Palliative care experience of US adult nephrology fellows: a national survey

Abstract

Palliative care (PC) training and experience of United States (US) adult nephrology fellows was not known. It was also not clear whether nephrology fellows in the US undergo formal training in PC medicine during fellowship. To gain a better understanding of the clinical training and experience of US adult nephrology fellows in PC medicine, we conducted a national survey in March 2012. An anonymous on-line survey was sent to US adult nephrology fellows via nephrology fellowship training program directors. Fellows were asked several PC medicine experience and training questions. A total of 105 US adult nephrology fellows responded to our survey (11% response rate). Majority of the respondents (94%) were from university-based fellowship programs. Over two-thirds (72%) of the fellows had no formal PC medicine rotation during their medical school. Half (53%) of the respondents had no formal PC elective experience during residency. Although nearly 90% of the fellows had a division or department of PC medicine at their institution, only 46.9% had formal didactic PC medicine experience. Over 80% of the respondent's program did not offer formal clinical training or rotation in PC medicine during fellowship. While 90% of the responding fellows felt most comfortable with either writing dialysis orders in the chronic outpatient unit, seeing an ICU consult or writing continuous dialysis orders in the ICU, only 35% of them felt most comfortable “not offering” dialysis to a patient in the ICU with multi-organ failure. Nearly one out of five fellows surveyed felt obligated to offer dialysis to every patient regardless of benefit. Over two-thirds (67%) of the respondents thought that a formal rotation in PC medicine during fellowship would be helpful to them. To enhance clinical competency and confidence in PC medicine, a formal PC rotation during fellowship should be highly considered by nephrology training community.

• Nephrology fellowship training
• nephrology educational research
• nephrology fellow survey
• palliative care education
• palliative care experience

Acknowledgments

We gratefully acknowledge the nephrology training program directors throughout the U.S. to whom we are indebted for their assistance in carrying out this study. We like to thank Dr. Tanveer Mir (palliative care medicine attending) for her assistance in helping us design some of the survey questions. We also like to thank Dr Vipulbhai Sakhiya for his assistance in analyzing some of our survey results. Results of this study were presented at the American Society of Nephrology Kidney Week 2012 in San Diego, California.

Dr. Hitesh H. Shah is the Director of Nephrology Fellowship Program at the Hofstra North Shore-LIJ School of Medicine. Dr. Divya Monga was a nephrology fellow at the Hofstra North Shore-LIJ School of Medicine. Dr. April Caperna is a palliative care medicine attending at the Hofstra North Shore-LIJ School of Medicine. Dr. Kenar D. Jhaveri is the Internal Medicine Clerkship Director at the Hofstra North Shore-LIJ School of Medicine.