Abstract: SA-PO487
Development and Validation of a Formative Objective Structured Clinical Examination (OSCE) Assessing Home Hemodialysis (HHD) Clinical Skills
Session Information
- Home Dialysis - 2
October 26, 2024 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Dialysis
- 802 Dialysis: Home Dialysis and Peritoneal Dialysis
Authors
- Jones, Jason Andrew, Walter Reed National Military Medical Center, Bethesda, Maryland, United States
- Tobin, Trevor Wesley, Eisenhower Army Medical Center, Fort Gordon, Georgia, United States
- Bermudez, Maria, Geisinger Medical Center, Danville, Pennsylvania, United States
- Braden, Gregory Lee, Baystate Medical Center, Springfield, Massachusetts, United States
- Gupta, Nupur, Indiana University School of Medicine, Indianapolis, Indiana, United States
- Fisher, Evan I., Walter Reed National Military Medical Center, Bethesda, Maryland, United States
- Landry, Daniel L., Baystate Medical Center, Springfield, Massachusetts, United States
- Nee, Robert, Walter Reed National Military Medical Center, Bethesda, Maryland, United States
- Pasiuk, Bret N., SSM Health Care of Wisconsin, Fond du Lac, Wisconsin, United States
- Yuan, Christina M., Walter Reed National Military Medical Center, Bethesda, Maryland, United States
Group or Team Name
- Nephrology Education Research and Development Consortium.
Background
The Accreditation Council for Graduate Medical Education(ACGME) requires that graduating nephrology fellows demonstrate competence in HHD. Because low patient numbers may lead to gaps in training, there is an opportunity to enhance clinical experience using simulation. We designed a case-based formative OSCE assessing clinical care of an uncomplicated patient initiating HHD.
Methods
The blueprint, test and rubric were developed by a nephrology fellow, an academic nephrologist, and 4 nephrologists practicing HHD (2 academic, 2 community-based). It was further refined by a 9-member test committee: 5 in HHD practice; 5 in academic nephrology; 1 in regulatory administration; 1 nephrology fellow (who had been a HHD partner). The final test consisted of 27 items (31 points), 4 (10 points) of which were evidence based. Median time in practice: 12 years. Pass threshold was set at 20/31 points (with one possible negative point). 3/27 items were assessed as “hard”, the others were of “medium” to “easy” difficulty. Median relevance for all items was “important” or “essential”, with a test content validity index of 0.84.
Results
11 validators, all board-certified, 4 with outpatient HHD practices, took the test. Median years of practice: 10 (range 3-35) All passed: percentage correct 77-97%, mean score 28 ± 2 points. Inter-grader agreement was high; Kappa: 0.83 (95%CI 0.667-0.992).
24 fellows at 4 programs have thus far taken the test, 15 have been graded. 100% (15/15) passed (percentage correct 65-89%); mean score 24 ± 1 points.
73% (8/11) validators vs. 80% (12/15) fellows correctly indicated 4 benefits/2 risks associated with HHD, 64% (7/11) vs. 27% (4/15) correctly defined minimum recommended standard weekly Kt/V, 91% (10/11) vs. 87% (13/15) correctly defined flow fraction, and 100% (11/11) vs. 80% (12/15) described risks associated with buttonhole cannulation.
Conclusion
The HHD OSCE may be used as a formative assessment of fellow knowledge and confidence in prescribing HHD.
Disclaimer: The views expressed are those of the authors and do not necessarily reflect the official policy of the Department of Defense or the U.S. government.