Questionnaire instrument to assess knowledge of chronic kidney disease clinical practice guidelines among internal medicine residents

Abstract

The National Kidney Foundation published Kidney Disease Outcomes Quality Initiative guidelines that recommend early detection and management of chronic kidney disease (CKD) and timely referral to a nephrologist. Many patients with CKD are seen by primary care doctors who maybe less experienced than a nephrologist to offer optimal early CKD care. It is not known whether postgraduate training adequately prepares a future internist in CKD management. We developed a 15-item questionnaire instrument to assess knowledge of CKD guidelines among internal medicine residents in USA using an online survey programme. We studied the validity and reliability measures of our instrument. The survey was completed by 166 PGY1 (postgraduate year one), 187 PGY2 and 126 PGY3. The questionnaire tested various aspects of CKD including definition, classification, identification of risk factors, laboratory evaluation, development of clinical action plan, identification of complications, anaemia and bone and mineral disorder, referral to a nephrologist and medication use. Validity was supported by the use of official guidelines and an expert panel of nephrologists to develop content and improvement in mean test performance with increasing level of training (PGY1 59.2 +/- 13.5%, PGY2 62.6 +/- 12.3% and PGY3 64.3 +/- 12.2%; P = 0.002). The reliability coefficient for the questionnaire instrument (Cronbach's alpha) was 0.69. Our brief questionnaire is a valid and reliable instrument to assess knowledge of CKD guidelines among internal medicine residents and identify specific gaps for improvement.