Establishing a National Quality Improvement Program for Nephrology Fellows: The Canadian Society of Nephrology Experience

Novel Educational Approaches to Enhance Learning and Interest in Nephrology

Recurrent Polyuria

As free open access medical education (FOAMed) use increases, it is important to characterize how and why learners are using this educational material in nephrology. We describe the frequency, purpose, and type of FOAMed usage across US nephrology fellows. In this cross-sectional survey, items were emailed to all US adult and pediatric nephrology fellows via the American Society of Nephrology (ASN) Fellow Survey in May 2022. The eight-item survey, developed to measure FOAMed engagement, had previously undergone instrument validation. The results were analyzed by descriptive statistics. In total, 43% (359/842) adult nephrology fellows and 51% (45/88) pediatric nephrology fellows completed the survey. Seventy-four percent (300/404) of fellows reported using FOAMed, and 72% (215/300) started using FOAMed within the past 2 years. Of FOAMed users, 41% (122/300) reported viewing FOAMed and 33% (99/300) reported applying knowledge gained from these resources daily or weekly. Common purposes for FOAMed engagement included searching Twitter to learn about others' opinions in the field (43%; 130/300), reading blogs to answer clinical questions (35%; 105/300), and listening to podcasts for the most up-to-date information (39%; 116/300). Compared with traditional educational resources, fellows preferred using FOAMed for staying up to date on nephrology topics (75%) and answering clinical questions (37%). Among all fellows, the greatest barriers to FOAMed use were unfamiliarity with FOAMed (27%; 111/404), validity concerns (22%; 90/404), and a lack of a local community of FOAMed users (22%; 87/404). Seventy-four percent of nephrology fellows used FOAMed resources in a variety of ways, and of them, 33% of fellows clinically applied knowledge gained from these resources. Reasons for engaging with FOAMed varied across resources.

Editors’ Note and Prologue

Securing the future of kidney transplantation by addressing the challenges of transplant nephrology.

Low Serum Bicarbonate in a Patient With Diabetes Mellitus:: A Quiz

The State of Quality Improvement Training in Pediatric Emergency Medicine Programs: A National Survey of Fellowship Program Directors

This needs assessment survey of physical medicine and rehabilitation (PM&R) program directors (PDs) from Accreditation Council for Graduate Medical Education-accredited programs aimed to (1) describe current quality improvement (QI) training, (2) characterize PDs' perceptions of their own and their faculty's QI knowledge and skill, and (3) determine PDs' opinions of optimal QI training to inform the development of a future QI curriculum. Descriptive statistics were used for data analysis. Forty-five percent of PDs (35/78) responded. All programs had QI education and required QI project participation; however, the quantity and types of learning experiences varied greatly. PDs assessed their ability as less than proficient to teach QI (67%) and lead a project (57%), and rated 60% of their faculty as having novice or advanced beginner QI skills. PDs reported 31% of graduating residents had less than competent QI skills. Almost all PDs were interested in a standardized QI curriculum.

Background and objectives:A shift to holding individual physicians accountable for patient outcomes, rather than facilities, is intuitively attractive to policy makers and to the public. We were interested in nephrologists’ attitudes to, and awareness of, quality metrics and how nephrologists would view a potential switch from the current model of facility-based quality measurement and reporting to publically available reports at the individual physician level.Design, setting, participants, and measurements:The study was conducted using a web-based survey instrument (Online Appendix 1). The survey was initially pilot tested on a group of 8 nephrologists from across Canada. The survey was then finalized and e-mailed to 330 nephrologists through the Canadian Society of Nephrology (CSN) e-mail distribution list. The 127 respondents were 80% university based, and 33% were medical/dialysis directors.Results:The response rate was 43%. Results demonstrate that 89% of Canadian nephrologists are engaged in efforts to improve the quality of patient care. A minority of those surveyed (29%) had training in quality improvement. They feel accountable for this and would welcome the inclusion of patient-centered metrics of care quality. Support for public reporting as an effective strategy on an individual nephrologist level was 30%.Conclusions:Support for public reporting of individual nephrologist performance was low. The care of nephrology patients will be best served by the continued development of a critical mass of physicians trained in patient safety and quality improvement, by focusing on patient-centered metrics of care delivery, and by validating that all proposed new methods are shown to improve patient care and outcomes.

Is Nephrology Fellowship Training on the Right Track?

BackgroundWhile many residency programmes have implemented quality improvement (QI) training programmes, few have been rigorously evaluated.MethodsResidents at the authors' institution participated in a required course, the Quality Assessment and Improvement...

Kidney Pathology Education for Nephrology Fellows: Past, Present, and Future.

Educational Resources for Resident Training in Quality Improvement: A National Survey of Urology Residency Program Directors

Key Points Because of low patient numbers and uneven geographical distribution, nephrology fellows may not have experience caring for home hemodialysis (HHD) patients.We developed and preliminarily validated a formative HHD objective structured clinical examination.The objective structured clinical examination may be used to assess HHD curriculum and basic HHD clinical skills in individual fellows. Background The Accreditation Council for Graduate Medical Education requires graduating nephrology fellows demonstrate competence in home hemodialysis (HHD). Because low patient numbers may lead to training gaps, clinical experience may be enhanced using simulation. We designed and preliminarily validated a formative objective structured clinical examination (OSCE) assessing clinical care of an uncomplicated patient initiating HHD, using a unified model of construct validity. Methods The OSCE was developed by a nephrology fellow and five faculty (three practicing HHD). The nine-member test committee (five in HHD practice; one HHD care partner) assessed test item difficulty/relevance and determined passing scores. The final test consisted of 27 items (31 possible points); seven were evidence-based/standard-of-care questions (9.5 possible points). Passing score was 20 of 31 points (65%). Median relevance for all items was “important” or “essential.” Content validity index was 0.84. On preliminary validation by 11 board-certified volunteers (four practicing HHD), overall mean±SD score was 27.5±2 (100% passing), kappa=0.83 (95% confidence interval, 0.67 to 0.99). Validator evidence-based question score was 9.0±0.6. Results Thirty-eight fellows (9 programs, 21 first-year; 17 second-year) were tested. Seventy-one percent passed (Cronbach α=0.70). Fellows' mean±SD scores were lower than validators: 21.5±4.0 versus 27.5±2, P < 0.001, as were their scores on evidence-based questions: 7.4±1.4 versus 9.0±0.6, P < 0.001. Eighty-eight percent of evidence-based/standard-of-care questions were answered correctly by validators versus 62% by fellows (P < 0.001). Forty-two percent of fellows were able to name four potential benefits and two risks associated with HHD; 79% recognized that the primary risk of buttonhole cannulation was infection. Seventy-four percent correctly identified minimum single pool Kt/V for thrice-weekly hemodialysis, and 29% knew the minimum standard weekly Kt/V target. Eighty-eight percent of fellows surveyed (22 of 25) agreed/strongly agreed that the OSCE was useful in self-assessing proficiency. Conclusions The OSCE may be used as a formative assessment of fellow proficiency in prescribing HHD.

Pediatric Resident Education in Quality Improvement (QI): A National Survey