[Certified residency curriculum for the specialization training in urology from the German Society of Urology according to the 2018 Training Regulations (version of 20. September 2019)]

[Sustainable residency training in urology in context of current changes in the German healthcare system]

Promoting sustainable structures and measures in residency is crucial to meet current and future requirements of the German healthcare system. This process does not only involve the integration of social, ecological, and economic aspects into everyday professional life but also into residency training. Specifically, sustainable structures and measures in residency include initiatives such as structured training curricula, simulation-based training, digital training opportunities, flexible working time models, and gender equality. In addition, consideration of environmental aspects as well as expansion of quality management programs are essential. A holistic approach that considers both the efficiency and the needs of physicians and their patients is the key to sustainable urologic residency programs. This way, urology will remain an attractive specialty for future generations.

Value-Based Health Care for Prostate Cancer Centers by Implementing Specific Key Performance Indicators Using a Balanced Score Card

BACKGROUND

Prostate cancer (PC) is the most common cancer in men in 112 countries, and accounts for 15% of cancers. Because it cannot be prevented, the rise in cases is inevitable, and improvements in diagnostic pathways and treatments are needed, as there is still a shortage of cost-effective diagnostics and widespread oncologically safe treatment options with measurable quality. As part of the implementation of a Full Cycle of Care, instruments have been developed to achieve value-based medicine, such as consistent commitment to measurability. One of these instruments is the Balanced Scorecard (BSC). Here, we propose the first BSC for prostate cancer (PC) treatment.

METHODS

BSCs are used to assess performance in healthcare organizations across four dimensions: financial, patient and referrer, process, and learning and development. This study aimed to identify Key Performance Indicators (KPIs) for each perspective. A systematic literature search was conducted according to PRISMA guidelines using multiple databases and specific search terms to identify KPIs for PC care, excluding case reports and conference abstracts. In total, 44 reports were included in analyses and development of the PC-specific BSC.

RESULTS

In the present study, a PC-specific BSC and KPIs were defined for the four classic perspectives, as well as for a newly developed PC-Specific Disease and Outcome perspective, including patient-related parameters from the German Cancer Society and the International Consortium for Health Outcomes Measurement. In addition, the Process perspective includes KPIs of fulfillment of continuing education of residents and the metrics of structured training of the radical prostatectomy procedure in the Learning and Development perspective.

CONCLUSIONS

The developed BSC provides a comprehensive set of perspectives for an Integrated Practice Unit or center in PC care, ensuring that the indicators remain manageable and applicable. The BSC facilitates value creation in line with Porter's Full Cycle of Care by systematically collecting and providing economic, personnel, and medical results, actions, and indicators. In particular, this BSC includes KPIs of structured training of practitioners and metrics of the German Cancer Society, that recently proved to improve PC patients outcomes.

[Another encroachment on our liberal profession-The German Federal Ministry of Health continues to stubbornly ignore the self-government]

Overall, the German healthcare system is shaped by numerous players and institutions. With the state medical associations as public corporations for self-governance and the Heilberufsgesetz (German Health Professions Act), professional practice, professional representation and professional jurisdiction are regulated at the state level. The Joint Federal Committee ("Gemeinsame Bundesausschuss"), the highest decision-making body of joint self-governance in the German health care system, plays a central role. Practicing a liberal profession is intended to guarantee an undisturbed physician-patient relationship. Neither in hospitals nor in outpatient care can medical care be separated from economic constraints, but the fundamental binding of medical care to pure service catalogs leads to mismanagement. The goal of the hospital reform proposals currently being developed by the German Federal Ministry of Health is to avoid unnecessary hospital closures and to ensure high-quality care throughout the country, even in rural regions. In the age of strict separation of outpatient and inpatient care, the diagnosis-related group (DRG) system has primarily led to services migrating to the inpatient sector. It may no longer be possible to offer all continuing education courses at all continuing education centers following a reform of the care structure.

[Status quo of urological residency training in Germany-a strengths, weaknesses, opportunities, and threats (SWOT) analysis]

BACKGROUND

Urological residency training is a decisive step on the urological career path. The aim of this review is to develop strategies and approaches to actively shape, improve and further develop urological residency training.

METHODS

With the help of a strengths, weaknesses, opportunities, and threats (SWOT) analysis, the status quo of urological residency training in Germany is analyzed in a structured manner.

RESULTS

Strengths of urological residency training incorporate the attractiveness of the specialty itself, and the residency training curriculum in urology ("Weiterbildungscurriculum Urologie", WECU), including the networking of inpatient and outpatient training and accompanying internal and external further training. The German Society of Residents in Urology (GeSRU) also provides a networking platform for residents. Weaknesses include country-specific differences and a lack of checkpoints during residency training. Opportunities for urological continuing education arise from freelance work, digitalization, and technical and medical progress. In contrast, the aftermath of the coronavirus disease 2019 (COVID 19) pandemic, with still limited staff and surgical capacities, an increased psychosocial workload, and the rising number of outpatient treatments in urology pose threats for urological residency programs.

CONCLUSIONS

With the help of a SWOT analysis, factors for the further development of urological residency training can be identified. In order to provide high-quality residency training in the future, strengths and opportunities should be consolidated and weaknesses and threats should be addressed at an early stage.

Standardized evaluation of satisfaction within urology residents during clinical training: Implementation of a new urological residency rotation program at the university hospital Frankfurt

Background

Structured curricula are demanded to improve training programs of future urologists. This study aimed to evaluate the acceptance of the newly implemented residency rotation program at the University Hospital Frankfurt. Primary endpoint was resident's satisfaction with the current residency rotation program. Secondary endpoint was the fulfilment of the objectives and expectations by residents.

Methods

A standardized 15-item, online-based survey was sent to every urologic resident of the University Hospital Frankfurt, completing their rotation between August 2020 and August 2022. In addition to baseline characteristics, training and working conditions were assessed. Descriptive statistics were applied.

Results

In total 15 rotations of the Residency Rotation Program at the University Hospital Frankfurt were evaluated, including urologic practice (5/15), Intermediate Care Unit (4/15), urooncology (4/15) and clinical exchange to St. Gallen (2/15). Overall, the majority were very (67%) or rather satisfied (2%) with their rotation. Of the pre-rotation defined objectives, 71% were fulfilled, 18% partially fulfilled and 8% not fulfilled. With respect to the expectations, 67% were fulfilled, 19% partly fulfilled and 4% were not fulfilled. All residents would recommend their respective rotations.

Conclusion

Our results demonstrate that the residency rotation program at the University Hospital Frankfurt enjoys a high level of acceptance as well as a positive impact on urologic training. Satisfaction with the completed rotation was convincing, most of the expectations and objectives for the respective rotation could be fulfilled. These results help to ensure the quality of urologic curricula and to improve the structure of training programs for future urologists.

MatricS-A novel tool for monitoring professional role development in surgical disciplines

Introduction

Mentoring is an effective method for human resource development. Monitoring the process is important for individual mentee/mentor pairs as well as for program directors. Due to individual personality differences of both mentees and mentors and their respective interactions, it is challenging to monitor the individual development process of mentees in a structured manner. This study investigates to what extent a novel instrument, the mentee-based assessment tool for role development of interpersonal competencies in surgical professions (MatricS) can adequately monitor the professional role development process of residents during an established mentoring program.

Material and methods

In a prospective longitudinal study, the competence development of 31 mentees in two subsequent cohorts was assessed by a modified role matrix based on Canadian Medical Education Directives for Specialists. The evaluation focused on three defined roles (D, developer; N, networker; M, multiplicator) at three levels (private, employer-related, national/international) with four stages of development. For validation of mentee self-assessments, the assessments of the respective mentors were recorded alongside. For correlation analyses, Pearson coefficients were calculated, pre-post-comparisons were done by paired t-tests; significance was assumed at p < 0.05, respectively.

Results

Mentee self-assessments overall correlated well with the objective mentor assessments (Pearson's r 0.8, p < 0.001). Significant correlations of this magnitude were found for both individual cohorts as well as for all individual roles. The mentees acquired competencies in all roles indicated by significant increases of corresponding MatricS scores. The largest competency gains (mean ± SD) were found in the role D (start: 1.30 ± 0.77, end: 2.13 ± 0.83, p < 0.001). The majority of mentees achieved the prespecified target competency level in >75% of all roles and levels.

Conclusion

The role development process during mentoring can be reliably monitored by using MatricS. MatricS scores highly correlate between mentees and mentors, indicating that mentee self-assessments are suitable and sufficient for monitoring. These findings help to lessen the work burden on senior surgeons and thus can help to increase the acceptance of mentoring programs in surgical disciplines.

[Promotion of next generation urologists-Construct urology of the future]

In view of the growing demand for urological care and the simultaneous demographic change, the need for urologists in Germany is increasing. Therefore, young professionals are urgently needed to ensure urological care in the future. This objective can be achieved by fascinating medical students for urology and by implementing satisfactory residency programs in clinical departments and outpatient offices. Perspectives and possible career paths should be shown to junior colleagues at an early stage. Structured research funding is needed to reconcile academic with clinical work. The German Society for Residents in Urology (GeSRU) offers young urologists a platform for networking, for representation of interests as well as for education and training.

[Experiencing continuing education-experience of future urologists]

Structured residency programmes within dedicated associations of hospitals, practices and medical care centres offer the opportunity to improve the quality of training and to increase the attractiveness of urology through fixed rotations of doctors in continued training. The implementation of such programmes is guided by the framework conditions of the respective location. Possible rotations range from andrology to paediatric urology and uro-gynaecology to interdisciplinary uro-oncology. An outpatient training period also offers the chance for a change of perspective and supports career orientation. Rotations in the interdisciplinary intermediate care unit offer the opportunity to become familiar with the care of complex disease processes, including the differential diagnostic assessment of abdominal diseases, which is important in urology. In summary, the diversity of urological training available can enable junior urologists to receive more individualised and targeted training by promoting multilayered, intersectoral as well as interprofessional training.

[Training and work conditions of residents in urology in Germany : Results of the second German Society of Residents in Urology e. V. (GeSRU) residency survey from 2020]

BACKGROUND

Residency is the fundation for high-quality medical care and also for career development of young urologists. In 2015 the GeSRU (German Society of Residents in Urology) carried out the first nationwide survey among young physicians in urology and described the status quo of their residency. This revised follow-up examination draws an updated picture of the training and working conditions of residents in urology and assesses the development.

METHODS

In 2020 the GeSRU conducted an online-based survey of all residents in urology; therefore, the 2015 questionnaire was expanded. The model of the professional gratification crisis was used again.

RESULTS

A total of 332 questionnaires were analyzed. Major findings have not changed since 2015. The daily working routine is characterized by high pace and workload and economic considerations. Family- and research-friendly working conditions are largely lacking. 35% of the respondents draw professional consequences. The psychosocial strain remains very high and conveys a risk for physicians' health and patients' quality of care.

CONCLUSION

These results demonstrate that there are still systemically immanent burdens for residents in urology, which require adjustments to the working and training conditions. A structured, transparent curriculum for urological residency, remuneration and time for training and models which enable work-life balance should be established.

[Influence of the working model on the education of young urologists : Education through the ages]

BACKGROUND

There is a trend of increasing discontent of urologic residents with educational programs. One point being mentioned is lack of time during residency for education and self-training. We analyzed the available time for education in our department depending on the used working model through the last 25 years.

MATERIALS AND METHODS

We calculated the absolute availability of residents during their residency for working models in 1996, 2000, 2007 and 2017. As a basis we used the working model of 1996 as no compensatory time-off for being on call was used. All days on which a delayed start is planned and no schedule in daily routine is possible had been excluded from education time. The numbers implemented in the regulation on further education in the corresponding years had been used to calculate the expenditure of time on the basis of median length of the different intervention. In addition, the patient numbers on the ward and our outpatient clinic had been documented over time.

RESULTS

With increasing patient numbers in the in- and outpatient clinic there is a continuous decreasing time available for education. The absolute available time in our department is calculated to be 3.1 years compared to 5 years in 1996. With the first day of training a resident has to complete 66.9 min of self-contained diagnostics or interventions per day in addition to clinical routine and administration to meet the requested numbers of the regulation on further education.

CONCLUSIONS

The limited time being available for the educational program is improved by the current regulation of education. To teach the complex segments of urology there is an urgent need for a well-structured curriculum, which should be used nationwide.