Division of Urology, Virginia Commonwealth University School of Medicine, Richmond, VA 23298-0118, USA.
J Sex Med. 2011 Oct;8(10):2726-32. doi: 10.1111/j.1743-6109.2011.02418.x. Epub 2011 Aug 3.
The challenge of resident education in urologic surgery programs is to overcome disparity imparted by diverse patient populations, limited training times, and inequalities in the availability of expert surgical educators. Specifically, in the area of prosthetic urology, only a small proportion of programs have full-time faculty available to train residents in this discipline.
To examine whether a new model using yearly training sessions from a recognized expert can establish a successful penile prosthetics program and result in better outcomes, higher case volumes, and willingness to perform more complex surgeries.
A recognized expert conducted one to two operative training sessions yearly to teach standardized technique for penile prosthetics to residents. Each session consisted of three to four operative cases performed under the direct supervision of the expert. Retrospective data were collected from all penile prosthetic operations before (February, 2000 to June, 2004: N = 44) and after (July, 2004 to October, 2007: N = 79) implementation of these sessions.
Outcomes reviewed included patient age, race, medical comorbidities, operative time, estimated blood loss, type of prosthesis, operative approach, drain usage, length of stay, and complications including revision/explantation rates. Statistical analysis was performed using Student's t-tests, Fisher's tests, and survival curves using the Kaplan-Meier technique (P value ≤ 0.05 to define statistical significance).
Patient characteristics were not significantly different pre- vs. post-training. Operative time and estimated blood loss significantly decreased. Inflatable implants increased from 19/44 (43.2%, pre-training) to 69/79 (87.3%, post-training) (P < 0.01). Operations per year increased from 9.96 (pre-training) to 24 (post-training) (P < 0.01). Revision/explantation occurred in 11/44 patients (25%, pre-training) vs. 7/79 (8.9%, post-training) (P < 0.05).
These data demonstrate that yearly sessions with a recognized expert can improve surgical outcomes, type, and volume of implants and can reduce explantation/revision rates. This represents an excellent model for improved training of urologic residents in penile prosthetics surgery.
泌尿科手术项目的住院医师教育面临的挑战是克服由不同患者群体、有限的培训时间以及专家外科教育者的可用性不平等带来的差异。具体而言，在假体泌尿科领域，只有一小部分项目有全职教师可以培训住院医师进行该学科的学习。
研究一种新的模式，即每年由一位知名专家进行培训课程，能否建立一个成功的阴茎假体项目，并带来更好的结果、更高的手术量以及更愿意进行更复杂的手术。
一位知名专家每年进行一到两次手术培训课程，向住院医师传授标准化的阴茎假体技术。每次课程包括三到四个在专家直接监督下进行的手术病例。回顾性收集了所有阴茎假体手术的数据，包括实施这些课程之前（2000 年 2 月至 2004 年 6 月：N = 44）和之后（2004 年 7 月至 2007 年 10 月：N = 79）的手术数据。
评估的结果包括患者年龄、种族、合并症、手术时间、估计失血量、假体类型、手术入路、引流管使用、住院时间和并发症（包括返修/取出率）。使用学生 t 检验、Fisher 检验和 Kaplan-Meier 技术的生存曲线进行统计学分析（P 值≤0.05 定义为统计学意义）。
患者特征在培训前后没有显著差异。手术时间和估计失血量明显减少。可膨胀假体从 44 例中的 19 例（培训前为 19/44，43.2%）增加到 79 例中的 69 例（培训后为 69/79，87.3%）（P < 0.01）。每年手术次数从 44 例中的 9.96 次（培训前）增加到 79 例中的 24 次（培训后）（P < 0.01）。在 44 例患者中，有 11 例（培训前为 25%）需要返修/取出，而在 79 例患者中，有 7 例（培训后为 8.9%）需要返修/取出（P < 0.05）。
这些数据表明，与知名专家进行的年度培训课程可以改善手术结果、假体类型和数量，并降低取出/返修率。这为泌尿科住院医师在阴茎假体手术方面的培训提供了一个极好的模式。
