Urology Residents Research Articles

(008) Update on Female Sexual Dysfunction Training in Urology Residencies: Are We Making Progress?

Abstract Introduction As urologists and sexual medicine specialists, we are the experts in treating sexual health issues. Female sexual dysfunction (FSD) receives considerably less attention than male sexual dysfunction (MSD). The AUA Core Curriculum includes lessons on FSD and MSD, and thus urology residencies should be providing education on both. Objective We sought to evaluate all AUA accredited urology residency program websites in order to determine the availability of FSD and MSD information. Our group conducted a preliminary study on this subject in 2017 and now wish to see how this information has changed over time. Methods Program websites of accredited U.S. urology residencies listed on the AUA website were analyzed. Two independent reviewers each collected information from the websites of the 147 residency programs. Information on FSD and MSD content, curricula, subspecialists on faculty, and program directors (PDs) were recorded, as well as the minimum number of clicks required to reach each topic. Data was stratified by AUA section. Chi-square analysis was performed to compare the proportion of programs with FSD and MSD content. Results In 2023, 132 (89.8%) program websites included MSD content with a median of 1 click required to access that content, compared to 74 (58.2%) programs in 2017 when 2.5 clicks were required (p<0.01). In 2023, 43 (29.3%) program websites included FSD content with a median of 2 clicks, compared to 12 (9.4%) in 2017 with the number of clicks remaining at 2 (p<0.01). In 2023, all AUA sections are represented by programs containing both MSD and FSD content, although there are significantly fewer programs with FSD (43) compared to MSD content (132) across all sections (p <0.01). However, this is an improvement from 2017 when the Northeastern, Mid-Atlantic, and Southeastern sections contained no program websites with FSD content. Curricula with FSD is lacking; only 4 programs (2.7%) specifically include FSD, compared to MSD being included in 39 (26.5%) program’s curricula (p<0.01). 127 (86.4%) residencies have MSD subspecialists on faculty compared to only 29 (19.7%) with FSD subspecialists on faculty (p <0.01). Interestingly, 15% of PDs (22/147) are FPMRS subspecialists compared to 8% (12/147) who are Andrology or Sexual Medicine subspecialists. Neither PD subspecialty of FPRMS vs Andrology/Sexual Medicine nor PD gender predicted FSD content. Conclusions More urology residency program websites are including FSD and MSD content, although the number with MSD content has increased to a greater degree compared to the number with FSD content. MSD content is becoming more available, now requiring fewer clicks to access than FSD content. While increasing, FSD content still remains lower than MSD content in all analyzed domains. Although the gap is closing, the opportunity to increase FSD education still exists within urology residency programs. Disclosure No.

(120) A Survey of Exposure to the Use of Xiaflex for the Treatment of Peyronie’s Disease Among United States Urology Residency Programs

Abstract Introduction Xiaflex (Collagenase Clostridium Histolyticum) is an FDA-approved treatment for patients with Peyronie’s Disease. However, despite its approval and widespread implementation in clinical practice, there is concern that urologists in training are offered minimal exposure to its use. Objective Thus, the purpose of this study was to evaluate the exposure of urology residents to Peyronie’s Disease and its management, particularly Xiaflex. Methods A six-question Google Forms survey regarding exposure of residents to Peyronie’s Disease and the Use of Xiaflex was created. The survey was disseminated through email to urology residency program directors, chief residents, or andrology-focused faculty. Results Overall, 47 institutional responses were received, eliciting a response rate of approximately 34%. At 45 institutions (96%), residents receive training in directly evaluating and caring for patients with Peyronie’s disease. Of these, in 36 institutions the training is led by an academic faculty who is fellowship trained in sexual medicine. At 46 institutions (98%), residents receive training in observing and/or performing surgical procedures such as plication, grafting, and penile implants for Peyronie’s disease. With regards to surgical treatment, residents are trained by an academic faculty who is fellowship trained in sexual medicine at 35 programs. Conversely, residents at only 31 institutions (66%) receive observational or procedural training for non-surgical management of Peyronie’s disease, specifically Xiaflex. Residents receive non-surgical training by an academic faculty who is fellowship trained in sexual medicine at 25 institutions and an academic faculty who is not trained in sexual medicine at 6 institutions. When categorizing based on AUA section: 3 out of 4 Mid-Atlantic programs (75%), 3 out of 4 New England programs (75%), 2 out of 8 New York programs (25%), the 1 Northeastern program (100%), all 11 North Central programs (100%), 5 out of 6 South Central programs (83.33%), 5 out of 6 Southeastern programs (83.33%), and 3 out of 6 Western programs (50%) reported residency exposure to the use of Xiaflex. Conclusions Urology residents receive broad exposure to the management of Peyronie’s Disease, particularly its surgical treatment. However, there exists a glaring disparity in residency exposure to Xiaflex, which represents the sole FDA-approved medical management for Peyronie’s Disease. To our knowledge, we present the first study evaluating resident exposure to Xiaflex in the treatment of PD. We believe it is important for United States residency programs to ensure that their trainees are educated on the use of this treatment option. A broader incorporation of training of Xiaflex among urology residents may increase the number of providers who are comfortable and competent with providing this level of care to a potentially vulnerable patient population. Further research is warranted to elucidate why this discrepancy exists and how programs can provide residents with further exposure to the use of Xiaflex in patients with Peyronie’s Disease. Disclosure No.

(286) Gender Disparities Exist in the Surgical Management of Peyronie's Disease and Urologic Prosthetics: An Evaluation of American Board of Urology (ABU) Surgical Case Logs

Abstract Introduction Urology has been predominantly male-dominated, although recent trends indicate increased female representation among urology residents, physicians and advanced-practitioner providers. While progress has been made, gender disparities persist due to societal perceptions and biases. The goal of this study was to investigate whether a provider gender gap exists in the field of reconstructive urology using American Board of Urology (ABU) case logs. Objective To examine case volume characteristics for provider gender disparities in Peyronie’s disease and urologic prosthetic surgery. Methods Retrospective review of surgical case log data from 2003 to 2023 of certified urologists was performed for 11 Current Procedural Terminology (CPT) codes for the surgical management of Peyronie’s disease (penile plication CPT 54360, plaque excision/incision with grafting CPT 54111, 54112), male urethral sling or artificial urinary sphincter (CPT 53440, 53445), and placement of penile implant (CPT 54400, 54401, 54405). Inclusion criteria included male patients who were 18 years old or older. Data collected included patient and surgeon demographics, surgical procedure, and surgeon fellowship training status. Cases were analyzed using descriptive statistics and regression testing. Results From 2003 to 2023, a total 2,852 urologists performed 15,171 Peyronie’s disease and urologic prosthetic surgical procedures. Among these procedures, 1,910 (13%) Peyronie’s disease, 8,940 (59%) penile implant, and 4,321 (28%) incontinence procedures were identified. Out of the total practicing urologists, 2,626 were male and 226 were female; the distribution of cases revealed 5 cases performed per male surgeon and 4 cases per female surgeon. Over two decades, there was a significant positive trend in the proportion of cases performed by female surgeons (p < 0.001). 169 (6%) surgeons completed fellowships in Andrology or Male Reconstruction, and performed 2,129 (14%) of total procedures. Across surgeons with Andrology or Male Reconstruction fellowship-training, there were 13 cases performed per male surgeon and 7 cases per female surgeon. Conclusions Our study confirms underrepresentation of female surgeons in the field of Peyronie's disease and prosthetic urology. Although there is a trend of increasing female representation over time, further research can be done to identify barriers to gender equality in the field. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: Boston Scientific, Coloplast.

(350) Assessment of Fundamental Knowledge and Comfortability of Medical Trainees in the Diagnosis and Treatment of Genito-pelvic Pain Penetration Disorder

Abstract Introduction Genito-Pelvic Pain/Penetration Disorder (GPPPD) is a common condition affecting up to 25% of the US population. Despite its prevalence, significant barriers exist for patients to obtain appropriate diagnosis and treatment. Lack of uniform education in vulvar anatomy, physiology, and vulvar pain conditions in medical schools for trainees may be a contributing factor in the delay to diagnosis for patients. The vulvar examination is pivotal in diagnosing GPPPD but is often omitted, despite its importance, due to shortcomings in medical education. The lack of formal education may leave many healthcare workers feeling unprepared to care for their patients' sexual health. Objective Our study aims to assess the fundamental knowledge of medical trainees who treat vulvar health in the diagnosis and treatment of GPPPD. We also aim to assess the knowledge and confidence of physician residents on how to conduct a comprehensive vulvar examination. Methods This cross-sectional analytical survey study uses Qualtrics to administer the survey after obtaining IRB approval. The target audience includes urology residents, obstetrics and gynecology residents, dermatology residents, internal medicine residents, family medicine residents, emergency medicine residents, and medical students. The survey link and a brief description of the project were emailed to all residency program directors in these specialties who had valid email addresses provided in the FREIDA American Medical Association Residency Database. Program directors were instructed to share the link to the anonymous online survey with their current resident cohorts. Results Survey collection is currently ongoing and formal results are forthcoming. We hypothesize that the results will demonstrate that resident physicians in urology, obstetrics and gynecology, dermatology, internal medicine, family medicine, and emergency medicine as well as medical students are not receiving instruction or counseling on vulvar anatomy, how to diagnose common vulvar conditions, or how to treat common vulvar conditions. Each of these shortcomings significantly contributes to the lack of access and misdiagnosis that patients with GPPPD experience which leads to overutilization of the healthcare system and significant disruption in patient’s quality of life. We aim to show the disparities that exist in order to affect a systematic change and standardization in how we teach vulvar sexual health curriculum nationwide. Conclusions It is crucial to assess these knowledge gaps in training to create educational tools to alleviate these medical education shortcomings. We believe that our findings will provide evidence that will warrant targeted interventions, such as the creation of a nationwide standardized curriculum of medical school training in vulvar anatomy and physiology. Furthermore, we hope this work serves as a catalyst for increased cultural competency training for medical trainees to better address structural barriers for patients with GPPPD to obtain health care with the goal of effectively increasing equity, diversity, and inclusion in the healthcare landscape. Disclosure No.

Effect of United States Medical Licensing Examination Score Cutoffs on Recruitment of Underrepresented Applicants in the Urology Match

To determine how the use of United States Medical Licensing Examination (USMLE) score cutoffs during the screening process of the Urology Residency Match Program may affect recruitment of applicants who are underrepresented in medicine (URM). Deidentified data from the Association of American Medical Colleges' (AAMC) Electronic Residency Application Service (ERAS) system was reviewed, representing all applicants to our institution's urology residency program from 2018 to 2022. We analyzed self-reported demographic variables including race/ethnicity, age, sex/gender, as well as USMLE Step 1 and Step 2 scores. Chi-square tests and ANOVA were used to determine the association between race/ethnicity and other sociodemographic factors and academic metrics. Applicants were stratified according to USMLE Step 1 cutoff scores and the distribution of applicants by race/ethnicity was assessed using a Gaussian nonlinear regression fit. A total of 1258 applicants submitted applications to our program during the 5-year period, including 872 males (69.3%) and 386 females (30.7%). Most applicants were White (43.5%), followed by Asian (28.3%), Hispanic/Latino (11.7%), and Black (7.0%). There was an association between race/ethnicity and USMLE scores. Median USMLE Step 1 scores for White, Asian, Hispanic/Latino, and Black applicants were 242, 242, 237, and 232, respectively (P<.001). As cutoff score increases, percentage of URM applicants decreases. The use of cutoffs based on USMLE scores disproportionately affects URM applicants. Transitioning from numeric scores to pass/fail may enhance holistic review processes and increase the representation of URM applicants offered interviews at urology residency programs.

Is the learning curve of the urology resident for conventional radical prostatectomy similar to that of staff initiating robot-assisted radical prostatectomy?

The superiority of the functional results of robot-assisted radical prostatectomyis still controversial. Despite this, it is known that minimally invasive surgery obtains better results when analyzing blood loss, blood transfusion and length of stay, for example. Several studies have analyzed the impact of the resident physician's involvement on the results of urological surgeries. The simple learning curve for robot-assisted radical prostate surgery is estimated to be around 10 to 12 cases. Learning curve data for robotic surgeons is heterogeneous, making it difficult to analyze. Rare studies compare the results of a radical prostatectomy of an inexperienced surgeon starting his training in open surgery, with the results of the same surgeon, a few years later, starting training in robotic surgery. to analyze the results of open radical prostatectomy surgeries (ORP) performed by urology residents, comparing them to the results of robot-assisted radical prostatectomy (RARP), performed by these same surgeons, after completing their training in urology. a retrospective analysis of the cases of only 3 surgeons was performed. 50 patients underwent ORP (group A). The surgeons who operated on the ORP patients were in the 3rd and final year of the urology residency program and beginners in ORP surgery, but with at least 4 years of experience in open surgery. The same surgeons, already trained urologists, began their training in robotic surgery and performed 56 RARP surgeries (group B). For the comparative analysis, data were collected on age, number of lymph nodes removed, surgery time, hospitalization time, drain volume, drain permanence time, indwelling bladdercateter (IBC) permanence time, positive surgical margin, biochemical recurrence, risk classification (ISUP), intra and postoperative complications, urinary incontinence (UI) and erectile dysfunction (ED). The console used was the Da Vinci Si, from Intuitive®. For statistical analysis, the Shapiro-Wilk test verified that the data did not follow normality, the Levene test guaranteed homogeneity, and the Mann-Whitney test performed the comparative analysis of the quantitative data. For the analysis of qualitative data, the Chi-square test was used for nominal variables and the Mann-Whitney U test for ordinal variables. Additionally, the Friedman test analyzed whether there was an improvement in the perception of UI or ED over the months, for each group individually (without comparing them), and the post-hoc Durbin-Conover test, for the results with statistically significant difference. We used a p-value < 0.05, and the Jamovi® program (Version 2.0). there was no statistically significant difference between the groups for age, number of lymph nodes removed, positive surgical margin, biochemical recurrence, risk classification and urinary incontinence. Additionally, we observed that the surgical time was longer in group B. On the other hand, the length of stay, drain volume, drain time, IBC time, complication rate and levels of erectile dysfunction in the third and sixth months were higher in group A, when compared to group B. We also observed that there was no evolutionary improvement in ED over the months in both groups, and that there was a perception of improvement in UI from the 1st to the 3rd month in group A, and from the 1st to the 6th month, and from the 3rd to the 12th month, in group B. the learning curve of RARP is equivalent to the curve of ORP. In general, the results for the robotic group were better, however, the functional results were similar between the groups, with a slight tendency of advantage for the robotic arm.

Trends in PubMed-Indexed Research in Matched Urology Applicants: A Cross-Sectional Analysis of the 2017 to 2021 Match Cycles

Purpose: Urology is one of the most competitive specialties for residency matches in the United States. Data reported by the American Urological Association from match cycles spanning 2014 to 2021 reveal a median of 0.34% (0%-3%) of unfilled spots, a median of 1.48 (1.28-1.87) applicants per position, and a median of 75% (63%-87%) match rate. Recent research has shown that program directors value applicants' research highly. We sought to assess the research productivity of matched urology residency applicants, identify trends in research volume over time, and investigate the potential correlation between research output and program ranking. Materials and Methods: Doximity Urology program ranking list from the 2017 to 2021 match cycles was sorted by reputation, extracted, and populated using each program's official website resident roster, including name, medical school, postgraduate year, and additional degrees. Rosters were crossed-checked against social media posts from the official accounts. Each identified urology resident was queried in PubMed. Journal ranking was determined through Scimagojr; top-quartile journals were classified as Q1. Results: In total 131 of 145 programs were identified, and 1605 matched applicants spanning the 2017 to 2021 match cycles. The mean and median total publications were 2.44 and 1, respectively, and 2.17 and 1 when excluding case reports. 64.2% of applicants had at least one publication, and 42.2% had at least one urological publication. Applicants matching into higher-ranked programs had more research and urological research. Multivariable regression analysis revealed that Q1 research (β 2.38) and urology research (β 2.33) significantly affected rank. Match cycle analysis revealed an increase in total and urology-focused research, whereas regression analysis demonstrated significant increases in total publications (β 0.019) per cycle. Conclusion: Overall research, urology-focused research, first authorship, and publication in higher-ranked journals play an essential role in the urology match.

The Future State of Race/Ethnicity in Urology: Urology Workforce Projection From 2021-2061

To project the proportion of the urology workforce that is from under-represented in medicine (URiM) groups between 2021-2061. Demographic data were obtained from AUA Census and ACGME Data Resource Books. The number of graduating urology residents and proportion of URiM graduating residents were characterized with linear models. Stock and Flow models were used to project future population numbers and proportions of URiM practicing urologists, contingent on assumptions regarding trainee demographics, retirement trends, and growth in the field. Currently, there is an increase in the percentage of URiM graduates by 0.145% per year. If historical trends continue, URiM urologists will likely comprise 16.2% of urology residency graduates and 13.3% of the practicing urological workforce in 2061. These percentages would constitute an underrepresentation of URiM urologists relative to the projected 44.2% of the U.S. population who would identify as American Indian/Alaskan Native, Black/African American, Latinx/Hispanic and Native Hawaiian/Pacific Islander by 2060.1 An increase in the percentage of URiM graduates by 0.845% per year would result in 44.2% URiM urology residency graduates and 26.1% URiM practicing urologists by 2061. An interactive app was designed to allow for a range of assumptions to be explored and for future data to be incorporated. URiM physician representation within urology over the next 40years will remain disproportionately low compared to that of the projected share of people of color in the general U.S. In order to achieve the AUA's Diversity, Equity and Inclusion goals, a concerted effort to implement interventions to recruit, train, and retain a generation of racially diverse urologists appears necessary.

Incidence and predictors of delays in starting fellowship training in urology.

The completion of residency and start of fellowship training marks a critical transition for urologists in the pursuit of subspeciality training. Most graduating urology residents are under contract until June 30, and most fellowships are scheduled to begin on July 1. There has been no investigation into the practical implications of fellowship delays in urology from a trainee perspective. Our research study aimed to investigate the incidence and predictors of delays in fellowship starts. Pediatric urology fellows that began their fellowship training between 2019 and 2023 and endourologic fellows that began their fellowship training between 2017 and 2022 were surveyed using SurveyMonkey®. A total of 250 endourology (EU) fellows and 90 pediatric urology (PU) fellows were contacted. A total of 26.0% and 14.3% of EU and PU fellows, respectively, experienced a delay in their training, despite many leaving their residency positions early (33.8% vs. 44.9%, p=0.2097); 11.7% and 8.2% of EU and PU fellows, respectively, experienced delays they reported to be "very stressful" and 9.1% and 4.1%, respectively, found them "somewhat stressful." Delays of 2-4 weeks were experienced by 5.2% and 6.1%, 4-6-week delays by 7.8% and 4.1%, and delays >6 weeks by 2.6% and 0% of EU and PU fellows, respectively (p=0.0007). Delays in fellowship training do occur at a notable rate, despite nearly half of urology fellows leaving their residency training positions early, with unclear impacts on patient care and resident colleague well-being. This research highlights the importance of fellowship programs considering delaying fellowship starts to mid-July or August, with support of the prior fellow cohorts.

The New Urology Match: How Recent Innovations Including Virtual Interviews and Preference Signaling Have Changed Match Outcomes.

To determine how recent changes in the urology match occurring from 2021 to 2023, including virtual interviews (VIs) and preference signals (PS), affected match outcomes. The American Urological Association (AUA)match data from 2021 to 2023 was compared to the 15 years prior. This was obtained from the AUA website and a previous study of public AUA match data. Self-reported applicant characteristics and outcomes from the Urology Residency Applicant Spreadsheet 2021-2023 were compared to the four years prior. Between 2021 and 2023, residency programs offered 43 interviews each, compared to an average of 35 in the 15 years prior. Programs have been receiving more applications each year, from a low of 225 in 2019 to a peak of 347 in 2022. This resulted in an interview offer rate of 13% between 2021 and 2023, compared to 16% in the five years prior. Applicants applied to a mean of 88 programs in 2023, increasing each year since 40 in 2006. Applicants attended 12 interviews on average between 2021 and 2023, compared to 13 in the two years prior. Self-reported applicant data similarly demonstrated that, compared to the four years prior, applicants between 2021 and 2023 applied to more programs (81 vs. 70), had a lower interview offer rate (22% vs. 32%), and a higher interview acceptance rate (90% vs. 75%). During the years with VIs, programs offered more interviews and applicants attended fewer on average, indicating a larger applicant pool was interviewed. Despite the introduction of PS, applicants applied to more programs in 2022 and 2023 than ever before.

Surgical Force: Initial Study and Clinical Implications in the Assessment of Ureteral Access Sheath Induced Injury.

Purpose: Ureteral access sheaths (UAS) pose the risk of severe ureteral injury. Our prior studies revealed forces ≤6 Newtons (N) prevent ureteral injury. Accordingly, we sought to define the force urologists and residents in training typically use when placing a UAS. Materials and Methods: Among urologists and urology residents attending two annual urological conferences in 2022, 121 individuals were recruited for the study. Participants inserted 12F, 14F, and 16F UAS into a male genitourinary model containing a concealed force sensor; they also provided demographic information. Analysis was completed using t-tests and Chi-square tests to identify group differences when passing a 16F sheath UAS. Participant traits associated with surpassing or remaining below a minimal force threshold were also explored through polychotomous logistic regression. Results: Participant force distributions were as follows: ≤4N (29%), >6N (45%), and >8N (32%). More years of practice were significantly associated with exerting >6N relative to forces between 4N and 6N; results for >8N relative to 4N and 8N were similar. Compared to high-volume ureteroscopists (those performing >20 ureteroscopies/month), physicians performing ≤20 ureteroscopies/month were significantly less likely to exert forces ≤4N (p = 0.017 and p = 0.041). Of those surpassing 6N and 8N, 15% and 18%, respectively, were high-volume ureteroscopists. Conclusions: Despite years of practice or volume of monthly ureteroscopic cases performed, most urologists failed to pass 16F access sheaths within the ideal range of 4N to 6N (74% of participants) or within a predefined safe range of 4N to 8N (61% of participants).

How long do we need to reach sufficient expertise with the avatera® robotic system?

To investigate the learning curve in four basic surgical skills in laparoscopic and robotic surgeries, and evaluate the approximate time needed to reach sufficient expertise in performing these tasks with the avatera® system. Twenty urology residents with no previous experience in dry-lab and robotic surgery were asked to complete four basic laparoscopic tasks (peg transfer, circle cutting, needle guidance, and suturing) laparoscopically and robotically. All participants were asked to complete the tasks first after watching the Uroweb educational material and, second, after undertaking a 2-hour training in robotic and laparoscopic dry-lab. Thereafter, all trainees continued to undertake 2-hour training programs until being able to complete the tasks with the avatera® robot at the desired time. Paired t test and one-way ANOVA test were used to analyze time differences between the groups. Time needed to complete all tasks either robotically or laparoscopically was significantly less in the second compared to the first attempt for all Groups in each Task. In the robotic dry-lab, time needed to complete the tasks was significantly less than in the laparoscopic dry-lab. A significant effect of previous laparoscopic experience of the participants on the training time needed to achieve most of the goal times was detected. The results of the study highlight the role of previous laparoscopic experience in the training time needed to achieve the performance time goals and demonstrate that the learning curve of basic surgical skills using the avatera® system is steeper than the laparoscopic one.

Simulators in urology resident's training in retrograde intrarenal surgery.

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.

A complete year of urology residency training under COVID-19: impact on education and health.

To evaluate the impact of COVID-19 pandemics on clinical and surgical practice, educational activities, health and lifestyle behavior of Brazilian urology residents after 1 year of socio-economic restrictions. An electronic survey was e-mailed to all postgraduate (PG) students registered by the Brazilian Society of Urology. The survey inclu-ded an assessment of socio-demographic, clinical practice, educational, health-related and behavior parameters. We also evaluated which subareas of urology were predominantly affected. A similar survey was adapted and sent to the directors of all urology residency programs. COVID-19 pandemic has severely impacted the clinical, surgical, and educational activities of urology residents in Brazil. Urology residents reported >50% decrease in multiple surgical modalities. We highlight kidney transplantation surgeries (66.2%), minor surgeries (62.3%), endoscopic surgeries (42.6%) and reconstructive surgeries (38.8%). This could represent a critical skills gap that residents may face beyond the COVID-19 pandemic. Furthermore, PG students faced stressful situations that caused worsening of mental and physical health, such as getting redirected to assistance of COVID-19 patients (66.9%), and high rate of infection by SARS-CoV-2 (58.2%). The COVID-19 pandemic has severely impacted the clinical, surgical, and educational activities of urology residents in Brazil. This could represent a critical skills gap that residents may face beyond the COVID-19 pandemic. PG students faced stressful situations that caused worsening of mental and physical health such as redirection to assistance of COVID-19 patients, concern about their own contamination and of family members.

Training ultrasound-guided percutaneous nephrostomy technique with porcine model.

There is increasing interest in the use of ultrasound for endoscopic and percutaneous procedures. Access can be achieved without radiation exposure under ultrasound guidance. Our aim was to develop a porcine-based training model for ultrasound-guided percutaneous renal access that could also be personalized to a specific patient. The Institutional Animal Care and Use Committee of Severance Hospital approved the study protocol. An anesthetized pig was placed in the dorsal lithotomy position. For the nephrostomy puncture, a Chiba biopsy needle with an echo tip was used under ultrasound guidance. Eight residents and three consultants in urology participated. Puncture time was defined as the nephrostomy time to confirm the flow of irrigation via the needle. After training, satisfaction survey results for clinical usability and procedural difficulty were evaluated. The 5-point Likert scale satisfaction survey for clinical usability and procedural difficulty found mean results of 4.64 and 4.09 points, respectively. There were no differences between residents and consultants for either variable. For all participants combined, there was a significant difference for nephrostomy time between the first and second trials (278.8±70.6 s vs. 244.5±47.0 s; p=0.007). The between-trial difference was greater for residents (291.5±71.2 s vs. 259.1±41.9 s; p=0.039). The difference for the consultant was not significant (245.0±69.4 s vs. 205.7±42.5 s; p=0.250). We developed a porcine-based ultrasound-guided nephrostomy puncture training model. Satisfaction survey results indicated high clinical usability and procedural difficulty. For nephrostomy time, the model was more effective for urology residents than for consultants.

"Self-Designed Simulation-Based Laparoscopic Training Program for Urology Residents: Results After 6 Years of Experience".

Learning laparoscopy (LAP) is challenging and requires different skills to conventional open surgery. There is a recognized need for a standardized laparoscopic training framework within urology to overcome these difficulties and to shift learning curve from patient to skills laboratory. Simulation-based training has been widely commented, but implementation in real day practice is lacking. We present our "LAP training program for residents". Between 2017 and 2022, 11 residents participated in our self-designed program: Theoretical: (Moodle platform) basic knowledge and multimedia content for initiation into LAP. Evaluated through online exam. Practical: exercises for LAP skills acquisition were proposed and encouraged residents' practice in a box trainer available and experimental surgery sessions on a porcine model. On-site E-BLUS (European Basic Laparoscopic Urologic Skills) examination was performed annually. Feedback was obtained through an anonymous online survey. All residents positively evaluated the program. Theoretical: 82% passed the online exam. The most valued topics: LAP in special clinical situations, complications, instruments, and configuration of the operating room (OR). Practical: all residents increased dry-lab box practices. A total of 23 experimental surgical sessions were carried out. For 64%, simulation in the experimental OR was a necessary complement to achieve laparoscopic skills and allowed them to feel more confident. Forty-five percent considered it essential to improve their surgical technique. E-BLUS evaluation was valued as a means to achieve dexterity and safer surgery by 90%. Reduction in time and errors were observed through time, although only 2 passed the E-BLUS. Our program for learning LAP includes the acquisition of knowledge, training of basic skills and surgical technique in a safe environment, as well as an objective evaluation. Encouraged practice of basic skills and surgical technique simulation and improved objective evaluation. It is structured, reproducible, systematic and has been positively valued, although it requires commitment for success.

What’s new in academic medicine: Pros and cons of expanding urology residency training programs

What’s new in academic medicine: Pros and cons of expanding urology residency training programs

Evaluation of the GeSRU-Steps educational video concept (German Society of Residents in Urology e. V.)

Surgical educational videos represent acontemporary, multimedia supplement to surgical education and training. The German Society of Residents in Urology e. V. (GeSRU) developed an educational video platform (steps.GeSRU.de) with free, quality-assured educational videos for urologists, especially for residents. The purpose of this study was to evaluate the GeSRU Steps teaching videos. Prospectively, 29GeSRU Steps training videos were made available (03/2019-05/2023) via amboss.com, and an online questionnaire was inserted following the videos. This comprised 12items on medical, technical, and didactic quality, usefulness for own knowledge acquisition, and sociodemographic data of respondents. Aspects of video quality were assessed with the Acceptability E‑scale and the Global Quality Score. During the survey period, the GeSRU Steps videos implemented on the amboss.com website were viewed 49,698 times. Atotal of 474 questionnaires were answered (rate 0.25%). The collective of respondents consisted of 419 (88%) students, 47 (10%) physicians in training, and 5 (1%) specialists; 351 (74%) were female, 107 (23%) were male, and 4 (1%) were diverse. Each educational video was rated amedian of 10times (range 5-65). The six questions of the Acceptability E‑scale and the Global Quality Score were rated good and very good (81.6-95.8%), respectively. GeSRU teaching videos achieved avery good rating with high user satisfaction. By specific promotion of these teaching videos, which are quality-assured through supervision, the portfolio of surgical videos available at alow threshold can be expanded and can serve as acontemporary education tool.

Inter-observer variance of examiner scoring in urology Objective Structured Clinical Examinations.

The Objective Structured Clinical Examination (OSCE) is an attractive tool of competency assessment in a high-stakes summative exam. An advantage of the OSCE is the ability to assess more realistic context, content, and procedures. Each year, the Queen's Urology Exam Skills Training (QUEST) is attended by graduating Canadian urology residents to simulate their upcoming board exams. The exam consists of a written component and an OSCE. The aim of this study was to determine the inter-observer consistency of scoring between two examiners of an OSCE for a given candidate. Thirty-nine participants in 2020 and 37 participants in 2021 completed four stations of OSCEs virtually over the Zoom platform. Each candidate was examined and scored independently by two different faculty urologists in a blinded fashion at each station. The OSCE scoring consisted of a checklist rating scale for each question. An intra-class correlation (ICC) analysis was conducted to determine the inter-rater reliability of the two examiners for each of the four OSCE stations in both the 2020 and 2021 OSCEs. For the 2020 data, the prostate cancer station scores were most strongly correlated (ICC 0.746, 95% confidence interval [CI] 0.556-0.862, p<0.001). This was followed by the general urology station (ICC 0.688, 95% CI 0.464-0.829, p<0.001), the urinary incontinence station (ICC 0.638, 95% CI 0.403-0.794, p<0.001), and finally the nephrolithiasis station (ICC 0.472, 95% CI 0.183-0.686, p<0.001). For the 2021 data, the renal cancer station had the highest ICC at 0.866 (95% CI 0.754-0.930, p<0.001). This was followed by the nephrolithiasis station (ICC 0.817, 95% CI 0.673-0.901, p<0.001), the pediatric station (ICC 0.809, 95% CI 0.660-0.897, p<0.001), and finally the andrology station (ICC 0.804, 95% CI 0.649-0.895, p<0.001). A Pearson correlation coefficient was calculated for all stations, and all show a positive correlation with global exam scores. It is noteworthy that some stations were more predictive of overall performance, but this did not necessarily mean better ICC scores for these stations. Given a specific clinical scenario in an OSCE exam, inter-rater reliability of scoring can be compromised on occasion. Care should be taken when high-stakes decisions about promotion are made based on OSCEs with limited standardization.

A Contemporary Review of Barriers and Methods to Fostering Academic Urologists.

Urology has shown a gradual decrease in the number of graduating residents who plan to pursue a career in academic medicine. Our objective was to identify barriers to academic urology, present options to mitigate those barriers, and explore strategic ways to encourage trainees to seek careers in academic urology. The authors performed a contemporary review of relevant articles through PubMed assessing prior survey studies, editorials, and expert opinion articles that evaluated academic urology, perceptions of academic medicine, physician burnout, and barriers that have been identified to pursuing careers in academic medicine. Selected articles were then independently reviewed by three authors for relevance and application of factors mitigating perceived barriers to pursuing a career in academic medicine, specifically academic urology.Barriers at the academic levels of medical school and residency were found to consist of the following: lack of exposure to research early in their medical careers, inadequate mentorship, all-specialty leading levels of burnout, current average levels of medical school indebtedness contrasted to perceptions of pay disparity when compared to private practice urologists' income, and perceptions of difficulty in maintaining the academic "triple threat." More acutely, the decision to make Step 1 a pass/fail exam, with the addition of historically low match rates in urology, have resulted in additional complications and concerns for aspiring academic urologists.There are clear barriers that graduating urology residents encounter when considering a career in academic medicine. In this review, we present possible mitigating factors that may be instituted at the individual, medical school, and postgraduate levels to increase the number of practicing academics.