Department of Urology, University of California, Irvine, Orange, California.
Department of Urology, University of California, Irvine, Orange, California.
J Surg Educ. 2019 Jul-Aug;76(4):936-948. doi: 10.1016/j.jsurg.2019.02.002. Epub 2019 Feb 23.
OBJECTIVE: To identify differences and potential deficiencies in urology residency training programs in the United States as they are perceived by residents/recent graduates and program directors. MATERIALS AND METHODS: A 45-question and 38-question survey was sent to chief residents/recent graduates and program directors, respectively, at all 120 US urology programs regarding prior medical education, urologic training curricula, and perceived surgical proficiency, among other topics. RESULTS: Survey response rate was 58% and 52% for residents and program directors, respectively. Responses regarding program characteristics (e.g., salary, vacation) and research training were similar between program directors and residents. However, their responses regarding skills training and subspecialty training (e.g., robotics and pediatrics) differed substantially. Program directors reported the availability of advanced skills trainers (robot-88%, laparoscopic-86%), whereas fewer residents felt they were available (robot 54% and laparoscopic 72%). The same discrepancies persisted with questions about subspecialty exposure (e.g., program directors reported 48% renal transplant experience vs. 13% reported by residents). Most residents felt comfortable performing essential urology procedures (e.g., cystoscopy/ureteroscopy, open nephrectomy). In contrast, the majority expressed a lack of confidence in performing unsupervised advanced minimally invasive procedures (e.g., laparoscopic and robotic partial nephrectomy, endopyelotomy). Among the responding residents, 72% pursued fellowship training; nearly two-thirds of these residents chose to enter fellowship in order to overcome perceived training deficiencies. CONCLUSIONS: Program directors and residents have differing perceptions regarding the education and resources associated with US urology residency training programs. US graduates of urology residency programs express a perceived lack of confidence in several procedures that are commonly encountered in a general urologic practice.
目的：确定美国泌尿科住院医师培训计划在住院医师/应届毕业生和项目主任眼中的差异和潜在缺陷。
材料与方法：向全美 120 个泌尿科项目的住院医师/应届毕业生和项目主任分别发送了一份包含 45 个问题和 38 个问题的调查，内容涉及既往医学教育、泌尿科培训课程以及手术熟练程度等方面。
结果：住院医师和项目主任的调查回复率分别为 58%和 52%。关于项目特点（如薪酬、休假）和研究培训的回答在项目主任和住院医师之间相似。然而，他们在技能培训和专科培训（如机器人和儿科）方面的回答存在很大差异。项目主任报告称有高级技能培训师（机器人 88%，腹腔镜 86%），而住院医师则认为这些培训师的可用性较低（机器人 54%，腹腔镜 72%）。同样的差异也存在于专科培训经历方面（例如，项目主任报告称有 48%的肾移植经验，而住院医师报告的只有 13%）。大多数住院医师对执行基本泌尿科手术（如膀胱镜检查/输尿管镜检查、开放性肾切除术）感到舒适。相比之下，大多数人表示缺乏进行无人监督的高级微创手术（如腹腔镜和机器人部分肾切除术、内切开术）的信心。在回应的住院医师中，有 72%的人接受了专科培训；其中近三分之二的人选择进入专科培训是为了克服感知到的培训缺陷。
结论：项目主任和住院医师对美国泌尿科住院医师培训计划的教育和资源有不同的看法。美国泌尿科住院医师项目的毕业生表示，他们对几种在普通泌尿科实践中常见的手术缺乏信心。
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