Nephrology Certification Procedural Requirements: Call for Comment

The ABIM specialty boards that oversee each subspecialty of internal medicine periodically review procedural requirements in their respective disciplines to ensure that trainees are prepared for independent practice based on current medical standards.

The Nephrology Board is now considering a number of changes to nephrology initial certification procedural requirements and invites diplomates certified in nephrology to share their feedback during the public comment period closing June 1, 2023.

Background

To determine what the required procedures for initial ABIM certification in nephrology should be, the Nephrology Board surveyed nephrology diplomates in August of 2021 about how frequently they perform the currently required procedures and emerging procedural competencies in practice, and a second survey was conducted in February of 2022 for policy input on the nephrology procedural requirements. That information was shared with nephrology program directors and other stakeholders to get their opinions on which procedural requirements should be added, removed or changed.

In addition, ABIM conducted a survey of the program directors of all Accreditation Council for Graduate Medical Education (ACGME)-accredited nephrology fellowships in the summer of 2022. According to the survey, program directors felt that trainees underestimate what they need to know for their intended career setting. Survey responses emphasized the need for outpatient follow-ups for transplant patients, and raised concerns about competency in certain procedures that might be performed on a frequent basis early in fellowship, but infrequently thereafter.

The survey found that, of the current requirements, most procedures received consensus as important procedures to maintain or strengthen, including:

• Acute hemodialysis
• Continuous renal replacement therapy
• Chronic outpatient hemodialysis
• Chronic outpatient peritoneal dialysis

And the remainder received more varied responses on whether to remove, change, keep or offer opportunity-to-train* for:

• Temporary vascular access for hemodialysis and related procedures (non-tunneled dialysis catheter)
• Percutaneous biopsy of both autologous and transplanted kidney

The survey also requested input on emerging procedural competencies (e.g., home hemodialysis) and whether they should be added to the current list of requirements, strengthened or considered opportunity-to-train¹ with respect to initial certification requirements.

Collaboration with the Nephrology Community

The Nephrology Board sought qualitative feedback from nephrology societies, including the American Society of Nephrology (ASN), Renal Physicians Association, the National Kidney Foundation and the American Association of Kidney Patients. They also invited comments from ABIM discipline-specific governance in nephrology and dialysis providers.

At the same time, ASN convened the Task Force on the Future of Nephrology in response to procedural requirements from ABIM and the ACGME. The Task Force published a report prior to ASN Kidney Week in November 2022 with recommendations about procedural competencies for initial certification in nephrology, incorporating feedback from stakeholders across the discipline.

Nephrology Board Recommendation

Taking into consideration the breadth of feedback received from stakeholders and the ASN Task Force’s report, the ABIM Nephrology Board has proposed draft requirements with an impact statement*.

*PLEASE NOTE: The Nephrology Board’s recommendation has not been finalized. All current requirements can be found on ABIM’s website.

What Happens Next

Nephrology diplomates are an integral part of the decision-making process, and are invited to participate candidly and anonymously in the open comment period until June 1, 2023.

The Nephrology Board will discuss an update on procedural requirements at its spring meeting, but a decision will not be made until after the public comment period closes in June. All nephrology diplomates will be notified with the final decision.

The new procedural requirements would go into effect for nephrology fellows beginning their training July 1, 2024, and after.  

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¹Opportunity to Train: An opportunity-to-train standard would consist of both a knowledge requirement of training all fellows in the indications, contraindications, risks and benefits of the procedure, and a requirement to provide the opportunity to train in the procedure to the level of competent and independent performance for those fellows who request the training. This opportunity to train must be arranged and sponsored by the fellowship program, but the training can be provided outside of the program. All fellows are not required to perform the procedure to competence to be eligible for ABIM certification, but program directors will need to attest that all fellows fulfilled the knowledge requirement and that fellows requesting the training to procedural competency were provided the opportunity to train.