Abstract
BackgroundEarly recognition and management of chronic kidney disease (CKD) are associated with better outcomes. Internal medicine residency should prepare physicians to diagnose and manage CKD.MethodsTo examine whether residency training and program characteristics were associated with CKD knowledge and investigate the effectiveness of an internet-based training module in improving CKD knowledge, we analyzed data from CKD training modules administered annually to U.S. internal medicine residents from July 1, 2005 to June 30, 2009. Baseline CKD knowledge was assessed using pre-tests. The modules’ effectiveness was evaluated by post-tests. Comparisons were performed using X2 tests and paired t-tests.ResultsOf 4,702 residents, 38%, 33%, and 29% were program year (PGY)-1, PGY-2, and PGY-3, respectively. Baseline CKD knowledge was poor, with mean pre-test scores of 45.1-57.0% across the four years. The lowest pre-test performance was on CKD recognition. Pre-test scores were better with higher training levels (P-trend < 0.001 except 2005–2006 [P-trend = 0.35]). Affiliation with a renal fellowship program or program location within a region of high end-stage kidney disease prevalence was not associated with better baseline CKD knowledge. Completion of the CKD module led to significant improvements from pre- to post-test scores (mean improvement 27.8% [SD: 21.3%] which were consistent from 2005 to 2009.ConclusionsKnowledge of diagnosis and management of CKD improves during residency training but remains poor among graduating residents. Web-based training can be effective in educating physicians on CKD-related issues. Studies are needed to determine whether knowledge gained from such an intervention translates to improved care of CKD patients.
Highlights
Recognition and management of chronic kidney disease (CKD) are associated with better outcomes
We evaluated the familiarity with recognition and management of CKD among U.S internal medicine trainees and determined the effectiveness of an existing online-based training module on the diagnosis and management of CKD used by U.S internal medicine training programs to improve CKD knowledge
Based upon review of published scientific literature and the National Kidney Foundation (NKF) Kidney Disease Outcomes Quality Initiative (KDOQI) guidelines and commentaries, and the Kidney Disease: Improving Global Outcomes (KDIGO) guidelines, key areas of knowledge to inform the focus of the module were identified and encompassed the following: 1) risk factors for CKD; 2) methods for assessment of kidney abnormalities and kidney function; 3) recognition and staging of CKD severity; and 4) diagnosis and management of CKD-related conditions including anemia, mineral bone disease, and cardiovascular disease
Summary
Recognition and management of chronic kidney disease (CKD) are associated with better outcomes. An estimated 15 million adults in the U.S have moderate to severe chronic kidney disease (CKD) [1]. Recognition and management of CKD can slow the progression towards. Primary care providers shoulder the burden of managing CKD-related issues in addition to other coexisting chronic medical conditions. Demonstrate that many primary care providers lack knowledge of existing national CKD guidelines and important aspects of CKD care [5,6]. We evaluated the familiarity with recognition and management of CKD among U.S internal medicine trainees and determined the effectiveness of an existing online-based training module on the diagnosis and management of CKD used by U.S internal medicine training programs to improve CKD knowledge
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