Impact of a Longitudinal Virtual Education Series on Home Dialysis Education: A Mixed-Methods Evaluation

Background: Home dialysis has clinical and economic benefits, yet it remains underutilized in the United States. One barrier is a lack of experience amongst fellows due to inadequate training. To enhance fellow training, the American Society of Nephrology launched the Home Dialysis Virtual Longitudinal Education Program (ASN-HDU) with Home Dialysis University (HDU) in 2023. Methods: We evaluated the ASN-HDU longitudinal program using mixed-methods. We sampled participants from two groups: (1) fellows who attended both HDU and the ASN virtual program, and (2) fellows who only attended HDU. We sent a post-HDU survey and eight-month follow-up survey to assess quantitative changes in comfort in home dialysis. We interviewed participants from both groups and used a constant comparative method to identify qualitative themes related to home dialysis training. Results: After attending HDU, 52 participants reported median comfort levels of 7-8 out of 10 for peritoneal dialysis (PD) topics, and 4-5 out of 10 for home hemodialysis topics. In the follow-up survey, only participants of ASN-HDU demonstrated significant improvement in comfort level for all home dialysis topics by 1-2 out of 10 (except volume overload management on PD). Two main themes emerged from 10 qualitative interviews: (1) home dialysis training is sporadic and lacks structure, with subthemes describing challenges with receiving hands-on training, lack of systematic training, and a need for fellows to create their own training pathways, and (2) HDU and ASN-HDU are structured curricula that fill many educational gaps, but not all, with subthemes describing the value of these programs, examples of how fellows apply knowledge gained in clinical practice, and gaps that these curricula cannot directly address. Conclusions: Participation in ASN-HDU was associated with improved fellow comfort levels in home dialysis. Both HDU and ASN-HDU help address several gaps in home dialysis training in fellowship programs, but trainees may benefit from additional hands-on clinical experience.