Program Director and Nephrology Fellow's Perceptions of Home Hemodialysis Education in the United States

Abstract

Key Points: Our survey reports the existence of home hemodialysis (HHD) curricula, including didactic, outside HHD courses, shared decision-making training, and continuity clinics. Fellows attending outpatient clinics were more likely to be confident in their ability and prepared to manage HHD patients. The critical barrier to HHD education identified by program directors and fellows was insufficient patients. Background: Public policy focuses on increasing the prevalence of home dialysis. Home hemodialysis (HHD) education and comfort with the procedure are significant barriers to increasing prevalence. This study examines nephrology fellowship didactic curriculum, training program infrastructure, and barriers identified by both program directors and trainees. Methods: An anonymous, online survey was developed to assess HHD curriculum in US nephrology fellowship programs. During academic year 2023–2024, all US nephrology program directors (n=150) were surveyed and asked to forward survey link to their fellows and to indicate the number to whom they forwarded the link. Results: Fifty-five (55/150; 37%) US nephrology program directors responded to the survey; 80% completed it. Thirty-seven (37/55, 67%) forwarded the link to their fellows. Fellow response rate was 53/237 (22%); 50/53 completed it (94%). Seventy-five percent of the program directors reported either having an HHD curriculum or were developing one. Program directors reported that didactic lectures (87%) were the most frequently available curriculum component, whereas fellows report education on counseling (72%) was most frequent. Sixty percent of fellows and 86% of program directors reported fellow attendance at HHD longitudinal/continuity clinic (routinely or as part of a block rotation). Both peritoneal dialyses and fellows identified insufficient patients as a key barrier to implementing HHD curriculum. Fellows who attended outpatient HHD clinic felt more confident and prepared in HHD-related competencies. Conclusions: The HHD curriculum exists as didactic lectures, attendance at outside HHD courses, and ESKD-shared decision-making at training programs. Most programs also have continuity clinics. Our findings highlight the presence of curriculum although inconsistent. Fellows who worked in clinic were more likely to be confident and more prepared to manage HHD patients. In addition, fellows with longitudinal clinic felt better prepared than those attending block rotations. Training programs should consider incorporating HHD longitudinal clinical rotations, although this may require creativity to achieve.