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The performance of renal biopsies is a crucial practice in the diagnostic assessment and treatment of a variety of kidney diseases. Proper training of nephrology residents to conduct renal biopsies is essential to ensure accurate diagnoses and promote the quality of patient care. In this context, "milestones" represent specific competency markers that residents must achieve during their training. Within nephrology, milestones related to renal biopsy encompass technical skills as well as the clinical interpretation of obtained results. This work explores the key milestones associated with the execution of renal biopsies by residents, emphasizing the significance of these markers for professional development and the assurance of high-quality care for patients with kidney diseases.
Data from reports and medical records regarding 216 ultrasound-guided renal biopsies performed at the Hospital das Clinicas da UFMG by supervised and concurrently evaluated nephrology residents were collected. All of the biopsies were performed with a 16-gauge needle. The assessment of the medical resident was conducted considering the milestones necessary for the execution of a renal biopsy. The levels stipulated by the Accreditation Council for Graduate Medical Education (ACGME) were utilized to classify the resident in the procedure and determine the next educational step for them specifically. In addition to this, the collected data were analyzed to assess the quality of renal sample in those biopsies performed by residents through quantifying glomeruli per sample, the number of diagnoses defined with the performed biopsy, and reports of severe complications post-puncture.
Based on the results of the analysis of 216 renal biopsies conducted over three years, there was an average of 14.59 glomeruli per sample, ranging from 1 to 53 glomeruli, indicating significant variability in the quantity of obtained glomeruli. Remarkably, even the samplev with only 1 glomerulus provided diagnostic information. It's noteworthy that during the study period, 16 residents performed the procedures under guidance and supervision. Regarding severe complications, a total of two hospitalizations were reported due to hematoma in the renal capsule, both without the need for surgical intervention. Treatment consisted of analgesia and monitoring. Additionally, out of the 216 procedures, 10 did not present glomeruli in their samples. However, it's important to emphasize that the other 206 biopsies allowed for the closure of renal diagnosis, representing 95,37% of samples, highlighting the overall effectiveness of the procedure in obtaining relevant diagnostic information.
This study sheds light on the pivotal role of renal biopsies in diagnosing and managing kidney diseases, stressing the importance of proper training for nephrology residents.
Throughout the study, the collaboration of 16 residents, working under guidance and supervision, not only demonstrated a significant distribution of workload but also highlighted the potential for enhanced teaching and learning opportunities within the medical team. The two cases of post-biopsy complications represent 0.9%, highlighting the safety of the procedure and indicating that it can and should be performed by trainee physicians as well.
Despite challenges such as instances where glomeruli were absent in some samples, the overall success rate in closing renal diagnoses attests to the efficacy of the procedure in obtaining crucial diagnostic information. This study reinforces the relevance of milestones, as defined by the Accreditation Council for Graduate Medical Education (ACGME), in shaping the competency and proficiency of residents in renal biopsy procedures.
As we reflect on these findings, it becomes evident that continuous training, meticulous supervision, and adherence to milestones are integral components in ensuring both the professional development of residents and the delivery of high-quality care to patients with kidney diseases.