Abstract
BackgroundImproper catheterization can lead to urethral injury. Yet research from four continents suggests training of junior doctors in catheterization is insufficient. European research suggests a majority of catheterization related morbidities occur when the procedure is performed by interns.MethodsTo assess the knowledge and practices of medical interns relating to urethral catheterization and iatrogenic urethral injury secondary to traumatic catheter insertion, a questionnaire survey was conducted of all first year medical interns at a tertiary national university hospital in the Philippines. The questionnaire contained 17 items covering 4 areas: methods of training in catheterization and level of experience; perceived adequacy of training; theoretical knowledge of catheterization; the mechanisms of catheter-related urethral injury.Results225/240 interns (94%) completed the survey (130 (57.8%) female). 125 (55.6%) responded that they had adequate theoretical training and 150 (66.7%) adequate practical training. All had performed more than 10 catheterizations and 204 (90%) were supervised when they first performed catheterization. Despite relatively high levels of experience and confidence, deficits were identified in detailed knowledge of correct catheterization procedures and of risks associated with urethral injury.ConclusionsMore thorough training of incoming medical interns in urinary catheterization may help to reduce the risk of complications and injury. Training should be universal and thought given to its timing within the curriculum. Training should include step by step instruction in the process, emphasis on history taking and awareness of factors associated with increased risk of urethral injury.
Highlights
Improper catheterization can lead to urethral injury
Progression from medical education to clinical practice differs from country to country, in general junior doctors will spend a year or more after completing medical school as interns or foundation doctors in teaching hospitals developing and demonstrating their clinical competencies before progressing to specialist residency training
Data collection A questionnaire was designed for the study to gather data relating to the training, knowledge and experience of medical interns in their first six months of training in a tertiary university hospital on urethral catheterization
Summary
Improper catheterization can lead to urethral injury. Yet research from four continents suggests training of junior doctors in catheterization is insufficient. Seldom life-threatening, iatrogenic urethral injury associated with catheter insertion may have devastating long-term sequelae including strictures, incontinence, erectile dysfunction, and infertility. Progression from medical education to clinical practice differs from country to country, in general junior doctors will spend a year or more after completing medical school as interns or foundation doctors in teaching hospitals developing and demonstrating their clinical competencies before progressing to specialist residency training. It is considered essential for safe patient care that basic practical clinical skills are in place at this early post medical school stage of a doctor’s training. Recommendations for minimum standards in scholarship, practice and professionalism for those completing medical school published by the UK’s General Medical Council include urinary catheterization in male and female patients [5]
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