Point-of-Care Ultrasound Training during Nephrology Fellowship

Abstract

Background and objectivesPoint-of-care ultrasound (POCUS)—performed by a clinician during a patient encounter and used in patient assessment and care planning—has many potential applications in nephrology. Yet, US nephrologists have been slow to adopt POCUS, which may affect the training of nephrology fellows. This study sought to identify the current state of POCUS training and implementation in nephrology fellowships.Design, setting, participants, & measurementsConcise survey instruments measuring attitudes toward POCUS, its current use, fellow competence, and POCUS curricula were disseminated to (1) 912 US nephrology fellows taking the 2021 Nephrology In-Training Examination and (2) 229 nephrology training program directors and associate program directors. Fisher exact, chi-squared, and Wilcoxon rank sum tests were used to compare the frequencies of responses and the average responses between fellows and training program directors/associate program directors when possible.ResultsFellow and training program directors/associate program directors response rates were 69% and 37%, respectively. Only 38% of fellows (240 respondents) reported receiving POCUS education during their fellowship, and just 33% of those who did receive POCUS training reported feeling competent to use POCUS independently. Similarly, just 23% of training program directors/associate program directors indicated that they had a POCUS curriculum in place, although 74% of training program directors and associate program directors indicated that a program was in development or that there was interest in creating a POCUS curriculum. Most fellow and faculty respondents rated commonly covered POCUS topics—including dialysis access imaging and kidney biopsy—as “important” or “very important,” with the greatest interest in diagnostic kidney ultrasound. Guided scanning with an instructor was the highest-rated teaching strategy. The most frequently reported barrier to POCUS program development was the lack of available instructors.ConclusionsDespite high trainee and faculty interest in POCUS, the majority of current nephrology fellows are not receiving POCUS training. Hands-on training guided by an instructor is highly valued, yet availability of adequately trained instructors remains a barrier to program development.PodcastThis article contains a podcast at https://www.asn-online.org/media/podcast/CJASN/2022_09_21_CJN01850222.mp3

Current opinion in quantitative lung ultrasound for the nephrologist

“…Recently, a national survey of nephrology fellows and training program directors demonstrated that point-of-care ultrasound (POCUS) is starting to fill that role with 38% of nephrology trainees reporting some form of POCUS education [36 ▪▪ ]. More investment is needed on the part of fellowships with only one third of those fellows reporting POCUS training feeling confident in performing POCUS [37 ▪ ].…”

Point of Care Ultrasound Training in Nephrology: Twitter Poll as a Modern Tool for Development of an Effective Curriculum

“…We have previously outlined the scope and value of multi-organ POCUS in nephrology and provided a detailed blueprint of our curriculum [2,3]. However, despite growing interest among nephrologists, structured POCUS education remains rudimentary in most of the nephrology fellowship programs, which was recently highlighted by Moore et al [4] in their national survey. Not unsurprisingly, the most frequently reported barrier to POCUS program development was the lack of trained faculty.…”

Incorporating Training in POCUS in Nephrology Fellowship Curriculum

“…Moore et al . (2) surveyed fellows and training program directors/associate program directors (TPDs/APDs) using a digital survey instrument. Demographic information was broadly representative of fellows as a whole.…”

“…Indeed, discussion is ongoing about whether to add core POCUS competencies to the Accreditation Council for Graduate Medical Education (ACGME) requirements for nephrology training programs. In this issue of CJASN, Moore et al (2) present data from a national survey of nephrology fellows and training program directors on training in POCUS. They demonstrate the existence of established POCUS education in a substantial portion of nephrology training programs and the desire on the part of the vast majority of fellows and training program directors to expand learning opportunities in this sector.…”

“…The study by Moore et al . (2) comes at the exact right time as more and more nephrology fellowships are building POCUS programs in response to growing demand from nephrology fellows. Moore et al .…”