Impact of Ultrasound-Guided Kidney Biopsy Simulation on Trainee Confidence and Biopsy Outcomes
To improve procedural skill competence in real-time ultrasound-guided renal biopsy, we have developed an inexpensive simulation tool (a porcine kidney inserted under a turkey breast) that mimics biopsy conditions in human patients in terms of kidney size, depth, echogenicity and overall structural characteristics. This study investigated the utility of this simulation tool for improving trainees' confidence in performing renal biopsy and biopsy-associated bleeding complications.
We have quantitatively assessed the confidence level of renal fellows before and after their initial renal biopsy simulation training. Subsequently, we determined the effect of this simulation training on trainees' procedural competence by comparing outcomes of clinical renal biopsies performed by fellows that did versus those who did not participate in the simulation training.
We show that renal biopsy simulation has improved the confidence level of trainees (23.4 presimulation to 70.3 postsimulation on a 0-100 scale; p = 0.001; η(2) = 0.69). The improvement in trainees' confidence did not vary across their prior experience performing renal biopsies (η(2) = 0.23; p = 0.060). Additionally, fellows who participated in the simulation training demonstrated improved competence in performing the renal biopsy procedure in patients. Successful retrieval of renal tissue per pass was 94% (vs. 73% in fellows who did not participate in this simulation training; p = 0.002) and procedure-related blood loss was reduced as indicated by smaller postbiopsy versus prebiopsy hematocrit decline (1.18 vs. 2.68; p = 0.049).
Renal biopsy simulation training may improve trainees' confidence and reduce the severity of biopsy-associated bleeding complications in patients.
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ABSTRACT: Objectively structured clinical examinations (OSCEs) are widely used in medical education, but we know of none described that are specifically for nephrology fellowship training. OSCEs use simulation to educate and evaluate. We describe a technically simple, multidisciplinary, low-cost OSCE developed by our program that contains both examination and training features and focuses on management and clinical knowledge of rare hemodialysis emergencies. The emergencies tested are venous air embolism, blood leak, dialysis membrane reaction, and hemolysis. Fifteen fellows have participated in the OSCE as examinees and/or preceptors since June 2010. All have passed the exercise. Thirteen responded to an anonymous survey in July 2013 that inquired about their confidence in managing each of the 4 tested emergencies pre- and post-OSCE. Fellows were significantly more confident in their ability to respond to the emergencies after the OSCE. Those who subsequently saw such an emergency reported that the OSCE experience was somewhat or very helpful in managing the event. The OSCE tested and trained fellows in the recognition and management of rare hemodialysis emergencies. OSCEs and simulation generally deserve greater use in nephrology subspecialty training; however, collaboration between training programs would be necessary to validate such exercises.American Journal of Kidney Diseases 06/2014; 63(6). DOI:10.1053/j.ajkd.2014.01.419 · 5.90 Impact Factor
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ABSTRACT: Nephrologists play an important role in providing medical education in a variety of settings, including the medical school classroom, nephrology consult service, outpatient clinic, and dialysis unit. Therefore, nephrologists interact with a variety of learners. In this article the current state of published literature in medical education in nephrology is reviewed. Eight attending roles are identified of the nephrologist as a medical educator in the academic settings: inpatient internal medicine service, nephrology inpatient consult service, inpatient ESRD service, outpatient nephrology clinic, kidney transplantation, dialysis unit, classroom teacher, and research mentor. Defining each of these distinct settings could help to promote positive faculty development and encourage more rigorous education scholarship in nephrology. Copyright © 2015 by the American Society of Nephrology.Clinical Journal of the American Society of Nephrology 08/2015; DOI:10.2215/CJN.12151214 · 4.61 Impact Factor