ASN's Mission

To create a world without kidney diseases, the ASN Alliance for Kidney Health elevates care by educating and informing, driving breakthroughs and innovation, and advocating for policies that create transformative changes in kidney medicine throughout the world.

learn more

Contact ASN

1401 H St, NW, Ste 900, Washington, DC 20005


The Latest on Twitter

Kidney Week

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


  • 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

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.


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.


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.


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


  • Other U.S. Government Support