Current State and Future Direction of Vascular Access Training in the United States

Abstract

Key Points:

1. Hands-on training is crucial for vascular access training.

2. A multidisciplinary approach to vascular access training is paramount.

3. Creation of a multifaceted vascular access curriculum is needed in all training programs.

Background: This study seeks to provide insights into the current state of vascular access education in adult nephrology fellowship programs in the United States and to identify areas for improvement.

Methods: A total of 63 adult nephrology programs and 71 second-year adult nephrology fellows were randomly selected for participation in a roundtable. Virtual roundtable discussions preceded by a survey were conducted to gather information on the delivery of vascular access education. Descriptive statistics were used for analysis.

Results: Among the respondents invited to the roundtable discussions, 42 individuals (30 faculty and 12 fellows) completed the survey, while 21 individuals (13 faculty and eight fellows) also participated in the roundtable discussion. Of these respondents, most (67%) didactic lectures on vascular access in fellowship programs were delivered by general nephrologists, with 57% provided by interventional nephrologists, 36% by surgeons, and 17% by interventional radiologists (respondents were able to select multiple disciplines). The respondents reported limited exposure to proceduralists, including interventional nephrologists and vascular access surgeons during fellowship training. Faculty and fellows were less comfortable with physical examination skills related to vascular access, particularly in using point-of-care ultrasound and interpreting vascular imaging as compared with naming and identification of vascular access. Both groups emphasized the importance of hands-on modalities in vascular access education.

Conclusion: Roundtable discussions highlighted the need for enhanced hands-on training, multidisciplinary collaboration, and standardized curricula in vascular access education. Recommendations were formulated in alignment with the three levels of competency outlined by the American Society of Nephrology Task Force on the Future of Nephrology, aiming to address gaps and improve the quality of vascular access education in nephrology fellowship programs. This study underscores the importance and need for a comprehensive vascular access education in nephrology fellowship training. By implementing the identified recommendations, programs can better prepare fellows to manage vascular access-related challenges in clinical practice.

Keywords: interventional nephrology; medical education; vascular access.