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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.
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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.
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Bandini M, Barbagli G, Leni R, Cirulli GO, Basile G, Balò S, Montorsi F, Sansalone S, Salonia A, Briganti A, Butnaru D, Lazzeri M. Assessing in-hospital morbidity after urethroplasty using the European Association of Urology Quality Criteria for standardized reporting. World J Urol 2021; 39:3921-3930. [PMID: 33855598 DOI: 10.1007/s00345-021-03692-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Accepted: 03/30/2021] [Indexed: 11/29/2022] Open
Abstract
PURPOSE To conduct a rigorous assessment of in-hospital morbidity after urethroplasty according with the European Association of Urology (EAU) guidelines for complication reporting. METHODS We retrospectively (2015-2019) identified 469 consecutive patients receiving urethroplasty (e.g. bulbar urethroplasty with grafts, penile urethroplasty with/without grafts/flaps, Johanson, de novo or revision perineostomy, end-to-end anastomosis, meatoplasty and/or meatotomy) at our tertiary care institution. Complications were graded with Clavien-Dindo score and Comprehensive Complication Index (CCI). Complications were classified in: bleeding no gastrointestinal, cardiac, gastrointestinal, genitourinary, infectious, neurological, oral, wound, miscellaneous, and pulmonary. Logistic regression tested for predictors of in-hospital complications and prolonged hospitalization (> 75th percentile). Kaplan-Meier and Cox regression investigated the effect of complications on failure after urethroplasty. RESULTS Overall, 161 (34.3%) patients experienced at least one complication. Of those, 47 (10%) experienced two or more complications and 59 (12.6%) experienced at least one Clavien-Dindo ≥ II complication. Only two patients had Clavien-Dindo III complications. Infectious was the most frequent complication, and de novo or revision perineostomy was associated with the highest rate of complications. The occurrence of any complications, as well as complication with Clavien-Dindo ≥ II were associated with prolonged hospitalizations, but not with higher rates of post-urethroplasty failure. CONCLUSIONS Complications after urethroplasty were common events, but rarely with severe sequelae. Infectious were the most common complications and perineostomy was the type of urethroplasty with the highest rate of complications. The application of the EAU recommendations allowed the identifications of a higher number of complications after urethroplasty if compared with previous reports based on unsupervised chart review.
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Affiliation(s)
- Marco Bandini
- Center for Reconstructive Urethra Surgery, Arezzo, Rome, Milan, Italy. .,Centro Chirurgico Toscano, Arezzo, Italy. .,Unit of Urology, Urological Research Institute (URI), San Raffaele Hospital, Vita-Salute San Raffaele University, IRCCS Ospedale San Raffaele Via Olgettina 60, 20132, Milan, Italy.
| | - Guido Barbagli
- Center for Reconstructive Urethra Surgery, Arezzo, Rome, Milan, Italy.,Centro Chirurgico Toscano, Arezzo, Italy
| | - Riccardo Leni
- Unit of Urology, Urological Research Institute (URI), San Raffaele Hospital, Vita-Salute San Raffaele University, IRCCS Ospedale San Raffaele Via Olgettina 60, 20132, Milan, Italy
| | - Giuseppe O Cirulli
- Unit of Urology, Urological Research Institute (URI), San Raffaele Hospital, Vita-Salute San Raffaele University, IRCCS Ospedale San Raffaele Via Olgettina 60, 20132, Milan, Italy
| | - Giuseppe Basile
- Unit of Urology, Urological Research Institute (URI), San Raffaele Hospital, Vita-Salute San Raffaele University, IRCCS Ospedale San Raffaele Via Olgettina 60, 20132, Milan, Italy
| | - Sofia Balò
- Centro Chirurgico Toscano, Arezzo, Italy
| | - Francesco Montorsi
- Unit of Urology, Urological Research Institute (URI), San Raffaele Hospital, Vita-Salute San Raffaele University, IRCCS Ospedale San Raffaele Via Olgettina 60, 20132, Milan, Italy
| | | | - Andrea Salonia
- Unit of Urology, Urological Research Institute (URI), San Raffaele Hospital, Vita-Salute San Raffaele University, IRCCS Ospedale San Raffaele Via Olgettina 60, 20132, Milan, Italy
| | - Alberto Briganti
- Unit of Urology, Urological Research Institute (URI), San Raffaele Hospital, Vita-Salute San Raffaele University, IRCCS Ospedale San Raffaele Via Olgettina 60, 20132, Milan, Italy
| | - Denis Butnaru
- Institute for Regenerative Medicine, Sechenov First Moscow State Medical University, Moscow, Russia
| | - Massimo Lazzeri
- Department of Urology, Humanitas Clinical and Research Center, IRCCS, Rozzano, Milan, Italy
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