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This Article Full Text Full Text (PDF) All Versions of this Article: CJN.00490108v1 3/4/941    most recent Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Google Scholar Articles by Berns, J. S. Articles by O'Neill, W. C. PubMed PubMed Citation Articles by Berns, J. S. Articles by O'Neill, W. C. Related Collections Related Articles

Performance of Procedures by Nephrologists and Nephrology Fellows at U.S. Nephrology Training Programs

Jeffrey S. Berns^*, and W. Charles O'Neill

^* University of Pennsylvania School of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania; and Emory University School of Medicine, Renal Division, Atlanta, Georgia

Correspondence: Dr. Jeffrey S. Berns, University of Pennsylvania School of Medicine, Hospital of the University of Pennsylvania, 3400 Spruce Street, 1 Founders Pavilion, Philadelphia, PA 19104. Phone: 215-615-1677; Fax: 215-615-1688; E-mail: bernsj{at}uphs.upenn.edu; or Dr. W. Charles O'Neill, Emory University School of Medicine, Renal Division, WMB 338, 1639 Pierce, Drive Atlanta, GA 30322. Phone: 404-727-3922; Fax: 404-727-3425; E-mail: woneill{at}emory.edu

Background and objectives: Some procedures (e.g., placement of temporary hemodialysis catheters and kidney biopsies) are required in nephrology fellowship training. Others (e.g., placement of tunneled hemodialysis catheters, ultrasonography, and hemodialysis access interventions) are not required but are performed at some centers. To assess the procedures performed by nephrologists and nephrology fellows at U.S. adult nephrology training programs and the number of procedures required for fellow competency, a survey was conducted of all such training programs.

Design, setting, participants, & measurements: An on-line survey was e-mailed to the directors of all U.S. adult nephrology fellowship programs in October to November 2007.

Results: Responses were received from 93 of 136 programs. Nephrologists and nephrology trainees perform native and transplant kidney biopsies in 98% to 99% of programs and, in about half of programs, also perform the ultrasound guidance. Diagnostic ultrasounds are performed at fewer programs. Temporary dialysis catheters are inserted at nearly all programs. Tunneled hemodialysis catheters and peritoneal dialysis catheters are placed at 20% of programs. Interventional procedures on hemodialysis access are performed at 13% to 21% of programs. Continuous renal replacement therapy is performed at 99% of programs, plasmapheresis at 40%. Many programs either do not specify a minimum number of supervised procedures that need to be performed to demonstrate competence or require a very limited number.

Conclusions: Core procedures are performed at almost all programs. Experience and training in other procedures are variable. Many programs have limited requirements for the number of procedures trainees need to perform to demonstrate competence.

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