Dataset Information

Race disparities in U.S. nephrology fellowship training.

ABSTRACT:

Background and objectives

Renal disease disproportionately affects African-American patients. Trust has been implicated as an important factor in patient outcomes. Higher levels of trust and better interpersonal care have been reported when race of patient and physician are concordant. The purpose of this analysis was to examine trends in the racial background of U.S. medical school graduates, internal medicine residents, nephrology fellows, and patients with ESRD.

Design, setting, participants, & measurements

Data for medical school graduates were obtained from the Association of American Medical Colleges and data for internal medicine and nephrology trainees from GME Track. ESRD data were obtained from U.S. Renal Data System (USRDS) annual reports.

Results

A significant disparity continues to exist between the proportional race makeup of African-American nephrology fellows (3.8%) and ESRD patients (32%). The low numbers of African-American nephrology fellows, and consequently new nephrologists, in light of the increase in ESRD patients has important implications for patient-centered nephrology care.

Conclusions

Efforts are needed to increase minority recruitment into nephrology training programs, to more closely balance the racial background of trainees and patients in hopes of fostering improved trust between ESRD caregivers and patients, increasing access to care, alleviating ESRD health care disparities, and improving patient care.

SUBMITTER: Onumah C

PROVIDER: S-EPMC3052231 | biostudies-literature | 2011 Feb

REPOSITORIES: biostudies-literature

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Publications

Race disparities in U.S. nephrology fellowship training.

Onumah Chavon C Kimmel Paul L PL Rosenberg Mark E ME

Clinical journal of the American Society of Nephrology : CJASN 20110127 2

<h4>Background and objectives</h4>Renal disease disproportionately affects African-American patients. Trust has been implicated as an important factor in patient outcomes. Higher levels of trust and better interpersonal care have been reported when race of patient and physician are concordant. The purpose of this analysis was to examine trends in the racial background of U.S. medical school graduates, internal medicine residents, nephrology fellows, and patients with ESRD.<h4>Design, setting, pa ...[more]

PMID: 21273375

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Project description:BackgroundControversy exists as to whether the insertion of temporary hemodialysis catheters (THDCs) should remain a mandatory requirement of nephrology fellowship training in Canada. A survey conducted by our group in 2012 showed that many nephrology trainees reported inadequate training to achieve procedural competence.ObjectiveTo determine the current practices and training of the insertion of THDCs in nephrology fellowship programs in Canada and how this has evolved since 2012.DesignA survey study was designed comprising the following sections: demographics, details regarding the number and types of THDCs inserted within the past 6 months of fellowship training, adherence to sterile techniques, the use of ultrasound guidance during THDC insertion, training for THDC insertion received before and during nephrology fellowship, and self-perceived adequacy of training and competence in THDC insertion.SettingThe survey was distributed by e-mail in May 2018 either directly or through Canadian nephrology training programs.ParticipantsCurrent trainees of Canadian adult nephrology training programs.MeasurementsDescriptive statistics were used to analyze the summarized data. The means and interquartile ranges (IQRs) were used to summarize the number of THDC insertions performed, and the categorical data, including data on training and self-perceived competency, were reported using frequencies and percentages. A chi-squared test was used to evaluate the relationship between those who received simulation-based training and self-perceived confidence in either internal jugular or femoral catheter insertion.MethodsAn online survey, available in both English and French, was distributed to all adult nephrology trainees in Canada in May 2018 either directly or through their respective programs.ResultsCompleted surveys were received from 46 of 136 nephrology trainees across Canada (34%). Of those who responded, the median (IQR) number of combined femoral and/or internal jugular THDCs inserted in the past 6 months of fellowship training was 3 (1-6). Eight respondents (17%) indicated that they had not inserted a THDC in the past 6 months. However, only 7 of 42 respondents (17%) indicated that they did not feel competent or adequately trained to perform either femoral or internal jugular THDC insertion.LimitationsLimitations of the study include participation of trainees at different stages of their training. Many trainees indicated that it was not a requirement to keep a formal log of their procedures performed and likely had recall bias when reporting their procedure details.ConclusionsNephrology fellows in Canada are performing fewer THDC insertions compared to 2012 but report higher levels of self-perceived competence and better training. This may be as a result of significantly more simulation-based training. Our data suggest that training to procedural mastery using simulation-based techniques may be a path to ensuring adequate training for THDC insertion despite fewer procedures being performed during training.

Project description:BACKGROUND AND OBJECTIVES:Medical specialty and subspecialty fellowship programs administer subject-specific in-training examinations to provide feedback about level of medical knowledge to fellows preparing for subsequent board certification. This study evaluated the association between the American Society of Nephrology In-Training Examination and the American Board of Internal Medicine Nephrology Certification Examination in terms of scores and passing status. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS:The study included 1684 nephrology fellows who completed the American Society of Nephrology In-Training Examination in their second year of fellowship training between 2009 and 2014. Regression analysis examined the association between In-Training Examination and first-time Nephrology Certification Examination scores as well as passing status relative to other standardized assessments. RESULTS:This cohort included primarily men (62%) and international medical school graduates (62%), and fellows had an average age of 32 years old at the time of first completing the Nephrology Certification Examination. An overwhelming majority (89%) passed the Nephrology Certification on their first attempt. In-Training Examination scores showed the strongest association with first-time Nephrology Certification Examination scores, accounting for approximately 50% of the total explained variance in the model. Each SD increase in In-Training Examination scores was associated with a difference of 30 U (95% confidence interval, 27 to 33) in certification performance. In-Training Examination scores also were significantly associated with passing status on the Nephrology Certification Examination on the first attempt (odds ratio, 3.46 per SD difference in the In-Training Examination; 95% confidence interval, 2.68 to 4.54). An In-Training Examination threshold of 375, approximately 1 SD below the mean, yielded a positive predictive value of 0.92 and a negative predictive value of 0.50. CONCLUSIONS:American Society of Nephrology In-Training Examination performance is significantly associated with American Board of Internal Medicine Nephrology Certification Examination score and passing status.

Dataset Information

Race disparities in U.S. nephrology fellowship training.

Background and objectives

Design, setting, participants, & measurements

Results

Conclusions

Publications

Race disparities in U.S. nephrology fellowship training.

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