Urology Faculty Research Articles

Implementation of a Urologic Surgery Skills Fair for Medical Students

To increase the proportion of applicants to urology residencies, we created a surgical skills fair to introduced urology early in undergraduate medical education. Funded by the Department of Urology, the fair was designed to have student rotations through 12 hands-on practice stations supervised by faculty and an advanced care practitioner or resident physicians. At conclusion, medical students completed a voluntary survey about their experience. Surgical skills fairs were organized at Yale School of Medicine (New Haven, CT) in 2022 and 2023. The fair was designed to encourage interaction between medical students, urology residents, and urology faculty by highlighting common urologic procedures and skills. The fair was well received by medical students at all levels of training. Over 2 years, 155 medical students attended, including 67 (43%) first-year and 60 (39%) second-year medical students. Eighty-two medical students completed the survey. An average of 19 attendings, advanced care practitioners and residents attended each event. Of the survey respondents, 42.7% reported prior interest in a surgical specialty but had not considered urology. Students reported increased interest in urology and greater confidence in urologic skills after the event (p < 0.001). We demonstrate that creating a surgical fair in urology is feasible and enhances early exposure and interest in urology. For students who do not pursue urology, the fair provides knowledge of urological pathologies and valuable skills for all physicians.

Development and Validation of a Simulation Model for Ureteral Stent Placement.

Currently, there are no validated training models for cystoscopy with ureteral stent placement. The objectives of this study were to develop and validate a novel endoscopic simulation model for training in ureteral stent placement. A low-cost, low-fidelity training model was developed to simulate ureteral stent placement. Recruited participants were divided into 3 groups: novices (postgraduate year 3/4 gynecology residents), advanced learners (urogynecology and reconstructive pelvic surgery fellows), and experts (urology residents, urogynecology faculty, and urology faculty). Construct validity was measured using de-identified video-recorded performances on the model, which were evaluated by 2 expert reviewers using validated scales (Global Operative Assessment of Laparoscopic Skills [GOALS], Global Rating Scale [GRS]) and procedure-specific metrics. The model was created using a hollow Styrofoam sphere, plastic tubing from a retropubic sling, and a silicone pacifier. Thirty-six surgeons were assessed performing the procedure using the model with cystoscopic equipment. The experts (n = 12) performed significantly better than the advanced learners (n = 17) and novices (n = 7) in total scores (max 75, median [IQR]: 75 [75-75], 61 [56.5-68.5], 45 [43-46], respectively; P < 0.001) and within each individual scale domain. Increasing experience with ureteral stent placement had a significant correlation (P < 0.001) with better performance on the model. A minimum total passing score of 63 was established. On post simulation assessment, most participants "agreed" or "strongly agreed" that the model closely approximates the feel of ureteral stent placement. This ureteral stenting simulation model is easy to construct, affordable, and reproducible. The model is valid and reliable for practicing the procedure in preparation for live surgery.

Student Urology Conference Increases Participant Knowledge of Urology Match and Confidence in Research.

To study the impact of a student-specific urology conference for students considering a career in urology. The first symposium specifically for medical students interested in urology was designed to provide an opportunity to present their research, explore urological subspecialties, and network with faculty members, residents, and other students. Medical students and faculty at a U.S. medical school organized the inaugural New England Student Urology Symposium (NESUS). The conference consisted of presentations from faculty members on various urology subspecialties, invited keynote speakers from regional Urology faculty, student poster and oral presentations, a surgical skills fair, and student and faculty panels surrounding the Urology Match and impact on career decision-making. Surveys were administered both before and after the conference to assess student perspectives. 42 medical students attended the conference, representing 21 medical schools from 15 states across all major U.S. regions. Attending the conference was associated with increased knowledge surrounding the Urology Match for students at schools without urology clinical rotations and decreased certainty about pursuing urology as a specialty along with increased comfort with presenting research for all attendees. 100% of student attendees recommended the conference to medical students interested in urology. Our study demonstrates that conference attendees found NESUS to be a valuable opportunity to gain confidence in presenting research, strengthen knowledge about the match process and its competitiveness, and network with faculty, residents, and fellow students. Future student-focused conferences in urology and other specialties should be considered at the regional or national level.

G.G. Smith: A Urologist on the Western Front

Objectives World War I (WWI) left a devastating impact on Europe. Urologist George Gilbert (GG) Smith served with a Harvard-associated group of surgeons and nurses stationed at the western front from 1915-1916. First-hand accounts and medical observations from the front are rare, so Smith’s wartime diary is a valuable source to gain further insight into what was once termed the ‘War to End All Wars’. Our objective was to study Smith’s diaries from WWI to better understand the personal and professional experiences and sacrifices of those who fought and served Methods The GG Smith diaries were obtained courtesy of the Smith family. Archives were consulted from the American Urological Association (AUA) William P. Didusch library (Linthicum, MD), Center for the History of Medicine at Countway Library (Cambridge, MA), the British Red Cross, the American Hospital of Paris, and cited secondary sources. Results Smith graduated from Harvard medical school in 1908 after training at Massachusetts General Hospital (MGH). He joined the growing urology faculty at Harvard under the leadership of Hugh Cabot. Following the start of WWI and before the United States’ formal involvement in the war, the Harvard Surgical Unit (HSU) was one of a number of ‘neutral’ medical corps from America’s elite hospitals, composed of individual doctors and nurses who were deployed wherever they were needed for a 3-month tour of duty. As a member of the HSU, Smith was stationed by the warfront, braving air attacks and bombs to care for hundreds of wounded, combatting infections, trauma, and fractious personalities.. The skill in leadership he developed served him well as President of the AUA from 1935-1936, Chair of Urology at MGH from 1938-1945, and President of the Massachusetts Society of Social Hygiene from 1937-1945 Conclusions Smith’s war time diary is testimony to the great philanthropic efforts of America’s institutions during WWI, to the remarkable progress in medical and surgical care that was motivated by the devastation of that war, and to the diversity of people whose pragmatic heroism contributed to the Allied victory.

(203) Awareness of Monkeypox Virus Among International Urology Faculty and Trainees is Low: Implications for Early Recognition and Diagnosis

Abstract Introduction The recent international outbreak of Monkeypox virus (Mpox), has raised concerns regarding the recognition and management of this disease among healthcare professionals. The genitourinary presentation of Mpox as variable cutaneous lesions poses a unique challenge for Urologists in its prevention, diagnosis, and management. Objective To assess the understanding and recognition of Mpox among international urologists and urology trainees. Methods A survey relating to the presentation, transmission, and management of Mpox was distributed to urologists and urology trainees during the joint 23rd Sexual Medicine Society of North America (SMSNA)/ 23rd International Society for Sexual Medicine (ISSM) conference. Results Out of 960 attendees, 97 (10.1%) responded to the survey. The rate of respondents who correctly identified a Mpox lesion from a series of cutaneous lesions was 25.8%. A similarly low number of respondents were able to identify the likelihood of having anogenital lesions and oral bleeding on presentation with Mpox at 15.5% and 19.6% respectively. A higher number of respondents accurately noted that diagnosis of Mpox may be made with PCR (79.4%) and that men with multiple male sexual partners are at the highest risk of transmission (72.2%) (Table 1). Conclusions When surveyed regarding the presentation, transmission, and management of Mpox, urologists and urology trainees were generally unable to accurately identify Mpox from a series of cutaneous lesions or the rate at which Mpox may present with anogenital lesions. The limited recognition of its presentation, appropriate diagnostic methods, and distinguishing features from sexually transmitted lesions raises concerns about potential missed diagnoses and delayed treatment. Continued education within the urology community may be necessary for the appropriate detection of and intervention against Mpox. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: Coloplast, Antares Pharma, Clarus Therapeutics.

MP25-04 UROANKI: EXAMINING THE IMPACT OF SPACED-REPETITION ON UROLOGIC SURGICAL EDUCATION

You have accessJournal of UrologyCME1 Apr 2023MP25-04 UROANKI: EXAMINING THE IMPACT OF SPACED-REPETITION ON UROLOGIC SURGICAL EDUCATION Chanan Reitblat, Stephanie Daignault-Newton, Bryn Launer, Vadim Osadchiy, Abhishek Venkataramana, Jeff Wieder, Ganesh Palapattu, and Kate Kraft Chanan ReitblatChanan Reitblat More articles by this author , Stephanie Daignault-NewtonStephanie Daignault-Newton More articles by this author , Bryn LaunerBryn Launer More articles by this author , Vadim OsadchiyVadim Osadchiy More articles by this author , Abhishek VenkataramanaAbhishek Venkataramana More articles by this author , Jeff WiederJeff Wieder More articles by this author , Ganesh PalapattuGanesh Palapattu More articles by this author , and Kate KraftKate Kraft More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003253.04AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: UroAnki is a free, peer-reviewed digital flashcard deck that leverages spaced repetition to help trainees master the fundamentals of Urology efficiently and effectively. The aim of this pilot study is to describe the implementation of UroAnki and to provide preliminary data on its adoption and impact on junior resident education. METHODS: In May 2022, Urology faculty and residents adapted Pocket Guide to Urology into a digital flashcard deck that tests common clinical scenarios junior residents are expected to evaluate and manage. Users were surveyed 3 months after implementation regarding usage patterns, perceived impact on self-efficacy, and feedback on areas of improvement. RESULTS: 227 out of 1169 (19.4%) UroAnki users responded to the survey, of which 114 (50%) identified as junior residents (PGY1-3). 89% of junior residents reported using UroAnki in the preceding month, with 62% reporting at least once a week usage. After studying the UroAnki cards, a majority of junior residents reported feeling better prepared for their clinical responsibilities (75%), on-the-spot questions posed by senior residents and faculty (83%), and the Urology in-service exam (66%) (Figure 1a). 80% of junior residents reported that studying UroAnki cards reduced stress and anxiety levels regarding building their fund of clinical knowledge (Figure 1a). Junior residents also ranked UroAnki as the most valuable resource for learning the fundamentals of Urology as compared to other commonly used educational resources (Figure 1b). CONCLUSIONS: UroAnki has been broadly adopted by Urology trainees. Among junior residents, UroAnki improved perceived self-efficacy, reduced stress and anxiety levels, and was ranked the most valuable resource for learning the fundamentals of Urology. Source of Funding: University of Michigan Urology Resident Education and Research Fund © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e343 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Chanan Reitblat More articles by this author Stephanie Daignault-Newton More articles by this author Bryn Launer More articles by this author Vadim Osadchiy More articles by this author Abhishek Venkataramana More articles by this author Jeff Wieder More articles by this author Ganesh Palapattu More articles by this author Kate Kraft More articles by this author Expand All Advertisement PDF downloadLoading ...

MP48-10 SURGICAL INTRAOPERATIVE HANDOFF INITIATIVE: STANDARDIZING OPERATING ROOM COMMUNICATION USING A VISUAL COGNITIVE AID

You have accessJournal of UrologyCME1 Apr 2023MP48-10 SURGICAL INTRAOPERATIVE HANDOFF INITIATIVE: STANDARDIZING OPERATING ROOM COMMUNICATION USING A VISUAL COGNITIVE AID Wesley Wilt, Brittany Levy, Sherry Lantz, and Andrew Harris Wesley WiltWesley Wilt More articles by this author , Brittany LevyBrittany Levy More articles by this author , Sherry LantzSherry Lantz More articles by this author , and Andrew HarrisAndrew Harris More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003294.10AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Operating room (OR) staff changes can potentiate communication failures, potentially leading to adverse events and disruption of OR flow. OR handoffs are not universally standardized, though standardized sign outs have been proven to provide effective communication in other aspects of healthcare. We hypothesize creating a standardized handoff, with persistent auditing, will result in highly reliable, standardized communication between OR staff members. METHODS: An engaged frontline stakeholder approached our OR quality improvement (QI) team, led by a QI experienced urology faculty member, with concern regarding lack of information discussed during surgical technician handoffs during staff changes. Following, the Surgical Intraoperative Handoff Initiative commenced from 5/2022 through 9/2022. The OR QI team created an audit tool for preliminary data collection, and current handoffs were audited. The pilot cohort of audits was discussed with stakeholders, including intraoperative staff and OR leadership, to develop a standardized communication protocol. A finalized communication tool was created with domains regarding sponges, sharps, hidden items, replaced items, instruments, implants, medications, procedure overview, and specimens. As a memory aid, an acronym of these domains, SHRIMPS, was affixed to each OR wall. RESULTS: 23 cases were observed both pre- and post-implementation. Handoffs occurred in 83% of cases pre-intervention, of which only 42% included communication with the surgeon, and the elements of the handoff varied. Sharps were discussed in 78%, instrument needs in 61%, medications in 65%, specimens requiring collection in 39%, and hidden items in 30% of handoff communications. In the initial Plan-Do-Study-Act (PDSA) cycle, piloted and audited in urology, general surgery, and neurosurgery after implementation of the standardized handoff, 100% of the 15 observed cases had a handoff performed, averaging 65 seconds per handoff. Additionally, 100% of cases announced a handoff to the surgeon, and all elements were addressed 99.6% of the time. PDSA cycle 2 involved implementation to all service lines, and of the 9 cases observed, 100% had a handoff performed at an average of 86 seconds per handoff, with 100% of elements addressed. CONCLUSIONS: Little standardization of communication exists within the OR, especially regarding intraoperative staff changes. Implementation of a standardized handoff resulted in substantial improvement in critical communication during staff changes. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e658 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Wesley Wilt More articles by this author Brittany Levy More articles by this author Sherry Lantz More articles by this author Andrew Harris More articles by this author Expand All Advertisement PDF downloadLoading ...

MP06-04 TRANSFORMING PERIOPERATIVE PROCESSES: COLLABORATION, EVALUATION, AND IMPROVEMENT

You have accessJournal of UrologyCME1 Apr 2023MP06-04 TRANSFORMING PERIOPERATIVE PROCESSES: COLLABORATION, EVALUATION, AND IMPROVEMENT Brittany Levy, Julia Haye, Wesley Wilt, Raymond Young, Emily Eichinger, and Andrew Harris Brittany LevyBrittany Levy More articles by this author , Julia HayeJulia Haye More articles by this author , Wesley WiltWesley Wilt More articles by this author , Raymond YoungRaymond Young More articles by this author , Emily EichingerEmily Eichinger More articles by this author , and Andrew HarrisAndrew Harris More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003217.04AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: On-time first case starts (FCS) is a nationally recognized indicator for operating room efficiency. While much attention is given to the minutes surrounding in-room time, opportunities for efficiency start from the moment the patient arrives in the hospital. Therefore, initial processes surrounding patient registration and rooming play an important role in achieving an on-time operating room (OR) start. We hypothesize LEAN methodology process improvement could enhance perioperative efficiency and standardization. METHODS: The Parallel Process Quality Improvement Initiative was conducted from 7/2022-9/2022 in the main OR of a tertiary care academic center. 844 visits pre-implementation and 244 visits post-implementation were audited over the study period. The QI initiatives were developed in concert with a QI experienced urology faculty member. Both leadership and frontline stakeholders were engaged, including perioperative leadership, perioperative staff, and administrative staff to identify current workflows and potential interventions targeting outpatient elective procedures. Process mapping outlined current rooming workflows. Benchmarks were developed through stakeholder team collaboration, and outcomes based on these benchmarks were obtained. RESULTS: Preliminary data revealed 844 patients who underwent elective FCS outpatient surgeries over a 2-month time period. Pre-implementation, patients were roomed by a mean time of 6:06 AM. However, after collaboration with the multidisciplinary team, 6 AM was chosen as the benchmark for FCS rooming. Overall, pre-implementation, 33% of FCS patients were roomed by 6 AM. Process mapping revealed a sequential process, which was converted to a parallel process. Implementation of the parallel process rendered an improved 6 AM rooming rate to 81% of FCS patients (Figure 1). Additionally, the parallel process reduced downtime for perioperative staff, by an average of 9 minutes (IQR=0, 13 min). CONCLUSIONS: Using LEAN methodology of process improvement and collaboration, perioperative processes can be evaluated and improved. Benchmarking, process evaluation, and auditing are needed for sustainable improvement. Standardized, parallel processes support enhanced efficiency in the perioperative process. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e54 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Brittany Levy More articles by this author Julia Haye More articles by this author Wesley Wilt More articles by this author Raymond Young More articles by this author Emily Eichinger More articles by this author Andrew Harris More articles by this author Expand All Advertisement PDF downloadLoading ...

MP66-17 TOWARDS PROCESS IMPROVEMENT: DEVELOPMENT OF AN EVALUATION TOOL TO IDENTIFY POTENTIAL PATIENT SAFETY HAZARDS PRE-OPERATIVELY

You have accessJournal of UrologyCME1 Apr 2023MP66-17 TOWARDS PROCESS IMPROVEMENT: DEVELOPMENT OF AN EVALUATION TOOL TO IDENTIFY POTENTIAL PATIENT SAFETY HAZARDS PRE-OPERATIVELY Wesley Wilt, Brittany Levy, Sherry Lantz, and Andrew Harris Wesley WiltWesley Wilt More articles by this author , Brittany LevyBrittany Levy More articles by this author , Sherry LantzSherry Lantz More articles by this author , and Andrew HarrisAndrew Harris More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003329.17AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Broken processes in the preoperative progression are dangerous and expose patients to unnecessary risks in the operating room (OR). A better understanding of issues is paramount to appropriately scope the intervention. We hypothesized creation of a preoperative audit tool would better identify unnecessary risk within the preoperative holding area (PHA) to allow for future quality improvement (QI). METHODS: Frontline stakeholders noted potential patient safety issues, frequent case delays, and redundant work in the PHA. Using lean methodology, problems within the PHA were evaluated through engagement with key stakeholders and the OR QI team, led by a QI experienced urology faculty member. A current-state process map of patient preparation for surgery in the PHA was constructed and was used create an audit tool aimed to measure patient readiness in the PHA. Following a pilot, stakeholders reassessed the components of the audit tool until issues within the PHA were adequately captured (Figure 1). RESULTS: PHA audit tool creation occurred from 4/2022 to 6/2022. The initial Plan-Do-Study-Act (PDSA) cycle of audit tool implementation included questions regarding appropriate paperwork and lab work, equipment readiness, medication administration, imaging completeness, and OR delays. After reengaging stakeholders, this was refined to include further information regarding preoperative chart issues, including reasons for incorrect consent, detailed equipment issues to identify specific departmental issues, and room for additional comments to capture redundant work or other issues experienced. A total of 4 PDSA cycles were completed to adequately refine the audit tool to assess if the patient chart was sufficiently reviewed and completed by the operative service prior to proceeding to the operating room. Subsequently, this tool identified 250 incomplete patient charts out of 377 (66.3%) cases audited between 6/2022 and 8/2022. CONCLUSIONS: Using lean methodology, key stakeholders were engaged in creating an audit tool with multiple iterations, successfully identifying areas of deficit in preoperative patient evaluation and readiness on the day of surgery. This data will help guide intervention, and the audit tool will be utilized post-intervention to measure success. Source of Funding: N/A © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e940 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Wesley Wilt More articles by this author Brittany Levy More articles by this author Sherry Lantz More articles by this author Andrew Harris More articles by this author Expand All Advertisement PDF downloadLoading ...

Factors Influencing Underrepresented in Medicine Urologist Recruitment to Academic Institutions.

We characterize factors associated with recruitment of underrepresented in medicine urology trainees and faculty to academic institutions given the excessive disparity between urology and other fields of medicine. A database of urology faculty and residents in Accreditation Council for Graduate Medical Education programs was created. Demographic data were obtained from departmental websites, Twitter, LinkedIn, and Doximity. Program prestige was defined by U.S. News and World Report rankings. Program location and city size were determined using the U.S. Census data. Multivariable analysis was performed assessing the association of gender, AUA section, city size, and rankings on underrepresented in medicine recruitment. Of urologists in this study 8.7% were underrepresented in medicine status. More women urologists were underrepresented in medicine (31.4%) than non-underrepresented in medicine (21.3%; P < .001). Factors predictive of more underrepresented in medicine urologists were practice in South Central AUA section (OR 2.1, P = .04), and medium metro areas (OR 1.6, P < .01). Among residents, factors predictive of more underrepresented in medicine urologists were female gender (P < .001), living in medium metro areas (P = .03), and training in top 10 programs (P = .001). Underrepresented in medicine faculty were more likely to be women compared to non-underrepresented in medicine faculty (P = .05). Pearson correlation test found no association between the presence of underrepresented in medicine faculty and underrepresented in medicine residents (r = 0.20). Underrepresented in medicine urology residents and faculty were more likely to be women, compared to non-underrepresented in medicine residents and faculty. Underrepresented in medicine residents are more prevalent in medium metro areas and in top 10 programs. More underrepresented in medicine faculty status was not associated with more underrepresented in medicine residents.

MP10-11 REPRESENTATION IN UROLOGY RESIDENTS AND FULL-TIME ACADEMIC UROLOGY FACULTY: A SNAPSHOT OF DIVERSITY AND INCLUSION IN MEDICINE AND UROLOGY

You have accessJournal of UrologyCME1 May 2022MP10-11 REPRESENTATION IN UROLOGY RESIDENTS AND FULL-TIME ACADEMIC UROLOGY FACULTY: A SNAPSHOT OF DIVERSITY AND INCLUSION IN MEDICINE AND UROLOGY Michelle Chen, Jeffrey Ellis, and Justin Friedlander Michelle ChenMichelle Chen More articles by this author , Jeffrey EllisJeffrey Ellis More articles by this author , and Justin FriedlanderJustin Friedlander More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002532.11AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: As under-represented in medicine (URM) groups are growing in the United States and in US medical schools, their proportional growth in academic medicine may not reflect present population demographics. We aimed to describe the racial representation of urologic academic faculty relative to current urologic residents, current US medical students, as well as national population trends. METHODS: This was a retrospective analysis of active full-time urology faculty according to the American Association of Medical College (AAMC) database as of August 31, 2021. Faculty demographics were self-reported. This was compared to the most recent AUA census data for residents using chi-square tests. For clarity, “other” was used to classify those who did not self-identify as Asian, black, Hispanic, or white. The same criteria were applied to AAMC Diversity in Medicine data for full-time US medical faculty for 2018, which was the most recent publicly available dataset. RESULTS: Study demographics can be seen in Table 1. Of 435 full-time urology faculty members, 83 (19%) were Asian, 11 (2.5%) were black, 10 (2.3%) were Hispanic, and 315 (72%) were white. The 2019 AUA census included 415 resident respondents which identified as 21% Asian, 3% black, 6% Hispanic, and 68% white. Racial distributions between urologic faculty and residents were significantly different (p=0.001). Greater differences in URM representation existed at associate professor (p<0.001), assistant professor (p<0.001), and instructor (p<0.001) levels. Representation in urology faculty also differed from US medical faculty at professor (p<0.001), assistant professor (p=0.02), and instructor (p=0.002) levels. Associate professor representation was similar (p=0.08) among urology and US medical faculty. CONCLUSIONS: As of 2021, the racial representation of urology faculty at all ranks significantly differed from that of current urology residents, with a greater proportion of persons in URM groups currently in training compared to faculty. We noted differences in URM representation at most ranks between urology and US medical faculty. Continued recruitment of diverse individuals will improve representation in the field of urology in general and lead to greater representation amongst academic faculty. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e150 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Michelle Chen More articles by this author Jeffrey Ellis More articles by this author Justin Friedlander More articles by this author Expand All Advertisement PDF DownloadLoading ...

MP19-07 CHARACTERIZING THE USE OF TWITTER AMONGST ACADEMIC UROLOGISTS

You have accessJournal of UrologyCME1 May 2022MP19-07 CHARACTERIZING THE USE OF TWITTER AMONGST ACADEMIC UROLOGISTS Alberto Castro Bigalli, Clara Sun, Ilaha Isali, Andrew Gianakopoulos, Justin Dubin, Seyed Behzad Jazayeri, Mohit Sindhani, and Laura Bukavina Alberto Castro BigalliAlberto Castro Bigalli More articles by this author , Clara SunClara Sun More articles by this author , Ilaha IsaliIlaha Isali More articles by this author , Andrew GianakopoulosAndrew Gianakopoulos More articles by this author , Justin DubinJustin Dubin More articles by this author , Seyed Behzad JazayeriSeyed Behzad Jazayeri More articles by this author , Mohit SindhaniMohit Sindhani More articles by this author , and Laura BukavinaLaura Bukavina More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002552.07AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The dramatic reduction of clinical and research activities within medicine during COVID-19, coupled with virtual electives and conferences, have all posed important implications within academics. Given the heavy reliance on virtual interaction during the pandemic and the active role that social media (SoMe) has, our study aims to characterize the state of SoMe use among current academic urology faculty. METHODS: We identified residency programs utilizing the American Urological Association (AUA) website. All MD/DO faculty information including gender, program location, and subspecialty training was recorded. After the designation of all faculty and their Twitter handles, Twitter Development API was set up with required authorizations and tokens. Python and R were used as the supporting language and setup using Anaconda Navigator. RESULTS: We identified 143 residency programs with a total of 2,377 faculty (1,975 males and 402 females). Among all faculty, 945 (39.75%) had registered Twitter accounts with the majority being male [760 (80.40%) vs 185 (19.60%)] (Figure 1a). Proportionately, female urologists were more likely to have a registered Twitter account (Figure 1a). Differences among specialty and SoMe use were also evident, with oncology (48%) and endourology (47.24%) among male faculty representing the highest registered user accounts (Figure 1b). When assessing registered accounts by gender across all faculty, there was no notable change during COVID (2019-2020), with peak for male faculty in 2014 (10.05% of all accounts registered) and peak for female faculty in 2015 (Figure 1c). The top five hashtags by occurrence were #prostatecancer, #urology, #bladdercancer, #covid19, and #aua19 among males, female faculty extending #sexmed as an additional common hashtag. When assessing faculty representation on Twitter, The University of Colorado (69.57%), Mayo Clinic Rochester (67.86%), and Case Western Reserve (65.22%) had the most represented faculty on SoMe proportional to the size of their program (Figure 1d). CONCLUSIONS: There is a steady increase in Twitter representation among academic urology, largely unaffected by COVID. While the majority of Twitter representation is largely skewed toward male faculty, there has been a steady increase in female faculty representation across all subspecialties over the last 16 years. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e309 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Alberto Castro Bigalli More articles by this author Clara Sun More articles by this author Ilaha Isali More articles by this author Andrew Gianakopoulos More articles by this author Justin Dubin More articles by this author Seyed Behzad Jazayeri More articles by this author Mohit Sindhani More articles by this author Laura Bukavina More articles by this author Expand All Advertisement PDF DownloadLoading ...

Closing the Gap: Evaluation of Gender Disparities in Urology Resident Operative Autonomy and Performance

Gender disparities have demonstrated influence on several areas of medical trainee academic performance and surgeon professional attainment. The impact of gender on perceived operative autonomy and performance of urology residents is not well understood. This single-institution pilot study explores this relationship by evaluating urology faculty and resident assessment of resident operative autonomy and performance using the Society for Improving Medical Professional Learning app. Using Society for Improving Medical Professional Learning, trainees in a single urology residency program were assessed in operative cases on three scales (autonomy, performance, and case complexity). Intraoperative assessments were completed by both faculty and residents (self-evaluation). Respective evaluations were compared to explore differences in ratings by gender. University of Michigan Health, Ann Arbor, MI. University of Michigan Urology Residents and Faculty. A total of 516 evaluations were submitted from 18 urology residents and 20 urology faculty. Self-reported ratings among female and male residents did not differ significantly for autonomy (p = 0.20) or performance (p = 0.82). Female and male residents received overall similar autonomy ratings that were not significantly different from female faculty (p = 0.66) and male faculty (p = 0.81). For female residents, there was no significant difference in performance ratings by faculty gender (p = 0.20). This finding was consistent when the resident was male (p = 0.70). At our institution, there is no overall gender-based difference in self-rated or faculty-rated operative autonomy or performance among urology trainees. Understanding relevant facets of institutional culture as well as educational strategies between faculty and residents may identify factors contributing to this outcome.

ANTEGRADE URETERIC STENTING IN MANAGEMENT OF URETERIC OBSTRUCTION IN CASE OF DIFFICULT RETROGRADE ACCESS; INDICATIONS, SUCCESS RATES &amp; PREDICTORS OF FAILURE

Background: Double j (jj) routinely inserted cystoscopically in retrograde manner in managing various causes of ureteric obstruction. sometimes we face situations at which the jj failed to be inserted in such conventional route or carrying high degree of difficulty. antegrade jj can be successful alternative modality in managing such failures/ difficulties.Aim of the work: Evaluate the antegrade ureteric stenting as an alternative to the retrograde ureteric stenting in the difficult cases of ureteric obstruction and to evaluate the predictors of success/failure of this procedurePatients & Methods: Prospective non-blinded interventional study that is conducted from the department of urology faculty of medicine Ain Shams University, Cairo, Egypt, between 2016 till 2020. included 78 patients with different causes of ureteric obstruction in two groups; group(I) included 28 patients with ureteric obstruction who had failed retrograde ureteric stenting; for them antegrade jj stenting were tried & group (II) included 50 cases of ureteric obstruction with high probability of difficulty or failure of retrograde stenting for them retrograde jj stenting tried first in 34 cases & if failed retrograde stenting were tried, while antegrade stenting tried directly in 16 patients due to high patients vulnerability.Results: In patients of group(I) antegrade stenting succeeded in 26 (92.86) patients & failed in 2 (7.14) patients.in group (II) retrograde trial succeeded in (7) cases & antegrade tried in (43) cases (27 cases after retrograde trial failure & 16 cases tried from the start), antegrade stenting succeeded in 39 (90.7%) cases & failed in 4(9.3%) cases. dye study e.g flow of dye to bladder showed statistically significant predictor of success/failure in both groups. most prevalent complications were hematuria in group(I) in (57 %) of the studied cases(hemoglobin drop didn’t exceed 1 gm /dl & hematuria subsided with genera measures) while in group (II) no complications occurred in (44%) of cases. nephrostomy tube needed in(21%) of cases in group (I) & needed in (38%) of cases in group(II)Conclusion: Antegrade ureteric stenting is successful alternative in cases of failure of conventional retrograde stenting & show high success rate in cases of high probability of difficulties.

MP12-09 LANGUAGE DIFFERENCES IN LETTERS OF RECOMMENDATION BASED ON GENDER OF LETTER WRITER

You have accessJournal of UrologyEducation Research II (MP12)1 Sep 2021MP12-09 LANGUAGE DIFFERENCES IN LETTERS OF RECOMMENDATION BASED ON GENDER OF LETTER WRITER Asha Sidhu, Samantha Freeman, Priya Dave, Nitya Abraham, and Kara Watts Asha SidhuAsha Sidhu More articles by this author , Samantha FreemanSamantha Freeman More articles by this author , Priya DavePriya Dave More articles by this author , Nitya AbrahamNitya Abraham More articles by this author , and Kara WattsKara Watts More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000001985.09AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Letters of Recommendation (LOR) play an integral role when considering applicants for a position in the medical profession. Applicant gender may influence language used, with studies showing potential disadvantage to female applicants. While many studies have examined how LOR language varies based on applicant gender, few have evaluated this based on LOR writer. We sought to investigate how the gender of the letter writer contributes to differences in LORs. METHODS: LORs written for medical students, residents, or colleagues by our full-time Urology faculty were requested on a voluntary basis as part of a faculty development initiative. Using the licensed text analysis software, Linguistic Inquiry and Word Count program, LOR were analyzed based on 16 word categories. T-tests assuming equal variances were used to compare continuous variables. RESULTS: Fifty-four LOR were voluntarily submitted and analyzed from 8 different full-time Urology faculty, of whom 4 writers were female and 4 were male. There was a significant difference in 3 of the 16 word categories by LOR author gender: Female authors wrote longer LORs (486.1 vs 364.1 words, p= .006) and included more risk (“danger, doubt” p-value = .047) and achieve words (“win, success, better” p-value= .049) than male writers. CONCLUSIONS: Differences in LOR language based on applicant gender have been well-studied, however to date there is a lack of data identifying differences due to the gender of the letter writer. We found gender of the LOR author impacted the length of the letter and the frequency of achieve and risk words. By exposing these differences and increasing awareness of potential subconscious biases observed in linguistic patterns between male and female authors, we hope to identify areas for faculty development that could potentially mitigate the gender disparity gap in medical fields such as urology. Source of Funding: N/A © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e191-e191 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Asha Sidhu More articles by this author Samantha Freeman More articles by this author Priya Dave More articles by this author Nitya Abraham More articles by this author Kara Watts More articles by this author Expand All Advertisement Loading ...

PD24-03 TRENDS IN THE RACIAL AND ETHNIC DIVERSITY OF THE U.S. UROLOGY WORKFORCE

You have accessJournal of UrologyEducation Research IV (PD24)1 Sep 2021PD24-03 TRENDS IN THE RACIAL AND ETHNIC DIVERSITY OF THE U.S. UROLOGY WORKFORCE Efe Ghanney Simons, Aileen Arevalo, Samuel Washington, Serena Does, Lorna Kwan, Anissa Nguyen, Tracy Downs, and Christopher Saigal Efe Ghanney SimonsEfe Ghanney Simons More articles by this author , Aileen ArevaloAileen Arevalo More articles by this author , Samuel WashingtonSamuel Washington More articles by this author , Serena DoesSerena Does More articles by this author , Lorna KwanLorna Kwan More articles by this author , Anissa NguyenAnissa Nguyen More articles by this author , Tracy DownsTracy Downs More articles by this author , and Christopher SaigalChristopher Saigal More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002017.03AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Historically, urology has had a lack of racial/ethnic diversity in its workforce. In 2019, only 2.0% of practicing urologists were Black and 3.9% Hispanic. Few empirical studies describe trends in urologists who are Under-Represented in Medicine (URM). We aimed to describe the historical trends and current state of racial/ethnic representation within the urology workforce compared to the national population. METHODS: Using data from the U.S. Census Bureau and the Association of American Medical Colleges, trends in racial/ethnic distribution for 2007-2019 were described for the educational “pipeline” for academic urologists, defined as starting with the U.S. population, leading to medical school application and graduation, then residency application, matching and graduation, and ending with urology faculty appointment. A comparative cohort analysis was done for the 2018-2019 academic year for differences in racial/ethnic distribution across cohorts by binomial tests. RESULTS: From 2010-2019, the U.S. Black and Latinx populations increased from 13 to 13.4% and 16 to 18.5% respectively. During that same time, the proportion of Black (3-4%) and Latinx (3-5%) urology residents remained unchanged, despite the increase in total number of residents (N=1043 to 1331). In 2019, there were step-wise decreases in proportion of Black and Latinx members represented at each stage of the educational pipeline, p<0.0001. CONCLUSIONS: The proportion of URM urologists was stagnant and did not match the national increase in racial/ethnic diversity during 2010-2019. This may be due to the loss of potential URM urologists at each educational stage. Our findings highlight possible strategies to diversify the urology workforce: diversifying the pool of undergraduates qualified to apply for medical school, targeted support for URM medical students, adequate preparation of URM urology applicants, appraising the equitability of application policies and promoting inclusion for URM faculty retention. Source of Funding: Office of the Vice Dean for Education and Executive Director of the DGSOM AntiRacism Roadmap © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e426-e427 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Efe Ghanney Simons More articles by this author Aileen Arevalo More articles by this author Samuel Washington More articles by this author Serena Does More articles by this author Lorna Kwan More articles by this author Anissa Nguyen More articles by this author Tracy Downs More articles by this author Christopher Saigal More articles by this author Expand All Advertisement Loading ...

Trends in the Racial and Ethnic Diversity in the US Urology Workforce

To examine the historical trends and factors underlying the current state of racial/ethnic representation within the urology workforce at each stage of the educational pipeline. Using data from the US Census Bureau and the Association of American Medical Colleges, trends in racial/ethnic distribution for 2007-2008 to 2019-2020 were tracked in the educational pipeline for academic urologists. This pipeline was defined as progressively diminishing cohorts, starting with the US population, leading to medical school application, acceptance, and graduation, through to urology residency application, matching, and graduation, and ending with urology faculty appointment. A comparative cohort analysis was performed for academic year 2018-2019 for differences in racial/ethnic distribution across cohorts by binomial tests. From 2007-2008 to 2019-2020, while the proportion of Latinx/Hispanic urology applicants increased by 0.38% per year (95% CI 0.24, 0.52), their proportion in the urology resident population remained unchanged (0.07% per year, 95% CI -0.20, 0.06) from 2011-2012 to 2019-2020. There was a decrease in the proportion of Black urology applicants (-0.13% per year, 95% CI -0.24, -0.02) and no change in the resident population (-0.03% per year, 95% CI -0.11, 0.05), despite an increase in total number of residents (n = 1043 to n = 1734) from 2009-2010 to 2019-2020. In 2018-2019, there were step-wise decreases in proportion of Black and Latinx/Hispanic members represented at critical stages of the educational pipeline (P <0.0001). Attrition in URM urologists occur at key educational stages. This paper offers opportunities for the design of interventions to diversify the urology workforce.

Crowd-Sourced Assessment of Surgical Skills of Urology Resident Applicants: Four-Year Experience

To determine a) if surgical skills among urology resident applicants could be reliably assessed via crowdsourcing and b) to what extent surgical skills testing impacts resident selection. Interviewees completed the following surgical skills tasks during their interview day: open knot tying (OKT), laparoscopic peg transfer (LPT), and robotic suturing (RS). Urology faculty and crowd-workers evaluated each applicant's video-recorded performance using validated scoring and were assessed for agreement using Cronbach's alpha. Applicants' USMLE scores, interview scores, and Jefferson Scale of Physician Empathy (JSPE-S) scores were assessed for correlation with skills testing scores and match rank. Additionally, a survey was distributed to interviewees assessing match outcomes. University of California Irvine Department of Urology, Surgical Skills Laboratory PARTICIPANTS: All 94 urology residency interviewees at the University of California Irvine Department of Urology from 2015-2018 were invited to complete the three surgical skills tasks on their interview day. Survey responses were received from all 94 interviewees (100%). Crowd and expert agreement was good (α=0.88), fair (α=0.67), and poor (α=0.32) for LPT, RS, and OKT scores, respectively. The skills testing scores did not correlate with match rank, USMLE score, or JSPE-S score. On multivariate analysis, only interview score (r= -0.723; p<0.001) and faculty LPT score (r=-0.262; p=0.001) were significant predictors of match rank. Interviewees who reported matching into a top 3 residency choice had significantly higher faculty LPT scores than those who did not (11.9 vs. 9.7, p=0.03). Surgical skills overall did not significantly impact match rank. Expert assessment of laparoscopic peg transfer skills and interview performance among urology resident applicants correlated with match rank.

Simulator based teaching of Trans-Urethral Resection of Prostate (TURP) skills in urology.

Background: After the introduction of simulators in urology, urology education has evolved significantly. The development of Transurethral Resection of Prostate (TURP) skills has shifted to simulator-based learning from being directly on patients. We evaluated the outcome of simulation-based teaching of TURP procedural skills on virtual reality simulator and objectively assessed the operative skills on the Global Rating Scale (GRS).&#x0D; Methodology: In this prospective comparative study, high fidelity (VirtaMed | UroSim™) simulator was used. A total of 17 participants were enrolled in this study, 4 were urology faculty members, and 13 were post-graduate urology trainees. All participants performed five attempts of real-time TURP complete procedure and were allowed to resect the maximum possible prostate tissue (goal ≥ 85%). Skills were assessed in terms of resection, bleeding control and safety parameters. Objective assessment of simulative operative skills was done on GRS score sheets by faculty, based on the Global Rating Index for Technical Skills (GRITS) and OSATS. The data from the 1st and 5th attempts of all participants was analyzed on SPSS version 22.0.&#x0D; Results: There was statistically significant difference in the mean resection score at 1st attempt between faculty and trainees i.e. 112±8.6 and 86.69±9.95, respectively (p&lt;0.01), while the scores were comparative by the 5th attempt. All the enrolled members resected &gt;80% of prostate volume (40 score points). Similarly, for the parameters associated with bleeding control, there was a significant difference in the bleeding control, lost blood and remaining bleeders between trainees and faculty members (p&lt;0.01) at 1st attempt while on 5th attempt, the outcomes were comparative in both groups. The objective assessment of operative skills of the trainee’s displayed improvement in all 5 parameters including tissue injury, movement and time, instrument application, surgical process and surgical details.&#x0D; Conclusion: Simulation-based TURP teaching significantly improves simulative operative skills in resection, bleeding control and safety parameters. GRS is an effective tool in assessing simulative operative skills and may evaluate endo-urological procedural training in urology trainees periodically.

Multi-Institutional Collaborative Resident Education in the Era of COVID-19.

The 2019-2020 coronavirus pandemic has had a significant impact on all aspects of health care. Decrease in clinical and operative volume and limitations for conferences has drastically decreased educational opportunities for resident trainees. We describe the formation and initial success of the Collaborative Online Video Didactics lecture series, a multi-institutional online video didactics collaboration. Zoom data extraction and postlecture evaluation surveys were used to collect data on the impact of the pandemic on local educational activities as well as feedback about the lecture series. Lectures are being given by faculty from 35 institutions. The twice daily, hour-long webinar averages more than 470 live viewers per session with an average of 33.5 questions per session and has over 7,000 YouTube views of the recordings after the first 2 weeks. Viewers reported significant decreases in outpatient (75.2%), inpatient (64.9%) and operating room (77.7%) volumes at local programs, and only half (52.7%) of the survey responders indicated an increase in didactics locally. The lectures have been well-received, with over 90% of respondents giving the lecturers and series above average or excellent ratings. A significant majority of responders indicated that the lecture series has allowed for ongoing education opportunities during the pandemic (95.0%), helped to access faculty experts from other institutions (92.3%) and provided a sense of community connectedness during this period of social isolation (81.7%). We strongly encourage other institutions and trainees to participate in the didactic series and hope that this series can continue to evolve and be of benefit beyond the pandemic.