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To become a nephrologist in Brazil, a physician must complete a fellowship in nephrology. Recently, the nephrology´s fellowship curriculum was reviewed, becoming a competency-based curriculum, with the aim of training professionals with the knowledge, skills and attitudes necessary to meet the demands of the community in which they are inserted. Despite the existence of several active fellowship programs in our country, there is no formative evaluation of them by program graduates. This study aims to assess the perception of nephrologists about the skills acquired during nephrology fellowship in Brazil and their importance for daily practice.
A cross-sectional study was carried out using a self-administered questionnaire. The form evaluates the participant, his performance as a nephrologist and asks about the learning of different skills during fellowship and the importance of this for current practice.
163 nephrologists were included in this research, from 42 fellowship programs in Brazil. From this total, 55% of the respondents were females, with the average age of 41 years old. 11 years was the average time working as a nephrologist, with 86% working in outpatient clinics, 85% in hospitals and 69% in dialysis centers. In these locations, the following procedures are performed by the nephrologist: implantation of non-tunneled catheter for hemodialysis (HD) (85%), renal biopsy (56%), passage of tunneled catheter for HD (44%) and passage of peritoneal dialysis (PD) catheter (38%). As shown in figure 1, all clinical skills assessed were considered useful in current clinical practice and more than 50% of the participants left the training programs considering themselves capable of carrying them out. The biggest discrepancy found was in relation to recognizing and addressing terminality: 54% felt capable and 94% consider this skill useful. In relation to procedures, unanimity was found only in relation to the passage of non-tunneled catheter for HD. To perform a kidney biopsy, 50% felt ready and 46% considered it as a useful knowledge; for the passage of a tunneled HD catheter, 20% felt ready and 31% consider this knowledge useful; for the passage of a PD catheter, 26% consider themselves able and 30% consider this practice useful. The fundus examination was also evaluated (24% felt capable, 52% considered it useful) and performing an ultrasound as a diagnostic tool and to guide procedures (34% felt capable, 75% considered it useful). Less than half felt able to manage nephrology services, manage a medical career, carry out clinical research and teaching activities, although most understand these skills as useful.
The current study provided unprecedented information on the perception of learning during nephrology fellowship. Some skills, however, need to be improved. Systematic assessment of graduates and continuing education programs are essential.