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MacDonald L, Ory J, Rendon RA, Bailly G, Skinner T, Cox A, Langille G, Bell D. Using GoPro to create an educational database of open urological procedures for residents. Can Urol Assoc J 2020; 15:207-209. [PMID: 33212004 DOI: 10.5489/cuaj.6768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Landan MacDonald
- Department of Urology, Dalhousie University, Halifax, NS, Canada
| | - Jesse Ory
- Department of Urology, Dalhousie University, Halifax, NS, Canada
| | - Ricardo A Rendon
- Department of Urology, Dalhousie University, Halifax, NS, Canada
| | - Gregory Bailly
- Department of Urology, Dalhousie University, Halifax, NS, Canada
| | - Thomas Skinner
- Department of Urology, Dalhousie University, Halifax, NS, Canada
| | - Ashley Cox
- Department of Urology, Dalhousie University, Halifax, NS, Canada
| | - Gavin Langille
- Department of Urology, Dalhousie University, Halifax, NS, Canada.,Horizon Health Network, Saint John, NB, Canada
| | - David Bell
- Department of Urology, Dalhousie University, Halifax, NS, Canada
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Variability in gynecologic case volume of obstetrician-gynecologist residents graduating from 2009 to 2017. Am J Obstet Gynecol 2020; 222:617.e1-617.e8. [PMID: 31765644 DOI: 10.1016/j.ajog.2019.11.1258] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2019] [Revised: 10/21/2019] [Accepted: 11/17/2019] [Indexed: 12/21/2022]
Abstract
BACKGROUND Residency training in obstetrics-gynecology has changed significantly over time, with residents expected to master an increasing number of surgical procedures. Residency operative case logs are tracked by the Accreditation Council for Graduate Medical Education, which sets case minimums for all procedures. In 2018, the Accreditation Council for Graduate Medical Education created a combined minimally invasive hysterectomy category and now requires graduating residents to complete a minimum of 70 minimally invasive hysterectomies. OBJECTIVES The objectiges of the study were to evaluate the range of operative gynecological experience across graduating obstetrician-gynecologist residents in the United States and to estimate the number of residents able to meet new Accreditation Council for Graduate Medical Education minimum hysterectomy cases. STUDY DESIGN Accreditation Council for Graduate Medical Education surgical case logs of graduating obstetrician-gynecologist residents from 2009 to 2017 were analyzed for case volume trends. RESULTS The average total number of gynecological cases per resident decreased from 438.2 to 431.5 (P < .0001). Minimally invasive hysterectomy averages increased from 43.6 to 69.3 (P < .0001), a trend driven principally by an increase in total laparoscopic hysterectomies. Mean case log decreases were noted in invasive cancer (70.7 to 54.3), incontinence and pelvic floor (85.6 to 56.7), and total abdominal hysterectomies (74.4 to 42.9); (P < .0001 for all). Mean increases were seen in total laparoscopic (118.8 to 146.3) and operative hysteroscopy (68.6 to 77.1) cases (P < .0001 for all). The ratio of the 90th percentile to the 10th percentile of resident case logs showed substantial variation in surgical volume for all procedures, although this ratio decreased over time. Graduates who logged 70 minimally invasive hysterectomy cases were estimated to fall at the 51st percentile in 2017; this was down from the 91st percentile in 2009. CONCLUSION Nationwide, graduates of obstetrician-gynecologist residency experience significant variability in their surgical training. Based on our extrapolation of Accreditation Council for Graduate Medical Education data, approximately half of residency graduates fell below the 70 case minimally invasive hysterectomy minimum in 2017. Meeting the new Accreditation Council for Graduate Medical Education hysterectomy minimums may be challenging for a significant proportion of residency programs. Understanding the scope and variability of gynecology training is needed to continue to improve and address gaps in resident education.
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Levasseur-Fortin P, Law KW, Nguyen DD, Zakaria A, Misrai V, Elterman D, Bhojani N, Rijo E, Zorn KC. National discrepancies in residency training of open simple prostatectomy for benign prostatic enlargement: Redefining our gold standard. Can Urol Assoc J 2020; 14:182-186. [PMID: 31977302 DOI: 10.5489/cuaj.6242] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION In light of the recent Canadian Urological Association (CUA) and other urological associations' (America Urological Association, European Association of Urology) recommendations for the treatment of benign prostate hyperplasia (BPH) with lower urinary tract symptoms (LUTS), open simple prostatectomy (OSP) remains the recommended approach for large prostates with measured volumes over 80 cc. We sought to assess the current state of OSP and other BPH surgical training across Canadian urology residency programs and the use of guideline-recommended imagery prior to BPH surgery. METHODS A survey was distributed among Canadian urology program directors in June 2019. We identified the various surgical modalities available for the treatment of BPH offered by each program and obtained the annual number of OSP performed at each academic residency program. Additionally, we evaluated if preoperative transrectal ultrasound (TRUS) of the prostate was routinely performed to obtain the prostate volume during patient counselling, as recommended by 2018 CUA guidelines. RESULTS All 13 program directors from the Canadian urology programs responded to our survey. OSP and monopolar transurethral resection of the prostate (TURP) remain the most common across programs and are practiced in all centers. Greenlight photo-vaporization, bipolar TURP, holmium laser enucleation of the prostate, and robot-assisted simple prostatectomy were practiced in 76.8%, 69.2%, 23.1%, and 23.1% of centers, respectively. The mean number of OSP per academic training program was 4.7 cases annually. Moreover, only five (38%) academic centers routinely performed a preoperative TRUS to evaluate prostate volume for BPH counselling. CONCLUSIONS Although recognized and referenced as the BPH gold standard for the treatment of prostates over 80 cc, Canadian urology trainees' annual OSP exposure remains extremely limited. Considering the degree of importance given (category A) to the direct observation (of a minimum of five) of this intervention during residency training in the new Royal College's practice guidelines, it may be unrealistic to reach these national standards considering the annual case OSP volumes in Canadian academic urology faculties.
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Affiliation(s)
| | - Kyle W Law
- Faculty of Medicine, McGill University, Montreal, QC, Canada
| | | | - Ahmed Zakaria
- Division of Urology, Centre hospitalier de l'Université de Montréal, Université de Montréal, Montreal, QC, Canada
| | - Vincent Misrai
- Department of Urology, Clinique Pasteur, Toulouse, France
| | - Dean Elterman
- Division of Urology, University of Toronto, Toronto, ON, Canada
| | - Naeem Bhojani
- Division of Urology, Centre hospitalier de l'Université de Montréal, Université de Montréal, Montreal, QC, Canada
| | - Enrique Rijo
- Department of Urology, Hospital Quiron Barcelona, Barcelona, Spain
| | - Kevin C Zorn
- Division of Urology, Centre hospitalier de l'Université de Montréal, Université de Montréal, Montreal, QC, Canada
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Cebulla A, Bolenz C, Carrion DM, Bellut L. [Urology training in Germany: international comparison of educational concepts and satisfaction]. Urologe A 2019; 58:132-138. [PMID: 30683972 DOI: 10.1007/s00120-019-0854-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
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.
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Affiliation(s)
- A Cebulla
- Klinik für Urologie und Kinderurologie, Universitätsklinikum Ulm, Albert-Einstein-Allee 23, 89081, Ulm, Deutschland.
| | - C Bolenz
- Klinik für Urologie und Kinderurologie, Universitätsklinikum Ulm, Albert-Einstein-Allee 23, 89081, Ulm, Deutschland
| | - D M Carrion
- Klinik für Urologie, Universitätsklinikum La Paz, Madrid, Spanien
| | - L Bellut
- Klinik für Urologie und Kinderurologie, Universitätsklinikum Erlangen, Erlangen, Deutschland
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Arnold H, Meyer CP, Salem J, Raspe M, Struck JP, Borgmann H. [Work and training conditions of residents in urology in Germany : Results of a 2015 nationwide survey by the German Society of Residents in Urology]. Urologe A 2019; 56:1311-1319. [PMID: 28835996 DOI: 10.1007/s00120-017-0495-0] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND High-quality urologic residency training programs are crucial to secure both the future of our specialty and patient care. However, little is known about the current training and working conditions among German urology residents. OBJECTIVES To comprehensively assess the training- and working conditions among urologic residents in Germany. MATERIALS AND METHODS The GeSRU invited all German urologic residents to complete an online survey on training- and work conditions. Furthermore, the model of effort-reward imbalance (ERI) was applied to measure psychosocial strain at work. RESULTS A total of 476 urologic residents participated in the survey. Workdays are characterized by high pace and workload and economic considerations. This comes at the cost of professional training, research and family time. Due to these circumstances, a relevant part of residents draws or at least considers consequences. Psychosocial strain among participants is high and conveys a risk for physicians' health and patients' quality of care. CONCLUSION Our findings call for an adjustment of urologic working and training conditions to preserve high-quality medical treatment and to ensure an attractive working environment.
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Affiliation(s)
| | - C P Meyer
- Klinik und Poliklinik für Urologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland
| | - J Salem
- Klinik für Urologie, Universitätsklinikum Köln, Köln, Deutschland
| | - M Raspe
- Medizinische Klinik m.S. Infektiologie und Pneumologie, Charité - Universitätsmedizin Berlin, Berlin, Deutschland
| | - J P Struck
- Klinik für Urologie, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Lübeck, Deutschland
| | - H Borgmann
- Klinik für Urologie, Universitätsklinikum Mainz, Mainz, Deutschland
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Okike K, Berger PZ, Schoonover C, O Toole RV. Do Orthopaedic Resident and Fellow Case Logs Accurately Reflect Surgical Case Volume? JOURNAL OF SURGICAL EDUCATION 2018; 75:1052-1057. [PMID: 29287752 DOI: 10.1016/j.jsurg.2017.12.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/04/2017] [Revised: 10/15/2017] [Accepted: 12/04/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVE The purpose of this study is to determine whether orthopedic resident and fellow case logs accurately reflect trainee case volume. DESIGN For each orthopedic case performed at our institution between 7/1/14 and 10/31/14, the names of trainees who participated were obtained from the chart. The trainee Accreditation Council for Graduate Medical Education case logs were queried to determine if the procedure in question was logged and, if so, which current procedural terminology (CPT) codes were reported. The CPT codes reported by the trainees were compared to those reported by the attendings in the billing database. To ascertain the opinions of trainees regarding coding, a survey was conducted. SETTING University of Maryland Medical Center (Baltimore, MD), a tertiary and quaternary care center which features a state-wide trauma referral center as well as orthopedic residency and fellowship training programs. PARTICIPANTS All orthopedic surgery residents and fellows present at the institution during the study period. RESULTS Trainees failed to log their cases 24% of the time (465/1925), including 25% (283/1117) for residents and 23% (182/808) for fellows (p = 0.16). Among cases that were logged, CPT codes were missed 46% of the time (673/1460) and extra codes were added 28% of the time (412/1460) compared to the attendings. In the survey, most trainees stated that it was "extremely" or "very" important for them to be able to code correctly (83%; 29/35). CONCLUSIONS In this study of orthopedic trainee case logging practices, cases were not logged 24% of the time. Caution should be taken with activities which rely on trainee case logs given the potential for inaccuracy.
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Affiliation(s)
- Kanu Okike
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland.
| | - Peter Z Berger
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland
| | - Carrie Schoonover
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland
| | - Robert V O Toole
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland
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Borgmann H, Arnold HK, Meyer CP, Bründl J, König J, Nestler T, Ruf C, Struck J, Salem J. Training, Research, and Working Conditions for Urology Residents in Germany: A Contemporary Survey. Eur Urol Focus 2018; 4:455-460. [DOI: 10.1016/j.euf.2016.12.001] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2016] [Revised: 11/17/2016] [Accepted: 12/02/2016] [Indexed: 11/27/2022]
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Deebel NA, Koontz WW, Klausner AP. Changes in Chief Resident Surgical Volume and Case Type across 70 Years: Lessons Learned from a Urology Training Program. UROLOGY PRACTICE 2018. [DOI: 10.1016/j.urpr.2017.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Nicholas A. Deebel
- Department of Surgery/Division of Urology, Virginia Commonwealth University School of Medicine and Hunter Holmes McGuire Veterans Affairs Medical Center, Richmond, Virginia
| | - Warren W. Koontz
- Department of Surgery/Division of Urology, Virginia Commonwealth University School of Medicine and Hunter Holmes McGuire Veterans Affairs Medical Center, Richmond, Virginia
| | - Adam P. Klausner
- Department of Surgery/Division of Urology, Virginia Commonwealth University School of Medicine and Hunter Holmes McGuire Veterans Affairs Medical Center, Richmond, Virginia
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Pak JS, Silva M, Deibert CM, Cooper KL, Badalato GM. Male Urethral, Penile, and Incontinence Surgery: Is Resident Exposure Adequate? Urology 2015; 86:868-72. [DOI: 10.1016/j.urology.2015.05.052] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2015] [Revised: 05/28/2015] [Accepted: 05/29/2015] [Indexed: 10/23/2022]
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Gupta N, Dragovic K, Trester R, Blankstein J. The Changing Scenario of Obstetrics and Gynecology Residency Training. J Grad Med Educ 2015; 7:401-6. [PMID: 26457146 PMCID: PMC4597951 DOI: 10.4300/jgme-d-14-00730.1] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Significant changes have been noted in aspects of obstetrics-gynecology (ob-gyn) training over the last decade, which is reflected in Accreditation Council for Graduate Medical Education (ACGME) operative case logs for graduating ob-gyn residents. OBJECTIVE We sought to understand the changing trends of ob-gyn residents' experience in obstetric procedures over the past 11 years. METHODS We analyzed national ACGME procedure logs for all obstetric procedures recorded by 12 728 ob-gyn residents who graduated between academic years 2002-2003 and 2012-2013. RESULTS The average number of cesarean sections per resident increased from 191.8 in 2002-2003 to 233.4 in 2012-2013 (17%; P < .001; 95% CI -47.769 to -35.431), the number of vaginal deliveries declined from 320.8 to 261 (18.6%; P < .001; 95% CI 38.842-56.35), the number of forceps deliveries declined from 23.8 to 8.4 (64.7%; P < .001; 95% CI 14.061-16.739), and the number of vacuum deliveries declined from 23.8 to 17.6 (26%; P < .001; 95% CI 5.043-7.357). Between 2002-2003 and 2007-2008, amniocentesis decreased from 18.5 to 11 (P < .001, 95% CI 6.298-8.702), and multifetal vaginal deliveries increased from 10.8 to 14 (P < .001, 95% CI -3.895 to -2.505). Both were not included in ACGME reporting after 2008. CONCLUSIONS Ob-gyn residents' training experience changed substantially over the past decade. ACGME obstetric logs demonstrated decreases in volume of vaginal, forceps, and vacuum deliveries, and increases in cesarean and multifetal deliveries. Change in experience may require use of innovative strategies to help improve residents' basic obstetric skills.
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Affiliation(s)
- Natasha Gupta
- Corresponding author: Natasha Gupta, MD, Mount Sinai Hospital, Department of Obstetrics and Gynecology, 1500 S California Avenue, Chicago, IL 60608, 248.464.0451,
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Bründl J, Zengerling F, Borgmann H, Syring I. [Prostate surgery within residency programs in urology]. Urologe A 2014; 53:379-81. [PMID: 24556710 DOI: 10.1007/s00120-014-3424-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- J Bründl
- Klinik für Urologie, Caritas-Krankenhaus St. Josef, Universität Regensburg, Landshuter Straße 65, 93053, Regensburg, Deutschland,
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Bachir BG, Aprikian AG, Kassouf W. Are Canadian urology residency programs fulfilling the Royal College expectations?: A survey of graduated chief residents. Can Urol Assoc J 2014; 8:109-15. [PMID: 24839479 DOI: 10.5489/cuaj.1339] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION We assess outgoing Canadian urology chief residents' well-being, their satisfaction with their surgical training, and their proficiency in surgical procedures throughout their residency program. METHODS In 2012 an anonymous survey was sent by email to all 29 graduated urology chief residents across Canada. The survey included a list of all urologic surgical procedures listed by the Royal College of Physicians and Surgeons of Canada (RCPSC). According to the A/B/C classification used to assess competence in these procedures (A most competent, C least competent), we asked chief residents to self-classify their competence with regards to each procedure and we compared the final results to the current RCPSC classification. RESULTS The overall response rate among chief residents surveyed was 97%. An overwhelming majority (96.4%) of residents agreed that the residency program has affected their overall well-being, as well as their relationships with their families and/or partners (67.8%). Overall, 85.7% agreed that research was an integral part of the residency program and 78.6% have enrolled in a fellowship program post-graduation. Respondents believed that they have received the least adequate training in robotic surgery (89.3%), followed by female urology (67.8%), andrology/sexual medicine/infertility (67.8%), and reconstructive urology (61.4%). Interestingly, in several of the 42 surgical procedures classified as category A by the RCPSC, a significant percentage of residents felt that their proficiency was not category A, including repair of urinary fistulae (82.1%), pediatric indirect hernia repair and meatal repair for glanular hypospadias (67.9%), open pyeloplasty (64.3%), anterior pelvic exenteration (61.6%), open varicocelectomy (60.7%) and radical cystoprostatectomy (33.3%). Furthermore, all respondents (100%) believed they were deficient in at least 1 of the 42 category A procedures, while 53.6 % believed they were deficient in at least 10 of the 42 procedures. CONCLUSIONS Most residents agree that their residency program has affected their overall well-being as well as their relationships with their families and/or partners. There is also a clear deficiency in what outgoing residents perceive they have achieved and what the RCPSC mandates. Future work should concentrate on addressing this discrepancy to assure that training and RCPSC expectations are better aligned.
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Affiliation(s)
- Bassel G Bachir
- Department of Surgery (Urology), McGill University, Montreal, QC
| | - Armen G Aprikian
- Department of Surgery (Urology), McGill University, Montreal, QC
| | - Wassim Kassouf
- Department of Surgery (Urology), McGill University, Montreal, QC
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Menhadji A, Abdelshehid C, Osann K, Alipanah R, Lusch A, Graversen J, Lee J, Quach S, Huynh V, Sidhom D, Gerbatsch I, Landman J, McDougall E. Tracking and Assessment of Technical Skills Acquisition Among Urology Residents for Open, Laparoscopic, and Robotic Skills Over 4 Years: Is There a Trend? J Endourol 2013; 27:783-9. [DOI: 10.1089/end.2012.0633] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Affiliation(s)
- Ashleigh Menhadji
- Department of Urology, University of California, Irvine, Orange, California
| | | | - Kathyrn Osann
- Department of Urology, University of California, Irvine, Orange, California
| | - Reza Alipanah
- Department of Urology, University of California, Irvine, Orange, California
| | - Achim Lusch
- Department of Urology, University of California, Irvine, Orange, California
| | - Joseph Graversen
- Department of Urology, University of California, Irvine, Orange, California
| | - Jason Lee
- Department of Urology, University of California, Irvine, Orange, California
| | - Stephen Quach
- Department of Urology, University of California, Irvine, Orange, California
| | - Victor Huynh
- Department of Urology, University of California, Irvine, Orange, California
| | - Daniel Sidhom
- Department of Urology, University of California, Irvine, Orange, California
| | - Isabelle Gerbatsch
- Department of Urology, University of California, Irvine, Orange, California
| | - Jaime Landman
- Department of Urology, University of California, Irvine, Orange, California
| | - Elspeth McDougall
- Department of Urology, University of California, Irvine, Orange, California
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Talati JJ. The training of a 'stone doctor'. Arab J Urol 2012; 10:220-9. [PMID: 26558030 PMCID: PMC4442950 DOI: 10.1016/j.aju.2012.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Objective To propose alternative models of training for doctors treating patients with stones, and to identify their relative value, as such doctors are trained through urology programmes which sometimes cannot be expanded to meet the need, are short of teachers, too comprehensive and lengthy. This review explores new pathways for training to provide competence in the care of patients with stones. Methods Previous reports were identified and existing training models collectively categorised as Model 1. Three alternative models were constructed and compared in the context of advantages, acceptability, feasibility, educational impact and applicability in different geosocio-political contexts. Results In Model 2, urological and stone training diverge as options after common basic courses and experience. In Model 3, individuals access training through a common educational matrix (EM) for nurses, physicians, etc., according to the match between their capacities, entry requirements, personal desires and willingness for further responsibility. Stone doctors with no urological background cannot fulfil other service and educational commitments, and might create unwelcome dependence on other colleagues for complex situations. Programmes involving a common EM affect professional boundaries and are not easily acceptable. There is a lack of clarity on methods for medical certification and re-certification. However, the lack of technically competent stone experts in developing worlds requires an exploration of alternative models of training and practice. Conclusions The ability to provide exemplary care after abbreviated training makes alternative models attractive. Worldwide debate, further exploration and pilot implementation are required, perhaps first in the developing world, in which much of the ‘stone belt’ exists.
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Affiliation(s)
- Jamsheer J Talati
- Department of Surgery (Urology), Aga Khan University, Karachi, Pakistan
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Steele SS. Is there still a role for pubovaginal slings in the treatment of SUI in the era of mid-urethral slings? Can Urol Assoc J 2012; 6:41. [PMID: 22396367 DOI: 10.5489/cuaj.12011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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