Waheed Sana, Maursetter Laura, Yevzlin Alexander
Division of Nephrology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.
Division of Nephrology, University of Michigan School of Medicine, Ann Arbor, MI, USA.
Semin Dial. 2018 Mar;31(2):149-153. doi: 10.1111/sdi.12670. Epub 2018 Jan 3.
Historically, the placement and maintenance of dialysis access has been an integral part of nephrology training. However, in recent years, a big debate has ensued regarding whether this should be limited to trainees' understanding and counseling the patients regarding indications, alternatives, risks and possible complications of these procedures or should it actually involve more of a hands-on experience for the trainees. Some of the barriers in making these procedures a requirement across the board are the lack of standardization of procedural training across various training programs and the absence of consensus on what achieving competency in these procedures looks like. However, in the era of declining interest in nephrology, giving up "ownership" of nephrology procedures and increasing reliance on other sub specialties might be a deterrent in attracting residents to this field; we have to make a concerted effort to increase the exposure and opportunities for the trainees to perform these procedures. Moreover, we need to emphasize the implementation of a curriculum for nephrology fellows to evaluate access properly in order to decrease the burden of access related complications. Lastly, we need to continue working towards a more structured curriculum for a dedicated interventional nephrology fellowship for trainees who want to focus on procedures for their long-term career goals.
从历史上看，透析通路的建立与维护一直是肾脏病学培训的一个重要组成部分。然而，近年来，关于这是否应仅限于学员向患者讲解这些操作的适应症、替代方案、风险及可能的并发症，还是实际上应让学员有更多实际操作经验，引发了一场激烈的争论。将这些操作全面列为一项要求存在一些障碍，包括各个培训项目中操作培训缺乏标准化，以及对于在这些操作中达到胜任水平的标准尚无共识。然而，在肾脏病学吸引力下降的时代，放弃对肾脏病学操作的“掌控权”并越来越依赖其他亚专业，可能会阻碍吸引住院医师投身该领域；我们必须齐心协力，增加学员进行这些操作的机会和接触。此外，我们需要强调为肾脏病学进修医生实施一门课程，以便正确评估通路，从而减轻与通路相关并发症的负担。最后，对于那些希望将操作作为长期职业目标的学员，我们需要继续努力制定一门更具结构性的课程，用于专门的介入肾脏病学进修培训。
