1
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Zhang Z, He S, Wang H, Zhong Y, Zou H, Gao X. Immersion ultrasonography improves the repeatability of cephalic vein diameter measurements for inexperienced operators. Ren Fail 2022; 44:1634-1639. [PMID: 36239605 PMCID: PMC9578475 DOI: 10.1080/0886022x.2022.2131573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Objective To reduce the empirical dependence of ultrasound measurement of the cephalic vein diameter, improve the repeatability of measurements for inexperienced operators, and provide a new method for inexperienced operators. Methods Operators without ultrasound experience used contact ultrasound and immersion ultrasound to measure the diameter of the cephalic vein. The intraobserver and interobserver repeatability of measurements obtained via the two methods were analyzed. Results The intraobserver and interobserver repeatability of the cephalic vein diameter measured via contact ultrasound by inexperienced operators were average, with intraclass correlation coefficients (ICCs) of 0.572 (95% CI: 0.239–0.759) and 0.405 (95% CI: −0.057–0.666), respectively. The intraobserver and interobserver reproducibility of the cephalic vein diameter measured by immersion ultrasound were very good, with ICCs of 0.955 (95% CI: 0.922–0.975) and 0.943 (95% CI: 0.900–0.967), respectively. In the Bland–Altman diagram of the intraobserver and interobserver agreement of the immersion ultrasound measurements of the cephalic vein diameter, 96% of the points fell within the 95% limits of agreement. Conclusion Immersion ultrasonography can be used to measure the cephalic vein diameter while reducing the dependence of the results on operator experience; inexperienced operators can achieve very good repeatability.
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Affiliation(s)
- Zhijun Zhang
- Department of Ultrasound, University-Town Hospital of Chongqing Medical University, Chongqing, China
| | - Shu He
- Chongqing Renji Hospital, University of Chinese Academy of Sciences, Chongqing, China
| | - Hui Wang
- Department of Ultrasound, University-Town Hospital of Chongqing Medical University, Chongqing, China
| | - Yu Zhong
- Department of Ultrasound, University-Town Hospital of Chongqing Medical University, Chongqing, China
| | - Hairong Zou
- Department of Ultrasound, University-Town Hospital of Chongqing Medical University, Chongqing, China
| | - Xuan Gao
- Department of Ultrasound, University-Town Hospital of Chongqing Medical University, Chongqing, China
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2
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Affiliation(s)
- Mark G. Parker
- Division of Nephrology and Transplantation, Department of Medicine, Maine Medical Center, Portland, Maine,Department of Quality and Safety, Maine Medical Center, Portland, Maine,Tufts University School of Medicine, Boston, Massachusetts
| | - Stephen M. Sozio
- Division of Nephrology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland,Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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3
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Pivert KA, Boyle SM, Halbach SM, Chan L, Shah HH, Waitzman JS, Mehdi A, Norouzi S, Sozio SM. Impact of the COVID-19 Pandemic on Nephrology Fellow Training and Well-Being in the United States: A National Survey. J Am Soc Nephrol 2021; 32:1236-1248. [PMID: 33658283 PMCID: PMC8259681 DOI: 10.1681/asn.2020111636] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 01/21/2021] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND The coronavirus disease 2019 (COVID-19) pandemic's effects on nephrology fellows' educational experiences, preparedness for practice, and emotional wellbeing are unknown. METHODS We recruited current adult and pediatric fellows and 2020 graduates of nephrology training programs in the United States to participate in a survey measuring COVID-19's effects on their training experiences and wellbeing. RESULTS Of 1005 nephrology fellows-in-training and recent graduates, 425 participated (response rate 42%). Telehealth was widely adopted (90% for some or all outpatient nephrology consults), as was remote learning (76% of conferences were exclusively online). Most respondents (64%) did not have in-person consults on COVID-19 inpatients; these patients were managed by telehealth visits (27%), by in-person visits with the attending faculty without fellows (29%), or by another approach (9%). A majority of fellows (84%) and graduates (82%) said their training programs successfully sustained their education during the pandemic, and most fellows (86%) and graduates (90%) perceived themselves as prepared for unsupervised practice. Although 42% indicated the pandemic had negatively affected their overall quality of life and 33% reported a poorer work-life balance, only 15% of 412 respondents who completed the Resident Well-Being Index met its distress threshold. Risk for distress was increased among respondents who perceived the pandemic had impaired their knowledge base (odds ratio [OR], 3.04; 95% confidence interval [CI], 2.00 to 4.77) or negatively affected their quality of life (OR, 3.47; 95% CI, 2.29 to 5.46) or work-life balance (OR, 3.16; 95% CI, 2.18 to 4.71). CONCLUSIONS Despite major shifts in education modalities and patient care protocols precipitated by the COVID-19 pandemic, participants perceived their education and preparation for practice to be minimally affected.
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Affiliation(s)
- Kurtis A. Pivert
- Data Science and Public Impact, American Society of Nephrology, Washington, DC
| | - Suzanne M. Boyle
- Section of Nephrology, Hypertension, and Kidney Transplantation, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania
| | - Susan M. Halbach
- Department of Pediatrics, Division of Nephrology, University of Washington and Seattle Children’s Hospital, Seattle, Washington
| | - Lili Chan
- Charles Bronfman Institute of Personalized Medicine, Department of Genetics and Genomics; Department of Medicine, Division of Nephrology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Hitesh H. Shah
- Division of Kidney Diseases and Hypertension, Department of Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Great Neck, New York
| | - Joshua S. Waitzman
- Division of Nephrology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Ali Mehdi
- Department of Nephrology and Hypertension—Glickman Urological and Kidney Institute, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Sayna Norouzi
- Department of Nephrology, Loma Linda University Medical Center, Loma Linda, California
| | - Stephen M. Sozio
- Division of Nephrology, Department of Medicine, Johns Hopkins University School of Medicine; and Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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4
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Cunningham A, Hung W, Levin A, Jamal A. Adapting Nephrology Training Curriculum in the Era of COVID-19. Can J Kidney Health Dis 2021; 8:2054358120988446. [PMID: 33614055 PMCID: PMC7868498 DOI: 10.1177/2054358120988446] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 12/23/2020] [Indexed: 11/26/2022] Open
Abstract
PURPOSE OF REVIEW The COVID-19 pandemic has widespread implications not only for clinical practice but also for academic medicine and postgraduate training. The need to promote physical distancing and flexibility within our department has generated important revisions to the core curriculum for the Adult Nephrology Training Program in Vancouver, Canada. SOURCES OF INFORMATION We reviewed available educational resources and objectives to develop curricular adaptations informed by staff and trainee feedback. METHODS Many facets of the program including clinical rotations, scholarly activities, evaluation, and wellness have been impacted, and thus revised for online delivery where possible. Trainees have personalized a learning plan based on individual goals and supplemented by a list of internet-based resources for independent review. Changes in learning objectives and methods for specific rotations have occurred and are described. Ongoing evaluation will be undertaken. KEY FINDINGS Curriculum adaptation in the era of COVID-19 is necessary to ensure ongoing high-quality education for future nephrologists. We describe existing changes to formal training in British Columbia (BC), which will be tailored as the pandemic evolves, and anticipate them to have lasting impact on the way we structure training programs in the future. Standardization and harmonization of modified curriculum may be possible across Canada with sharing of these learnings. LIMITATIONS Formal evaluation of these changes in terms of knowledge acquisition and examination performance has not yet been undertaken. Next steps will include assessing and documenting the impact of this curricular transformation to further optimize scheduling, educational yield, and trainee wellness.
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Affiliation(s)
- Amanda Cunningham
- Division of Nephrology, The University of British Columbia, Vancouver, Canada
| | - Wayne Hung
- Division of Nephrology, The University of British Columbia, Vancouver, Canada
| | - Adeera Levin
- Division of Nephrology, The University of British Columbia, Vancouver, Canada
| | - Abeed Jamal
- Division of Nephrology, The University of British Columbia, Vancouver, Canada
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5
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Trepiccione F. ERA-EDTA fellowship, a 'bonne opportunité': the scientific and human experience of a fellow. Clin Kidney J 2019; 12:465-467. [PMID: 31384435 PMCID: PMC6671323 DOI: 10.1093/ckj/sfy123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2018] [Indexed: 12/02/2022] Open
Abstract
As a fellow of the ERA-EDTA long-term fellowship programme, I spent two fantastic years as a post-doc in Prof. D. Eladari’s laboratory at Inserm U970, Paris-Cardiovascular Research Centre. It was a highly formative and productive scientific experience. On a personal level, immersion into the French society and the international environment of the laboratory were added bonuses that enriched my experience. I am honoured to report my experience here from the ERA-EDTA fellowship programme. I hope this will inspire young fellows to apply for such a programme and pursue their career in science. Good mentorship, a passion for scientific investigation and determination are required.
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Affiliation(s)
- Francesco Trepiccione
- Biogem Scarl, Istituto di Ricerche Gaetano Salvatore, Ariano Irpino, Italy.,Department of Medical Translational Sciences, University of Campania 'Luigi Vanvitelli', Naples, Italy
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6
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Pinsk M, Karpinski J, Carlisle E. Introduction of Competence by Design to Canadian Nephrology Postgraduate Training. Can J Kidney Health Dis 2018; 5:2054358118786972. [PMID: 30034814 PMCID: PMC6050612 DOI: 10.1177/2054358118786972] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2018] [Accepted: 01/10/2018] [Indexed: 11/20/2022] Open
Abstract
Purpose of the review: The Royal College of Physicians and Surgeons of Canada, with its Competence by Design initiative, is adopting the principles of competency-based medical education for residency training and continuing professional development. This initiative is being undertaken to meet the new standards of medical education in Canada, which include social accountability to meet performance-based outcomes of training. Nephrology is poised to implement Competence by Design into residency training in July 2018 and initiate a continuous quality improvement cycle to periodically renew and update the training requirements to be socially accountable and relevant in the modern age of medicine. The purpose of this review is to describe the process of entrustable professional activity and required training experience development and how they will affect subspecialty training in Canada. Sources of information: The construct of competency-based medical education was derived from existing literature searches of the medical education literature, including documentation provided by the Royal College of Physicians and Surgeons of Canada. The content for each entrustable professional activity and milestone was derived by consensus from the community expertise of the working group, existing speciality training requirements, and elements of training requirements that the Royal College has been mandated to superimpose on all training requirements to meet societal expectations. Methods: The Royal College Specialty Committee in Nephrology participated in 2 years of preparation for this implementation, which has included the creation of a new educational design for the discipline and the elucidation of entrustable professional activities to describe the scope of nephrology practice and to guide teaching, learning, and assessment in residency, and ultimately maintenance of competence in practice. Key findings: This article introduces the set of entrustable professional activities for adult and pediatric nephrology and describes the national consultation as part of an ongoing quality improvement of this work. Limitations: The implementation of Competence by Design will be tested by whether trainees embrace competency-based education by training to just entrustable professional activities, rather than the holistic model idealized in physician training. This is mitigated by the entrustable professional activity development incorporating multiple layers of competencies beyond a procedural skill. Time commitment for faculty will pose additional challenges in increasing the time for assessment of trainees, but is supported by electronic platforms at the Royal College to assist in data gathering and analysis. Implications: Competence by Design in nephrology is an outcomes-based curriculum and assessment platform that aims to train nephrologists to meet societal expectations in an ever-changing and complicated health care system. The goals are to increase safety and professional accountability to society and improve upon the already high standards of training within Canada.
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Affiliation(s)
- Maury Pinsk
- Department of Paediatrics and Child Health, University of Manitoba, Winnipeg, MB, Canada
| | - Jolanta Karpinski
- Royal College of Physicians and Surgeons of Canada, Ottawa, ON, Canada
| | - Euan Carlisle
- Department of Medicine, McMaster University, Hamilton, ON, Canada
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7
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Brown RS. Kidney Biopsy Training and the Future of Nephrology: What about the Patient? Clin J Am Soc Nephrol 2018; 13:1105-1106. [PMID: 29907622 PMCID: PMC6032597 DOI: 10.2215/cjn.05870518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Robert S Brown
- Division of Nephrology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts
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8
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Sellars M, Clayton JM, Morton RL, Luckett T, Silvester W, Spencer L, Pollock CA, Walker RG, Kerr PG, Tong A. An Interview Study of Patient and Caregiver Perspectives on Advance Care Planning in ESRD. Am J Kidney Dis 2017; 71:216-224. [PMID: 29132946 DOI: 10.1053/j.ajkd.2017.07.021] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2017] [Accepted: 07/30/2017] [Indexed: 11/11/2022]
Abstract
BACKGROUND Advance care planning (ACP) empowers patients to consider and communicate their current and future treatment goals. However, it can be an emotionally charged process for patients with kidney disease and their caregivers. This study aimed to describe the perspectives and attitudes of patients with end-stage renal disease (ESRD) and their caregivers toward ACP. STUDY DESIGN Qualitative study. SETTING & PARTICIPANTS Patients with ESRD (n=24) and their caregivers (n=15) aged 36 to 91 years at various stages of ACP ("not commenced," "in progress," or "completed") from 3 renal services. METHODOLOGY Semistructured interviews. ANALYTICAL APPROACH Transcripts were analyzed using thematic analysis. RESULTS 5 major themes were identified: articulating core values (avoiding futile and undignified treatment, reevaluating terms of dialysis, framing a life worth living, and refusing to be a burden), confronting conversations (signifying death and defeat, accepting inevitable death, and alleviating existential tension), negotiating mutual understanding (broaching taboos and assisting conflicted caregivers), challenging patient autonomy (family pressures to continue dialysis, grief diminishing caregivers' capacity, and leveraging support), and decisional disempowerment (lacking medical transparency and disappointment with clinical disinterest). LIMITATIONS Only English-speaking patients/caregivers participated in the interview. CONCLUSIONS ACP provides patients with ESRD and their caregivers a conduit for accepting and planning for impending death and to express treatment preferences based on self-dignity and value of living. However, ACP can be considered taboo, may require caregivers to overcome personal and decisional conflict, and may be complex if patients and caregivers are unable to accept the reality of the patient's illness. We suggest that ACP facilitators and clinicians make ACP more acceptable and less confrontational to patients and caregivers and that strategies be put in place to support caregivers who may be experiencing overwhelming grief or who have conflicting goals, particularly when they are called on to make end-of-life decisions.
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Affiliation(s)
- Marcus Sellars
- Kolling Institute, Northern Clinical School, Faculty of Medicine, The University of Sydney, Sydney, Australia; Advance Care Planning Australia, Austin Health, Melbourne, Australia.
| | - Josephine M Clayton
- Kolling Institute, Northern Clinical School, Faculty of Medicine, The University of Sydney, Sydney, Australia; HammondCare Palliative & Supportive Care Service, Greenwich Hospital, Sydney, Australia; Improving Palliative Care through Clinical Trials (ImPaCCT), New South Wales, Australia
| | - Rachael L Morton
- NHMRC Clinical Trials Centre, The University of Sydney, Sydney, Australia
| | - Tim Luckett
- Improving Palliative Care through Clinical Trials (ImPaCCT), New South Wales, Australia; Faculty of Health, University of Technology Sydney (UTS), Sydney, Australia
| | - William Silvester
- Kolling Institute, Northern Clinical School, Faculty of Medicine, The University of Sydney, Sydney, Australia
| | - Lucy Spencer
- Department of Renal Medicine, Royal North Shore Hospital, Sydney, Australia
| | - Carol A Pollock
- Kolling Institute, Northern Clinical School, Faculty of Medicine, The University of Sydney, Sydney, Australia
| | - Rowan G Walker
- Department of Renal Medicine, Alfred Hospital, Melbourne, Australia
| | - Peter G Kerr
- Department of Nephrology, Monash Medical Centre, Melbourne, Australia
| | - Allison Tong
- Sydney School of Public Health, The University of Sydney, Sydney, Australia; Centre for Kidney Research, The Children's Hospital at Westmead, NSW, Australia
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9
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Topf JM, Sparks MA, Phelan PJ, Shah N, Lerma EV, Graham-Brown MPM, Madariaga H, Iannuzzella F, Rheault MN, Oates T, Jhaveri KD, Hiremath S. The Evolution of the Journal Club: From Osler to Twitter. Am J Kidney Dis 2017; 69:827-836. [PMID: 28233653 DOI: 10.1053/j.ajkd.2016.12.012] [Citation(s) in RCA: 100] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2016] [Accepted: 12/11/2016] [Indexed: 11/11/2022]
Abstract
Journal clubs have typically been held within the walls of academic institutions and in medicine have served the dual purpose of fostering critical appraisal of literature and disseminating new findings. In the last decade and especially the last few years, online and virtual journal clubs have been started and are flourishing, especially those harnessing the advantages of social media tools and customs. This article reviews the history and recent innovations of journal clubs. In addition, the authors describe their experience developing and implementing NephJC, an online nephrology journal club conducted on Twitter.
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Affiliation(s)
- Joel M Topf
- Oakland University William Beaumont School of Medicine, Detroit, MI
| | - Matthew A Sparks
- Division of Nephrology, Department of Medicine, Duke University and Durham VA Medical Center, Durham, NC
| | - Paul J Phelan
- Department of Nephrology, Royal Infirmary of Edinburgh, NHS Lothian, Edinburgh, United Kingdom
| | - Nikhil Shah
- Department of Nephrology and Immunology, University of Alberta, Edmonton, Canada
| | - Edgar V Lerma
- University of Illinois at Chicago/Advocate Christ Medical Center, Oaklawn, IL
| | | | - Hector Madariaga
- Division of Nephrology, University of Maryland Medical Center, Baltimore, MD
| | | | - Michelle N Rheault
- Department of Pediatrics, University of Minnesota Masonic Children's Hospital, Minneapolis, MN
| | - Thomas Oates
- UCL Centre for Nephrology, London, United Kingdom
| | - Kenar D Jhaveri
- Hofstra Northwell School of Medicine, Hempstead, NY; Division of Kidney Diseases and Hypertension, Department of Medicine, North Shore University Hospital and Long Island Jewish Medical Center, Northwell Health, Great Neck, NY
| | - Swapnil Hiremath
- University of Ottawa and Ottawa Hospital Research Institute, Ottawa, Canada.
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10
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Sellars M, Tong A, Luckett T, Morton RL, Pollock CA, Spencer L, Silvester W, Clayton JM. Clinicians' Perspectives on Advance Care Planning for Patients With CKD in Australia: An Interview Study. Am J Kidney Dis 2017; 70:315-323. [PMID: 28216281 DOI: 10.1053/j.ajkd.2016.11.023] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Accepted: 11/27/2016] [Indexed: 11/11/2022]
Abstract
BACKGROUND Advance care planning (ACP) empowers patients to consider and communicate their current and future treatment goals. However, ACP is not widely implemented in chronic kidney disease (CKD) care settings. This study aims to describe clinicians' beliefs, challenges, and perspectives of ACP in patients with CKD. STUDY DESIGN Qualitative study. SETTING & PARTICIPANTS Nephrologists (n=20), nurses (n=7), and social workers (n=4) with a range of experience in facilitating ACP for patients with CKD across Australia. METHODOLOGY Semistructured interviews were digitally recorded and transcribed verbatim. ANALYTICAL APPROACH Transcripts were analyzed using thematic analysis. RESULTS 5 major themes were identified: facilitating informed decision making (avoiding preconceptions, conveying complete truths, focusing on supportive care, and synchronizing with evolving priorities), negotiating moral boundaries (contending with medical futility and respecting patient vs family autonomy), navigating vulnerable conversations (jeopardizing the therapeutic relationship, compromising professional confidence, emotionally invested, and enriching experiences), professional disempowerment (unsupportive culture, doubting logistical feasibility, and making uncertain judgments), and clarifying responsibilities (governing facilitation, managing tensions, and transforming multidisciplinary relationships). LIMITATIONS Some findings may be specific to the Australian context. CONCLUSIONS The tensions among themes reflect that ACP is paradoxically rewarding for clinicians because ACP empowers patients yet can expose personal and professional vulnerabilities. Clinicians believe that a more collaborative approach is needed, with increased efforts to identify the evolving and individualized needs and goals of patients with CKD. Models of ACP that address clinicians' personal and professional vulnerabilities when initiating ACP may foster greater confidence and cultural acceptance of ACP in the CKD setting.
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Affiliation(s)
- Marcus Sellars
- Sydney Medical School, The University of Sydney, Sydney, Australia
| | - Allison Tong
- Sydney School of Public Health, The University of Sydney, Sydney, Australia; Centre for Kidney Research, The Children's Hospital at Westmead, Australia
| | - Tim Luckett
- Improving Palliative Care through Clinical Trials (ImPaCCT) New South Wales, Australia; Faculty of Health, University of Technology Sydney (UTS), Australia
| | - Rachael L Morton
- NHMRC Clinical Trials Centre, The University of Sydney, Australia
| | - Carol A Pollock
- Sydney Medical School, The University of Sydney, Sydney, Australia; Department of Renal Medicine, Royal North Shore Hospital, Australia
| | - Lucy Spencer
- NHMRC Clinical Trials Centre, The University of Sydney, Australia
| | | | - Josephine M Clayton
- Sydney Medical School, The University of Sydney, Sydney, Australia; Improving Palliative Care through Clinical Trials (ImPaCCT) New South Wales, Australia; HammondCare Palliative & Supportive Care Service, Greenwich Hospital, Sydney, Australia.
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11
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Feehally J, Brusselmans A, Finkelstein FO, Harden P, Harris D, Manuzi G, Naicker S, Tonelli M, Cameron H. Improving global health: measuring the success of capacity building outreach programs: a view from the International Society of Nephrology. Kidney Int Suppl (2011) 2016; 6:42-51. [PMID: 30675419 DOI: 10.1016/j.kisu.2016.09.002] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
Capacity building is key to the advance of health care in the developing world, but capacity building can take several forms, and it is not yet clear which forms and funding models are most effective. The International Society of Nephrology (ISN) has developed and sustained a portfolio of global outreach programs that make a unique contribution at low cost to the appropriate training and continuing support of nephrologists throughout the developing world. We describe the programs and present encouraging findings of their outcomes. Finally, we reflect on how the ISN interventions and evaluations measure up against recommended approaches in the literature and consider lessons for ISN and other organizations involved in planning, evaluating, and benchmarking similar programs.
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Affiliation(s)
- John Feehally
- International Society of Nephrology, Brussels, Belgium
| | | | | | - Paul Harden
- International Society of Nephrology, Brussels, Belgium
| | - David Harris
- International Society of Nephrology, Brussels, Belgium
| | | | | | | | - Helen Cameron
- Centre for Medical Education, University of Edinburgh, Edinburgh, UK
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12
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McQuillan RF, Clark E, Zahirieh A, Cohen ER, Paparello JJ, Wayne DB, Barsuk JH. Performance of Temporary Hemodialysis Catheter Insertion by Nephrology Fellows and Attending Nephrologists. Clin J Am Soc Nephrol 2015; 10:1767-72. [PMID: 26408550 DOI: 10.2215/cjn.01720215] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2015] [Accepted: 06/17/2015] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND OBJECTIVES Concerns have been raised about nephrology fellows' skills in inserting temporary hemodialysis catheters. Less is known about temporary hemodialysis catheter insertion skills of attending nephrologists supervising these procedures. The aim of this study was to compare baseline temporary hemodialysis catheter insertion skills of attending nephrologists with the skills of nephrology fellows before and after a simulation-based mastery learning (SBML) intervention. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS This pre- post-intervention study with a pretest-only comparison group was conducted at the University of Toronto in September of 2014. Participants were nephrology fellows and attending nephrologists from three university-affiliated academic hospitals who underwent baseline assessment of internal jugular temporary hemodialysis catheter insertion skills using a central venous catheter simulator. Fellows subsequently completed an SBML intervention, including deliberate practice with the central venous catheter simulator. Fellows were expected to meet or exceed a minimum passing score at post-test. Fellows who did not meet the minimum passing score completed additional deliberate practice. Attending nephrologist and fellow baseline performance on the temporary hemodialysis catheter skills assessment was compared. Fellows' pre- and post-test temporary hemodialysis catheter insertion performance was compared to assess the effectiveness of SBML. The skills assessment was scored using a previously published 28-item checklist. The minimum passing score was set at 79% of checklist items correct. RESULTS In total, 19 attending nephrologists and 20 nephrology fellows participated in the study. Mean attending nephrologist checklist scores (46.1%; SD=29.5%) were similar to baseline scores of fellows (41.1% items correct; SD=21.4%; P=0.55). Only two of 19 attending nephrologists (11%) met the minimum passing score at baseline. After SBML, fellows' mean post-test score improved to 91.3% (SD=6.9%; P<0.001). Median time between pre- and post-test was 24 hours. CONCLUSIONS Attending nephrologists' baseline temporary hemodialysis catheter insertion skills were highly variable and similar to nephrology fellows' skills, with only a small minority able to competently insert a temporary hemodialysis catheter. SBML was extremely effective for training fellows and should be considered for attending nephrologists who supervise temporary hemodialysis catheter insertions.
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Affiliation(s)
| | - Edward Clark
- Division of Nephrology, The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada; and
| | - Alireza Zahirieh
- Division of Nephrology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | | | | | - Diane B Wayne
- Departments of Medicine and Medical Education, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Jeffrey H Barsuk
- Departments of Medicine and Medical Education, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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13
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Prince LK, Abbott KC, Green F, Little D, Nee R, Oliver JD, Bohen EM, Yuan CM. Expanding the role of objectively structured clinical examinations in nephrology training. Am J Kidney Dis 2014; 63:906-12. [PMID: 24613400 DOI: 10.1053/j.ajkd.2014.01.419] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2013] [Accepted: 01/03/2014] [Indexed: 11/11/2022]
Abstract
Objectively structured clinical examinations (OSCEs) are widely used in medical education, but we know of none described that are specifically for nephrology fellowship training. OSCEs use simulation to educate and evaluate. We describe a technically simple, multidisciplinary, low-cost OSCE developed by our program that contains both examination and training features and focuses on management and clinical knowledge of rare hemodialysis emergencies. The emergencies tested are venous air embolism, blood leak, dialysis membrane reaction, and hemolysis. Fifteen fellows have participated in the OSCE as examinees and/or preceptors since June 2010. All have passed the exercise. Thirteen responded to an anonymous survey in July 2013 that inquired about their confidence in managing each of the 4 tested emergencies pre- and post-OSCE. Fellows were significantly more confident in their ability to respond to the emergencies after the OSCE. Those who subsequently saw such an emergency reported that the OSCE experience was somewhat or very helpful in managing the event. The OSCE tested and trained fellows in the recognition and management of rare hemodialysis emergencies. OSCEs and simulation generally deserve greater use in nephrology subspecialty training; however, collaboration between training programs would be necessary to validate such exercises.
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Affiliation(s)
- Lisa K Prince
- Nephrology Service, Department of Medicine, Walter Reed National Military Medical Center, Bethesda, MD
| | - Kevin C Abbott
- Nephrology Service, Department of Medicine, Walter Reed National Military Medical Center, Bethesda, MD
| | - Felicidad Green
- Nephrology Service, Department of Medicine, Walter Reed National Military Medical Center, Bethesda, MD
| | - Dustin Little
- Nephrology Service, Department of Medicine, Walter Reed National Military Medical Center, Bethesda, MD
| | - Robert Nee
- Nephrology Service, Department of Medicine, Walter Reed National Military Medical Center, Bethesda, MD
| | - James D Oliver
- Nephrology Service, Department of Medicine, Walter Reed National Military Medical Center, Bethesda, MD
| | - Erin M Bohen
- Organ Transplant Service, Department of Surgery, Walter Reed National Military Medical Center, Bethesda, MD
| | - Christina M Yuan
- Nephrology Service, Department of Medicine, Walter Reed National Military Medical Center, Bethesda, MD.
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14
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Arroyo D, Dominguez P, Panizo N, Quiroga B, Calvo M, Álvarez L, Macias N, Menendez D, Blazquez L, Galan I, Reque J. A Spanish multicentric study to evaluate the clinical activity of nephrology fellows during in-hospital on-call shifts. Clin Kidney J 2013; 6:556-60. [PMID: 26064520 PMCID: PMC4438395 DOI: 10.1093/ckj/sft080] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2013] [Accepted: 06/21/2013] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Nephrologists develop their work in diverse scenarios. A training programme must qualify trainees to assist different kinds of problems. The aim of this study was to characterize patients and pathologies that Spanish nephrology fellows face while on-call. METHODS This is a descriptive study with clinical and demographic data gathered with a form by 10 nephrology fellows of five university hospitals of Madrid (Spain), throughout their in-hospital 24 h on-call shifts in February and March 2013. RESULTS We collected 409 episodes over 338 patients, through 72 shifts. Among these, 16.7% had previous normal renal function, 24.6% chronic kidney disease, 39.5% were on dialysis and 18.2% had a kidney transplant. Most of the consults came from the emergency room (35.9%) or the previous on-call team (13.7%). Afterwards, the most usual destiny was admittance to a nephrology department (32.8%) or discharge (20.5%). The most frequent reason for consulting was a decline in renal function (31.6%) and the second motive an infection. Thirty-four episodes (8.3%) were related to dialysis access problems. Medical treatment was prescribed in 79.2% of the cases, primarily fluids (47.2%) and antibiotics (42.2%). The fellow had to place a central venous catheter in 24 cases (5.9%). Renal replacement therapy was prescribed in 19.8% of the episodes. CONCLUSIONS Specific renal reasons for consulting nephrologists are common, such as acute kidney injury or dialysis access complications. These patients benefit from a specialized approach to their problems. Clinical activities during in-hospital out-of-hours shifts are a priceless tool as part of the training programme of nephrology fellows.
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Affiliation(s)
- David Arroyo
- Hospital General Universitario Gregorio Marañón , Madrid , Spain
| | | | - Nayara Panizo
- Hospital General Universitario Gregorio Marañón , Madrid , Spain
| | - Borja Quiroga
- Hospital General Universitario Gregorio Marañón , Madrid , Spain
| | - Marta Calvo
- Hospital Clínico San Carlos , Madrid , Spain
| | | | - Nicolás Macias
- Hospital General Universitario Gregorio Marañón , Madrid , Spain
| | | | - Luis Blazquez
- Hospital Universitario de La Princesa , Madrid , Spain
| | - Isabel Galan
- Hospital General Universitario Gregorio Marañón , Madrid , Spain
| | - Javier Reque
- Hospital General Universitario Gregorio Marañón , Madrid , Spain
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15
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Abstract
In the past 25 years the International Society of Nephrology has sponsored 545 physicians from 83 developing countries to undertake nephrology training in renal units in the developed world. Data collected biennially from past fellows have demonstrated a very positive impact of the program on individual trainees and their home institutions. Many of the trainees have gone on to leadership positions in their home institutions, countries, and regions. Increasingly, fellowships are undertaken in selected developed centers within the fellow's own region, which increases the relevance and utility of the training to the fellow and the fellow's home institution, and lessens the risk of ‘brain drain'.
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Affiliation(s)
- David C H Harris
- International Society of Nephrology (ISN) Fellowship Program , Sydney, New South Wales, Australia
| | - Sophie Dupuis
- ISN Global Outreach (GO) Programs , Brussels, Belgium
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