Nephrology training in Australia and New Zealand: A survey of outcomes and adequacy

Beaton, Thomas J; Krishnasamy, Rathika; Toussaint, Nigel D; Phoon, Richard K.S.; Gray, Nicholas A

doi:10.1111/nep.12720

Cited by 13 publications

(33 citation statements)

References 19 publications

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“…This might also suggest that prognosis is communicated to patients infrequently. A recent survey found that 97% of Australian and New Zealand nephrology fellows over the last 10 years reported conservative care being a very important skill, but only 43% reported being well trained in it (27). This represents an area for clinical improvement, and education programs for nephrology trainees have begun to address this need.…”

Section: Discussionmentioning

confidence: 99%

Conservative Management and End-of-Life Care in an Australian Cohort with ESRD

Morton

Webster

McGeechan

et al. 2016

CJASN

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Section: Discussionmentioning

confidence: 99%

Conservative Management and End-of-Life Care in an Australian Cohort with ESRD

Morton

Webster

McGeechan

et al. 2016

CJASN

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“…A more recent survey of Australian and New Zealand nephrologists within 10 years of completing fellowship echoed these findings, noting persistent concerns regarding a lack of preparedness in PD, HHD, and conservative care. 7 Notably, this survey showed no improvement in training between cohorts from 2003 to 2009 and 2010 to 2014. Both studies identified practice management and research training as additional areas for improvement.…”

mentioning

confidence: 75%

“…Few educational needs assessments of nephrology fellowships have been conducted, but the limited literature points to several areas in need of improvement. [5][6][7][8] The most recent assessment, a survey of nephrologists generally in practice for ,5 years, identified several areas in which participants felt less than well prepared, including peritoneal dialysis (PD) and home hemodialysis (HHD) modalities; performing and interpreting renal ultrasounds; end of life care; and the care of patients with pediatric kidney diseases. 6 Nephrologists felt well trained in other core areas, including in-center hemodialysis, glomerular disease, hypertension, and general CKD management.…”

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confidence: 99%

Education in Nephrology Fellowship: A Survey-Based Needs Assessment

Rope

Pivert

Parker

et al. 2017

JASN

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Educational needs assessments for nephrology fellowship training are limited. This study assessed fellows' perceptions of current educational needs and interest in novel modalities that may improve their educational experience and quantified educational resources used by programs and fellows. We distributed a seven-question electronic survey to all United States-based fellows receiving complimentary American Society of Nephrology (ASN) membership at the end of the 2015-2016 academic year in conjunction with the ASN Nephrology Fellows Survey. One third (320 of 863; 37%) of fellows in Accreditation Council for Graduate Medical Education-accredited positions responded. Most respondents rated overall quality of teaching in fellowship as either "good" (37%) or "excellent" (44%), and most (55%) second-year fellows felt "fully prepared" for independent practice. Common educational resources used by fellows included UpToDate, , and; others-including ASN's online curricula-were used less often. Fellows indicated interest in additional instruction in several core topics, including home dialysis modalities, ultrasonography, and pathology. Respondents strongly supported interventions to improve pathology instruction and increase time for physiology and clinical review. In conclusion, current nephrology fellows perceive several gaps in training. Innovation in education and training is needed to better prepare future nephrologists for the growing challenges of kidney care.

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“…In a similar survey of Australian nephrologists, fewer than half of the respondents felt comfortable with automated PD (38.8%) and HHD (41.8%). 21 Rope and colleagues performed an educational needs assessment in 2017 19 to identify gaps in training for current nephrology fellows in the United States. Of the top five subjects identified (HHD, PD, kidney ultrasound, acute glomerulonephritis and obstetric nephrology), HHD (51%) and PD (45%) were identified as the areas most lacking from their training.…”

Section: Nephrology Training and Preparedness For Prescribing Home Dialysismentioning

confidence: 99%

The use of virtual physician mentoring to enhance home dialysis knowledge and uptake

et al. 2021

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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. K E Y W O R D S home dialysis, home haemodialysis, peritoneal dialysis, project ECHO, virtual mentorship | INTRODUCTIONThe Advancing American Kidney Health (AAKH) Initiative 1 in the United States has clearly signalled that home dialysis uptake needs to increase. The nephrology community has been challenged to provide either a kidney transplant or a home dialysis modality for 80% of patients requiring end-stage kidney disease (ESKD) care by 2025. Home dialysis therapies (home haemodialysis [HHD] and peritoneal dialysis [PD]) are cost-effective 2 and highly preferred modalities of renal replacement therapies when nephrologists and patients are surveyed. [3][4][5][6][7][8] Home dialysis therapies have been associated with improved quality of life, 9 greater satisfaction with therapy, 9 and improved blood pressure control. 10 Patients on HHD have reductions in left ventricular mass 10 while patients on PD have improved preservation of native kidney function when compared to patients on incentre haemodialysis (ICHD). 11 This has led nephrologists and professional bodies to adopt a 'Home First' culture when educating patients about kidney replacement therapies. 3 The incidence and prevalence of home dialysis therapies vary internationally and are explained by various clinical, social and economic factors. 12 We acknowledge that the barriers to home therapies will differ in different contexts. However, the relatively low rates of home dialysis therapies in the United States warrant further attention. According to the most recent USRDS data, 13,14 approximately 85% of incident ESKD patients in the United States begin ICHD as the initial mode of therapy. Only 10.9% of the incident ESKD population in 2018 initiated PD and even fewer initiated HHD as initial therapy (0.3% of incident patients with ESKD).The low rates of home modality uptake in the United States are not fully explained by c...

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Nephrology training in Australia and New Zealand: A survey of outcomes and adequacy

Abstract: Nephrology training in ANZ generally meets clinical needs and most secure their desired employment. Training in management and research are areas for improvement.

Cited by 13 publications

References 19 publications

Conservative Management and End-of-Life Care in an Australian Cohort with ESRD

Conservative Management and End-of-Life Care in an Australian Cohort with ESRD

Education in Nephrology Fellowship: A Survey-Based Needs Assessment

The use of virtual physician mentoring to enhance home dialysis knowledge and uptake

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