Dr Abhisri Negi1, Prof Shilpa Jesudason3,4, Dr Erin Vaughan5, Dr Alessandra Orsillo3, Dr Adam Steinberg6, Dr Melanie Wyld1,2
1Department of Renal Medicine, Westmead Hospital, Westmead, Australia, 2School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, Australia, 3Adelaide Medical School, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, Australia, 4Central Northern Adelaide Renal and Transplantation Service, Royal Adelaide Hospital, Adelaide, Australia, 5Department of Renal Medicine, RPA Hospital, Camperdown, Australia, 6Department of Renal Medicine, The Royal Melbourne Hospital, Melbourne, Australia
Biography:
Melanie Wyld (B.Econ(Hons) MBBS MBA MPH PhD FRACP) is a nephrologist at Westmead Hospital and senior lecturer in clinical epidemiology at the University of Sydney. She is a clinical researcher with research interests in obstetric nephrology, living donor kidney transplantation, and equity of access to care. She is a member of the ANZDATA Parenthood Working Group, Chair of Equity Diversity and Inclusion Committee of ANZSN, Chair of TSANZ’s Living Donor Transplantation Working Group.
Aim:
To identify gaps in training and confidence among Australian nephrology Advanced Trainees (ATs) and early-career Fellows in managing women’s health and obstetric nephrology, in women with chronic kidney disease (CKD) and kidney failure (KF).
Background:
CKD and KF significantly impact reproductive health in females, contributing to menstrual dysfunction, subfertility, and higher risk pregnancies. Despite this, formal training in obstetric nephrology and women’s health remains limited in Australia. International data report low confidence among nephrologists and trainees in managing these issues, but Australian data are lacking.
Methods:
A national cross-sectional survey was conducted using REDCap, targeting RACP Nephrology ATs and Fellows within five years post-training. The survey collected data on demographics, training exposure, clinical confidence, perceived barriers, and preferred educational supports. Descriptive statistics were used for analysis.
Results:
Seventy-nine complete responses were received (35 trainees, 44 Fellows; 58% female), from all states and territories except ACT. Although 82% had trained in units co-located with maternity services, only 48% received obstetric nephrology teaching and 17% women’s health education. Confidence was lowest for managing menstrual disorders (83% low/very low), menopause (77%), fertility counselling (68%), and fertility referrals (58%). Just 12% felt highly confident counselling on pregnancy outcomes by CKD stage; and 68% lacked confidence managing dialysis during pregnancy. Main barriers were insufficient training (74%) and low personal knowledge (66%). Respondents expressed a strong preference for clinical exposure and interdisciplinary Obstetric and Nephrology guidelines over online learning.
Conclusion:
This first national survey reveals substantial and previously under-recognised deficiencies in obstetric nephrology and women’s health training among Australian nephrology trainees and early-career Fellows. Addressing these gaps is critical to improving care for female patients with CKD/KF.