Applications of Point of Care Ultrasound in Urology Residency Training: A Practical Framework for Curriculum Design and Implementation.

European training in urology (ENTRY): quality-assured training for European urology residents.

Effect of COVID-19 on Urology Residency Training: A Nationwide Survey of Program Directors by the Society of Academic Urologists.

Urology Residency Training at the Time of COVID-19 in Italy: 1 Year After the Beginning

4-Year Curriculum for Urology Residency Training

The objective of this study was to determine the impact of having male infertility on urology residents' infertility training experience, surgical confidence, and In‐Service‐Exam Infertility/Sexual Medicine subscores. We electronically surveyed urology residents throughout the United States querying exposure to infertility faculty and fertility knowledge. Univariable and multivariable analysis was performed to determine predictors of higher In‐Service Exam Infertility/Sexual Medicine sub‐scores and self‐rated infertility competency. Fifty‐four of 72 respondents (75%) reported that male infertility comprises ≤10% of their training. Of the 63 residents who have a reproductive urologist on faculty, 66.7%, 47.6%, and 49.2% have scrubbed/observed a microsurgical varicocelectomy, vasectomy reversal and testicular sperm extraction, respectively. Residents exposed to infertility faculty are more likely to self‐rate their infertility understanding as “excellent” or “good” (p = 0.04 and p = 0.02, respectively), and 14.4× more likely to feel confident performing infertility procedures, versus residents lacking faculty (p < 0.001). Residents having formal microsurgical training have better self‐rated infertility understanding (p < 0.001), non‐obstructive azoospermia management (p = 0.01), and competency performing infertility procedures (p < 0.001). Residents exposed to fertility faculty are more likely to feel confident performing fertility procedures after residency (p = 0.001). In conclusion, infertility comprises a minority of residency training. Most residents anticipate performing infertility procedures in practice, despite two‐thirds lacking confidence performing these. Having an infertility faculty and formal microsurgical training improves residents' surgical confidence, non‐obstructive azoospermia management, and global male infertility understanding. A structured educational curriculum may improve resident infertility training.

To evaluate the impact of simulators on the training of urology residents in retrograde intrarenal surgery (RIRS). The study involved training eight urology residents, using two artificial simulators; one developed by the Universidade Estadual do Pará, using three-dimensional printing technology, and the other one patented by the medical equipment manufacturer Boston Scientific The qualification of residents took place through a training course, consisting of an adaptation phase (S0), followed by three training sessions, with weekly breaks between them (S1, S2 and S3). Study members should carry out a RIRS in a standardized way, with step-by-step supervision by the evaluator using a checklist. The participants' individual performance was verified through a theoretical assessment, before and after training (pre- and post-training), as well as by the score achieved in each session on a scale called global psychomotor skill score. In S3, residents performed an analysis of the performance and quality of the simulation, by completing the scale of student satisfaction and self confidence in learning (SSSCL). At the end of the course, everyone was able to perform the procedure in accordance with the standard. The training provided a learning gain and a considerable improvement in skills and competencies in RIRS, with p < 0.05. SSSCL demonstrated positive feedback, with an overall approval rating of 96%. Artificial simulators proved to be excellent auxiliary tools in the training of urology residents in RIRS.

Background: Point of care ultrasound (POCUS) use has rapidly expanded among internal medicine (IM) physicians in practice and residency training programs. Many benefits have been established; however, studies demonstrating the impact of POCUS on system metrics are few and mostly limited to the emergency department or intensive care setting. The study objective was to evaluate the impact of inpatient POCUS on patient outcomes and hospitalization metrics. Methods: Prospective cohort study of 12,399 consecutive adult admissions to 22 IM teaching attendings, at a quaternary care teaching hospital (7/1/2011-6/30/2015), with or without POCUS available during a given hospitalization. Multivariable regression and propensity score matching (PSM) analyses compared multiple hospital metric outcomes (costs, length of stay, radiology-based imaging, satisfaction, etc.) between the “POCUS available” vs. “POCUS unavailable” groups as well as the “POCUS available” subgroups of “POCUS used” vs. “POCUS not used”. Results: Patients in the “POCUS available” vs. “POCUS unavailable” group had lower mean total and per-day hospital costs ($17,474 vs. $21,803, p<0.001; $2,805.88 vs. $3,557.53, p<0.001), lower total and per-day radiology cost ($705.41 vs. $829.12, p<0.001; $163.11 vs. $198.53, p<0.001), fewer total chest X-rays (1.31 vs. 1.55, p=0.01), but more chest CTs (0.22 vs 0.15; p=0.001). Mean length of stay (LOS) was 5.77 days (95% CI = 5.63, 5.91) in the “POCUS available” group vs. 6.08 95% CI (5.66, 6.51) in the “POCUS unavailable” group (p=0.14). Within the “POCUS available” group, cost analysis with a 4:1 PSM (including LOS as a covariate) compared patients receiving POCUS vs. those that could have but did not, and also showed total and per-day cost savings in the “POCUS used” subgroup ($15,082 vs. 15,746; p<0.001 and $2,685 vs. $2,753; p=0.04). Conclusions: Availability and selected use of POCUS was associated with a meaningful reduction in total hospitalization cost, radiology cost, and chest X-rays for hospitalized patients.

Introduction: Point-of-care ultrasonography (PoCUS) is being incorporated into Canadian undergraduate medical school curricula. The purpose of this study was to evaluate novel PoCUS education sessions to determine what aspects of the sessions benefitted from hands-on training and which PoCUS skills were retained over time. Methods: Second year medical students voluntarily received three different PoCUS training sessions, each lasting three hours. Prior to the sessions, participants prepared independently with pre-circulated online learning materials. After a 15-minute lecture, experienced PoCUS providers led small group (1 instructor: 5 students), live scanning sessions. Evaluations were conducted before and after each session using expert validated multiple choice questions testing general and procedural knowledge, image recognition and interpretation. Volunteer students were evaluated via direct observation of live scanning using an objective structured assessment of technical skills (OSAT) based on the O-score and then re-evaluated at 2 months post-training to assess PoCUS skills retention. Results: 40 second year medical students participated in extended Focused Assessment with Sonography for Trauma (eFAST), cardiac, and gallbladder PoCUS sessions. The live-training sessions significantly improved student PoCUS knowledge beyond what they learned independently for eFAST (p &amp;lt; 0.001), cardiac (p &amp;lt; 0.001), and gallbladder (p = 0.02). The largest improvement was noted in procedural knowledge test scores improving from 44.0% to 84.0% (n = 38). 16 students were evaluated after each session with a mean O-score of 2.37. 8 students returned two months later to be re-evaluated demonstrating a change in O-scores for eFAST (2.00 to 2.38, p = 0.15), cardiac (2.28 to 2.00, p = 0.32), and gallbladder (2.91 to 1.88, p &amp;lt; 0.001). Conclusion: Procedural PoCUS knowledge benefited the most with hands-on training. eFAST and cardiac PoCUS competency was maintained over time while gallbladder PoCUS competency degraded suggesting that targeted PoCUS skills training may be possible. Further study is required to determine the best use of PoCUS resources in undergraduate medical education.

Point-of-care ultrasound (POCUS) has diverse applications across various clinical specialties, serving as an adjunct to clinical findings and as a tool for increasing the quality of patient care. Owing to its multifunctionality, a growing number of medical schools are increasingly incorporating POCUS training into their curriculum, some offering hands-on training during the first 2 years of didactics and others utilizing a longitudinal exposure model integrated into all 4 years of medical school education. Midwestern University Arizona College of Osteopathic Medicine (MWU-AZCOM) adopted a 4-year longitudinal approach to include POCUS education in 2017. There is a small body of published research supporting this educational model, but there is not much data regarding how this approach with ultrasound curriculum translates to real-world changes in POCUS use by graduate student clinicians having received this model of education. The objectives of this study are to determine the frequency of POCUS use by MWU-AZCOM graduates and to assess how a 4-year longitudinal ultrasound curriculum may enhance the abilities of MWU-AZCOM graduates to perform and interpret ultrasound imaging in specific residency programs. The study was approved by the MWU Institutional Review Board (#IRBAZ-5169, approval date October 3, 2022). An anonymous novel 12-question survey was conducted utilizing Research Electronic Data Capture (REDCap), a secure online platform, and distributed to MWU-AZCOM 2021 and 2022 graduates via email. Survey questions were aimed at assessing frequency of use, utilization of different imaging modalities, reasons for utilizing POCUS, barriers/enablers to utilizing POCUS, ultrasound training, and confidence in performing scans and interpreting POCUS imaging. All of the 104 surveys returned were included in the study. Statistical software R version 4.3 was utilized to conduct statistical analyses. Of the 484 surveys distributed, 104 were completed (21.5 % response rate). Responses came from residents working in 14 different specialties, 50 in primary care and 54 in nonprimary care. Of all respondents, 85.6 % currently utilize POCUS in their practice on at least a monthly basis and 77.0 % believe that their POCUS training in medical school enriches their current practice in residency. The top five modalities utilized by residents were procedures (89.9 %), cardiac (88.8 %), pulmonary (82.0 %), Focused Assessment with Sonography for Trauma (FAST, 73.0 %), and vascular (71.9 %). Respondents recognized POCUS as a beneficial diagnostic tool (97.8 %) and reported enhancements in physical examination skills (58.4 %) and professional growth (61.8 %). Facilitators for POCUS adoption included cost-effectiveness (82.0 %), diagnostic differentiation (78.7 %), and safety (79.8 %). Barriers included a lack of trained faculty (27.9 %), absence of necessary equipment (26.9 %), and cost of equipment (22.1 %). Participants demonstrated high confidence levels in performing (74.0 %) and interpreting (76.0 %) POCUS, with 43.3 % believing that their POCUS training enhanced their attractiveness as residency candidates. This study supports the positive impact of a 4-year longitudinal POCUS curriculum on graduates' practice. It emphasizes the link between MWU-AZCOM's curriculum and real-world clinical needs. Addressing identified barriers and advancing hands-on training can further enhance POCUS understanding, ensuring that future physicians are well-prepared to leverage its diagnostic potential across medical specialties.

Urological residency training is adecisive step on the urological career path. The aim of this review is to develop strategies and approaches to actively shape, improve and further develop urological residency training. With the help of astrengths, weaknesses, opportunities, and threats (SWOT) analysis, the status quo of urological residency training in Germany is analyzed in astructured manner. Strengths of urological residency training incorporate the attractiveness of the specialty itself, and the residency training curriculum in urology ("Weiterbildungscurriculum Urologie", WECU), including the networking of inpatient and outpatient training and accompanying internal and external further training. The German Society of Residents in Urology (GeSRU) also provides anetworking platform for residents. Weaknesses include country-specific differences and alack of checkpoints during residency training. Opportunities for urological continuing education arise from freelance work, digitalization, and technical and medical progress. In contrast, the aftermath of the coronavirus disease 2019 (COVID19) pandemic, with still limited staff and surgical capacities, an increased psychosocial workload, and the rising number of outpatient treatments in urology pose threats for urological residency programs. With the help of aSWOT analysis, factors for the further development of urological residency training can be identified. In order to provide high-quality residency training in the future, strengths and opportunities should be consolidated and weaknesses and threats should be addressed at an early stage.

Lack of general medicine faculty expertise is a likely contributor to the slow adoption of point of care ultrasound (POCUS) by internal medicine (IM) residency training programs. We developed a 10-week faculty development program, during which 15 faculty members participated in 2 hours and 10 hours of online didactic and hands-on training, respectively. Pre–post comparisons showed that there were statistically significant improvements in faculty participants' ability to interpret images (p<0.001), perceived understanding of the capabilities and limitations of POCUS (p=0.003), comfort using POCUS to make clinical decisions (p=0.003), and perceptions regarding the extent to which POCUS can improve patient care (p=0.026). The next challenge for IM programs is to improve access to ultrasound machines and provide follow-up workshops to facilitate further development of skills and integration of POCUS into daily practice by general medicine faculty.

Background: The early integration of hands-on point-of-care ultrasound (POCUS) during medical students' preclinical curriculum has expanded the utilization of this tool which can provide rapid and effective bedside diagnosis in clinical practice. Many medical schools that have incorporated POCUS into their curriculum allude to the limitations of a large class size, learning retention, and applying these skills to aid in diagnosing pathologic conditions. Indeed, it is interesting that there is currently no consensus as to what and how much hands-on ultrasound training should be included in the medical school curriculum. At Midwestern University (MWU), we introduced a 4-year inclusion of ultrasound training throughout the medical curriculum. The core Physiology courses taken in winter and spring quarter of first year medical school, incorporate several mandatory ultrasound workshops taken by osteopathic medical students and podiatry students together. This study hypothesizes that the incorporation of cardiac POCUS in small group physiology workshops increases student confidence in their ability to measure the parameters to effectively assess cardiac output. Moreover, we hypothesize that this hands-on teaching tool reinforces the concepts taught in the didactic lectures, applying the material in a clinically relevant manner. Data obtained during the 2023-2024 winter quarter will be presented at the APS meeting. Methods: This study aims to utilize a brief survey administered via REDCap, in a questionnaire format to first year osteopathic medical students and podiatric medical students after the cardiac physiology workshop administered during the first year of medical school. Survey questions will be generated using Likert 5-point scales, ratings of (strongly agree to strongly disagree, very comfortable to very uncomfortable, high level of competence to no level of competence, and very confident to very unconfident). Survey questions will seek to assess confidence level using POCUS, ease of quantifying assessments, and differences in perceptions between podiatry and osteopathic medical students. Associations between two question responses will be assessed using the Chi-square test for independent responses and McNemar test to compare responses that were paired. A p-value &lt;0.05 for both tests will indicate statistical significance. Furthermore, we aim to determine whether retention and application of the information taught during the cardiac POCUS workshop can be evaluated by student performance on POCUS-specific exam questions. IRB approval is currently pending. Results: We plan to share: (1) the survey questions, (2) data obtained using POCUS from the last academic years class cohort and the current class (specifically relating to their use of POCUS to calculate cardiac output) to highlight the variability in these assessments, (3) exam question analyses for the last 2-years (as assessment outcomes), (4) survey responses from the current class, (5) correlations of student perceived confidence and determined understanding. Conclusion: The introduction of POCUS utilization during the physiology courses in the first year of Osteopathic and Podiatry pre-clinical years reinforces key concepts covered in didactic lectures. We hypothesize that student perceptions of these workshops will be largely positive and improve student confidence in POCUS use. No funding. This is the full abstract presented at the American Physiology Summit 2024 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

Background: The early integration of hands-on point-of-care ultrasound (POCUS) during medical students' preclinical curriculum has expanded the utilization of this tool which can provide rapid and effective bedside diagnosis in clinical practice. Many medical schools that have incorporated POCUS into their curriculum allude to the limitations of a large class size, learning retention, and applying these skills to aid in diagnosing pathologic conditions. Indeed, it is interesting that there is currently no consensus as to what and how much hands-on ultrasound training should be included in the medical school curriculum. At Midwestern University (MWU), we introduced a 4-year inclusion of ultrasound training throughout the medical curriculum. The core Physiology courses taken in winter and spring quarter of first year medical school, incorporate several mandatory ultrasound workshops taken by osteopathic medical students and podiatry students together. This study hypothesizes that the incorporation of bladder POCUS in small group physiology workshops increases student confidence in their ability to measure the parameters to effectively assess bladder volume. Moreover, we hypothesize that this hands-on teaching tool reinforces the concepts taught in the didactic lectures, applying the material in a clinically relevant manner Data obtained during the 2023-2024 spring quarter will be presented at the APS meeting. Methods: This study aims to utilize a brief survey administered via REDCap, in a questionnaire format to first year osteopathic medical students and podiatric medical students after the bladder physiology workshop administered during the first year of medical school. Survey questions will be generated using a Likert 5-point scale, a rating of (strongly agree to strongly disagree, very comfortable to very uncomfortable, high level of competence to no level of competence, and very confident to very unconfident). Survey questions will seek to assess confidence level using POCUS, ease of quantifying assessments, and differences in perceptions between podiatry and osteopathic medical students. Associations between two question responses will be assessed using the Chi-square test for independent responses and McNemar test to compare responses that were paired. A p-value &lt;0.05 for both tests will indicate statistical significance. Furthermore, we aim to determine whether retention and application of the information taught during the bladder POCUS workshops can be evaluated by student performance on POCUS-specific exam questions. IRB approval is currently pending. Results: We plan to share: (1) the survey questions, (2) data obtained using POCUS from the last academic years class cohort and the current class (specifically relating to their use of POCUS to calculate and interpret bladder volume) to highlight the variability in these assessments, (3) exam question analyses for the last 2-years (as assessment outcomes), (4) survey responses from the current class, (5) correlations of student perceived confidence and determined understanding. Conclusion: The introduction of POCUS utilization during the physiology courses in the first year of Osteopathic and Podiatry pre-clinical years reinforces key concepts covered in didactic lectures. We hypothesize student perceptions of these workshops will be largely positive and will improve student confidence in POCUS use. No Funding. This is the full abstract presented at the American Physiology Summit 2024 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

Introduction / Innovation Concept: In Canada, family physicians (FPs) provide the majority of 1st trimester pregnancy care and are often first to evaluate complications, including threatened and spontaneous abortion and ectopic pregnancy. To receive a same day urgent US, most patients will be sent to the emergency department (ED). With increasing availability and affordability of point of care ultrasound (PoCUS), FPs are starting to use US in their offices, potentially diverting some ED visits for patients with reassuring US findings. To date, no formal certification process exists for FPs who wish to use PoCUS for 1st trimester indications. Methods: The objective of this educational initiative was to implement and evaluate a novel, 2-day didactic and hands-on certification process for FPs utilizing office-based PoCUS to identify intrauterine pregnancy and fetal cardiac activity. The FaMOUS course was modeled after the Canadian Emergency Ultrasound Society Emergency Department Echo (CEUS EDE) curriculum and adapted with permission for FPs. Curriculum, Tool, or Material: The curriculum consisted of a deliberate practice mastery model utilizing on-line materials, seminars and hands-on training. Prior to the 2-day course, FPs completed an e-learning module comprised of core competency material specific to obstetrical practice. Learners were required to score 100% on a post-module exam to participate in the 2-day course. Attendees participated in a 4-hour training session to learn US image generation and interpretation. This was followed by 10 hours of hands-on training with CEUS instructor supervision to complete the certification process (50 determinate scans). Thirteen FPs from 3 family practice units successfully completed the certification process. Cumulative knowledge and skill levels were assessed throughout the 2-day workshop through feedback from CEUS supervisors to confirm key concepts were learned. All 13 participants agreed to utilize PoCUS in their clinical assessments of patients with 1st trimester complaints using handheld PoCUS equipment provided to the sites. FPs will be surveyed at 3 month intervals for 12 months following the FaMOUS course to assess provider confidence, satisfaction and perceived impact on clinical decision-making. Conclusion: The FaMOUS certification course is a standardized curriculum by which FPs can learn PoCUS safely to improve quality and timeliness of care for patients experiencing 1st trimester complaints. If PoCUS is adopted by FPs, lengthy ED visits may be decreased for this patient population.

BackgroundIn 2011, the role of Point of Care Ultrasound (POCUS) was defined as one of the top five research priorities in physician-provided prehospital critical care and future research topics were proposed; the feasibility of prehospital POCUS, changes in patient management induced by POCUS and education of providers. This systematic review aimed to assess these three topics by including studies examining all kinds of prehospital patients undergoing all kinds of prehospital POCUS examinations and studies examining any kind of POCUS education in prehospital critical care providers.Methods and resultsBy a systematic literature search in MEDLINE, EMBASE, and Cochrane databases, we identified and screened titles and abstracts of 3264 studies published from 2012 to 2017. Of these, 65 studies were read in full-text for assessment of eligibility and 27 studies were ultimately included and assessed for quality by SIGN-50 checklists. No studies compared patient outcome with and without prehospital POCUS. Four studies of acceptable quality demonstrated feasibility and changes in patient management in trauma. Two studies of acceptable quality demonstrated feasibility and changes in patient management in breathing difficulties. Four studies of acceptable quality demonstrated feasibility, outcome prediction and changes in patient management in cardiac arrest, but also that POCUS may prolong pauses in compressions. Two studies of acceptable quality demonstrated that short (few hours) teaching sessions are sufficient for obtaining simple interpretation skills, but not image acquisition skills. Three studies of acceptable quality demonstrated that longer one- or two-day courses including hands-on training are sufficient for learning simple, but not advanced, image acquisition skills. Three studies of acceptable quality demonstrated that systematic educational programs including supervised examinations are sufficient for learning advanced image acquisition skills in healthy volunteers, but that more than 50 clinical examinations are required for expertise in a clinical setting.ConclusionPrehospital POCUS is feasible and changes patient management in trauma, breathing difficulties and cardiac arrest, but it is unknown if this improves outcome. Expertise in POCUS requires extensive training by a combination of theory, hands-on training and a substantial amount of clinical examinations – a large part of these needs to be supervised.