Dedicated Research Time in Urology Residency: Current Status

The Impact of Dedicated Research Years During Residency Upon Continued Academic Productivity of Plastic Surgeons

BACKGROUND

This study explored the impact of dedicated research year(s) on long-term research productivity and career choices of plastic surgeons as academicians.

METHODS

Scopus and Web of Science were accessed in September 2020 to collate publications and H indexes of alumni who graduated from integrated plastic surgery residency programs from 2011 to 2020. Public profiles were utilized to determine academic status. Corresponding data were grouped by residency program type (traditional programs without required research, programs with one required research year, and a single program with variable research years). Unpaired t tests and 1-way analysis of variance were conducted to compare average H indexes and publication counts of alumni from each group. χ 2 tests analyzed differences in academic statuses.

RESULTS

Alumni who completed one required research year published significantly more with a higher H index compared with those from traditional programs. Similar results were found among alumni who completed 2 research years compared with 0 or 1 year within a single program. Residents who completed one required research year were more likely to hold dual academic and nonacademic positions after graduation compared with their traditional counterparts. However, there was no statistical difference in academic status observed for surgeons who graduated from the program with variable research years.

CONCLUSIONS

Participating in research year(s) during residency is predictive of ongoing academic productivity of surgeons within the first 10 years of completion of residency. This becomes important for training craniofacial surgeons, the majority of whom practice in academic settings.

Current status of urological training and differences between institutions

OBJECTIVES

Appropriate training of urology residents is important to secure not only high-quality patient care, but also the bright future of our specialty. We aimed to investigate residency training from the perspective of qualification and standardization and to evaluate surgical education, publication output, working conditions, future plans, and overall satisfaction, in a comprehensive way.

METHODS

We conducted a survey of urology chief residents/recent graduates in Turkey to identify differences between institutions and deficiencies in urology resident training. A total of 155 chief residents/recently graduated specialists were contacted by phone and a survey was completed.

RESULTS

The survey response rate was 96.1%. Respondents had high proficiency in endourology (97.3%), similar to Canada and European countries. However, they reported a lack of proficiency in laparoscopy (28.9%) and functional urology (26.2%). Also, no one had completed a robotic procedure as first surgeon. A total of 75.2% respondents had no first author publication, and 10.1% had no first author abstract presentation. There was no significant difference between institution types with or without certification. There was a satisfaction rate of 87.2% among participants.

CONCLUSIONS

It was observed that qualified and standardized training could has not been achieved and the positive effects of certification have not been seen yet. There is a lack of modernization in all aspects of education, and there is no standardized curriculum addressing academic research. Therefore, there is a risk that future urologists will have insufficient skills. We hope this study serves as a guide for modernization and standardization in urology training.

Barriers to effective research supervision in clinical specialist training: Experience from a medical school in Malaysia

INTRODUCTION

A compulsory research component is becoming increasingly common for clinical residents. However, integrating research into a busy clinical training schedule can be challenging. This study aimed to explore barriers to research supervision in specialist training programmes from the perspectives of clinical supervisors and trainees at a Malaysian university hospital.

METHODS

Qualitative interviews and focus group discussions were conducted (December 2016 to July 2017) with clinical supervisors (n=11) and clinical trainees (n=26) utilising a topic guide exploring institutional guidelines, research culture and supervisor-student roles. Interviews were transcribed verbatim and analysed thematically to identify barriers to research supervision.

RESULTS

Supervisors and trainees from 11 out of 18 departments participated. Both clinical supervisors and trainees struggled to successfully integrate a compulsory research component into residency training. Among the reasons identified included a lack of supervisory access due to the nature of clinical rotations and placements, clashing training priorities (clinical vs research) that discouraged trainees and supervisors from engaging in research, poor research expertise and experience among clinical supervisors hampering high-quality supervision, and a frustrating lack of clear standards between the various parties involved in research guidance and examination.

CONCLUSION

Both clinical supervisors and trainees struggled to successfully integrate a compulsory research component into residency training. This was not only an issue of resource limitation since questions regarding clinical priorities and unclear research standards emerged. Thus, institutional coordinators need to set clear standards and provide adequate training to make research meaningful and achievable for busy clinical supervisors and trainees.

Urology residency training in Greece. Results from the first national resident survey

BACKGROUND AND OBJECTIVES

This is the first national survey assessing Greek Urology residency programs. The main objective of this study is to assess the level of confidence and perception of Greek Urology residents regarding their educational program and detect areas of improvement.

MATERIAL AND METHODS

A 51-question survey was developed via an electronic platform and answered by 91 out of 104 Greek residents from March 2019 until May 2019. Fisher's exact test, chi-squared test and Kruskal-Wallis test were used with statistical significance set at p = .05.

RESULTS

The median overall satisfaction regarding surgical training was 6/10 regardless of working schedule, working in a University Department, PGY or number of residents in clinic. Most residents have not performed any scrotal ultrasound or pressure-flow-studies; however, they are more familiar with KUB ultrasound. Double-J stent insertion and cystoscopy were common procedures for residents. Bureaucracy was reported as a major issue by 70.4% of residents. ESWL has not been performed by 80.2% of residents, 58.2% residents performed less than 10 ureteroscopies, and only the last year trainees performed more than 10 TURBT and TURP. Most residents mentioned to rarely perform basic steps in many open or laparoscopic urological procedures. Surprisingly, 59.3% of residents have not published any study in peer-reviewed journals. Regarding satisfaction, 44% rarely feel satisfied at work and 59.3% sometimes suffer from burnout. Response rate reached 87.5%.

CONCLUSIONS

Considering the results from this survey, regulatory authorities should join forces to establish a structured curriculum of clinical, surgical and research training in Urology across Europe.

[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.

Urology residency training in Greece. Results from the first national resident survey

BACKGROUND AND OBJECTIVES

This is the first national survey assessing Greek Urology residency programs. The main objective of this study is to assess the level of confidence and perception of Greek Urology residents regarding their educational program and detect areas of improvement.

MATERIAL AND METHODS

A 51-question survey was developed via an electronic platform and answered by 91 out of 104 Greek residents from March 2019 until May 2019. Fisher's exact test, chi-squared test and Kruskal-Wallis test were used with statistical significance set at p=.05.

RESULTS

The median overall satisfaction regarding surgical training was 6/10 regardless of working schedule, working in a University Department, PGY or number of residents in clinic. Most residents have not performed any scrotal ultrasound or pressure-flow-studies; however, they are more familiar with KUB ultrasound. Double-J stent insertion and cystoscopy were common procedures for residents. Bureaucracy was reported as a major issue by 70.4% of residents. ESWL has not been performed by 80.2% of residents, 58.2% residents performed less than 10 ureteroscopies, and only the last year trainees performed more than 10 TURBT and TURP. Most residents mentioned to rarely perform basic steps in many open or laparoscopic urological procedures. Surprisingly, 59.3% of residents have not published any study in peer-reviewed journals. Regarding satisfaction, 44% rarely feel satisfied at work and 59.3% sometimes suffer from burnout. Response rate reached 87.5%.

CONCLUSIONS

Considering the results from this survey, regulatory authorities should join forces to establish a structured curriculum of clinical, surgical and research training in Urology across Europe.

Dedicated Residency Research Time and Its Relationship to Urologic Career Academic Success

OBJECTIVE

To explore the relationship between research time during urologic training and career academic success.

METHODS

We included urologists graduating residency between 2002 and 2008 from 36 programs affiliated with a top 50 hospital for urology as ranked by the United States News and World Report, and collected research time during residency, fellowship training, current appointment (private practice, assistant professor, associate professor, professor, chair), national institutes of health (NIH) grant accrual, NIH R01 grant accrual, and current H-index in Scopus database. Publication output during and after residency was identified through the PubMed database.

RESULTS

In our cohort of 543 urologists, 66.3% of graduating trainees pursued private practice. Increasing residency research time was associated with increased publication count (P <.001), pursuit of professor positions (P <.001), and NIH funding (P <.001). One year of dedicated research increased the odds of being in the top 10th percentile of publication output during residency (odds ratio [OR]: 5.7, 95% confidence interval [CI]: 2.7-12.1), pursuing a fellowship (OR: 2.0, 95% CI: 1.3-3.1), promotion to professor (OR: 4.9, 95% CI: 2.0-12.2), obtaining a NIH grant (OR: 6.2, 95% CI: 2.3-16.5), and decreased the odds of pursuing private practice (OR: 0.4, 95% CI: 0.3-0.6). As amount of time dedicated to research in urologic residency increased from 3-4 to 6-12 months, OR increased for career academic success metrics.

CONCLUSION

Although a minority of trainees enter academics, dedicated time for research in urologic residency is associated with career academic success, with more research time associated with increased publication output, academic appointments, and grant funding.

[Urology training in Germany: international comparison of educational concepts and satisfaction]

BACKGROUND

The training of residents in urology is challenged by global trends in surgical education, increasing technological developments, subspecialization of the field and working hour regulations for physicians. Currently, there is no standardized curriculum in Europe and significant international differences exist in the education of residents.

OBJECTIVES

We aimed to comprehensively map the state of urological training in an international comparison.

MATERIALS AND METHODS

A selective literature review was conducted using the following keywords: "urology, training, residents".

RESULTS

Recent surveys have shown that urology training in Germany is subject to relatively few regulations on content, time and space when compared to other countries. A lack of a structured curriculum is considered as the main factor leading to dissatisfaction of the residents. Increasing work load, lack of surgical training and limited flexibility in family or research planning have been mentioned as barriers for successful training.

CONCLUSION

Structured and validated competence assessments and not "minimum numbers of operations" may help improve surgical training. An objective nationwide examination at the end of residency may be useful for international benchmarking.

Evaluation of Urology Residency Training and Perceived Resident Abilities in the United States

OBJECTIVE

To identify differences and potential deficiencies in urology residency training programs in the United States as they are perceived by residents/recent graduates and program directors.

MATERIALS AND METHODS

A 45-question and 38-question survey was sent to chief residents/recent graduates and program directors, respectively, at all 120 US urology programs regarding prior medical education, urologic training curricula, and perceived surgical proficiency, among other topics.

RESULTS

Survey response rate was 58% and 52% for residents and program directors, respectively. Responses regarding program characteristics (e.g., salary, vacation) and research training were similar between program directors and residents. However, their responses regarding skills training and subspecialty training (e.g., robotics and pediatrics) differed substantially. Program directors reported the availability of advanced skills trainers (robot-88%, laparoscopic-86%), whereas fewer residents felt they were available (robot 54% and laparoscopic 72%). The same discrepancies persisted with questions about subspecialty exposure (e.g., program directors reported 48% renal transplant experience vs. 13% reported by residents). Most residents felt comfortable performing essential urology procedures (e.g., cystoscopy/ureteroscopy, open nephrectomy). In contrast, the majority expressed a lack of confidence in performing unsupervised advanced minimally invasive procedures (e.g., laparoscopic and robotic partial nephrectomy, endopyelotomy). Among the responding residents, 72% pursued fellowship training; nearly two-thirds of these residents chose to enter fellowship in order to overcome perceived training deficiencies.

CONCLUSIONS

Program directors and residents have differing perceptions regarding the education and resources associated with US urology residency training programs. US graduates of urology residency programs express a perceived lack of confidence in several procedures that are commonly encountered in a general urologic practice.

The Urology Residency Program in Israel-Results of a Residents Survey and Insights for the Future

OBJECTIVE

Urology practice has undergone several changes in recent years mainly related to novel technologies introduced. We aimed to get the residents' perspective on the current residency program in Israel and propose changes in it.

METHODS

A web-based survey was distributed among urology residents.

RESULTS

61 residents completed the survey out of 95 to whom it was sent (64% compliance). A total of 30% replied that the 9 months of mandatory general surgery rotation contributed to their training, 48% replied it should be shortened/canceled, and 43% replied that the Step A exam (a mandatory written certifying exam) in general surgery was relevant to their training. A total of 37% thought that surgical exposure during the residency was adequate, and 28% considered their training "hands-on." Most non-junior residents (post-graduate year 3 and beyond) reported being able to perform simple procedures such as circumcision and transurethral resections but not complex procedures such as radical and laparoscopic procedures. A total of 41% of non-junior residents practice at a urology clinic. A total of 62% of residents from centers with no robotics replied its absence harmed their training, and 85% replied they would benefit from a robotics rotation. A total of 61% of residents from centers with robotics replied its presence harmed their training, and 72% replied they would benefit from an open surgery rotation. A total of 82% of the residents participated in post-graduate courses, and 81% replied they would engage in a clinical fellowship.

CONCLUSION

Given the survey results we propose some changes to be considered in the residency program. These include changes in the general surgery rotation and exam, better surgical training, possible exchange rotations to expose residents to robotic and open surgery (depending on the availability of robotics in their center), greater out-patient urology clinic exposure, and possible changes in the basic science period.

[Prerequisites, skills and productivity of young academic urologists in Germany]

BACKGROUND

To safeguard scientific and clinical progress, German urology requires properly trained junior scientists. Before initiating or continuing actions aiming at quality improvement an analysis of the status quo is necessary.

OBJECTIVE

To assess the conditions to pursue research, research skills and research output of junior scientists in urology in Germany.

MATERIAL UND METHODS

A 16-item online questionnaire was sent to 95 junior scientists in urology within the research network GeSRU Academics. Primary outcomes were the conditions to pursue research in terms of research time, research skills and sources of learning and research output as measured by peer-reviewed publications. Subpopulations were compared with respect to the number of peer-reviewed publications.

RESULTS

Out of 78 junior scientists (82% response rate) 45% pursued research exclusively in their leisure time. Self-assessment of research skills varied from good (systematic literature search) to sufficient (grant acquisition). The main source of learning for research skills was self-study, followed by mentor, own department, courses and networks. Of the junior scientists 81% had peer-reviewed publications (median 4). The groups of junior scientists who pursued research (partially) during working hours, who had good skills and whose research skills were supported by a mentor/network had significantly more peer-reviewed publications than their counterparts.

CONCLUSION

Junior scientists in urology in Germany lack protected time to pursue research and have varying research skills, which are predominantly acquired by self-study and demonstrate their first research output as peer-reviewed publications.

Urology Residency Training in Italy: Results of the First National Survey

BACKGROUND

Numerous surveys have been performed to determine the competence and the confidence of residents. However, there is no data available on the condition of Italian residents in urology.

OBJECTIVE

To investigate the status of training among Italian residents in urology regarding scientific activity and surgical exposure.

DESIGN, SETTING, AND PARTICIPANTS

A web-based survey that included 445 residents from all of the 25 Italian Residency Programmes was conducted between September 2015 and November 2015.

OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS

The main outcomes were represented by scientific activity, involvement in surgical procedures, and overall satisfaction.

RESULTS AND LIMITATIONS

In total, 324 out of 445 (72.8%) residents completed the survey. Overall, 104 (32%) residents had not published any scientific manuscripts, 148 (46%) published ≤5, 38 (12%) ≤10, 26 (8%) ≤15, four (1%) ≤20, and four (1%) >20 manuscripts, respectively. We did not observe any differences when residents were stratified by sex (p=0.5). Stent positioning (45.7%), extracorporeal shock wave lithotripsy (30.9%), transurethral resection of bladder tumor (33.0%), hydrocelectomy (24.7%), varicocelectomy (17%), ureterolithotripsy (14.5%), and orchiectomy (12.3%) were the surgical procedures more frequently performed by residents. Overall, 272 residents (84%) expressed a good satisfaction for urology specialty, while 178 (54.9%) expressed a good satisfaction for their own residency programme. We observed a statistically decreased trend for good satisfaction for urology specialty according to the postgraduate year (p=0.02).

CONCLUSIONS

Italian Urology Residency Programmes feature some heavy limitations regarding scientific activity and surgical exposure. Nonetheless, satisfaction rate for urology specialty remains high. Further improvements in Residency Programmes should be made in order to align our schools to others that are actually more challenging.

PATIENT SUMMARY

In this web-based survey, Italian residents in urology showed limited scientific productivity and low involvement in surgical procedures. Satisfaction for urology specialty remains high, demonstrating continuous interest in this field of study from residents.