Nephrology program directors report insufficient point-of-care ultrasound training
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Nephrology program directors, fellows and select graduates report insufficient point-of-care ultrasound training, according to data published in Kidney Medicine.
“Compared to some medicine subspecialties, such as cardiology and pulmonary-critical care, nephrology has been slower to incorporate [point-of-care ultrasound] POCUS into formal training and clinical practice and POCUS training varies widely among fellowship programs,” David L. Cook, MD, from the Walter Reed National Military Medical Center in Maryland, and colleagues wrote. They added, “Nephrology fellows have indicated a desire for more ultrasound and POCUS training. In a 2021 survey, 38% of nephrology fellows reported receiving POCUS training during fellowship and only 33% of these felt competent to perform POCUS independently.”
To determine how POCUS is being taught during fellowship and used in clinical practice, in addition to the barriers to teaching and use, researchers conducted an anonymous online survey. Participants of the survey included 151 nephrology program directors, their fellows from the academic year 2021 to 2022, and 89 graduates (1980-2021) of the Walter Reed nephrology program.
Program directors completed a 15-question survey online between Jan. 5 and March 6, 2022. They were asked to forward a 15-question survey to their fellows, which researchers then compared to the responses shared by the program directors.
As for the graduates, they completed a 16-question survey online between Jan. 4 and March 5, 2022. According to the study, questions paralleled the program director and fellow surveys, when possible, to allow for comparisons that were then analyzed using Chi-square or Fisher’s exact tests.
Survey results
Overall, 46% of program directors responded, 33% of fellows responded and 62% of graduates responded. Survey results revealed 51% of program directors offered PCIS training, 71% of which occurred during bedside training in nonPOCUS-oriented rotations, 68% occurred in didactic lectures and 43% occurred in simulations.
Among fellows, 43% reported undergoing training, but 56% reported insufficient POCUS training for kidney (56%), bladder (50%) and inferior vena cava assessments (46%). Both fellows and program directors reported a lack of training and confidence among faculty when it came to POCUS, and more than half of both groups reported a desire to have POCUS incorporated into fellowship curriculum. Further, 59% of fellows and 61% of graduates reported wanting hands-on training vs. didactic lectures of simulation.
Program directors shared barriers to training included not enough trained faculty (78%), not enough training themselves (55%) and equipment expense (51%).
Possible solution
Cook and colleagues noted that lack of training in some programs does not mean it is impossible to sufficiently teach POCUS.
“Our fellowship has instituted a POCUS training program; a 4-week rotation dedicated to training and practice in nephrology-specific POCUS with a required attainment of a minimum threshold number of procedures,” Cook and colleagues wrote. “Four classes have completed this program (training years 2018-2019 through 2021-2022). Notably, 50% of our graduates with less than 5 years practice experience (who would have received this training) regularly perform POCUS, significantly higher than those with 5 years or more in practice. While this particular model may not be feasible in every hospital system, we would recommend dedicated hands-on training and a minimum threshold number of procedures for faculty."
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