Search

Objectives: To assess the effect of the changing landscape of urologic residency education and training on resident operative exposure and inter-resident variability.Methods: The Accreditation Council for Graduate Medical Education (ACGME) case logs for graduating urology chief residents were reviewed from Academic Year (AY) 2009-2010 to 2016-2017. Cases were stratified into the 4 ACGME categories - general urology, endourology, oncology, and reconstruction. Linear regression models analyzed the association between training year, volume, and type of cases performed. Inter-resident variability in case exposure was calculated by the difference between the ACGME reported 10th and 90th percentiles.Results: During the study period, the mean number of cases performed per resident was 1092 (standard deviation 32.7). Although there was no significant change in total case volume, there were changes within case categories. Endoscopic, retroperitoneal oncology, and male reconstruction case volume all increased significantly (Δ20.1%, Δ 5.1%, Δ 8.2%, respectively, all P < .05). This was balanced with a concomitant decrease in pelvic oncology and female reconstruction cases (Δ 10.0% and Δ 14.5%, respectively, both P < .05). There was a 27.8% increase in laparoscopic/robotic cases (P < .001). The ratio difference between the 10th percentile and 90th percentile ranged from a low of 2.5 for retroperitoneal oncology cases to a high of 5.2 for extracorporeal shock wave lithotripsy and percutaneous nephrolithotomy.Conclusion: From AY2009-2010 to 2016-2017, residency case volume has remained constant, but there has been a change in types of cases performed and proliferation of minimally invasive techniques. Significant variability of inter-resident operative experience was noted. [ABSTRACT FROM AUTHOR]

Purpose: Professionalism is one of the most challenging of the Accreditation Council for Graduate Medical Education Competencies to define, teach and evaluate. At University of Washington we assessed whether defining professionalism, and training faculty and residents in the evaluation process would improve professional behavior. Materials and Methods: In 2003 the Accreditation Council for Graduate Medical Education Global Resident Competency Rating Form was distributed to faculty after each rotation to evaluate residents. The project included all 16 residents and 18 clinical faculty during a total of 15 rotations for 3 years at 4 Seattle area hospitals. After 21 months a training lecture on professionalism was presented to faculty and residents. Following this intervention all trained faculty completed a Graduate Medical Education Global Resident Competency Rating Form on every resident after each rotation. Three specific professionalism questions from the Graduate Medical Education Global Resident Competency Rating Form were chosen as representations of standard professional behaviors. These questions were used to assess the change in resident professional behavior. Results: Pre-intervention and post-intervention scores were compared. Mean post-intervention scores were higher by 0.4 to 0.5 points for each of the 3 questions (each p <0.01). There was less variation in scores after the intervention, suggesting that 1) residents were more consistent in their professional behavior and/or 2) the faculty observation of resident professional behaviors was more focused. Conclusions: These results suggest that training faculty and residents in professionalism may have a significant positive influence on improving resident professional behavior as well as the faculty ability to more objectively evaluate resident professional behaviors based on defined standards. [Copyright &y& Elsevier]

Purpose: The Accreditation Council for Graduate Medical Education requires that each residency program must demonstrate and document actual accomplishments through objective measures. At University of Washington we identified deficiencies in resident medical knowledge and designed interventions that would assist in improving resident AUA IS scores, using this as a metric to document the outcomes. Materials and Methods: In 2001 the University of Washington syllabus and faculty precepted chapter review sessions were formally established. The national AUA IS was used as an objective standardized examination to determine an annual group percentile score. Results: We noted a gradual and consistent increase in the average percentile group score on the national annual AUA IS examinations of our residents. A generalized estimating equation model demonstrated a significant difference between pre-intervention and post-intervention average percentile resident AUA IS scores (p <0.001). Average resident percentile rankings in 2001 to 2004 were 25.6 points higher than the average rankings of residents tested in 1997 to 2000. Conclusions: We developed and evaluated a cohesive core curriculum designed to improve resident knowledge in urology, as measured by the AUA IS metric. With the active participation of faculty the curriculum enhanced resident education. [Copyright &y& Elsevier]

Objective: To qualitatively assess Urology program directors' perspectives on the effectiveness of training residents after implementation of the Accreditation Council for Graduate Medical Education's (ACGME) 2011 Next Accreditation System, and identify differences in current perspectives and prior surveyed perspectives toward the ACGME Outcome Project.Methods: A national survey was developed by an ad hoc committee and distributed electronically to 105 Urology program directors. Thirty-four (34) multiple-choice, Likert-scale questions were administered. Data were evaluated and the results from the survey were compared to the one performed 15 years earlier to determine changes in the learning environment and effectiveness of training urology residents.Results: The current survey response rate was 89% which was similar to the 2005 response rate of 88%. Most program directors (61%) agreed that 20% protected time for program directors helped with administrative work and 31% felt this time needs to increase for larger residency programs. Seventy percent (70%) agreed that dedicated program administrator time has helped their program. More than half of the respondents agree that the ACGME is training the current workforce effectively.Conclusion: Current program directors appear to be more accepting of changes required by the Next Accreditation System as compared to the Outcome Project 15 years ago. Our study supports the need for protected time to train residents and to overcome barriers to change. [ABSTRACT FROM AUTHOR]