Development and Evaluation of a Kidney Point-Of-Care Ultrasound (POCUS) Training Program for Nephrology Fellows: A Quality Improvement Study.

Background: Point of care ultrasound (POCUS) has become increasingly integrated into routine clinical care, though its adoption in nephrology remains limited. Objective: This pilot study evaluated a program to train nephrology fellows to perform POCUS to detect small kidney size and hydronephrosis. Design and Setting: We performed a quality improvement initiative at a single academic center (St. Michael's Hospital). Patients: 63 patients were included. Measurements: Pre- and post-workshop surveys assessed trainees' comfort level with kidney POCUS imaging. Patient satisfaction was also measured using a questionnaire. Time to kidney imaging, radiologic diagnosis and kidney POCUS diagnostic accuracy were also assessed. Methods: Nephrology fellows participated in two 1-hour workshops featuring didactic and hands-on training using POCUS machines, after which they scanned hospitalized patients. Results: Sixty-two native kidneys and 32 transplant kidneys were scanned. Patient surveys indicated high satisfaction with POCUS, with 71% preferring bedside ultrasound in future care. Trainee confidence with using POCUS improved post-workshop. Trainee-performed POCUS demonstrated a specificity of 1.00 (95% CI 0.94-1.00) and 0.96 (95% CI 0.80-1.00) for the detection of hydronephrosis in native and transplant kidneys, respectively. Nephrology trainees demonstrated a specificity of 0.75 (95% CI 0.53-0.90) [left native kidneys], 0.81 (95% CI 0.61-0.93) [right native kidneys] and 0.97 (95% CI 0.84-1.00) [transplant kidneys] for the detection of small kidney size. Limitations: The prevalence of hydronephrosis and small kidneys was too low in this pilot study to draw conclusions about sensitivity. Additionally, a majority of the kidneys underwent POCUS imaging after an ultrasound had been performed in the medical imaging department. Conclusions: Despite the increasing demand for POCUS training in nephrology, a significant gap persists in its clinical integration. Our study demonstrates that a structured workshop improves trainee confidence in kidney POCUS, with high patient satisfaction. Preliminary findings suggest that nephrology fellow-performed POCUS is feasible and promising, though further large-scale studies are needed to validate its clinical utility.