Abstract: FR-PO004
Kidney Point-of-Care Ultrasonography (POCUS): Development and Evaluation of a Training Program for Nephrology Fellows
Session Information
- Classroom to Bedside: Transforming Medical Education
October 25, 2024 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Educational Research
- 1000 Educational Research
Authors
- Fang, Tony, University of Toronto Temerty Faculty of Medicine, Toronto, Ontario, Canada
- Jdiaa, Sara Saleh, University of Toronto, Toronto, Ontario, Canada
- Qureshi, Mohammad Azfar, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Zahirieh, Alireza, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Young, Ann, University of Toronto, Toronto, Ontario, Canada
- Yuen, Darren A., University of Toronto, Toronto, Ontario, Canada
Background
Insonation is now considered the 5th pillar in physical examination. Despite its exciting potential, the uptake of POCUS in nephrology training curricula is slow. Our study aims to evaluate a locally developed program to train nephrology fellows to accurately perform a kidney POCUS scan to answer two important questions in the workup of kidney dysfunction in hospitalized patients: 1) is there urinary tract obstruction? and 2) are there small kidneys?
Methods
The program consisted of two workshops that included a didactic session and hands-on training session. Trainees identified the presence or absence of urinary tract obstruction in each native kidney or kidney allograft. They also performed a measurement of kidney length. POCUS findings were compared with the abdominal ultrasound exams performed in the medical imaging department. All nephrology fellows participating in the workshop completed pre- and post-workshop surveys to document self-reported comfort level with the use of renal POCUS. Patients were asked to complete a patient satisfaction questionnaire.
Results
A total of 56 native kidneys were assessed. Assessment of hydronephrosis compared to radiology-read kidney imaging reports revealed a specificity of 0.96. Assessment of small right and left kidney size showed a specificity of 0.81 and 0.75, respectively. A total of 32 transplant kidneys were assessed. Assessment of hydronephrosis and kidney allograft size revealed a specificity of 0.96 and 0.97, respectively. Post-workshop, 10 out of 11 trainees had an overall comfort level of 5 or greater out of 7 using POCUS for kidney assessment, in ruling out urinary tract obstruction and measuring kidney size. A total of 51 patients were surveyed. Most patients (71%) strongly agreed that their interaction with their doctors was improved with POCUS.
Conclusion
Our study shows that training programs can provide trainees with the confidence to acquire and apply skills in POCUS and the downstream benefits from patient satisfaction.