Leonberg-Yoo Amanda K, Gilbert Scott J
Department of Medicine, Renal-Electrolyte & Hypertension Division, University of Pennsylvania, Philadelphia, PA.
Department of Medicine, Division of Nephrology, Tufts University School of Medicine, Boston, MA.
Semin Nephrol. 2023 Jan;43(1):151396. doi: 10.1016/j.semnephrol.2023.151396. Epub 2023 Aug 11.
Offering and providing effective conservative kidney management (CKM) for patients with end-stage kidney disease who do not want dialysis is a foundational skill that all nephrology fellows should learn during fellowship training. However, the current educational landscape in fellowship training programs is sparse and is not recognized currently as a skill within the Accreditation Council for Graduate Medical Education (ACGME) guidelines. Moreover, there is no standardized curriculum, methods of assessment of this learning objective, and no structure for implementation within general and subspecialty nephrology training programs. In this article, we discuss the current educational resources available for fellowship training programs, including interactive communication skills workshops such as NephroTalk, that address core concepts of CKM and assess communication skills and attitudes of trainees. Additional assessment tools should be prioritized when developing a CKM curriculum, including assessment of symptom management and medical knowledge acquisition. We propose that the ACGME nephrology milestones specifically highlight CKM as an important component within the ACGME nephrology milestones, thus ensuring that trainees understand how and when to offer CKM (knowledge), implement it effectively (skills), and conceptualize it as an appropriate course for patients in a number of varied situations (attitudes). We also outline a subspecialty pathway for palliative nephrology, to align with the recent American Society of Nephrology Task Force Recommendation to provide subspecialty training beyond core competencies, for those interested in pursuit of advanced training that ultimately can shape the CKM landscape in education and policy making.
为不想接受透析的终末期肾病患者提供并实施有效的保守肾脏管理（CKM），是所有肾脏病专科住院医师在专科培训期间都应掌握的一项基本技能。然而，目前专科培训项目中的教育现状并不理想，且目前在毕业后医学教育认证委员会（ACGME）的指南中，这一技能尚未得到认可。此外，对于这一学习目标，没有标准化的课程、评估方法，在普通肾脏病和肾脏病亚专科培训项目中也没有实施框架。在本文中，我们讨论了目前可供专科培训项目使用的教育资源，包括诸如NephroTalk等互动沟通技能工作坊，这些工作坊涉及CKM的核心概念，并评估学员的沟通技能和态度。在制定CKM课程时，应优先考虑其他评估工具，包括对症状管理和医学知识获取的评估。我们建议，ACGME肾脏病学里程碑应特别强调CKM是ACGME肾脏病学里程碑中的一个重要组成部分，从而确保学员了解如何以及何时提供CKM（知识）、有效地实施它（技能），并将其视为在多种不同情况下适合患者的一种恰当做法（态度）。我们还概述了姑息肾脏病学的亚专科路径，以与美国肾脏病学会特别工作组最近的建议保持一致，即为那些有兴趣接受高级培训的人提供超出核心能力的亚专科培训，这最终可能会在教育和政策制定方面塑造CKM的格局。
