Current perceptions of resident training in laparoscopic nephrectomy

Specific steps in the operation determine resident speed: Experience with a live tissue simulation model of laparoscopic nephrectomy

INTRODUCTION

It is increasingly important to identify and eliminate inefficiencies in resident education. We hypothesize that slower performance of specific operative steps in laparoscopic nephrectomy accounts for much of the slower operative speed observed in junior residents vs. their senior colleagues. Therefore, we sought to evaluate the by-step time-differential between experienced senior residents and their junior colleagues in a live-tissue simulation.

MATERIALS AND METHODS

Residents participated in our swine model surgical simulation of laparoscopic radical and partial nephrectomy (LRNx and LPNx). PGY5 and 6 residents were considered senior; junior residents were PGY3 and 4. We defined discrete surgical steps. Residents' post-graduate training levels were tracked and time-to-completion of each operative step was recorded.

RESULTS

Seven live-tissue simulations sessions took place, with 12 residents conducting 22 operations (12 LRNx, 10 LPNx). On average, each resident operated in 2 simulation sessions (range 1-4). The average time required by senior residents for LPNx was 152 min; junior residents required 173 min (p = 0.35). When considering the operative steps, juniors required nearly twice as much time to achieve hilar control (42 min vs. 23 min, p = 0.03). Significant differences in performance time were not seen in the other steps.

DISCUSSION

The performance differential between senior and junior residents conducting nephrectomies was most evident during hilar dissection. Our study suggests that specific efforts should be focused on teaching junior residents the skills required for this step early in their training.

Otolaryngology residents' perceptions of endoscopic ear surgery during surgical training

BACKGROUND

The introduction of endoscopic ear surgery has implications for the training of otolaryngology residents.

OBJECTIVES

To report on the status of endoscopic ear surgery and assess the effects of this new technology on otolaryngology training in Singapore, from the residents' perspective.

METHODS

An anonymous survey was conducted amongst all Singaporean otolaryngology residents. Residents' exposure to, and perceptions of, endoscopic ear surgery were assessed.

RESULTS

Residents from institutions that practise endoscopic ear surgery were more positive regarding its efficacy in various otological surgical procedures. Of residents in programmes with exposure to endoscopic ear surgery, 82.4 per cent felt that its introduction had adversely affected their training, with 88.3 per cent of residents agreeing that faculty members' learning of endoscopic ear surgery had decreased their hands-on surgical load. Both groups expressed desire for more experience with endoscopy.

CONCLUSION

The majority of residents view endoscopic ear surgery as an expanding field with a potentially negative impact on their training. Mitigating measures should be implemented to minimise its negative impact on residents' training.

Training of European urology residents in laparoscopy: results of a pan-European survey

OBJECTIVE

To assess the participation of European urology residents in urological laparoscopy, their training patterns and facilities available in European Urology Departments.

MATERIALS AND METHODS

A survey, consisting of 23 questions concerning laparoscopic training, was published online as well as distributed on paper, during the Annual European Association of Urology Congress in 2012. Exposure to laparoscopic procedures, acquired laparoscopic experience, training patterns, training facilities and motivation were evaluated. Data was analysed with descriptive statistics.

RESULTS

In all, 219 European urology residents answered the survey. Conventional laparoscopy was available in 74% of the respondents' departments, while robotic surgery was available in 17% of the departments. Of the respondents, 27% were first surgeons and 43% were assistants in conventional laparoscopic procedures. Only 23% of the residents rated their laparoscopic experience as at least 'satisfactory'; 32% of the residents did not attend any course or fellowship on laparoscopy. Dry laboratory was the most frequent setting for training (33%), although 42% of the respondents did not have access to any type of laparoscopic laboratory. The motivation to perform laparoscopy was rated as 'high' or 'very high' by 77% of the respondents, and 81% considered a post-residency fellowship in laparoscopy.

CONCLUSIONS

Urological laparoscopy is available in most European training institutions, with residents playing an active role in the procedure. However, most of them consider their laparoscopic experience to be poor. Moreover, the availability of training facilities and participation in laparoscopy courses and fellowships are low and should be encouraged.

The newly graduated Canadian urologist: Over-trained and underemployed?

INTRODUCTION

There are two prevailing perceptions among urology residents (1) fellowship training is becoming a requirement after residency, and (2) there are few job opportunities after graduation. In this study, we examine postgraduate training patterns and employment choices of urology residents.

METHODS

All Canadian urology program directors provided a summary of fellowship training and employment of Canadian residents graduating between 1998 and 2009. Logistic regression models were used to detect linear trends.

RESULTS

In total, 258 Canadian urology residents graduated over the study period, with a median of 22 (interquartile range 21-22) graduating per year. Of these, 72% completed a fellowship. Of these fellowships, 62% included protected research time. The most common subspecialty area was minimally invasive surgery (MIS)/endourology (39% of fellowships). There was a significant increase in fellowship training over time (p < 0.0001); this was mostly due to an increase in MIS/endourology fellowships. The number of urologists obtaining graduate degrees after medical school has increased significantly over the study period. Almost all graduates are employed. Of the employed graduates in total, 34% are academic urologists. Among all graduates, 50% are practicing within 100 km of their residency site, 16% are practicing in the United States and 22% are in rural practice. There has been no significant change over time in the proportion of residents practicing within 100 km of their training program, practicing rurally, leaving their province of training, practicing in the United States, or choosing academic practice.

CONCLUSIONS

Fellowship training, especially in MIS/endourology, has become significantly more common. Graduate degrees are more frequently being obtained. We did not find evidence that there has been a significant change in a urology resident's ultimate ability to obtain employment upon graduation.

Status of robotic-assisted surgery among Canadian urology residents

BACKGROUND

Robotic-assisted surgery (RAS) has been rapidly adopted in urology, especially in the United States. Although less prevalent in Canada, RAS is a growing and controversial field that has implications for resident training. We report on the status and perception of RAS among Canadian urology residents.

METHODS

: All Canadian urology residents from anglophone programs were contacted by email and asked to participate in an online survey. Current resident exposure to, and perception of, RAS was assessed.

RESULTS

: Of the residents contacted (n = 128), 50 (39%) completed the survey. Of the respondents, 52% have been involved in RAS. Those who have not been involved in RAS express lower interest and lesser knowledge of RAS. Ninety-two percent of respondents feel the use of RAS will increase, although only 29% feel this is feasible in Canada. Just 24% and 36% feel RAS to be superior to open and laparoscopic techniques, respectively. Sixty-eight percent of residents in programs with a robot viewed it as detrimental to training, whereas 81% of residents in programs without one viewed its absence to either have no impact, or even be beneficial. Both groups expressed a desire for more experience with RAS.

CONCLUSION

: The resident experience with respect to RAS is mixed. Overall, residents view RAS as an expanding field with potentially negative impacts on their present training, although they appear to desire the acquisition of more experience in RAS. We plan to monitor the evolution of these perceptions over next four years.

Enhancing the case log by coding the level of trainee participation in vascular interventional radiology procedures

OBJECTIVE

The purpose of this article is to describe a new method for coding trainee participation in vascular interventional radiology procedures.

MATERIALS AND METHODS

From July 2008 through June 2009, all interventional radiology fellows maintained an enhanced case log at our institution; 748 unique cases were logged by procedure type, supervising physician, and level of participation in the case. Level of participation was classified on a 5-point scale that included designations for observation, first assistant, performance of basic techniques, performance of advanced techniques, and primary operation. Descriptive statistics of participation scores were calculated for each quarter and were analyzed by procedure type and by teaching faculty member.

RESULTS

As expected, analysis by procedure type showed that average participation scores increased from one quarter to the next in most cases. By the fourth quarter, the modal participation score was 5, indicating primary operation or performance of multiple critical steps. Analysis by teaching faculty member revealed three patterns: those attending physicians facilitating increasing levels of participation in every quarter, those facilitating maximal growth within the first 6 months, and those with irregular trainee participation profiles.

CONCLUSION

Data from a 5-point participation scale add information to the procedure case log that could be used to quantitatively track the technical progress of trainees while providing education quality feedback to both teaching physicians and program directors.