Kidney biopsies are an integral part of Nephrology. In the
last decade, nephrologists are slowly shying away from performing this
procedure. Both in academia and private practice, the procedure is being slowly
and surely diverted to dedicated hands of interventional radiology. In certain
centers, the nephrologists still perform and teach fellows on doing this
important procedure. Recently, 4 opinion articles in CJASN discuss the pros and
cons on continuing to teach the kidney biopsy procedure to our fellows.
Bob
Brown discusses a balanced form of approach. While the arguments for doing
the kidney biopsy are obvious , the counterarguments that kidney biopsy
performance should no longer be a requirement for nephrology certification are
that about
65% of practicing nephrologists do not perform biopsies and the standards for evaluating biopsy
competency of graduating fellows are not defined despite the risk of the
procedure. In United States nephrology training program directors survey, 45%–51%
thought that biopsy competency should not be required for fellowship
completion.
Stuart
Shankland takes the con approach and discusses the reasons not to require
fellows to be doing catheters and kidney biopsies. He takes a patient centered
and safety approach. Having the
radiologists who do this on a daily basis perform the procedure provides a more
safer environment than the nephrologists doing it.
Jeff
Berns takes the pro approach and discusses the reasons that require the
fellows to be doing catheters and kidney biopsies.
Suzanne
Norby gives a program director’s perspective and provide a framework for
the need for fellowship training.
Personally, I feel conflicted. As a fellow, I learnt doing
kidney biopsies and enjoyed doing them. Since I am in teaching institution and part
of a fellowship program, I feel that
teaching the fellows kidney biopsies is important and I make time for doing
kidney biopsies and teaching fellows. If I was in community private practice, I
doubt I would have done the same. While
it is a great asset to have, the time commitment is enormous from booking the
room, getting supplies and setting up the table and so forth. Divisions that have their own interventional
nephrology suites or biopsy suites might have it easier and faster to perform
these biopsies. A twitter conversation that started this discussion is very
interesting to see. It adds to the 4 articles that were published in
CJASN.
Second set of tweets start a more interesting discussionFour editorials on "should renal fellows be doing kidney biopsies" @CJASN in the recent articles https://t.co/azsjqOkl1u Check it out!! Where do you stand on this? Should kidney biopsy procedural training be required during renal fellowship?— Kenar Jhaveri (@kdjhaveri) June 16, 2018
Interesting editorials on Pros/Cons of dialysis catheter and kidney biopsy requirements in Nephrology training @CJASN— Matt Sparks (@Nephro_Sparks) June 15, 2018
🛑@StuartShankland https://t.co/sgxUUJwj12
✅@Jeff_Berns_POTD https://t.co/VIhQCkoPWi
I am impressed and congratulate CJASN on this amazing venture on such articles that really bring the tough questions to the table for nephrology. First set of tweets are an unofficial poll that was stated on this topic.
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