MP23-03 NEW INSIGHTS INTO THE PERFORMANCE OF JUNIOR AND SENIOR RESIDENTS ON BASIC UROLOGICAL PROCEDURES

Abstract

You have accessJournal of UrologyTechnology & Instruments: Surgical Education & Skills Assessment II1 Apr 2015MP23-03 NEW INSIGHTS INTO THE PERFORMANCE OF JUNIOR AND SENIOR RESIDENTS ON BASIC UROLOGICAL PROCEDURES Anna Helena de Vries, Maaike Boute, Malou Kuppen, Jeroen van Merriënboer, Evert Koldewijn, Rob Pelger, Barbara Schout, and Cordula Wagner Anna Helena de VriesAnna Helena de Vries More articles by this author , Maaike BouteMaaike Boute More articles by this author , Malou KuppenMalou Kuppen More articles by this author , Jeroen van MerriënboerJeroen van Merriënboer More articles by this author , Evert KoldewijnEvert Koldewijn More articles by this author , Rob PelgerRob Pelger More articles by this author , Barbara SchoutBarbara Schout More articles by this author , and Cordula WagnerCordula Wagner More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.1246AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Several studies have investigated learning curves, risks and training needs of complex urological procedures. However, very little is known about the learning curves and training needs of more basic urological procedures. To investigate current performance of residents in relation to patient safety issues and to identify specific training needs, we performed a study with the research question: How well do junior and senior residents perform four different urological procedures, considering 1) completeness of procedural steps 2) level of independence 3) time, and 4) the incidence of unintended events? METHODS Between July 2012 and April 2013 data were collected during 146 urethrocystoscopies (UCS), 27 transrectal ultrasounds of the prostate (TRUS), 38 transrectal ultrasound-guided prostatic biopsies (TRUSP), and 30 transurethral resections of bladder tumour (TURBT). Performance was evaluated using scoring lists including details on completeness of procedural steps (e.g. preparation, material usage), level of independence, time, and the incidence of unintended events. The causal factors contributing to the unintended events were identified by two expert urologists and classified into (sub) categories according to the recognized PRISMA-method. RESULTS Senior residents showed a lower degree of completeness in material usage than junior residents during UCS (p<0.01), and in preparation, material usage, and procedure during TRUSP (all p<0.05, Mann-Whitney U test). During UCS, TRUSP, and TURBT senior residents received significantly less feedback compared to junior residents (p<0.01, p<0.05, and p<0.01, resp.). Events with (potentially) harmful consequences occurred in UCS: 8%, TRUS: 4%, TRUSP 47%, and TURBT 33%. Overall, human factors, mainly verification and skills-based issues, were identified as the main causal factors of unintended events. CONCLUSIONS Present performance of basic urological procedures involves a high percentage of unintended events, especially in TRUSP and TURBT. These events are mainly caused by human factors and are a potential threat for patient safety. Junior residents are less independent but more thorough in the performance of UCS and TRUSP compared to senior residents. In order to decrease the incidence of unintended events and optimize patient safety, targeted skills training including assessment should be implemented before privileges to independent practice are granted. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e268 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Anna Helena de Vries More articles by this author Maaike Boute More articles by this author Malou Kuppen More articles by this author Jeroen van Merriënboer More articles by this author Evert Koldewijn More articles by this author Rob Pelger More articles by this author Barbara Schout More articles by this author Cordula Wagner More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...