Addition of a Home Hemodialysis Counseling Scenario to an Existing Formative Objective Structured Clinical Examination (OSCE) for Nephrology Fellows: A Research Letter

Background: Home hemodialysis (HHD) prevalence is low in the United States; thus, nephrology fellows may have limited HHD clinical experience and be hesitant to counsel suitable patients. We describe a formative HHD counseling simulation scenario, part of a previously described nephrology-specific formative Objective Structured Clinical Examination (OSCE) that assesses fellow counseling skills using validated assessment instruments. Methods: During a 20-minute simulation, fellow performance was assessed by a standardized patient using the Essential Elements of Communication-Global Rating Scale 2005 (EEC-GRS) and by faculty using an HHD-specific Mini-Clinical Evaluation Exercise (Mini-CEX). Overall, EEC-GRS and Mini-CEX scores were the primary outcome measures. After the simulation, fellows were surveyed anonymously regarding satisfaction with the scenario and HHD clinical experience/education. Program directors reported HHD curriculum components. Fellow performance was analyzed by training year. Results: Four programs (19 fellows: 10 first-year, nine second-year) participated. All had an HHD curriculum. Three offered HHD training courses but no HHD clinic. One had a longitudinal HHD clinic (two first-year and two second-year fellows) but did not offer a training course. There were no significant differences in overall EEC-GRS or Mini-CEX scores between first- and second-year fellows. No fellow had an unsatisfactory overall score. On the post-OSCE survey (37% response rate), six of seven (86%) responding fellows agreed/strongly agreed that the simulation increased their “comfort in discussing HHD with a patient.” Conclusion: This educational, formative HHD counseling scenario, part of a previously described OSCE, is a low-risk opportunity for fellows to practice patient communication skills and appears to increase fellow comfort in discussing HHD.