A Skills Lab to Facilitate Dialysis Training in Nephrology Fellowship

A Skills Lab to Facilitate
Dialysis Training in
Nephrology Fellowship
Author: Amit Kaushal MD CCFP FRCPC
Date: September 30, 2016
I do not have an affiliation (financial or otherwise) with a
pharmaceutical, medical device or communications organization.
Je n’ai aucune affiliation (financière ou autre) avec une
entreprise pharmaceutique, un fabricant d’appareils
médicaux ou un cabinet de communication.
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Outline
• The Curricular Challenge
• Current Curriculum
• Aims
• Dialysis Skills Lab
• Results
• Future Directions
3
The Curricular Challenge
• Time and opportunities to teach dialysis are
influenced by:
Competing priorities
Changing care models
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The Current Curriculum
• 22 x 1-hour lectures
• 2 months Hemodialysis
• 2 months Home dialysis
• 0-4 months of dialysis electives
• Scholarly activity
Variability in core experiences
Incomplete consolidation of conceptual
understanding
Limited flexibility in new application
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Aims
1.
To develop an effective
curricular innovation
targeting key
conceptual and
procedural knowledge
in dialysis.
2.
To develop effective
assessments of dialysis
knowledge/skills.
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Dialysis Skills Lab
• Objectives
1. Demonstrate feasibility of educational
strategy
2. Develop accurate tools for assessment
3. Capture self-assessment data in order to
inform future iterations
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Stations
Assessments
1.
Target weight assessment
1.
Pre- and post-tests
2.
PD manual exchange
2.
Pre-intervention survey
3.
PD cycler programming
4.
Access examination
5.
Access complications
6.
Access ultrasound
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Dialysis Skills Lab 2015
9
Task-specific Confidence
General Confidence
100%
80%
60%
Staff level experience
40%
Very confident
Confident
20%
Limited confidence
Not confident
0%
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2015 Mean Pre- and Post-test Scores (%)
100
90
80
70
60
50
Cohen’s d
= 1.50
(large effect size)
40
30
20
10
11
0
Pre-test
Post-test
2016 Mean Pre- and Post-test Scores (%)
100
90
80
70
60
p = 0.0001
50
40
30
20
10
0
Pre-test
Post-test
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Conclusions
• The dialysis skills lab is feasible to implement and an
effective educational strategy
• Pre/post assessments are sensitive, standard setting in
progress
• Self-assessments (both general and specific) are
consistent with the broader education literature
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Future Directions
• Alignment with CBD continuum
• Standard setting
• Reinforcement during training
Dialysis Skills Lab (4 hours)
Dialysis rotations
Simulation
Dialysis skills assessment
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Acknowledgements
•
•
•
Patient Volunteers
•
Residency Program Committee
Skills Lab Instructors
Ms. Deb Appleton
Ms. Fatima Benjamin-Wong
Dr. Rulan Parekh
Dr. Marc Goldstein
Dr. Jeffrey Schiff
Dr. Elisa Greco
Dr. Alireza Zahirieh
Dr. Elizabeth Harvey
Dr. Damien Noone
Ms. Joyce Hunter
Postgraduate Innovation Fund,
Department of Medicine
Dr. Damien Noone
Dr. Robert Richardson
Ms. Elizabeth Petershofer
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