British Journal of Medical & Surgical Urology

Editorial Board

2012-01-01

Announcing BAUS Office of Education/BJMSU CME review articles

Tamsin Greenwell — 2012-01-01

With the upcoming prospect of formal revalidation I am delighted to announce a new joint venture between the BAUS Office of Education and the British Journal of Medical and Surgical Urology. We have commissioned a range of CME review articles aimed at providing CCT level educational updates across the broad spread of urology. Each 3000-word article is accompanied by 10 single best answer MCQs that will allow you to test your understanding of the article and keep a record of your CME. The MCQs will be available online and are resittable until 70% have been answered correctly – at which point a CME certificate for 3 CME points will be available to print and add to your portfolio.

The evolution of urological education, training and assessment in the UK

Steve Payne, Kieran O’Flynn — 2012-01-01

Nowadays, trainees and their trainers readily acknowledge that to train as a urologist requires a syllabus, a curriculum (broadly defined as provision of a structured training programme) and a validated assessment method to determine that theoretical and applied knowledge, allied to technical skills acquisition, have been obtained. While much of this is now in place, and will continue to evolve, it is worthwhile reflecting on how education and training has evolved within the speciality over the past 50 years.

Medical students’ exposure to Urology in the undergraduate curriculum, a web based survey

L.F. Derbyshire, K.J. O’Flynn — 2011-12-02

Summary: Objective: Urological knowledge and skills are lacking in junior doctors and Urology is undersubscribed for specialist training. Lack of exposure as undergraduates may be responsible. We aimed to assess Urology exposure, confidence about managing common conditions and career prospects, in current UK medical students.Methods: All UK medical schools were contacted. Final year students were asked to complete an online survey about Urology.Results: 610 responses were received. Only 42% of respondents had a compulsory clinical attachment in Urology, lasting on average 1 week. 46% had compulsory attachments partially based in Urology, mainly with other surgical specialities. Common urological activities had been attended by >50% of respondents, however 6% had not attended any. Over 80% of respondents received teaching on common Urology topics except for urological emergencies (62%). Lectures and anatomy sessions were the main teaching methods. 87% of teaching was from Urologists. Most respondents felt ‘confident’ managing common urological problems, but 32% felt ‘not very confident’ with urological emergencies. Only 14% of respondents would consider a career in Urology.Conclusion: Urology experience is not compulsory in UK medical schools and is variable. Final year students lack confidence managing urological emergencies and have limited interest in Urology as a career. Development of a Urology undergraduate curriculum should help address these issues.

What undergraduate factors influence medical students when making their choice of postgraduate career?

C. Yap, S. Rosen, A.M. Sinclair, I. Pearce — 2011-12-15

Summary: Objectives: To determine what factors final year medical students consider when deciding upon their future post graduate career and to what extent each factor influences their decision.Methods: 150 final year medical students were asked to complete an anonymous questionnaire relating to factors relating to their future career choice. Students were asked to rate each factor according to the level of importance or influence it exerted when choosing a post graduate career. A simple visual analogue scale from 1 to 10 was utilised with 10 being most influential.Results: The most significant factors influencing final year medical students in their career choice were clinical mentors and specialty themed PBL cases with scores of 6.8 and 6.5 out of a maximum of 10. Clinical exposure exerted the weakest influence with a mean score of 2.5.Conclusion: Various factors influence the future career choice of final year medical students to a differing extent. In order to promote Urology as a favourable career choice in this cohort, a concerted and coherent effort should be made at national level to engage medical students and promote the specialty.

Is there a need for an undergraduate urological curriculum?

R. Scott, A.M. Sinclair, I. Pearce — 2011-12-02

Summary: Objectives: To review Medical student education in urology and assess students self reported knowledge and management competency of common urological conditions. To determine the degree of undergraduate exposure to urology and students intentions to follow a post graduate career in urology.Methods: Questionnaires were completed by final year medical students prior to final examinations over a five year period to assess exposure to undergraduate urology and consideration of urology as a postgraduate career. Students from a single year were asked to rate their knowledge and management competency with respect to a variety of common urological pathologies.Results: Students reported low levels of confidence to manage common and emergency urological conditions. Undergraduate exposure to urology is decreasing year on year, with fewer and fewer students considering urology as a future career option.Conclusions: Undergraduate exposure to urology is poor and as a consequence of this, fewer students are considering a career in urology. This trend needs to be reversed, possibly in part, by the implementation of a defined undergraduate urological curriculum and BAUS needs to foster a greater undergraduate presence to stimulate current medical undergraduates to consider a urological career.

Undergraduate urology in the UK: Does it prepare doctors adequately?

Sachin Malde, Nitin Shrotri — 2011-11-02

Summary: Objectives: Undergraduate medical education in the UK has recently changed. Medical schools are expected to provide the core knowledge required for medical practice, with the foundation programme building upon this. However, studies have suggested that both undergraduate and postgraduate exposure to urology have declined. This study aims to evaluate the views of newly qualified doctors regarding undergraduate urology training.Subjects and methods: An online questionnaire was emailed to all UK foundation doctors in August 2010 (total 4339).Results: 289 responses were received, giving a confidence level of 95% with an error rate of 5.6%. 26.6% of respondents had no undergraduate urology attachment, with a further 30.5% receiving one week or less. 68.9% felt that more time should be devoted to urology teaching, with only 9.7% believing that their undergraduate training was adequate. Most (67.8%) thought there was not enough practical skills experience, with 60.4% never having inserted a female urethral catheter. 77.5% felt that a basic urological skills course would be beneficial, with 54% wanting a longer clinical attachment. Interestingly, 70.1% of those surveyed will not complete a urology rotation during the foundation programme, with only 15.6% having considered a career in urology.Conclusion: This survey highlights the wide variation in undergraduate urology teaching across the UK, and demonstrates that the foundation programme does not necessarily compensate for this. A national basic urological skills course may provide a standardised way to improve training across the country.

Trainees’ clinical exposure in the general urological outpatient environment and its relevance to their expected clinic throughput at completion of surgical training

Bharat Vissamsetti, Ian Pearce, Steve Payne — 2011-12-07

Summary: The aim of this study was to determine the number of patients seen in urological outpatient clinics by consultants and juniors in general urology clinics to determine whether trainees experience a workload they might expect in their future practice.Materials and methods: Data were acquired prospectively for two consultants’ outpatient activity and the general urology component extracted. Collection of new and follow-up patients attendances, and who saw them, was recorded in addition to the booked patient load. Data were analysed to show clinical throughput by consultants and junior doctors in formalized training or in trust-grade posts.Results: 7645, 2465 new and 5180 follow-up, patients attended 467 general urology clinics. 54.9% of new, and 65% of follow up patients were seen by the consultants when they and junior were present. There was no apparent difference in the numbers of patients seen by trainees and trust doctors irrespective of their experience.Conclusion: In a general urology setting juniors’ exposure to the available outpatient workload seems to be appropriate for what they might expect to encounter at the completion of training. Further research is required to determine the quality, and emphasis, in training necessary to optimize efficient patient management in this environment.

UK urology trainees’ exposure to dedicated infertility training: How good is that training?

B.R. Grey, K.J. O’Flynn, S.R. Payne — 2011-09-28

Summary: Objective: The management of male-factor infertility (MFI) is one component of the UK urological training curriculum. Sub-specialising gynaecologists, training in reproductive medicine, are also expected to achieve similar competencies. This study aimed to determine UK urology trainees’ views on the quality of their training in managing the infertile male.Methods: All UK urological trainees, identified through the British Association of Urological Surgeons (BAUS) or Joint Committee on Surgical Training (JCST) databases were e-mailed and invited to partake in an online survey, accessed through SurveyMonkey™.Results: 176 (51.6%) urological trainees responded. Only 3.6% were assured of exposure to training in MFI investigation and management and <35% had any exposure to vasectomy reversal. 61.3% wanted infertility to make up some part of their work as a consultant but only 27% rated their training as adequate. 79.9% felt threatened by the potential loss of skills and patients to gynaecologists with sub-specialist interests in reproductive medicine.Conclusions: UK urological trainees reported that exposure to dedicated training in MFI is suboptimal and ultimately, insufficient to equip them for the consultant practice they desire. Urology training needs re-structuring to ensure retention of this skill set and to support the aspirations of interested urological trainees.

Quality of feedback using Workplace Based Assessments in urological training

A.S. Ali, M. Bussey, K.J. O’Flynn, I. Eardley — 2011-11-07

Summary: Introduction: The ISCP (Intercollegiate Surgical Curriculum Programme) was introduced in 2007. It heralded a shift in surgical training from the traditional apprenticeship model, to a system where competence is assessed regularly within the workplace. Central to ISCP is the recording of Workplace Based Assessments, such as PBA (procedure-based assessment) and DOPS (Direct Observation of Procedural Skills). These are assessments “for” learning rather than assessments “of” learning and central to their purpose is detailed feedback from trainer to trainee. The aim of this study was to assess the quality of the feedback recorded on ISCP.Methods: The anonymised ISCP portfolios for 170 core and specialty urology trainees working in 16 deaneries were analysed. Over a three month period 469 DOPS and 592 PBAs were recorded and the presence and quality of assessors’ feedback were evaluated according to the presence of five criteria: • Encouragement through positive language, • Including strengths, • Raising appropriate development needs, • Suggestions for appropriate corrective action, • Providing explanations.Results: Feedback was recorded in 49% and 67% of PBAs and DOPS respectively. In those assessments where feedback was recorded, positive language was used in 83% in PBAs and 70% in DOPS. Strengths were recorded in 53% for both tools. Developmental needs, suggestions for development and detailed explanation were recorded in 25%, 26%, 29% for PBAs and 24%, 23%, 19% for DOPS respectively.Conclusion: This study highlights the lack of feedback being recorded on ISCP and the paucity of good quality feedback when it was given.

Ranking of urology registrar placements within a region. An SAC pilot

J.E. Oates, K.J. O’Flynn, D.C. Shackley — 2011-12-12

Summary: Background: There is a continual desire to improve educational standards, demonstrate quality assurance of training and to respond to the growing pressure to reduce SpR numbers. Any reduction would need to be based on an assessment which looks at educational value and trainee experience. We describe our experience using a tool to rank urology registrar posts in a single region.Methods and materials: An assessment scoring tool was created with equal trainee and trainer components. The trainee and trainer elements were developed from the proposed JCST trainee assessment and the GMC standards for trainers, with a maximum score of 200 achievable. Higher scores could be obtained by the unit being pro-active with educational activities. This tool was completed by all the training units and trainees within a single region.Results: Results were obtained from all units within the region, with scores ranging from 130 to 168 (mean 149). Units scoring highly in trainee components also scored highly in the trainer component.Conclusion: This tool allows objective assessment of training posts using evidence from the training unit, trainee and TPD. Incorporating this data into the annual ARCP would potentially improve the process. There was widespread support for repeating the exercise and the tool provided a powerful means of engagement in improving training.