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Clin J Am Soc Nephrol. 2018 May 7;13(5):718-725. doi: 10.2215/CJN.13471217. Epub 2018 Apr 18.

Survey of Kidney Biopsy Clinical Practice and Training in the United States.

Author information

1
Nephrology Service, and christina.m.yuan.civ@mail.mil.
2
Nephrology Service, and.
3
San Antonio Kidney Disease Center, San Antonio, Texas; and.
4
Department of Pathology, Walter Reed National Military Medical Center, Bethesda, Maryland.
5
Selzman Institute for Kidney Health, Baylor College of Medicine, Houston, Texas.

Abstract

BACKGROUND AND OBJECTIVES:

Practicing clinical nephrologists are performing fewer diagnostic kidney biopsies. Requiring biopsy procedural competence for graduating nephrology fellows is controversial.

DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS:

An anonymous, on-line survey of all Walter Reed training program graduates (n=82; 1985-2017) and all United States nephrology program directors (n=149; August to October of 2017), regarding kidney biopsy practice and training, was undertaken.

RESULTS:

Walter Reed graduates' response and completion rates were 71% and 98%, respectively. The majority felt adequately trained in native kidney biopsy (83%), transplant biopsy (82%), and tissue interpretation (78%), with no difference for ≤10 versus >10 practice years. Thirty-five percent continued to perform biopsies (13% did ≥10 native biopsies/year); 93% referred at least some biopsies. The most common barriers to performing biopsy were logistics (81%) and time (74%). Program director response and completion rates were 60% and 77%. Seventy-two percent cited ≥1 barrier to fellow competence. The most common barriers were logistics (45%), time (45%), and likelihood that biopsy would not be performed postgraduation (41%). Fifty-one percent indicated that fellows should not be required to demonstrate minimal procedural competence in biopsy, although 97% agreed that fellows should demonstrate competence in knowing/managing indications, contraindications, and complications. Program directors citing ≥1 barrier or whose fellows did <50 native biopsies/year in total were more likely to think that procedural competence should not be required versus those citing no barriers (P=0.02), or whose fellows performed ≥50 biopsies (P<0.01).

CONCLUSIONS:

Almost two-thirds of graduate respondents from a single military training program no longer perform biopsy, and 51% of responding nephrology program directors indicated that biopsy procedural competence should not be required. These findings should inform discussion of kidney biopsy curriculum requirements.

KEYWORDS:

Biopsy; Contraindications; Curriculum; Fellowships and Scholarships; Interventional Radiology; Military Personnel; Nephrologists; Nephrology Education; Nephrology Fellowship; Program Directors; Surveys and Questionnaires; Thinking; Transplants; United States; kidney biopsy; nephrology

PMID:
29669819
PMCID:
PMC5968891
[Available on 2019-05-07]
DOI:
10.2215/CJN.13471217

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