Urology Training Research Articles

Cost-Effective and Readily Replicable Surgical Simulation Model Improves Trainee Performance in Benchtop Robotic Urethrovesical Anastomosis.

Our objective was to develop a simple, cost-effective and reusable model for urethrovesical anastomosis for robotic-assisted radical prostatectomy and evaluate its impact on fundamental surgical skills and confidence of urology trainees. A model for the bladder, urethra and bony pelvis was created from materials easily purchased online. Each participant performed several trials of urethrovesical anastomosis using the da Vinci Si® surgical system. Pre-task confidence was assessed prior to each attempt. Two blinded researchers measured the following outcomes: time-to-anastomosis, number of suture throws, perpendicular needle entry and atraumatic needle driving. Integrity of the anastomosis was estimated by gravity filling and measuring pressure at which leakage occurred. These outcomes were translated into an independently validated Prostatectomy Assessment Competency Evaluation score. The model took 2 hours to create and total cost was 64 U.S. dollars. Twenty-one residents enrolled and demonstrated significant improvement in time-to-anastomosis, perpendicular needle driving, anastomotic pressure and total Prostatectomy Assessment Competency Evaluation score between the first and third trial. Pre-task confidence was measured on a Likert scale (1-5) and improved significantly over the 3 trials (Likert scale of 1.8, 2.8 and 3.3). We developed a cost-effective model of urethrovesical anastomosis that does not require the use of a 3D printer. This study demonstrates significant improvement of fundamental surgical skills and validated surgical assessment score for urology trainees over several trials. Our model shows potential for increasing accessibility of robotic training models for urological education. Additional investigation will be required to further assess the utility and validity of this model.

Portable Endoscopic Simulator for Urologic Training: A Face/Content and Construct Validity Study.

Mastering a surgical skill requires experience and repetition, yet opportunities for surgical trainees to gain real experience are variable and limited by case load. Surgical simulators have emerged in an attempt to overcome these limitations. However, the few currently available skills simulators for flexible endoscopy are costly, have limited accessibility and versatility, lack portability, and require dedicated time for practice. The use of a portable skills simulator to teach flexible endoscopy may provide a feasible alternative. This study introduces a novel, low-cost, portable, endoscopic simulation system for training basic endoscopic skills. Using custom software, the simulator presents a virtual environment featuring 3D models of anatomy, endoscopes, and endoscopic tools. The virtual endoscope and its tools are directly controlled in the simulation by motion input from a custom-manufactured portable endoscopic controller that communicates data via a Bluetooth interface. This two-part study presents proof of concept and initial pilot data examining the face/content validity and preliminary construct validity of the portable endoscopic simulator. In part 1, experts (n = 2) and novices (n = 6) provided ratings of fidelity and utility as a training tool. In part 2, experts (n = 4) and novices (n = 4) completed 10 simulated sequential basic endoscopic tasks, and time to completion was assessed. Findings indicate that the simulator has good utility as a training tool, but some features require modification to be more realistic. Furthermore, both novices and experts improved on the task with repeated measurements (p < 0.001), but there were no significant differences between experts and novices in time to completion. Although more robust validation is required, this simulator appears promising as a feasible and cost-effective tool for providing simulation training on basic endoscopic skills.

The feasibility of endourological surgery in low-resource settings.

One of the widest variations in contemporary surgical practice between high and low, or low-middle, income countries is the utilisation of endoscopy as a means of treating urological pathology. The endoscopic management of lower urinary tract problems such as benign prostatic hypertrophy, bladder cancer and urethral strictures was established in the UK in the late 1970s, whilst its adoption into everyday practice in sub-Saharan Africa (SSA) has been significantly retarded. It is still neither a major feature of urological training in those countries nor widely available to the patients that established consultants treat. Likewise, the explosion of less invasive technologies for treating upper tract stone disease in the 1980s, particularly the management of renal stone disease, has also lagged behind practice established in the UK over the last 40 years. This is not due to a lack of patients who could be treated endoscopically or restricted by the abilities of the surgeons in SSA. The restraint in assumption of these less-invasive management options is rather due to the physical availability of trained specialist surgeons, their access to basic infrastructure such as electricity and water, access to endoscopes and the peripheral equipment necessary to successfully deploy them, and the ability of patients to afford the disposable items required for less-invasive forms of management. Some endoscopic procedures are viable in resource-poor settings. However, they are largely dependent upon the supply of equipment from non-governmental organisations in high-income countries, frugal innovation to reduce individual procedure costs, adequately skilled mentors, and maintenance and supply chains to make them a durable option in patient management. Urolink and the Medi Tech Trust present their experience of how endoscopic surgery can be taught, and used sustainably, in a resource-poor healthcare environment.

EDITORIAL COMMENT

The structure of urology residency training across the country continues to evolve and change based on a variety of factors including not only feedback from current and former trainees, but also the culture surrounding medicine and clinical training. Anecdotally, in many institutions, this manifests as subtle changes from year to year stemming from a conventional hierarchical model. Program directors and chairmen ideally continually reassess resident needs and ideals for training in order to implement changes and improve resident education. However, little to no data is available on what structure and training environments are ideal for urology trainees. There is a dearth of literature to support one structure of training vs another, that is classical vs mentorship model, or spell out the ideal distribution of time spent in the operating room vs clinic settings. In this manuscript, the authors take a needed first step in assessing this question by collecting information from program directors across the country to begin to characterize how the clinical requirements of residency programs vary. Additionally, they begin a discussion of the program directors’ reflections on these structures and the perceived, but not directly assessed, opinions of residents. Presumably, the long-term objective of this work aims to better characterize the current variations of training and the efficacy therein. The authors are to be commended for taking on this type of study to lay the groundwork for this important and welcomed effort.

Laparoscopy training in Turkey through the view of residents; Turkish European Society of Residents in urology questionnaire

Objective: Laparoscopy is a minimal invasive surgery technique and getting more important nowadays. The success rate of the techniques used in laparoscopy education and the qualification of urology residents who finished their urology training, is unclear. In our study, qualification of Turkish urology residents for laparoscopy, the preferred educational techniques and the education models were investigated with a national survey. Material and Methods: The laparoscopy questionnaire that is used in our study has been prepared by modification of a questionnaire which was formed by Belgium European European Society of Residents in Urology. The techniques used in laparoscopy education, qualification of the education and the expectations from laparoscopy education were the main focus. All of the questions were Turkish and was sent to a total of 295 residents who are registered to the ESRU database. A total of 70 (23%) residents answered. SurveyMonkey was used for composing and distribution. All the data gathered from the survey was statistically investigated. Results: The biggest contribution was from the Marmara Region (39.29%). Laparoscopy is used in 91,07% of the clinics all around Turkey. The distribution of the residents in regards of year of urology training were: 14% 1st year, 23% 2nd year, 23% 3rd year, 12.7% 4th year, 25% 5th year. Training and Research Hospital and University Hospital participation rates were 46.77% and 53.23% respectively. The rate of residents who feel they will become capable of doing laparoscopic surgery after their residency period finished, was 28.5% and 71.4% of the residents expressed the laparoscopic training they take would not be sufficient. Assistance and observing are used as a training method by nearly all residents (91.07%). In addition being the primary surgeon, training videos, training boxes, animal practices are used by residents with the rate of 26.7%, 25%, 21.4%, 3.5% respectively. According to participants, to be given less opportunity, educational disinterest and limited laparoscopic cases were defined as the major 3 problems in laparoscopy training. Conclusion: The laparoscopy education differs between the urology clinics in Turkey without any standardization. An appropriate standardization of laparoscopy training can improve laparoscopy education and urology training

Training and Assessment in Urology: Perspective From a Third World Country.

Formative assessments are an essential yet often overlooked aspect of postgraduate surgical training. This report explores the strategies by which formative assessments are integrated into postgraduate surgical training in Pakistan (using urology as an example), by comparing the regional recommendations and infrastructures offered by local governing bodies to that of a more structured system, as offered by the General Medical Council (GMC). The College of Physicians and Surgeons Pakistan (CPSP) serves as the de facto local accrediting body for postgraduate surgical training and makes a conscious effort in maintaining the standard of training throughout the country. However, although formative assessment activities are encouraged in its roster, they are rarely monitored as strictly as summative outcomes. This is a far cry from how the structured format is exemplified by the GMC’s various guidelines and protocols. It must be emphasized that in order to improve the overall quality of training, measures need to be made to improve the ways in which feedback and formative activities are implemented and monitored.

Patients' perceptions of quality of care delivery by urology residents: A nationwide study.

To present the results of a nationwide survey among urological patients to evaluate their perception of the quality of care provided by residents. An anonymous survey was distributed to patients who were referred to 22 Italian academic institutions. The survey aimed to investigate the professional figure of the urology resident as perceived by the patient. A total of 2587 patients were enrolled in this study. In all, 51.6% of patients were able to correctly identify a urology resident; however, almost 40% of respondents discriminated residents from fully trained urologists based exclusively on their young age. Overall, 98.2% patients rated the service provided by the resident as at least sufficient. Urology trainees were considered by more than 50% of the patients interviewed to have good communication skills, expertise and willingness. Overall, patients showed an excellent willingness to be managed by urology residents. The percentage of patients not available for this purpose showed an increasing trend that directly correlated with the difficulty of the procedure. Approximately 5-10% of patients were not willing to be managed by residents for simple procedures such as clinical visits, cystoscopy or sonography, and up to a third of patients were not prepared to undergo any surgical procedure performed by residents during steps in major surgery, even if the residents were adequately tutored. Our data showed that patients have a good willingness to be managed by residents during their training, especially for medium- to low-difficulty procedures. Furthermore, the majority of patients interviewed rated the residents' care delivery as sufficient. Urology trainees were considered to have good communication skills, expertise and willingness.

PD30-08 UROLOGIC TRAINEE SURGICAL ASSESSMENT TOOLS: SEEKING STANDARDIZATION

You have accessJournal of UrologyCME1 May 2022PD30-08 UROLOGIC TRAINEE SURGICAL ASSESSMENT TOOLS: SEEKING STANDARDIZATION Lauren Conroy, Kyle Blum, Hannah Slovacek, Phillip Mann, and Steven Canfield Lauren ConroyLauren Conroy More articles by this author , Kyle BlumKyle Blum More articles by this author , Hannah SlovacekHannah Slovacek More articles by this author , Phillip MannPhillip Mann More articles by this author , and Steven CanfieldSteven Canfield More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002578.08AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Assessing a urology trainees’ performance is critical to evaluating longitudinal progress toward surgical autonomy. Presently, there is wide variability in surgical assessment tools used by training programs. We aim to critically analyze the available tools in urologic surgery and assess their validity, reliability, and feasibility in an effort to identify features that may lead to a more standardized assessment pathway. METHODS: The primary literature was reviewed to identify published surgical assessment tools within the past 20 years. Assessments specific to urologic training were included for final review. Each tool was assessed based on its ability to identify performance differences between participants with varying experience (construct validity), its ability to measure the behavior of which it intended to (content validity), if there was agreement amongst rater’s scores (interrater reliability), if there was correlation between individual rater’s scores and overall scores (internal consistency), and if it had been externally validated. RESULTS: Thirty surgical assessment tools were identified, 15 were specific to Urology, Table 1. Of these, six (40.0%) assessed surgical simulations (e.g. robotic trainer) and nine (60.0%) were designed to provide real-time feedback in the operating room. Twelve (80.0%) had some form of validity; eight (53.3%) had construct validity, nine (60.0%) had content validity, and five (33.3%) had both construct and content validity. Six (40.0%) of the tools were significantly reliable, with six (40.0%) demonstrating at least moderate interrater reliability for all of the tool’s components and one showing at least acceptable internal consistency. No tool was externally validated. CONCLUSIONS: There is high variability between available urologic trainee assessment tools. While 15 tools were identified, each had varying degrees of internal validity, and none had been externally validated. This lack of external validity creates the possibility of large inter-assessment variability between tools and invites evaluation discordance between training programs. There is an unmet need for a standardized surgical assessment tool to be incorporated into AUA training programs that is both internally consistent, reliable, and externally valid. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e513 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Lauren Conroy More articles by this author Kyle Blum More articles by this author Hannah Slovacek More articles by this author Phillip Mann More articles by this author Steven Canfield More articles by this author Expand All Advertisement PDF DownloadLoading ...

MP19-13 HAND DOMINANCE DECISION-MAKING AND OPERATING ROOM CHALLENGES EXPERIENCED BY LEFT-HANDED UROLOGY TRAINEES

You have accessJournal of UrologyCME1 May 2022MP19-13 HAND DOMINANCE DECISION-MAKING AND OPERATING ROOM CHALLENGES EXPERIENCED BY LEFT-HANDED UROLOGY TRAINEES Christopher Tam, Maia Anderson, Mary Byrnes, Julian Wan, and Bryan Sack Christopher TamChristopher Tam More articles by this author , Maia AndersonMaia Anderson More articles by this author , Mary ByrnesMary Byrnes More articles by this author , Julian WanJulian Wan More articles by this author , and Bryan SackBryan Sack More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002552.13AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Left-handed (LH) surgical trainees face unique challenges operating in a right-handed (RH) environment. This qualitative study aims to identify themes related to the operative difficulties encountered by LH urology trainees. METHODS: We conducted semi-structured interviews with LH trainees from surgical specialties at academic programs in the United States. The 6 urology trainee de-identified interview transcripts were analyzed iteratively, informed by interpretive description using MaxQDA20 software. RESULTS: Participants included 4 residents and 2 fellows from 5 urology programs. Three main themes emerged pertaining to decisions about operative hand dominance: expert advice, instrument challenges, and paradox of choice (Table 1). In expert advice, advice received from attendings during early phases of training, especially medical school, were critical determinants of their operative hand dominance. Advice received fell into two main categories: 1) recommendations to learn to operate right-handed from both right and left-handed surgeons, 2) advice about the importance of confidently choosing and maintaining a dominant operative hand through training. In instrument challenges, mechanical difficulties using RH instruments with their left-hand, especially needle drivers and suture scissors, influenced their decision to operate predominantly RH. In paradox of choice, trainees reported being encouraged to make their own choice about which hand to operate with, however, trainees also described feeling obligated to operate with their right-hand to accommodate their predominantly RH attendings. While trainees generally reported feeling like they made the correct decision, most described contemplating switching their operative hand dominance at some point during their career. CONCLUSIONS: Left-handed urology trainees report challenges with choosing hand dominance in the operating room secondary to use of RH instruments, receiving conflicting advice from surgical mentors, and using unnatural movements to adapt to a RH surgical setup. This increased awareness provides strategies to reduce barriers and increase inclusivity of LH trainees that could include LH surgical mentorship, procedural instruction, and instrumentation. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e312 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Christopher Tam More articles by this author Maia Anderson More articles by this author Mary Byrnes More articles by this author Julian Wan More articles by this author Bryan Sack More articles by this author Expand All Advertisement PDF DownloadLoading ...

MP10-05 TIME TO OPTIMIZE UROLOGY TRAINEE EDUCATION AND PREPARATION FOR SURGERY: VIDEO-BASED SURGICAL LEARNING

You have accessJournal of UrologyCME1 May 2022MP10-05 TIME TO OPTIMIZE UROLOGY TRAINEE EDUCATION AND PREPARATION FOR SURGERY: VIDEO-BASED SURGICAL LEARNING Miyad Movassaghi, Rainjade Chung, Zoe Cohen, Rashed Kosber, and Doreen Chung Miyad MovassaghiMiyad Movassaghi More articles by this author , Rainjade ChungRainjade Chung More articles by this author , Zoe CohenZoe Cohen More articles by this author , Rashed KosberRashed Kosber More articles by this author , and Doreen ChungDoreen Chung More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002532.05AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Surgical education has changed over the last several decades. The benefits of surgical video use, for teaching purposes, has been reported across other specialties. However, little data is available in the urology literature regarding usage patterns, preference and overall satisfaction. Our objective was to identify the most utilized video platforms by urology trainees. Secondary outcomes were to evaluate effectiveness, ease of access, and utility of surgical videos. METHODS: Using an anonymous online survey distributed between Sept – Oct 2021 by the Society of Academic Urology (SAU) to urology residents/fellows in the US, data was collected regarding demographics, frequency and source of surgical videos, helpfulness, ease of access, as well as overall effectiveness in case preparation. Study results were analyzed with descriptive statistics. RESULTS: Of current trainees surveyed, 169 completed the survey with demographics outlined in Table 1. All reported using videos (for open, robotic, vaginal and endoscopic mostly) with the majority reporting watching 1 (39%) or 2-3 surgical videos (57%) in preparation for cases. 95.3% of trainees report videos as helpful for case preparation. Similarly, 90% report surgical video use as important in their education/training. The most valued video features include ‘narration’ (58.6%) and ‘presence of tips and tricks’ (22.5%). YouTube (YT) (62.1%) and the AUA University (AUAU) (12.4%) are reportedly the most utilized. When stratified by trainee level, nearly all senior residents (PGY4-6) and fellows report using YT, compared to 38% of junior residents (PGY1-3). Comparing the two, 46% of trainees felt it is easy to navigate AUAU, compared to 77% using YT. Nearly 56% of trainees agreed that videos on AUAU help prepare for cases, compared to 87% using YT. Overall, 57% state they would recommend AUAU as a source for surgical videos, compared to 80% of trainees recommending YT. CONCLUSIONS: Although the AUAU contains a repository of surgical videos, most trainees report utilizing YT as the main source for case preparation. The results from our study support the continued use and optimization of surgical video-based learning for the urology trainee. Increasing access to a peer-reviewed video library will be critical in delivering accurate educational content. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e147 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Miyad Movassaghi More articles by this author Rainjade Chung More articles by this author Zoe Cohen More articles by this author Rashed Kosber More articles by this author Doreen Chung More articles by this author Expand All Advertisement PDF DownloadLoading ...

MP19-04 PEDIATRIC UROLOGY ACROSS US RESIDENCY PROGRAMS: A SURVEY OF RESIDENCY PROGRAM DIRECTORS TO IDENTIFY DIFFERENCES IN EDUCATION

You have accessJournal of UrologyCME1 May 2022MP19-04 PEDIATRIC UROLOGY ACROSS US RESIDENCY PROGRAMS: A SURVEY OF RESIDENCY PROGRAM DIRECTORS TO IDENTIFY DIFFERENCES IN EDUCATION Daniel Tennenbaum, and Lane Palmer Daniel TennenbaumDaniel Tennenbaum More articles by this author , and Lane PalmerLane Palmer More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002552.04AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Though all urologic training programs in the United States adhere to baseline thresholds of training, each program is able to offer different training experiences to their residents and trainees. In this study, we seek to determine differences in pediatric urology (PU) training amongst US residencies and their impact on influencing career choice. METHODS: Our survey was designed based on similar surveys sent to program directors of other specialties. The survey was sent by e-mail to the 142 AUA residency program directors. RESULTS: The response rate was 37% (53/142). Residents from 42 (79%) programs pursued PU fellowships within the last five years. All PU experiences were described as either favorable (29, 55%) or very favorable (24, 45%). Programs with very favorable experiences (p=0.0187), whose PU rotations were as U3 or U4 year (p=0.0465), or whose residents had more than 1 PU rotation (p=0.0481) were more likely to have residents pursue PU fellowship than those with favorable program experiences, non-senior rotations, or who had 1 or less dedicated PU rotation. There was no statistically significant relationship between favorability and either rotating at a children’s hospital or the presence of a PU fellow on rotation. While there was considerable variability in didactic criteria, there was no statistically significant relationship noted. Image 1 demonstrates differences in didactic curriculum. PU-focused didactics do not appear to occur often, other than journal club and text review. CONCLUSIONS: While there is expected variability of experience from urology residency program to program, our survey demonstrates broad differences amongst programs in regards to a resident’s PU exposure and experience. We identify very favorable resident PU experiences, the opportunity to rotate as a senior resident, and more than one dedicated PU rotation as significant influences for pursuit of a PU fellowship. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e308 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Daniel Tennenbaum More articles by this author Lane Palmer More articles by this author Expand All Advertisement PDF DownloadLoading ...

MP22-18 REVISION URETHROPLASTY AFTER FAILED EXCISION AND PRIMARY ANASTOMOSIS AND TISSUE TRANSFER REPAIR FOR BULBAR URETHRAL STRICTURES: OUTCOME ANALYSIS

You have accessJournal of UrologyCME1 May 2022MP22-18 REVISION URETHROPLASTY AFTER FAILED EXCISION AND PRIMARY ANASTOMOSIS AND TISSUE TRANSFER REPAIR FOR BULBAR URETHRAL STRICTURES: OUTCOME ANALYSIS David Barham, Aron Liaw, and Joel Gelman David BarhamDavid Barham More articles by this author , Aron LiawAron Liaw More articles by this author , and Joel GelmanJoel Gelman More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002561.18AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The published short and long-term success rates for anastomotic and dorsal buccal onlay urethroplasty for the treatment of bulbar strictures are as high as 95-99% at centers of excellence. As urethroplasty is being performed with increased frequency, more patients are presenting for re-do urethroplasty with highly complex and/or long strictures, especially after surgery performed by urologists without fellowship training and/or specialization in Male Reconstructive Urology. We report our 20-year experience and long-term outcomes with revision surgery when patients present to our institution after failed excision and primary anastomosis (EPA) or tissue transfer bulbar urethroplasty. METHODS: We reviewed our IRB approved, prospectively maintained database for patients who had repeat urethroplasty for bulbar or distal membranous stricture. Success was defined as a urethra >16Fr on followup cystoscopy and absence of obstructive voiding symptoms. RESULTS: 43 patients were identified, with a mean followup of 66 months (4-210). 21/43 (48%) had previously undergone EPA. Of these, 13/21 (62%) had a mean stricture length 6.8 cm, and underwent buccal graft urethroplasty as a revision. Conversely, 18/43 (42%) had previously undergone a graft urethroplasty, and of those, 9/18 (50%) underwent EPA as a salvage operation. The remaining 4 patients had prior flap surgery (2/43), or multiple different prior urethroplasties (2/43). 6/43 (14%) had documented recurrence of stricture, 3/6 of which were in the group that had previous graft urethroplasty and had EPA as a revision. CONCLUSIONS: Most patients with failed anastomotic urethroplasty had long stricture length and required tissue transfer for revision, indicating increased complexity after failure. Patients with failed graft urethroplasty did well when their revision was done with tissue transfer, but there was a higher failure rate in those who underwent anastomotic repair after a failed graft. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e378 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information David Barham More articles by this author Aron Liaw More articles by this author Joel Gelman More articles by this author Expand All Advertisement PDF DownloadLoading ...

MP10-20 MEDICAL MALPRACTICE LAWSUITS INVOLVING UROLOGY TRAINEES

You have accessJournal of UrologyCME1 May 2022MP10-20 MEDICAL MALPRACTICE LAWSUITS INVOLVING UROLOGY TRAINEES Roei Golan, Manish Kuchakulla, Arjun Watane, Raghuram Reddy, Ravi Parikh, and Ranjith Ramasamy Roei GolanRoei Golan More articles by this author , Manish KuchakullaManish Kuchakulla More articles by this author , Arjun WataneArjun Watane More articles by this author , Raghuram ReddyRaghuram Reddy More articles by this author , Ravi ParikhRavi Parikh More articles by this author , and Ranjith RamasamyRanjith Ramasamy More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002532.20AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Malpractice suits are lengthy and may cause a heavy psychological burden on young physicians at the inception of their careers. Our objective was to distinguish the various characteristics of medical malpractice lawsuits involving trainees to prevent future litigation. METHODS: LexisNexis, an online legal research database containing legal records from the United States, was retrospectively reviewed for malpractice cases involving urology interns, residents, or fellows from January 1, 1988, to December 31, 2020. RESULTS: A total of 16 cases were included, of which 7 (43.8%) involved urological allegations while 9 (56.2%) involved non-urological allegations. 5 of the cases consisting of non-urological adverse outcomes led to mortality. Procedural error was claimed in 12 (75%) cases, negligence in 7 (43.8%), delayed evaluation in 6 (37.5%), lack of informed consent of procedure or complications in 4 (25%), failure to pursue treatment in 4 (25%), inexperienced trainee in 2 (12.5%), failure to supervise trainee in 2 (12.5%), lack of informed consent of trainee involvement in 1 (6.2%), incorrect diagnosis in 1 (6.2%), and prolonged operative time in 1 (6.2%) case. The average time from medical injury to verdict date was around 5 years. The median time was 4.4 years (IQR 3.9 - 5.2 years), with a maximum time of 11.9 years and a minimum time of 1.8 years. Five (31.2%) cases led to the jury rendering a defense verdict, and 6 (37.5%) cases resulted in payout for the plaintiff (median $728,491; IQR $439,245 - $1,350,000). The other 5 (31.2%) cases resolved in a settlement (median $490,000; IQR $397,500 - $525,000). Payouts, whether through verdict or settlement, occurred in 11 (68.8%) cases. CONCLUSIONS: The cases reported in this study highlight the importance of perioperative care, communication skills between attending physicians, trainees, and patients, providing detailed informed consent, careful documentation, and acknowledging mistakes. Future research should focus on strengthening training programs' execution of malpractice prevention amongst trainees. In addition to mitigating malpractice lawsuit risk, malpractice education may benefit the healthcare system and most importantly, the patients and their families. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e155 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Roei Golan More articles by this author Manish Kuchakulla More articles by this author Arjun Watane More articles by this author Raghuram Reddy More articles by this author Ravi Parikh More articles by this author Ranjith Ramasamy More articles by this author Expand All Advertisement PDF DownloadLoading ...

MP08-05 EVALUATING THE QUALITY OF ONLINE HEALTH EDUCATIONAL RESOURCES REGARDING HYPOSPADIAS DIAGNOSIS AND TREATMENT

You have accessJournal of UrologyCME1 May 2022MP08-05 EVALUATING THE QUALITY OF ONLINE HEALTH EDUCATIONAL RESOURCES REGARDING HYPOSPADIAS DIAGNOSIS AND TREATMENT Yash Shah, Nathan Hyacinthe, Nicolas Fernandez, Carlos Villanueva, Paige Bosse, Melise Keays, and Christopher Long Yash ShahYash Shah More articles by this author , Nathan HyacintheNathan Hyacinthe More articles by this author , Nicolas FernandezNicolas Fernandez More articles by this author , Carlos VillanuevaCarlos Villanueva More articles by this author , Paige BossePaige Bosse More articles by this author , Melise KeaysMelise Keays More articles by this author , and Christopher LongChristopher Long More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002530.05AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: A diagnosis of hypospadias can be overwhelming for parents. Online patient and parental educational materials are frequently used by patients and family members as supplemental information to assist in understanding their child’s condition, for medical decision making, and for understanding post-surgery care. 98% of parents utilize the Internet for pediatric health advice. It is recommended that online resources be structured at a 6th grade level to ensure broad applicability and comprehension. We hypothesized that academic fellowship training institutional websites would exceed the average American adult’s reading level, impairing patient or caregiver understanding. METHODS: Online hypospadias educational material from all pediatric teaching hospitals with accredited Society of Pediatric Urology training programs in the US and Canada were compiled. Two reviewers independently edited text to remove extraneous information and calculated readability scores using Flesch Reading Ease Score (FRES), Flesch-Kincaid Grade Level (FKGL), Gunning-Fog Index (GFI), Simple Measure of Gobbledygook (SMOG), Coleman-Liau Index (CLI), and Automated Readability Index (ARI). Intra- and inter-observer reliability were measured. RESULTS: Of the 25 online hypospadias educational materials studied, the mean grade level across 5 tests was 11.06±2.21 (Table 1), with a wide range of grade levels across institutions from 7 to 13. None met the recommended 6th grade level. Altogether, the FRES was 50.64±11.66. This is classified as Fairly Difficult with an estimated 10-12 reading grade and 54% of U.S. adult comprehension. 17.30% of words were designated as complex. Only 1 institution had educational materials in a language other than English. Intra- and inter-observer reliability were excellent, with the Pearson correlation coefficient for each tool ≥0.95. CONCLUSIONS: Our findings indicate that online hypospadias resources published by leading pediatric hospitals are written above the recommended reading level for patient and caregiver education. Complex word usage was high and there was little information for non-English speaking patients. A standard for online resources for parental education that meets broad comprehension goals should be established to improve awareness and outcomes. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e126 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Yash Shah More articles by this author Nathan Hyacinthe More articles by this author Nicolas Fernandez More articles by this author Carlos Villanueva More articles by this author Paige Bosse More articles by this author Melise Keays More articles by this author Christopher Long More articles by this author Expand All Advertisement PDF DownloadLoading ...

MP10-13 AUTHORSHIP IN UROLOGY: A GENDER REVEAL

You have accessJournal of UrologyCME1 May 2022MP10-13 AUTHORSHIP IN UROLOGY: A GENDER REVEAL Leah Beland, Ginnie Jeng, Tareq Aro, and Jessica Kreshover Leah BelandLeah Beland More articles by this author , Ginnie JengGinnie Jeng More articles by this author , Tareq AroTareq Aro More articles by this author , and Jessica KreshoverJessica Kreshover More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002532.13AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: According to the American Urological Association (AUA) 2019 census, the percentage of women practicing urologists is 9.9% of the workforce in the USA, making urology one of the least gender-diverse specialties recognized by the Accreditation Council for Graduate Medical Education.The purpose of this study is to identify the proportion of urologic studies published in 5 major urologic journals by women in 2019 in the USA. We also aim to determine if any significant difference exists in the types of urologic studies authored by women as compared to those by men. METHODS: A cross-sectional study was designed to analyze trends in women authorship of urology publications in 2019 compared to AUA 2019 census data. All studies published by authors from USA institutions between January and April of 2019 in Journal of Urology, BJU International, Journal of Endourology, European Urology, and Prostate Cancer and Prostatic Diseases were evaluated. The gender of first and senior authors were collected. Studies were categorized as basic science, clinical medicine, economics/practice management, review/meta-analysis, editorial, and case report/technique. Chi-squared test was used for statistical analyses and p values <0.05 were considered statistically significant. RESULTS: 184 publications were included in this study. The proportion of women first authors was significantly higher than would be expected based on population proportions, X2 (1, N=178)=9.65, p=0.002. There was no significant difference in proportion of women senior authors compared to expected, X2 (1, N=165)=2.18, p=0.14. The proportion of women with basic science publications was significantly higher than expected, X2 (1, N=18)=6.45, p=0.011. There were no differences in proportion of women compared to men in all other types of studies, including case report/technique, X2 (1, N=14)=1.54, p=0.215, clinical medicine, X2 (1, N=178)=3.43, p=0.064, economics/practice management, X2 (1, N=40)=1.17, p=0.28, editorial, X2 (1, N=70)=0, p=0.978, and review/meta-analysis, X2 (1, N=42)=2.16, p=0.142. CONCLUSIONS: A recent study showed that amongst physicians, women were less likely than men to be promoted in academic medicine. This gender gap exists despite the high productivity of women as first authors in this study. This may reflect the growing number of women in urology training programs. As one of the least gender-diverse specialties, it is imperative that urologic institutions not only encourage productivity amongst women trainees and urologists but ultimately take actions to promote the advancement of women urologists within the ranks of academic leadership. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e151 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Leah Beland More articles by this author Ginnie Jeng More articles by this author Tareq Aro More articles by this author Jessica Kreshover More articles by this author Expand All Advertisement PDF DownloadLoading ...

MP19-08 AN ANALYSIS EXPLORING SELF-IDENTIFIED GENDER AMONG UROLOGISTS INCLUDED IN TOP DOCTOR MAGAZINE LISTS

You have accessJournal of UrologyCME1 May 2022MP19-08 AN ANALYSIS EXPLORING SELF-IDENTIFIED GENDER AMONG UROLOGISTS INCLUDED IN TOP DOCTOR MAGAZINE LISTS Elizabeth Adams, Marne Louters, Brandon Ansbro, Simone Thavaseelan, and Stephanie Kielb Elizabeth AdamsElizabeth Adams More articles by this author , Marne LoutersMarne Louters More articles by this author , Brandon AnsbroBrandon Ansbro More articles by this author , Simone ThavaseelanSimone Thavaseelan More articles by this author , and Stephanie KielbStephanie Kielb More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002552.08AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Top Doctor lists in magazines are often published annually, with variable methodologies and criteria for the award. As the number of women practicing urology has slowly grown to be 10.3% of urologists as of 2020, we sought to evaluate whether these lists reflect a contemporary distribution of urologists, to determine if there are regional differences in Top Doctor list gender composition, and to describe similarities and differences among female and male Top Doctors. METHODS: Magazines with a urology, pediatric urology, and/or urogynecology Top Doctor list comprised of physicians with formal urologic training published from January 1, 2020-June 22, 2021 using Castle Connolly (CC) Medical Ltd were included in this study. Information surrounding physician gender, education, affiliation, and award history was obtained from institution profiles and the CC website. A weighted average for patient rating scores was calculated for urologists with at least 20 ratings on Healthgrades and Vitals. Chi square, independent t-tests, ANOVA, and descriptive statistics were generated. RESULTS: A total of 494 Top Doctor urologists from 25 magazines were analyzed. Of the 494 urologists, 42 (8.50%) were women, with female urologists comprising a range of 0-27.8% per magazine list. Seven magazines (28.0%) did not include female urologists in their lists and eight (32.0%) included one woman on their list. By region, female urologists were represented more often in Western states’ Top Doctor Lists (15.1%) in comparison to the Northeast, South, or Midwest (7.97%, 7.84%, 5.41% respectively). Female urologists more often completed a clinical fellowship compared to their male counterparts (66.7% vs 55.1%). Female Top Doctor urologists were significantly more likely to complete a female pelvic medicine and reproductive surgery (FPMRS) fellowship than their male counterparts (50% vs. 7.8%, p<0.001, chi square). The most common fellowships male urologists completed were urologic oncology (36.3%), pediatric urology (22.3%), and endourology (19.5%). Male urologists were recognized as a Top Doctor with as little as 1 year of clinical practice compared to at least 6 years for females. Weighted average patient ratings were similar among female and male Top Doctor urologists (4.02 vs 4.12/5.00). CONCLUSIONS: Fewer female urologists were recognized as a Top Doctor than anticipated based on the percentage of practicing female urologists, especially in the Northeast, South, and Midwest. Top female urologists were more likely to complete a clinical fellowship, with FPMRS being the most common. Source of Funding: Northwestern University Feinberg School of Medicine © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e310 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Elizabeth Adams More articles by this author Marne Louters More articles by this author Brandon Ansbro More articles by this author Simone Thavaseelan More articles by this author Stephanie Kielb More articles by this author Expand All Advertisement PDF DownloadLoading ...

MP10-08 LONGITUDINAL COMPARISON OF SURGICAL CASE LOGS BETWEEN FEMALE AND MALE: UROLOGY RESIDENTS

You have accessJournal of UrologyCME1 May 2022MP10-08 LONGITUDINAL COMPARISON OF SURGICAL CASE LOGS BETWEEN FEMALE AND MALE: UROLOGY RESIDENTS Kathryn A. Marchetti, Emma C. Bethel, Stephanie Daignault - Newton, Charlie Ferrer, Suzanne Merril, Thomas Guzzo, Adam Klausner, Richard Lee, John Lynch, Jay D. Raman, Adam Reese, Patrick Shenot, R. Houston Thompson, Stanley Zaslau, and Kate H. Kraft Kathryn A. MarchettiKathryn A. Marchetti More articles by this author , Emma C. BethelEmma C. Bethel More articles by this author , Stephanie Daignault - NewtonStephanie Daignault - Newton More articles by this author , Charlie FerrerCharlie Ferrer More articles by this author , Suzanne MerrilSuzanne Merril More articles by this author , Thomas GuzzoThomas Guzzo More articles by this author , Adam KlausnerAdam Klausner More articles by this author , Richard LeeRichard Lee More articles by this author , John LynchJohn Lynch More articles by this author , Jay D. RamanJay D. Raman More articles by this author , Adam ReeseAdam Reese More articles by this author , Patrick ShenotPatrick Shenot More articles by this author , R. Houston ThompsonR. Houston Thompson More articles by this author , Stanley ZaslauStanley Zaslau More articles by this author , and Kate H. KraftKate H. Kraft More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002532.08AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Multiple studies suggest that gender inequity exists within medicine. Per AUA census data, a higher percentage of female residents pursue fellowship training following residency. While there are multiple measures for the quality of training and trainee preparedness for independent practice, surgical case logs are a critical component in the assessment of both. We aim to determine if disparities exist in the number and type of surgical cases completed by female residents compared to their male peers. METHODS: ACGME surgical case logs were collected from 12 accredited urology residency programs from 2010 to 2020. The number and type of cases of each graduate were collected and recorded. This information was correlated with resident year of graduation and gender. Residents with incomplete data logs were excluded.The median, and 25th and 75th percentile number of cases were calculated by gender, and then compared between female and male residents using Wilcoxon rank sum test. RESULTS: A total of 378 residents were included in the study, and 71 (18.8%) were female. Female residents completed a median total of 2164 cases during residency, compared to a median total of 2259 cases (p=0.17) completed by their male peers. Female residents completed on average 23 to 43 fewer cases per year than male residents (p=0.18–0.25, per year) (Figure 1). There was no significant difference between female and male trainees in the median total number of cases across case types, including general urology, endourology, reconstructive surgery, oncology, pediatrics, radiology, and cystoscopy. CONCLUSIONS: While male residents logged approximately 100 more surgical cases compared to female residents throughout residency, this difference was not statistically significant. Urology training programs and the ACGME work to provide an equal, balanced training environment for all residents. Further studies are needed to elucidate why female residents are more likely to pursue fellowship training after residency. Source of Funding: none © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e149 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Kathryn A. Marchetti More articles by this author Emma C. Bethel More articles by this author Stephanie Daignault - Newton More articles by this author Charlie Ferrer More articles by this author Suzanne Merril More articles by this author Thomas Guzzo More articles by this author Adam Klausner More articles by this author Richard Lee More articles by this author John Lynch More articles by this author Jay D. Raman More articles by this author Adam Reese More articles by this author Patrick Shenot More articles by this author R. Houston Thompson More articles by this author Stanley Zaslau More articles by this author Kate H. Kraft More articles by this author Expand All Advertisement PDF DownloadLoading ...

A Multinational Study of The Impact of Covid-19 On Urologic Surgery Residency and Wellbeing

ObjectiveTo assess changes to the experiences and wellbeing of urology trainees in the United States (US) and European Union (EU) during the COVID-19 pandemic. MethodsA 72-item anonymous online survey was distributed September 2020 to urology residents of Italy, France, Portugal, and the US. The survey assessed burnout, professional fulfillment, loneliness, depression and anxiety as well as 38 COVID specific questions. ResultsTwo hundred twenty-three urology residents responded to the survey. Surgical exposure was the main educational concern for 81% of US and 48% of EU residents. E-learning was utilized by 100% of US and 57% of EU residents with two-thirds finding it equally or more useful than traditional didactics. No significant differences were seen comparing burnout, professional fulfillment, depression, anxiety, or loneliness among US or EU residents, 73% of US and 71% of EU residents reported good to excellent quality of life during the pandemic. In the US and EU, significantly less time was spent in the hospital, clinic, and operating room (P <.001) and residents spent more time using telehealth and working from home during the pandemic and on research projects, didactic lectures, non-medical hobbies and reading. The majority of residents reported benefit from more schedule flexibility, improved work life balance, and increased time for family, hobbies, education, and research. ConclusionThe COVID-19 pandemic has resulted in significant restructuring of residents’ educational experience around the globe. Preservation of beneficial changes such as reduction of work hours and online learning should be pursued within this pandemic and beyond it.

AUTHOR'S REPLY

The editors note there exists a bottleneck at the level of recruiting underrepresented minority (URM) students into medical school. We made reference to this phenomenon citing the prevalence of URM students in medical school in 2019 was 14%, with a similar lag in URM (including Asian trainees) representation in urology trainees at 17.7% (30.8%) behind surgery at 20.4% (33.6%) and all fields at 25.6% (42.3%). While this bottleneck is evident at the beginning of medical education, these straggling numbers continue at every juncture of becoming a physician resulting in a further silo effect in competitive surgical subspecialties like urology.

EDITORIAL COMMENT

In this study, the authors examine the concordance of the proportion of women and underrepresented minorities (URM) among current urology trainees to the proportion of women and URMs in the general population. This paper eloquently leads a call to action to diversify our workforce so urologists better represent the patients we serve.