Kimmel P L, Bosch J P
Department of Medicine, George Washington University Medical Center, Washington, DC 20037.
Am J Kidney Dis. 1991 Aug;18(2):249-56. doi: 10.1016/s0272-6386(12)80886-9.
To assess whether nephrologists perceive disparities between the skills learned during fellowship training and those necessary for clinical subspecialty practice, we surveyed the perception of board-certified American nephrologists regarding the effectiveness of their clinical training. A questionnaire was sent to all Diplomates of the American Board of Internal Medicine in the subspecialty of Nephrology who successfully passed the qualifying examination in 1974, 1980, and 1986, regarding the effectiveness of academic instruction within the clinical fellowship program as regards traditional academic subject matter, patient management, performance of procedures, and interpretation of laboratory data. Questionnaires were returned by 42.1%. Although respondents were generally satisfied with training in academic nephrologic subject matter, dissatisfaction with training in pediatric nephrology, transplant immunology, nephrolithiasis, nutrition, and renal function and disease in pregnancy was evident. Training was thought to be ineffective in theoretical and practical aspects of management of end-stage renal disease. In addition, respondents were dissatisfied with the effectiveness of their training in interpretation of radiologic tests and procedures such as gaining access to the circulation. More recently trained nephrologists were dissatisfied with training in outpatient management and interpretation of radiographic tests. Differences between perceptions of older and younger nephrologists were most marked regarding their preparation for gaining access to the circulation, interpretation of intravenous pyelography, and training for continuous ambulatory peritoneal dialysis (CAPD). To prepare fellows in training for the exigencies of clinical practice. Nephrology training programs will have to emphasize the teaching of the cognitive and manual bases of performing procedures, and provide more outpatient experience for trainees.(ABSTRACT TRUNCATED AT 250 WORDS)
为评估肾病学家是否察觉到专科培训期间所学技能与临床亚专业实践所需技能之间的差异，我们调查了美国获得委员会认证的肾病学家对其临床培训效果的看法。向所有在1974年、1980年和1986年成功通过资格考试的美国内科医学委员会肾脏病亚专业的专科医师发送了一份问卷，内容涉及临床专科培训项目中学术指导在传统学术主题、患者管理、操作执行以及实验室数据解读方面的效果。问卷回复率为42.1%。尽管受访者总体上对肾病学术主题的培训感到满意，但对小儿肾病、移植免疫学、肾结石、营养以及妊娠肾功能与疾病方面的培训不满明显。人们认为在终末期肾病管理的理论和实践方面培训效果不佳。此外，受访者对其在放射学检查解读以及诸如建立血管通路等操作方面的培训效果不满意。近期接受培训的肾病学家对门诊管理和放射影像学检查解读方面的培训不满意。老年和年轻肾病学家在建立血管通路准备、静脉肾盂造影解读以及持续性非卧床腹膜透析（CAPD）培训方面的看法差异最为明显。为使专科培训学员做好应对临床实践紧急情况的准备，肾病培训项目将不得不强调操作执行的认知和实践基础教学，并为学员提供更多门诊经验。（摘要截选至250词）
