adopting an active approach to identify reasons for dissatisfaction, reduce burnout, and encourage a suitable work-life balance among nephrologists; (7) increasing remuneration; and (8) incentivizing advances in the field. Finally, a positive perspective for nephrology is presented to the next generation.
Assuntos
Nefrologistas/educação , Nefrologia/educação , Escolha da Profissão , Mão de Obra em Saúde , Humanos , Estudantes de MedicinaAssuntos
Hiperemia/diagnóstico por imagem , Nefrologistas/educação , Testes Imediatos/normas , Ultrassonografia Doppler/métodos , Adulto , Pressão Atrial/fisiologia , Creatinina/sangue , Nefropatias Diabéticas/complicações , Taxa de Filtração Glomerular/fisiologia , Átrios do Coração/diagnóstico por imagem , Veias Hepáticas/diagnóstico por imagem , Veias Hepáticas/fisiopatologia , Humanos , Hiperemia/etiologia , Masculino , Testes Imediatos/estatística & dados numéricos , Veia Porta/diagnóstico por imagem , Veia Porta/fisiopatologia , Insuficiência Renal Crônica/classificação , Insuficiência Renal Crônica/diagnóstico , Insuficiência Renal Crônica/etiologia , Índice de Gravidade de Doença , Ultrafiltração/métodosRESUMO
In the medical profession, teaching has always been a routine expectation for practicing physicians. While this remains true today, in recent years, we have seen the emergence of a well-defined career pathway for those practicing physicians who want to focus on education: the clinician educator. This is a physician who is highly active in the practice of teaching, science of learning, service as a role model for young physicians, and leading educational programs. In nephrology, one can have a fruitful and fulfilling career as a lifelong clinician educator. As career interest in our specialty wanes, the clinician educator is the professional well suited to reverse this trend. In this article, we will further define the clinician educator and map out a pathway of skills needed to thrive in this rewarding career. We also provide recommendations to both educators and leaders to ensure the clinician educator pathway continues to grow.
Assuntos
Educação Médica/tendências , Docentes de Medicina , Nefropatias , Nefrologistas , Nefrologia/educação , Escolha da Profissão , Mobilidade Ocupacional , Educação Médica/métodos , Docentes de Medicina/educação , Humanos , Nefropatias/diagnóstico , Nefropatias/terapia , Liderança , Nefrologistas/educação , Nefrologia/tendências , Ensino , TecnologiaRESUMO
The substantial burden of acute kidney injury and end-stage kidney disease among patients with critical illness highlights the importance and need for a specialized nephrologist in the intensive care unit. The last decade has seen a growing interest in a career focused on critical care nephrology. However, the scope of practice and job satisfaction of those who completed dual training in nephrology and critical care are largely unknown. This article discusses the current practice landscape of critical care nephrology and describes the educational tracks available to pursue this pathway and considerations to enhance the future of this field.
Assuntos
Cuidados Críticos , Nefrologistas/educação , Nefrologistas/estatística & dados numéricos , Nefrologia/estatística & dados numéricos , Papel do Médico , Adulto , Escolha da Profissão , Emigrantes e Imigrantes/estatística & dados numéricos , Feminino , Necessidades e Demandas de Serviços de Saúde , Mão de Obra em Saúde , Humanos , Satisfação no Emprego , Nefropatias/terapia , Masculino , Nefrologia/educação , Área de Atuação Profissional/estatística & dados numéricos , Salários e Benefícios/estatística & dados numéricos , Âmbito da Prática , Inquéritos e QuestionáriosAssuntos
Injúria Renal Aguda/terapia , Cuidados Críticos , Educação de Pós-Graduação em Medicina , Nefrologistas/educação , Nefrologia , Injúria Renal Aguda/diagnóstico , Injúria Renal Aguda/mortalidade , Escolha da Profissão , Estado Terminal , Currículo , Humanos , Satisfação no Emprego , Nefrologia/educação , PrognósticoRESUMO
BACKGROUND AND OBJECTIVES: Hospital rounds are a traditional vehicle for patient-care delivery and experiential learning for trainees. We aimed to characterize practices and perceptions of rounds in United States nephrology training programs. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: We conducted a national survey of United States nephrology fellows and program directors. Fellows received the survey after completing the 2019 National Board of Medical Examiners Nephrology In-Training Exam. Program directors received the survey at the American Society of Nephrology's 2019 Nephrology Training Program Directors' Retreat. Surveys assessed the structure and perceptions of rounds, focusing on workload, workflow, value for patient care, and fellows' clinical skill-building. Directors were queried about their expectations for fellow prerounds and efficiency of rounds. Responses were quantified by proportions. RESULTS: Fellow and program director response rates were 73% (n=621) and 70% (n=55). Most fellows (74%) report a patient census of >15, arrive at the hospital before 7:00 am (59%), and complete progress notes after 5:00 pm (46%). Among several rounding activities, fellows most valued bedside discussions for building their clinical skills (34%), but only 30% examine all patients with the attending at the bedside. Most directors (71%) expect fellows to both examine patients and collect data before attending-rounds. A majority (78%) of directors commonly complete their documentation after 5:00 pm, and for 36%, after 8:00 pm. Like fellows, directors most value bedside discussion for development of fellows' clinical skills (44%). Lack of preparedness for the rigors of nephrology fellowship was the most-cited barrier to efficient rounds (31%). CONCLUSIONS: Hospital rounds in United States nephrology training programs are characterized by high patient volumes, early-morning starts, and late-evening clinical documentation. Fellows use a variety of prerounding styles and examine patients at the beside with their attendings at different frequencies. PODCAST: This article contains a podcast at https://www.asn-online.org/media/podcast/CJASN/2020_03_17_CJN.10190819.mp3.
Assuntos
Atitude do Pessoal de Saúde , Educação de Pós-Graduação em Medicina , Bolsas de Estudo , Conhecimentos, Atitudes e Prática em Saúde , Nefrologistas/educação , Nefrologia/educação , Visitas de Preceptoria , Competência Clínica , Currículo , Feminino , Humanos , Masculino , Nefrologistas/psicologia , Inquéritos e Questionários , Estados Unidos , Carga de TrabalhoRESUMO
Sonography is increasingly being used by nephrologists and the field of dialysis access is no exception. Advances in technology have allowed the addition of this universally available, portable, non-invasive tool to the nephrologist's armamentarium, which provides information on both morphology and physiology without the need for contrast or radiation. Ultrasound may be used across the spectrum of dialysis access, including central venous catheter placements, vascular mapping, regional anesthesia, creation, maintenance and assessment of hemodialysis access as well as assessment of the abdominal wall and peritoneal dialysis catheter placements. However, the lack of exposure in most training programs limits incorporation of routine use of ultrasounds in nephrology practice. As our specialty embarks on the ultrasound revolution, a two-pronged approach is essential to provide ample training opportunities while ensuring establishment of basic standards for training and competency.
Assuntos
Derivação Arteriovenosa Cirúrgica/educação , Implante de Prótese Vascular/educação , Cateterismo Venoso Central , Educação de Pós-Graduação em Medicina , Nefrologistas/educação , Diálise Renal , Ultrassonografia de Intervenção , Derivação Arteriovenosa Cirúrgica/efeitos adversos , Implante de Prótese Vascular/efeitos adversos , Cateterismo Venoso Central/efeitos adversos , Cateterismo Venoso Central/instrumentação , Cateteres de Demora , Cateteres Venosos Centrais , Competência Clínica , Currículo , Humanos , Diálise Peritoneal , Diálise Renal/efeitos adversos , Diálise Renal/instrumentação , Ultrassonografia de Intervenção/efeitos adversosRESUMO
ABSTRACT Introduction: Vascular access and renal biopsy are common procedures in nephrology. In this study, two artisanal simulators of very low cost and excelent image quality are (prented) presented to guide, by ultrasound, the venous access and renal biopsy. Methods: The simulators are constructed using chicken breast slices, Penrose drain, plastic milk shake straw and pig kidney. Results: Both simulators enable immediate identification of the anatomical structures of interest, vessels and kidney, and enable spatial orientation and hand-eye coordination, essential for the development of the necessary skills to safely carry out invasive procedures. Conclusion: The simulators described, were extremely useful for simulating venous access and renal biopsy guided by ultrasonography, enabling training to reduce the failure rate in punctures and the potential complications associated with the described procedures.
RESUMO Introdução: O acesso vascular e a biópsia renal são procedimentos comuns na prática nefrológica. Neste estudo, são apresentados dois simuladores artesanais de baixo custo e excelente qualidade de imagem para guiar, ultrassonograficamente, o acesso venoso e a biópsia renal. Métodos: Os simuladores são construídos utilizando fatias de peito de frango, dreno de Penrose, canudo plástico milk shake e rim de porco. Resultados: Ambos os simuladores permitem a identificação imediata das estruturas anatômicas de interesse, vasos e rim, e possibilitam a orientação espacial e coordenação olho-mão, essenciais para o desenvolvimento das habilidades necessárias para realizar seguramente procedimentos invasivos. Conclusão: Os simuladores descritos, extremamente úteis para as simulações do acesso venoso e a biópsia renal guiados por ultrassonografia, possibilitam o treinamento objetivando a redução do insucesso das punções e das complicações potenciais associadas aos procedimentos descritos.
Assuntos
Animais , Ultrassonografia/métodos , Treinamento por Simulação/métodos , Nefrologistas/educação , Rim/patologia , Nefrologia/educação , Suínos , Vasos Sanguíneos , Punções , Galinhas , Competência Clínica , Músculo Esquelético , Biópsia Guiada por ImagemRESUMO
INTRODUCTION: Vascular access and renal biopsy are common procedures in nephrology. In this study, two artisanal simulators of very low cost and excelent image quality are (prented) presented to guide, by ultrasound, the venous access and renal biopsy. METHODS: The simulators are constructed using chicken breast slices, Penrose drain, plastic milk shake straw and pig kidney. RESULTS: Both simulators enable immediate identification of the anatomical structures of interest, vessels and kidney, and enable spatial orientation and hand-eye coordination, essential for the development of the necessary skills to safely carry out invasive procedures. CONCLUSION: The simulators described, were extremely useful for simulating venous access and renal biopsy guided by ultrasonography, enabling training to reduce the failure rate in punctures and the potential complications associated with the described procedures.
Assuntos
Rim/patologia , Nefrologistas/educação , Nefrologia/educação , Treinamento por Simulação/métodos , Ultrassonografia/métodos , Animais , Vasos Sanguíneos , Galinhas , Competência Clínica , Biópsia Guiada por Imagem , Músculo Esquelético , Punções , Suínos , Dispositivos de Acesso VascularRESUMO
Kidney transplantation is associated with improvement in quality of life and mortality as compared to remaining on dialysis. It is therefore the optimal treatment for kidney failure for most patients. While transplantation nephrologists typically care for the patient in the first 6 months posttransplantation, general nephrologists and internists often care for kidney transplant recipients after this period. Medical management of the kidney transplant recipient can be challenging, and primary care physicians and nephrologists may be unfamiliar with the medical nuances of caring for these patients. This includes drug interactions, which are common and can result in drug toxicities, rejection, and graft injury. Infections and malignancies related to long-term immunosuppression may pose diagnostic and treatment challenges. In this article, we review the mechanisms of immunosuppression, types of rejection, complications of recurrent disease, common infectious diseases, and the nonrenal complications commonly encountered in the kidney transplant recipient.
Assuntos
Competência Clínica , Falência Renal Crônica/cirurgia , Transplante de Rim/efeitos adversos , Nefrologistas/educação , Transplantados/estatística & dados numéricos , Currículo , Gerenciamento Clínico , Feminino , Rejeição de Enxerto , Humanos , Falência Renal Crônica/diagnóstico , Falência Renal Crônica/mortalidade , Transplante de Rim/métodos , Masculino , Medição de Risco , Imunologia de Transplantes , Resultado do TratamentoRESUMO
BACKGROUND: Nephrologists are placing fewer non-tunneled temporary hemodialysis catheters. Requiring competence for nephrology fellow graduation is controversial. METHODS: Anonymous, online survey of all graduates from a single, military nephrology training program (n = 81; 1985-2017) and all US Nephrology program directors (n = 150). RESULTS: Graduate response and completion rates were 59% and 100%, respectively; 93% agreed they had been adequately trained; 58% (26/45) place non-tunneled temporary hemodialysis catheters, independent of academic practice or time in practice, but 12/26 did ⩽5/year and 23/26 referred some or all. The most common reason for continuing non-tunneled temporary hemodialysis catheter placement was that it is an essential emergency procedure (92%). The single most significant barrier was time to do the procedure (49%). Program director response and completion rates were 50% and 79%, respectively. The single most important barrier to fellow competence was busyness of the service (36%), followed by disinterest (21%); 55% believed that non-tunneled temporary hemodialysis catheter insertion competence should be required, with 81% indicating it was an essential emergency procedure. The majority of graduates and program directors agreed that simulation training was valuable; 76% of programs employ simulation. Graduates who had simulation training and program directors with ⩽20 years of practice were significantly more likely to agree that simulation training was necessary. CONCLUSION: Of the graduate respondents from a single training program, 58% continue to place non-tunneled temporary hemodialysis catheters; 55% of program directors believe non-tunneled temporary hemodialysis catheter procedural competence should be required. Graduates who had non-tunneled temporary hemodialysis catheter simulation training and younger program directors consider simulation training necessary. These findings should be considered in the discussion of non-tunneled temporary hemodialysis catheter curriculum requirements.
Assuntos
Cateterismo/instrumentação , Cateteres de Demora , Competência Clínica , Educação de Pós-Graduação em Medicina/métodos , Nefrologistas/educação , Nefrologia/educação , Diálise Renal/instrumentação , Currículo , Humanos , Treinamento por Simulação , Inquéritos e Questionários , Estados Unidos , Carga de TrabalhoRESUMO
Automated urine technology and centralized laboratory testing are becoming the standard for providing urinalysis data to clinicians, including nephrologists. This trend has had the unintended consequence of making examination of urine sediment by nephrologists a relatively rare event. In addition, the nephrology community appears to have lost interest in and forgotten the utility of provider-performed urine microscopy. However, it is critical to remember that urine sediment examination remains a time-honored test that provides a wealth of information about the patient's underlying kidney disease. This test performs very favorably as a urinary "biomarker" for a number of acute kidney diseases. When used properly, urine sediment findings alert health care providers to the presence of kidney disease, while also providing diagnostic information that often identifies the compartment of kidney injury. Urine sediment findings may also guide therapy and assist in prognostication. In this review of the role of urine sediment examination in the diagnosis and management of kidney disease, we seek to help experienced nephrologists maintain their competency in performing this test and encourage ongoing training of nephrology fellows and others less experienced in such analyses.