Simulation on Communicating on Kidney Biopsy

1. Explanation of indications and contraindications for kidney biopsy

• 1

  Critical deficiency

  Confused, disorganised, or omitted explanations of indications of renal biopsy. Does not recognise contraindications or screen for them. Does not indicate whether biopsy is necessary or optional. Does not know potential diagnoses and their therapies

• 2

  Unsatisfactory for level of training

• 3

  Satisfactory for level of training

• 4

  Superior for level of training

• 5

  Aspirational

  Clear, organized explanation of indications, possible diagnoses and treatments. Recognizes and screens for contraindications comprehensively. Indicates clearly whether biopsy is optional or necessary and explains why.

2. Explanations of Process of Biopsy

• 1

  Critical deficiency

  Does not explain or plan for laboratory screening and BP control. Does not describe the procedure and postprocedure steps, omits steps, or incorrectly describes them.

• 2

  Unsatisfactory for level of training

• 3

  Satisfactory for level of training

• 4

  Superior for level of training

• 5

  Aspirational

  Explains laboratory screening. Indicates which medicines must be held and for how long. Plans BP control. Explains pre, intra, and postprocedural events, including the need for lying supine for correct time period, need for patient to have someone bring home and exercise restrictions for 2 weeks.

3. Explanation of Risks

• 1

  Critical deficiency

  Does not describe risks or misrepresents them

• 2

  Unsatisfactory for level of training

• 3

  Satisfactory for level of training

• 4

  Superior for level of training

• 5

  Aspirational

  Reviews all risks, including failure to obtain tissue, pain, bleeding, obstruction, transfusion, AV shunt, nephrectomy, death and estimates risk clearly, taking hypertension and CKD into account. Describes steps to ameliorate these risks. Explains risks of not having kidney biopsy as well.

4. Soliciting Questions

• 1

  Critical deficiency

  Does not describe risks or misrepresents them

• 2

  Unsatisfactory for level of training

• 3

  Satisfactory for level of training

• 4

  Superior for level of training

• 5

  Aspirational

  Answers questions and solicits them. Answers plainly, sympathetically and without jargon

5. Consent

• 1

  Critical deficiency

  Does not ask patient if he/she wishes to proceed. Does not appropriately deal with patient who refuses. Is unprofessional or unkind.

• 2

  Unsatisfactory for level of training

• 3

  Satisfactory for level of training

• 4

  Superior for level of training

• 5

  Aspirational

  Specifically asks if patient wishes to proceed. If patient does not wish biopsy, offers further discussion at later time or with another nephrologist and discusses an alternate plan of care.

Additional comments.

Please write specific examples and justifications if you have used grading 1, 2 or 5 for the above 5 questions.