Needs Assessment for Lower Urinary Tract Injury Curriculum for Female Pelvic Medicine and Reconstructive Surgery (FPMRS) Fellowships

Abstract

OBJECTIVE: Evaluation and management of lower urinary tract injuries (LUTI) are program requirements for FPMRS fellowship. We will determine level and types of training ACGME-accredited programs utilize to teach about LUTI. METHODS: Two surveys conducted among LUTI Curriculum from Program Directors (PDs) and fellows. Survey construction occurred through expert review, cognitive interviews, and pilot testing. Academic FPMRS surgeons vetted the surveys. Modified Delphi process used to finalize surveys. Surveys included demographics, questions assessing current education of LUTI, and competence among graduating fellows. IRB exempt. ABOG distributed electronic survey links to graduating fellows and PDs from 58 ACGME-accredited FPMRS programs. RESULTS: Response rate was 69%. 34 FPMRS graduating fellows (71%) and 39 PDs (67%) completed surveys. Most held primary certification in OB/GYN (100% and 85%) with remainder having primary certification in urology. Both groups responded LUTI curriculum was important to FPMRS training. Majority of PDs utilize combination of didactics and hands-on learning (60% and 71%). Only 40% and 30% incorporate LUTI simulation curricula. Graduates report low procedure numbers to evaluate/manage LUT complications. Only 15% of graduates perform greater than 2 ureteral re-implantations. 44% graduate have no minimally invasive abdominal vesico-vaginal fistula repairs. Majority of fellows reported feeling prepared to evaluate LUTI, but nearly 1/3 feel unprepared to independently manage LUTI. CONCLUSION: FPMRS PDs and fellows agree LUTI curricula is important. However, most programs utilize only didactics and hands-on learning in the OR with extremely low volume, leading to decreased proficiency. Simulation is a possible solution.