TY - JOUR
T1 - Survey of Kidney Biopsy Clinical Practice and Training in the United States
AU - Raghavan, Rajeev
N1 - Background and Objectives Practicing clinical nephrologists are performing fewer diagnostic kidney biopsies. Requiring biopsy procedural competence for graduating nephrology fellows is controversial. Design, Setting, Participants, & Measurements An anonymous, on-line survey of all Walter Reed training program graduates ( n =82; 1985-2017) and all United States nephrology program directors ( n =149; August to October of 2017), regarding kidney biopsy practice and training, was undertaken.
PY - 2018/5/7
Y1 - 2018/5/7
N2 - Background and objectives: Practicing clinical nephrologists are performing fewer diagnostic kidney biopsies. Requiring biopsy procedural competence for graduating nephrology fellows is controversial. Design, setting, participants, & measurements: An anonymous, on-line survey of all Walter Reed training program graduates ( n =82; 1985-2017) and all United States nephrology program directors ( n =149; August to October of 2017), regarding kidney biopsy practice and training, was undertaken. Results: Walter Reed graduates' response and completion rates were 71% and 98%, respectively. The majority felt adequately trained in native kidney biopsy (83%), transplant biopsy (82%), and tissue interpretation (78%), with no difference for ≤10 versus >10 practice years. Thirty-five percent continued to perform biopsies (13% did ≥10 native biopsies/year); 93% referred at least some biopsies. The most common barriers to performing biopsy were logistics (81%) and time (74%). Program director response and completion rates were 60% and 77%. Seventy-two percent cited ≥1 barrier to fellow competence. The most common barriers were logistics (45%), time (45%), and likelihood that biopsy would not be performed postgraduation (41%). Fifty-one percent indicated that fellows should not be required to demonstrate minimal procedural competence in biopsy, although 97% agreed that fellows should demonstrate competence in knowing/managing indications, contraindications, and complications. Program directors citing ≥1 barrier or whose fellows did <50 native biopsies/year in total were more likely to think that procedural competence should not be required versus those citing no barriers ( P =0.02), or whose fellows performed ≥50 biopsies ( P <0.01). Conclusions: Almost two-thirds of graduate respondents from a single military training program no longer perform biopsy, and 51% of responding nephrology program directors indicated that biopsy procedural competence should not be required. These findings should inform discussion of kidney biopsy curriculum requirements.
AB - Background and objectives: Practicing clinical nephrologists are performing fewer diagnostic kidney biopsies. Requiring biopsy procedural competence for graduating nephrology fellows is controversial. Design, setting, participants, & measurements: An anonymous, on-line survey of all Walter Reed training program graduates ( n =82; 1985-2017) and all United States nephrology program directors ( n =149; August to October of 2017), regarding kidney biopsy practice and training, was undertaken. Results: Walter Reed graduates' response and completion rates were 71% and 98%, respectively. The majority felt adequately trained in native kidney biopsy (83%), transplant biopsy (82%), and tissue interpretation (78%), with no difference for ≤10 versus >10 practice years. Thirty-five percent continued to perform biopsies (13% did ≥10 native biopsies/year); 93% referred at least some biopsies. The most common barriers to performing biopsy were logistics (81%) and time (74%). Program director response and completion rates were 60% and 77%. Seventy-two percent cited ≥1 barrier to fellow competence. The most common barriers were logistics (45%), time (45%), and likelihood that biopsy would not be performed postgraduation (41%). Fifty-one percent indicated that fellows should not be required to demonstrate minimal procedural competence in biopsy, although 97% agreed that fellows should demonstrate competence in knowing/managing indications, contraindications, and complications. Program directors citing ≥1 barrier or whose fellows did <50 native biopsies/year in total were more likely to think that procedural competence should not be required versus those citing no barriers ( P =0.02), or whose fellows performed ≥50 biopsies ( P <0.01). Conclusions: Almost two-thirds of graduate respondents from a single military training program no longer perform biopsy, and 51% of responding nephrology program directors indicated that biopsy procedural competence should not be required. These findings should inform discussion of kidney biopsy curriculum requirements.
UR - https://doi.org/10.2215/CJN.13471217
U2 - 10.2215/CJN.13471217
DO - 10.2215/CJN.13471217
M3 - Article
SN - 1555-9041
VL - 13
JO - Clinical journal of the American Society of Nephrology
JF - Clinical journal of the American Society of Nephrology
IS - 5
ER -