Gupta Nupur, Howard Andrew J, Yuan Christina M
Division of Nephrology, Indiana University School of Medicine, Indianapolis, Indiana.
Nephrology Service, Department of Medicine, Walter Reed National Military Medical Center, Bethesda, Maryland.
Kidney360. 2025 Feb 1;6(2):257-264. doi: 10.34067/KID.0000000644. Epub 2024 Nov 19.
Our survey reports the existence of home hemodialysis (HHD) curricula, including didactic, outside HHD courses, shared decision-making training, and continuity clinics. Fellows attending outpatient clinics were more likely to be confident in their ability and prepared to manage HHD patients. The critical barrier to HHD education identified by program directors and fellows was insufficient patients.
Public policy focuses on increasing the prevalence of home dialysis. Home hemodialysis (HHD) education and comfort with the procedure are significant barriers to increasing prevalence. This study examines nephrology fellowship didactic curriculum, training program infrastructure, and barriers identified by both program directors and trainees.
An anonymous, online survey was developed to assess HHD curriculum in US nephrology fellowship programs. During academic year 2023–2024, all US nephrology program directors (=150) were surveyed and asked to forward survey link to their fellows and to indicate the number to whom they forwarded the link.
Fifty-five (55/150; 37%) US nephrology program directors responded to the survey; 80% completed it. Thirty-seven (37/55, 67%) forwarded the link to their fellows. Fellow response rate was 53/237 (22%); 50/53 completed it (94%). Seventy-five percent of the program directors reported either having an HHD curriculum or were developing one. Program directors reported that didactic lectures (87%) were the most frequently available curriculum component, whereas fellows report education on counseling (72%) was most frequent. Sixty percent of fellows and 86% of program directors reported fellow attendance at HHD longitudinal/continuity clinic (routinely or as part of a block rotation). Both peritoneal dialyses and fellows identified insufficient patients as a key barrier to implementing HHD curriculum. Fellows who attended outpatient HHD clinic felt more confident and prepared in HHD-related competencies.
The HHD curriculum exists as didactic lectures, attendance at outside HHD courses, and ESKD-shared decision-making at training programs. Most programs also have continuity clinics. Our findings highlight the presence of curriculum although inconsistent. Fellows who worked in clinic were more likely to be confident and more prepared to manage HHD patients. In addition, fellows with longitudinal clinic felt better prepared than those attending block rotations. Training programs should consider incorporating HHD longitudinal clinical rotations, although this may require creativity to achieve.
我们的调查显示存在家庭血液透析（HHD）课程，包括理论教学、外部HHD课程、共同决策培训和连续性诊所。参加门诊诊所的研究员更有可能对自己管理HHD患者的能力充满信心并做好准备。项目主任和研究员确定的HHD教育的关键障碍是患者不足。
公共政策侧重于提高家庭透析的普及率。家庭血液透析（HHD）教育以及对该操作的接受度是提高普及率的重大障碍。本研究调查了肾脏病学研究员的理论课程、培训项目基础设施以及项目主任和学员确定的障碍。
设计了一项匿名在线调查，以评估美国肾脏病学研究员培训项目中的HHD课程。在2023 - 2024学年，对所有美国肾脏病学项目主任（=150人）进行了调查，并要求他们将调查链接转发给他们的学员，并注明转发链接的人数。
55名（55/150；37%）美国肾脏病学项目主任回复了调查；80%完成了调查。37名（37/55，67%）将链接转发给了他们的学员。学员的回复率为53/237（22%）；50/53完成了调查（94%）。75%的项目主任报告称要么有HHD课程，要么正在开发HHD课程。项目主任报告说理论讲座（87%）是最常见的课程组成部分，而学员报告咨询教育（72%）最为常见。60%的学员和86%的项目主任报告学员参加了HHD纵向/连续性诊所（常规或作为轮转的一部分）。腹膜透析和学员都将患者不足确定为实施HHD课程的关键障碍。参加门诊HHD诊所的学员在与HHD相关的能力方面感觉更有信心和准备更充分。
HHD课程以理论讲座、参加外部HHD课程以及培训项目中的终末期肾病共同决策的形式存在。大多数项目也有连续性诊所。我们的研究结果凸显了课程的存在，尽管存在不一致之处。在诊所工作的学员更有可能对管理HHD患者充满信心且准备更充分。此外，参加纵向诊所的学员比参加轮转的学员感觉准备更充分。培训项目应考虑纳入HHD纵向临床轮转，尽管这可能需要创造性地去实现。
