1
|
Malshy K, Khaleel S, Rourke K, Golijanin B, Thavaseelan S, Pareek G, Golijanin D. Investigation of Disparity of Urologic Fellowship Match Rates by Gender and US Versus International Medical Graduates Over the Past Decade. Urology 2024:S0090-4295(24)00544-2. [PMID: 38969145 DOI: 10.1016/j.urology.2024.06.065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2024] [Revised: 06/13/2024] [Accepted: 06/27/2024] [Indexed: 07/07/2024]
Abstract
OBJECTIVE To investigate the influence of postgraduate medical education (US vs international) and gender on applicant matching for postgraduate training across different urologic sub-specialties. METHODS Match statistics of 5 societies that participated in the AUA fellowship match between 2010 and 2024 were retrospectively reviewed. Societies included: Endourology Society (EUS), Society for Urological Oncology (SUO), American Society of Andrology (ASA), Society of Genitourinary Reconstructive Surgeons (GURS), and Society of Pediatric Urology (SPU). Candidates were classified based on gender (male/female) and their postgraduate medical education: local graduates from the United States or Canada (US/Ca) and international medical graduates (IMGs). The match odds were analyzed using the Chi-square test, while trends were assessed through the Mann-Kendall test. RESULTS Overall, 2439 applicants applied for 1627 programs from 2010 to 2024, comprising 1998 males (81.8%), 399 females (16.4%), and 42 undisclosed (1.7%). There were 1486 US/Ca graduates (60.8%) and 953 IMGs (39.2%). Around 1471 (60.6%) applicants were matched with a program, compared to 958 (39.4%) unmatched. The likelihood of US/Ca graduates matching (83.8%) was significantly higher than IMGs (23.3%), OR= 17.5, 95% CI: (14.3, 21.5), P <.001. IMGs had the highest match rate with GURS (33.8%, 47/118) and the lowest with SPU (7%, 1/14). Female applicants had a significantly higher chance of matching 324/399 (81.2%) than male applicants 1139/1998 (57%), OR= 3.26, 95% CI: (2.5, 4.3), P <.001. US/Ca-to-IMGs ratios and the male-to-female ratios were stable throughout the match years. CONCLUSION Compared to IMGs, U.S./Ca graduates had remarkably higher matching rates. Matching outcomes were also significantly better for female applicants. Further assessment of international involvement and diversity in urological subspecialty roles is warranted.
Collapse
Affiliation(s)
- Kamil Malshy
- The Minimally Invasive Urology Institute, The Miriam Hospital, Warren Alpert Medical School of Brown University, Providence, RI.
| | - Sari Khaleel
- The Minimally Invasive Urology Institute, The Miriam Hospital, Warren Alpert Medical School of Brown University, Providence, RI
| | - Keith Rourke
- Division of Urology at the University of Alberta, Edmonton, Canada
| | - Borivoj Golijanin
- The Minimally Invasive Urology Institute, The Miriam Hospital, Warren Alpert Medical School of Brown University, Providence, RI
| | - Simone Thavaseelan
- The Minimally Invasive Urology Institute, The Miriam Hospital, Warren Alpert Medical School of Brown University, Providence, RI
| | - Gyan Pareek
- The Minimally Invasive Urology Institute, The Miriam Hospital, Warren Alpert Medical School of Brown University, Providence, RI
| | - Dragan Golijanin
- The Minimally Invasive Urology Institute, The Miriam Hospital, Warren Alpert Medical School of Brown University, Providence, RI
| |
Collapse
|
2
|
Cruz AP, Skolarus TA, Ambani SN, Hafez K, Kraft KH. Aligning Urology Residency Training With Real-World Workforce Needs. JOURNAL OF SURGICAL EDUCATION 2021; 78:820-827. [PMID: 33046414 PMCID: PMC7546236 DOI: 10.1016/j.jsurg.2020.09.018] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Revised: 08/25/2020] [Accepted: 09/26/2020] [Indexed: 05/09/2023]
Abstract
OBJECTIVE Research suggests recently graduated urology residents do not feel ready for independent practice. We conducted a study to determine if Accreditation Council for Graduate Medical Education (ACGME) minimum case requirements, resident case logs, and graduating resident perceived readiness for practice are aligned with the procedural demand and needs of the current urology workforce. DESIGN Correlative study comparing the association between (1) workforce demand and ACGME case requirements, and (2) workforce demand and perceived resident competency. Three distinct datasets were used; (1) the 2017 Medicare Part B National Summary Data File; (2) the 2017 National Data Report published by the ACGME; and (3) a graduating resident survey from Okhunov et al. SETTING: N/A. PARTICIPANTS N/A. RESULTS In 2017, there were a total of 6,784,696 urologic cases performed through Medicare. We found nonsignificant positive associations between resident case logs (rho = 0.16, p = 0.5784), ACGME minimum procedure requirements (rho = 0.42, p = 0.1255), and Medicare procedural demand. Our 15 index procedures accounted for 21.1% (n = 1,431,775) of all Medicare cases, with a median number of 7706 procedures. Endopyelotomy was the least common procedure (n = 98), while cystoscopy was the most common (n = 980,623). Medicare case volume was positively correlated with graduating residents' procedural confidence (r = 0.86, p < 0.0001). We identified four categories with varied alignment of training and demand: (1) high volume and high confidence, (2) high volume and low confidence, (3) low volume and high confidence, and (4) low volume and low confidence. CONCLUSIONS Optimizing urology residency training is time-sensitive and important. Using national Medicare data coupled with recently graduated urology resident survey results, we provide a guiding framework for improving the alignment of training with workforce demand. Informed by these results, we recommend altering training requirements to reflect these needs.
Collapse
Affiliation(s)
| | - Ted A Skolarus
- Department of Urology, University of Michigan, Ann Arbor, Michigan; VA HSR&D Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, Michigan; Dow Division of Health Services Research, University of Michigan, Ann Arbor, Michigan
| | - Sapan N Ambani
- Department of Urology, University of Michigan, Ann Arbor, Michigan
| | - Khaled Hafez
- Department of Urology, University of Michigan, Ann Arbor, Michigan
| | - Kate H Kraft
- Department of Urology, University of Michigan, Ann Arbor, Michigan.
| |
Collapse
|
3
|
Collins C, Dudas L, Johnson M, Davenport D, Bernard A, Beck S, Muchow R, Pittman T, Talley C. ACGME Operative Case Log Accuracy Varies Among Surgical Programs. JOURNAL OF SURGICAL EDUCATION 2020; 77:e78-e85. [PMID: 32950429 DOI: 10.1016/j.jsurg.2020.08.045] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 07/29/2020] [Accepted: 08/29/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE This study evaluates the accuracy of reported the Accreditation Council for Graduate Medical Education (ACGME) operative case logs from graduated residents compared to institutional operating room electronic records (ORER). We hope this will help guide review committees and institutions develop complete, accurate resident case logs. DESIGN This is a retrospective, cross-sectional study of general surgery (GS), neurosurgery (NS), and orthopedic surgery (OS) resident physicians. ACGME and ORER cases from 2009 to 2010 were analyzed and each case and current procedural terminology (CPT) code directly compared (ORER vs. ACGME). SETTING Single academic tertiary-care medical center (University of Kentucky, Lexington, KY). PARTICIPANTS Eleven thousand nine hundred and twenty-three cases for 46 residents among the 3 residency programs were analyzed. RESULTS There was an overall logging accuracy of 72% for ORER cases reflected in the ACGME case logs. OS residents had a higher rate of logging accuracy (OS 91%, GS 69%, NS 58%, chi-square p = 0.014) and mean annual number of cases compared to the other 2 programs (OS 452, GS 183, NS 237, ANOVA p = 0.001). NS residents had higher accuracy of CPT codes than post-graduate years 2 to 5 in other programs (p < 0.017). There was a strong positive correlation between the number of cases completed per resident and case logging accuracy, (rho = 0.769, p < 0.001) consistent for NS and GS, but not OS. CONCLUSIONS This study shows only 72% of a residents' operative experience is captured in the ACGME case log across 3 surgical programs. There is significant variability among surgical programs and among post-graduate year cohorts regarding case log and CPT code accuracy. There is a strong correlation with the total number of cases performed and increasing case log accuracy. Low case log accuracy may reflect individual resident behavior instead of program operative exposure. Further studies are needed to determine if ORER may serve as a more complete assessment of the operative experience of a resident and program.
Collapse
Affiliation(s)
- Courtney Collins
- University of Kentucky, Department of Surgery, Lexington, Kentucky
| | - Lauren Dudas
- West Virginia University, Department of Surgery, Morgantown, West Virginia
| | - Mason Johnson
- University of Kentucky, Department of Surgery, Lexington, Kentucky
| | - Daniel Davenport
- University of Kentucky, Department of Surgery, Lexington, Kentucky
| | - Andrew Bernard
- University of Kentucky, Department of Surgery, Lexington, Kentucky
| | - Sandra Beck
- University of Kentucky, Department of Surgery, Lexington, Kentucky
| | - Ryan Muchow
- University of Kentucky, Department of Orthopaedic Surgery & Sports Medicine, Lexington, Kentucky
| | - Thomas Pittman
- University of Kentucky, Department of Neurosurgery, Lexington, Kentucky
| | - Cynthia Talley
- Medical University of South Carolina, Charleston, South Carolina.
| |
Collapse
|
4
|
Witthaus MW, Saba P, Melnyk R, Ajay D, Ralph D, Van Renterghem K, Warren G, Munarriz R, Ghazi A. The Future of Penile Prosthetic Surgical Training Is Here: Design of a Hydrogel Model for Inflatable Penile Prosthetic Placement Using Modern Education Theory. J Sex Med 2020; 17:2299-2306. [PMID: 32948488 DOI: 10.1016/j.jsxm.2020.08.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 06/26/2020] [Accepted: 08/02/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND There is a significant need for a non-biohazardous, educational platform to equip and maintain the surgical skills required by urology trainees and low-volume implanters for inflatable penile prosthetic (IPP) placement. AIM To design and develop an anatomic, hydrogel-based simulation platform for training and evaluate IPP placement using modern education theory. METHODS The backward design concept was used as a framework in the design and development of an IPP simulation platform. Steps included delineating requirements from a physicians' perspective, translating requirements into engineering tasks (deliverables), developing a prototype, and pilot validation. Using a combination of 3-dimensional printing and hydrogel casting, a genitourinary tract model was constructed to replicate the appropriate steps of IPP placement guided by expert feedback. Full-immersion IPP simulations were performed through both infrapubic and penoscrotal approaches by 4 expert surgeons under operative conditions. Questionnaires evaluating the simulation's realism, value as a training tool, and further recommendations were completed. OUTCOMES Using backward design educational pedagogy, a high-fidelity, full-procedural IPP simulation was fabricated and verified as an adequate educational tool for training and assessment. RESULTS An expert consensus on the anatomic landmarks, steps and substeps, instruments, and errors to be included in the model was reached using a hierarchical task analysis and was successfully translated into a prototype hydrogel model. Experts performed all appropriate steps of IPP surgery and rated the simulation highly in terms of its realism and value as a training tool. On average, experts agreed that the model could function as a training tool, assessment tool, prerequisite for IPP accreditation, and requirement before live surgery. Experts stated they would have their trainees ideally complete an average of 1.75 models before live surgical training. All experts believed an operative checklist would be an ideal assessment tool. Witthaus MW, Saba P, Melnyk R, et al. The Future of Penile Prosthetic Surgical Training Is Here: Design of a Hydrogel Model for Inflatable Penile Prosthetic Placement Using Modern Education Theory. J Sex Med 2020;17:2299-2306.
Collapse
Affiliation(s)
- Michael W Witthaus
- Department of Urology, University of Rochester Medical Center, Rochester, NY, USA
| | - Patrick Saba
- Simulation Innovation Laboratory, Department of Urology, University of Rochester, Rochester, NY, USA
| | - Rachel Melnyk
- Simulation Innovation Laboratory, Department of Urology, University of Rochester, Rochester, NY, USA
| | - Divya Ajay
- Department of Urology, University of Rochester Medical Center, Rochester, NY, USA
| | - David Ralph
- Department of Urology, University College London Hospitals, London, UK
| | | | - Gareth Warren
- Department of Urology, University of Rochester Medical Center, Rochester, NY, USA
| | | | - Ahmed Ghazi
- Department of Urology, University of Rochester Medical Center, Rochester, NY, USA; Simulation Innovation Laboratory, Department of Urology, University of Rochester, Rochester, NY, USA.
| |
Collapse
|
5
|
van Renterghem K, Ghazi A. Surgical education in the 21st century: implications for sexual medicine. Int J Impot Res 2019; 32:544-546. [PMID: 31772334 DOI: 10.1038/s41443-019-0218-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Revised: 10/30/2019] [Accepted: 11/13/2019] [Indexed: 11/09/2022]
Affiliation(s)
- Koenraad van Renterghem
- Department of Urology, Jessa Hospital Hasselt, Hasselt, Belgium. .,Faculty of Medicine, Hasselt University, Hasselt, Belgium. .,Department of Urology, University Hospitals Leuven, Leuven, Belgium.
| | - Ahmed Ghazi
- Department of Urology, University of Rochester, Rochester, New York, USA
| |
Collapse
|
6
|
3D pelvic cadaver model: a novel approach to surgical training for penile implant surgery. Int J Impot Res 2019; 32:261-263. [PMID: 31649337 PMCID: PMC8076011 DOI: 10.1038/s41443-019-0211-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Revised: 09/29/2019] [Accepted: 10/04/2019] [Indexed: 12/14/2022]
|