Education in Nephrology Fellowship: A Survey-Based Needs Assessment.
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ABSTRACT:
SUBMITTER: Rope RW
PROVIDER: S-EPMC5491292 | biostudies-literature | 2017 Jul
REPOSITORIES: biostudies-literature
Publications
Education in Nephrology Fellowship: A Survey-Based Needs Assessment.
Rope Robert W RW Pivert Kurtis A KA Parker Mark G MG Sozio Stephen M SM Merell Sylvia Bereknyei SB
Journal of the American Society of Nephrology : JASN 20170420 7
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 conj ...[more]
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Project description:BackgroundOur nephrology fellowship requires specific training in recognition and referral of end-stage renal disease patients likely to benefit from palliative and hospice care.MethodsTo identify end-of-life (EOL) referral barriers that require greater training emphasis, we performed a cross-sectional, 17-item anonymous online survey (August-October 2015) of 93 nephrologists associated with the program since 1987.ResultsThere was a 61% response rate (57/93 surveys). Ninety-five percent practiced clinical nephrology (54/57). Of these, 51 completed the survey (55% completion rate), and their responses were analyzed. Sixty-four percent were in practice?>10 years; 65% resided in the Southern USA. Ninety-two percent felt comfortable discussing EOL care, with no significant difference between those with??10 versus ?>10 years of practice experience (P?=?0.28). Thirty-one percent reported referring patients to EOL care 'somewhat' or 'much less often' than indicated. The most frequent referral barriers were: time-consuming nature of EOL discussions (27%); difficulty in accurately determining prognosis for?<6-month survival (35%); patient (63%) and family (71%) unwillingness; and patient (69%) and family (73%) misconceptions. Fifty-seven percent would refer more patients if dialysis or ultrafiltration could be performed in hospice. Some reported that local palliative care resources (12%) and hospice resources (6%) were insufficient.ConclusionsThe clinical nephrologists surveyed were comfortable with EOL care discussion and referral. Patient, family, prognostic and system barriers exist, and many reported lower than indicated referral rates. Additional efforts, including, but not limited to, EOL training during fellowship, are needed to overcome familial and structural barriers to facilitate nephrologist referral for EOL care.
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