Perception, career choice and self-efficacy of UK medical students and junior doctors in urology

Shaping the Undergraduate Curriculum in Europe: Consensus Statement from the European School of Urology

The European School of Urology has created a taskforce to develop a comprehensive, structured urology curriculum with clinical exposure, practical skills, and hands-on training. The curriculum proposal includes cognitive teaching by symptoms and practical aspects to guarantee uniform access to undergraduate medical education in urology among all European countries, regardless of location, local urology exposure, or bias in national curricula.

Role and effectiveness of an information guide in improving catheter confidence and knowledge in junior clinicians

Objective:

Referrals to the on-call urology team for catheter-related problems are common. Experience and previous studies highlight that urology exposure and catheter skills are unsatisfactory in undergraduate training as well as in subsequent junior clinical practice. These deficiencies may compromise patient safety and delay appropriate treatment. This study aimed to assess catheter insertion confidence and associated knowledge in junior doctors and advanced nurse practitioners in a single teaching hospital and evaluate whether this could be improved by introducing a freely available catheter information and problem-solving guide.

Methods:

An online survey assessing confidence inserting two and three-way urethral catheters, changing suprapubic catheters and assessing knowledge related to common catheter problems was delivered to all non-registrar junior clinicians. Based on these results, an information guide was created and made freely available to these clinicians. The survey was then repeated to check for catheter-related knowledge and confidence.

Results:

A total of 58 junior clinicians responded to the initial survey and 61 to the repeat survey. Catheterisation confidence and knowledge was generally low in the first survey but improved in all areas and across all grades after the introduction of the information guide. Of the respondents, 100% thought the guide was helpful and 93.4% said they would use it in future.

Conclusions:

A catheter information guide is a simple and effective method of improving junior clinician confidence with catheter insertion and managing catheter-associated problems.

Level of Evidence:

This study does not directly correlate with a defined level of evidence.

LEARN: A multi-centre, cross-sectional evaluation of Urology teaching in UK medical schools

OBJECTIVE

To evaluate the status of UK undergraduate urology teaching against the British Association of Urological Surgeons (BAUS) Undergraduate Syllabus for Urology. Secondary objectives included evaluating the type and quantity of teaching provided, the reported performance rate of General Medical Council (GMC)-mandated urological procedures, and the proportion of undergraduates considering urology as a career.

MATERIALS AND METHODS

LEARN was a national multicentre cross-sectional study. Year 2 to Year 5 medical students and FY1 doctors were invited to complete a survey between 3rd October and 20th December 2020, retrospectively assessing the urology teaching received to date. Results are reported according to the Checklist for Reporting Results of Internet E-Surveys (CHERRIES).

RESULTS

7,063/8,346 (84.6%) responses from all 39 UK medical schools were included; 1,127/7,063 (16.0%) were from Foundation Year (FY) 1 doctors, who reported that the most frequently taught topics in undergraduate training were on urinary tract infection (96.5%), acute kidney injury (95.9%) and haematuria (94.4%). The most infrequently taught topics were male urinary incontinence (59.4%), male infertility (52.4%) and erectile dysfunction (43.8%). Male and female catheterisation on patients as undergraduates was performed by 92.1% and 73.0% of FY1 doctors respectively, and 16.9% had considered a career in urology. Theory based teaching was mainly prevalent in the early years of medical school, with clinical skills teaching, and clinical placements in the later years of medical school. 20.1% of FY1 doctors reported no undergraduate clinical attachment in urology.

CONCLUSION

LEARN is the largest ever evaluation of undergraduate urology teaching. In the UK, teaching seemed satisfactory as evaluated by the BAUS undergraduate syllabus. However, many students report having no clinical attachments in Urology and some newly qualified doctors report never having inserted a catheter, which is a GMC mandated requirement. We recommend a greater emphasis on undergraduate clinical exposure to urology and stricter adherence to GMC mandated procedures.

Impact of Early Exposure to Simulation Program on Undergraduate Medical Students' Interest in Urology

BACKGROUND

Urological education is as important as surgical training for undergraduates. However, students in undergraduate medical schools have less exposure to urology as their curriculum focuses more on clinical skills, particularly community-based healthcare for a super-aging society. This study aimed to evaluate whether urology-related hands-on training could increase the interest of undergraduate medical students in urology.

METHODS

A 1-day elective program in urological surgery at the University of Tsukuba, particularly in robotic, laparoscopic, and endoscopic surgeries, was offered to 85 fourth-year medical students from 2018 to 2020, prior to their clinical clerkship. The average age of the participants was 22 (range: 21-25) years. We used a scoring system that comprised 1-5 Likert-type items to assess training activity, interest in surgery, and interest in urology before and after the course.

RESULTS

Before attending the program, the average scores of interest in urology were 3.53 in 2018, 3.15 in 2019, and 3.00 in 2020. The scores in surgery increased after the program; however, this was not significantly different from scores prior to the program. However, the average interest scores in urology were significantly increased to 3.91 ± 0.63 (P < .05), 3.88 ± 0.58 (P < .01), and 4.00 ± 0.61 (P < 0.01) in 2018, 2019, and 2020, respectively. Total likely scores of this program in 2018, 2019, and 2020 were 4.59, 4.76, and 4.88, respectively, indicating a motivation to study surgery and urology during clinical clerkship.

CONCLUSIONS

Urological hands-on training facilitated interest in urology in medical students prior to their clinical clerkship.

Attitude and perception of urology by fifth-year (GEMPIII) students at the end of their mixed block rotation at Wits Medical School

Background

This University Medical School offers a 6-year MBBCh programme, of which the fifth year consists of seven blocks of 6 weeks each of which 2 weeks are mixed rotations in specialities such as ophthalmology, ear–nose–throat and urology. The purpose of the study was to assess the current urology knowledge and skills confidence amongst undergraduate medical students regarding urological diagnostic and therapeutic procedures, in order to evaluate the current curriculum for possible need of improvement.

Methods

This was a qualitative survey of 250 fifth-year medical students from September 2019 to February 2020. The survey was conducted by means of a questionnaire consisting of two parts: The first component covered the students perceptions of the urology rotation, and the second component contained the students self-evaluations. The aim of the study was to evaluate students perceptions of the current urology curriculum and to assess the possible need for improvement in urological knowledge and skill.

Results

Of 250 (100%) voluntary participants, 159 (63.6%) were female and 91(36.4%) were male. The majority of students considered their urology knowledge on lithiasis/stone disease and erectile dysfunction sufficient and were comfortable with male catheterisation. Voiding dysfunction, paediatric urology and uro-oncology were the subjects students commonly expressed a deficit in. There was a statistical significant difference in females having a more positive attitude to urology, than males (p = 0.02). No statistical significant difference in attitude to urology was found between students who rotated in one center opposed to students who rotated in another center. Indeed, the majority of students had a negative attitude to urology at the end of the mixed block rotations regardless of the training location. Unattractivity and lack of knowledge were the most common reasons for not choosing urology as a career.

Conclusion

The study reveals a need for improvement in basic urological knowledge and skills during the mixed block rotation. A more practical curriculum, taking into account: bedside teachings, attendance of urological clinics and more exposure to urological patients, are some suggestions to be considered in improving the urological educational curriculum.

The perception and competency of undergraduates in urology: Is the clinical exposure necessary?

Objective:

The objective of this study is to investigate medical students’ perception, choices of future career, and competency in urology.

Methods:

A cross-sectional survey was distributed among 5^th, 6^th, and 7^th(interns) year medical students at King Saud bin Abdulaziz University for Health Sciences using both hard copies and soft copies. Major outcomes were medical students’ perception, future career decision, and core skills in urology.

Results:

The overall response rate was 51.3%. A total number of 163 responses (122 were males and 41 females) were collected. Only 8% indicated that they would pursue a surgical career in urology and 42% thought that they had received a good clinical exposure to urology. Of the participants, 67.5% viewed urology as a male-dominated field. Only 17% of the respondents either agreed or strongly agreed that they were considering a future career in urology. Female students were less likely to consider a urological career (P < 0.01). About 32.5% were confident at urethral catheterization. About 66.9% felt that a workshop day to enhance urological skills and knowledge will be beneficial. Females were more confident at assessing a urological case in an acute setting (P < 0.05).

Conclusion:

Most of the students agreed that their urology exposure was inadequate and their confidence at urethral catheterization was low. As in many different global studies, urology is still regarded as a specialty with a male dominance. This report is consistent with the global decline in formal urological education.

Undergraduate Education for Urology in Europe. Where Do We Stand?

Regardless of career intentions, junior doctors will meet patients with urological problems. There are no studies on the status of undergraduate education for urology in Europe. We designed an 18-item online survey using the platform www.surveymonkey.com to assess the current status of undergraduate education in urology. A total of 347 medical students, trainees, and urologists responded to the survey. Medical students' exposure to urology during their undergraduate career was heterogeneous. Although the quality of urology education was valued from moderate to high, urology as a speciality did not influence their future training decision making. Decision making in relation to residency training correlated with the number of hours spent on practical training, duration of urology rotation, and year of medical school in which urological exposure was introduced. The current European exposure to urology at undergraduate level is heterogeneous, with various factors influencing future decisions regarding training and specialisation. A uniform undergraduate curriculum would eliminate such heterogeneous exposure and facilitate a workforce fit for the future urological needs. PATIENT SUMMARY: Junior doctors will meet patients with urological problems in the wards, emergency departments, and primary care. Institutions should work together for a urological curriculum that fits the future clinical requirements.

Perception, knowledge, and interest of urologic surgery: a medical student survey

BACKGROUND

Although only a limited number of medical schools require a formal educational rotation in urologic surgery, urology as a medical specialty continues to attract a large number of students into the match each year. The purpose of this study was to describe medical student awareness, perception, and knowledge of urology, to determine factors influencing students' consideration of urology as a career, and to determine if prior urology clerkship experience is associated with differences in these variables.

METHODS

In this cross-sectional study, medical students were electronically surveyed in 07/2016. Self-reported and question-based knowledge of urology were determined. A total of 25 factors were assessed with a five-point Likert scale to determine their influence on students' consideration of urology as a career. Data analysis was performed using R.

RESULTS

The survey was completed by 114 students (13.5% of all medical students). A total of 11(9.65%)students had previously participated in a urology clerkship. All students reported awareness of urology; however, only 74 students (64.9%) correctly identified the training pathway and job duties of urologists. Self-perceived knowledge of urology was poor but improved with increased medical school training. Question-based assessment also demonstrated increased knowledge with advanced medical school training (27% per year; p < 0.01). Prior urology clerkship experience appeared to be associated with increased urologic knowledge; however, this was confounded by year in medical school training. When assessing factors impacting students' consideration of a career in urology, 'combination of medicine and surgery' was the most positively influential and 'competitiveness of the specialty' was the most negatively influential.

CONCLUSIONS

Although medical students are aware of urology as a specialty, they perceive their knowledge of urology as poor. However, knowledge of urology increases throughout medical school training. Multiple factors influence students' consideration of urology as a career choice. Additional studies are needed to further explore how participation in a formal urology experience alters students' perceptions and influences their consideration of urology as a career choice.

TRIAL REGISTRATION

Retrospectively registered.

Perceptions and Career Expectation in Ophthalmology among Saudi Undergraduate Medical Students

PURPOSE:

To assess the perceptions about ophthalmology as a career among undergraduate medical students and to investigate the determinants of career choice in ophthalmology.

METHODS:

A questionnaire was administered to all medical students (from 4^th year to interns) in King Abdulaziz University, Jeddah, Saudi Arabia. A total of 519 students were included in the study. Students who aspire for ophthalmology as a career, i.e., those who mentioned it in their top three choices (Group A), were compared to those who did not (Group B) regarding demographic and academic factors, factors generally influencing career choice and perception about and experience in ophthalmology.

RESULTS:

Among 519 included students, ophthalmology was the first career choice of 5.6% and in the top three choices of 13.5% of students. Students from Group A had female preponderance and comparable academic skills, by reference to Group B. Group A reported to have a better experience in ophthalmology, including conference attendance, research activity, and community services related to ophthalmology, as well as greater advantage from ophthalmology rotation. Determinants of career choice in ophthalmology included giving importance for workload during their residency (odds ratio [OR] = 3.38; P = 0.021), having concern about challenging instrumental features (OR = 0.29, P = 0.012), believing that ophthalmology should be included in primary care (OR = 13.60, P = 0.002), and having participated in community service activity in ophthalmology (OR = 10.10, P = 0.005).

CONCLUSION:

Students who aspire for a career in ophthalmology showed to have an early involvement in related academic activities and less concern about instrumental and intellectual challenges, as compared to their counterparts. The formal ophthalmology rotation is the key step to recruit future ophthalmologists by correcting misconceptions and enhancing interest about the specialty.

Development of a short and universal learning self-efficacy scale for clinical skills

Background

Learning self-efficacy, defined as learners’ confidence in their capability to learn specific subjects, is crucial for the enhancement of academic progress, because it is positively correlated with academic achievements and effective learning strategy use. In this study, we developed a universal scale called the Learning Self-Efficacy Scale (L-SES) for Clinical Skills for undergraduate medical students and validated it through item analysis and content validity index (CVI) calculation.

Design

The L-SES was developed based on the framework of Bloom’s taxonomy, and the questions were generated through expert consensus and CVI calculation. A pilot version of the L-SES was administered to 235 medical students attending a basic clinical skills course. The collected data were then examined through item analysis.

Results

The first draft of the L-SES comprised 15 questions. After expert consensus and CVI calculation, 3 questions were eliminated; hence, the pilot version comprised 12 questions. The CVI values of the 12 questions were between .88 and 1, indicating high content validity. Moreover, the item analysis indicated that the quality of L-SES reached the qualified threshold. The results showed that the L-SES scores were unaffected by gender (t = −0.049; 95% confidence interval [−.115, .109], p > .05).

Conclusion

The L-SES is a short, well-developed scale that can serve as a generic assessment tool for measuring medical students’ learning self-efficacy for clinical skills. Moreover, the L-SES is unaffected by gender differences. However, additional analyses in relevant educational settings are needed.

The application rate for urology specialty compared with other specialties from 2007 to 2014 in Korea: is it influenced by social interest manifested by internet trends?

BACKGROUND

Reduced clinical exposure to urology at the undergraduate or internship level is the main explanation for the marked decrease in applicants to urology residencies. This manuscript was to access the application rate for urology specialty compared with that of other specialties and to investigate the relationship between the decreasing trend in urology applications and social interest using internet trend tests.

METHODS

We reviewed data collected by the Korean Hospital Association from 2007 to 2014. We assessed internet trends using Naver Trend for domestic social interest and Google Trends for international social interest (2007 to 2014). Trend tests and Spearman correlations were used for statistical analyses.

RESULTS

Among the all specialties, the application rates to obstetrics and gynecology, emergency medicine, and occupational medicine are significantly increasing (p = 0.015, 0.012, and 0.048, respectively). Application to other specialties is mostly decreasing. The decreasing trend is highest for urology (beta = - 12.21 and p < 0.001). The application rate and domestic social interest revealed by Naver trends were significantly correlated (r = 0.786 and p = 0.021). No correlation was found between Naver trends and Google trends (r = - 0.19 and p = 0.651).

CONCLUSIONS

The rate of application to urology specialty is decreasing the fastest, and this trend is related to domestic social interest. An attempt should be made to increase the number of urologic applicants.