Perceptions of Home Dialysis Training and Experience Among US Nephrology Fellows

Abstract

Rationale & objective: Prior research suggests a lack of confidence among graduating US nephrology trainees in implementing both peritoneal dialysis (PD) and home hemodialysis (HHD). Gaps in fellowship training may represent an obstacle to achieving the Advancing American Kidney Health Initiative's goal of increasing the use of home dialysis. We sought to identify the strengths of and limitations in home dialysis training.

Design: A cross-sectional study surveying nephrology trainees regarding their confidence with home dialysis management and perceptions of home dialysis educational resources provided by their training program.

Setting & participants: A paper survey was distributed to 110 nephrology trainees with at least 1 year of nephrology fellowship training who attended any 1 of 3 home dialysis conferences.

Analytical approach: Data were summarized as percentages. χ², Fisher exact, and Kruskal-Wallis rank sum tests were used for statistical analysis.

Outcome: Self-perception of readiness to manage PD and HHD patients.

Results: 76 of 110 (66%) attendees completed the survey. Most respondents were moderately confident regarding principles of PD. However, only 3% had initiated patients on "urgent-start PD" and 11% observed a PD catheter insertion. The level of confidence for HHD was low. Most trainees attended a home dialysis continuity clinic with mentorship from faculty.

Limitations: A small number of participants and the inability to verify respondent-provided data for the number of PD and HHD patients seen and clinics attended. Potential lack of generalizability owing to inclusion of only trainees who attended a home dialysis conference.

Conclusions: Nephrology trainees perceive low and moderate levels of preparedness for managing HHD and PD, respectively. Educational innovation and optimization of resources at both the institutional and national levels may improve confidence and promote public policy goals regarding home dialysis therapies.

Keywords: Home dialysis; clinical skill; core competency; dialysis curriculum; dialysis modality; home hemodialysis (HHD); medical training; nephrology fellowship; nephrology trainee; peritoneal dialysis (PD); physician education; self-perceived competency; survey.