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Abstract: FR-OR099

The Acute Dialysis Orders Objective Structured Clinical Examination (OSCE): Results of Administration to 117 Nephrology Fellows Nationwide

Session Information

Category: Educational Research

  • 800 Educational Research

Authors

  • Prince, Lisa K., Walter Reed National Military Medical Center, Silver Spring, Maryland, United States
  • Campbell, Ruth C., Medical University of South Carolina, Charleston, South Carolina, United States
  • Kendrick, Jessica B., University of Colorado School of Medicine, Aurora, Colorado, United States
  • Maursetter, Laura J., University of Wisconsin School of Medicine & Public Health, Madison, Wisconsin, United States
  • Yuan, Christina M., Walter Reed National Military Medical Center, Silver Spring, Maryland, United States

Group or Team Name

  • Nephrology Education Research & Development Consortium
Background

Few quantitative, validated, Nephrology-specific simulations assess ACGME fellow competency performance. We developed, validated and administered a formative OSCE during 2016 and 2017 to 117 Nephrology fellows nationwide to assess medical knowledge, patient care, and systems-based practice in acute dialysis.

Methods

Fellows use institutional protocols and order sets to write dialysis orders and answer evidence based questions on 3 acute dialysis scenarios (49 test items; 58 possible points). 10 board-certified clinical nephrologists validated the test, determining a pass threshold of 46 points.

Results

The 2016 administration included 25 fellows (4 programs), and the 2017 administration included 92 fellows (15 programs). 51 first year fellows and 66 second/third year fellows completed the OSCE. All tests were scored by the 2 Principal Investigators. Median time to take the test was 65 minutes. 75% of fellows passed Scenario 1 (Acute CRRT), with 92% correctly prescribing a greater than 20 ml/kg/hr effluent dose, and 63% able to calculate CRRT clearance as effluent volume. 43% passed Scenario 2 (Urgent outpatient initiation) with 75% using a correct 3-4 meq/L K+ dialysate, but only 12% able to identify the 2 absolute, urgent indications for chronic dialysis initiation. Fellows performed poorly on Scenario 3 (Management prior to and dialysis prescription for acute hyperkalemia in ESRD). 6% passed, with only 20% correctly checking for rebound hyperkalemia with 2 separate lab draws. However, 83% were correct in not giving IV sodium bicarbonate as acute medical management for hyperkalemia. 32% of fellows passed the overall OSCE. No significant difference was found between first and second year fellow performance (overall score 42.7 ± 5 vs. 44.4 ± 4; p= 0.049; 24% vs. 39% pass rate; p= 0.082) with no correlation between second year fellow ITE and OSCE scores. The fellow satisfaction survey had a 56% response rate. 78% strongly agreed/agreed that the OSCE was useful in assessing proficiency in ordering acute renal replacement therapy.

Conclusion

The Acute Dialysis OSCE can provide quantitative data for fellow ACGME sub-competency assessments, and identify opportunities for dialysis curriculum development.

Funding

  • Other U.S. Government Support