Point-of-Care Ultrasound Training during Nephrology Fellowship: A National Survey of Fellows and Program Directors

Abstract

Background and objectives: Point-of-care ultrasound (POCUS)-performed by a clinician during a patient encounter and used in patient assessment and care planning-has many potential applications in nephrology. Yet, US nephrologists have been slow to adopt POCUS, which may affect the training of nephrology fellows. This study sought to identify the current state of POCUS training and implementation in nephrology fellowships.

Design, setting, participants, & measurements: Concise survey instruments measuring attitudes toward POCUS, its current use, fellow competence, and POCUS curricula were disseminated to (1) 912 US nephrology fellows taking the 2021 Nephrology In-Training Examination and (2) 229 nephrology training program directors and associate program directors. Fisher exact, chi-squared, and Wilcoxon rank sum tests were used to compare the frequencies of responses and the average responses between fellows and training program directors/associate program directors when possible.

Results: Fellow and training program directors/associate program directors response rates were 69% and 37%, respectively. Only 38% of fellows (240 respondents) reported receiving POCUS education during their fellowship, and just 33% of those who did receive POCUS training reported feeling competent to use POCUS independently. Similarly, just 23% of training program directors/associate program directors indicated that they had a POCUS curriculum in place, although 74% of training program directors and associate program directors indicated that a program was in development or that there was interest in creating a POCUS curriculum. Most fellow and faculty respondents rated commonly covered POCUS topics-including dialysis access imaging and kidney biopsy-as "important" or "very important," with the greatest interest in diagnostic kidney ultrasound. Guided scanning with an instructor was the highest-rated teaching strategy. The most frequently reported barrier to POCUS program development was the lack of available instructors.

Conclusions: Despite high trainee and faculty interest in POCUS, the majority of current nephrology fellows are not receiving POCUS training. Hands-on training guided by an instructor is highly valued, yet availability of adequately trained instructors remains a barrier to program development.

Podcast: This article contains a podcast at https://www.asn-online.org/media/podcast/CJASN/2022_09_21_CJN01850222.mp3.

Keywords: dialysis access; echocardiography; fellowships and scholarships; kidney anatomy; kidney biopsy; nephrology; point-of-care systems; vascular access.

Graphical abstract

Figure 1.

Nephrology point-of-care ultrasound topics rated “important”/“very important” for nephrology training by fellow and training program director (TPD)/associate program director (APD) respondents. Brackets indicate statistically significant differences between cohorts. AV, arteriovenous; PD, peritoneal dialysis.

Figure 2.

Comparison of fellow and TPD/APD agreement that fellows are competent to independently perform point-of-care ultrasound at the completion of training.