Palliative care (PC) training and experience of US adult nephrology fellows was not known. It was also not clear whether nephrology fellows in the US undergo formal training in PC medicine during fellowship. End-of-life care for the CKD and ESRD patients is an uncomfortable topic for many nephrologists and nephrology fellows, and a 2003 survey published in AJKD highlighted the need for palliative care training for nephrology fellows.
Since that publication, the field of PC nephrology had advanced significantly. There have been sessions and special series at Kidney Week on PC in the last decade. However, have we adopted the suggestions of the 2003 survey? Two recent studies within the last year shed light into this topic. Shah et al in 2013 and Combs et al recently published in AJKD confirm that there is lack of PC training during nephrology fellowship. Both studies surveyed fellows in the last 2 years, and showed that fellows currently lack end-of-life care experience and feel uncomfortable with “not offering” dialysis in the appropriate setting. Both surveys also suggested that program directors in nephrology try to include palliative care experience in their fellowship programs.
How can this be done? Several suggestions include:
- Special didactic sessions by content experts during fellowship
- Dedicated elective time with a palliative care consult team/unit within the institution
- Attendance of fellows at local, regional, or national conferences on this topic
- Nephro Talk seminars
It is important to note that the ASN Foundation for Kidney Research recently announced the inaugural Bennett Clinical Scholar, Jane Schell, MD, is one of the co founders of Nephro Talk and will focus her work on the advancement of education of nephrology fellows in palliative care.
Let us know what you think?
Kenar Jhaveri, MD