From the Division of Female Pelvic Medicine and Reconstructive Surgery, Departments of Obstetrics and Gynecology and Urology, Northwestern University Feinberg School of Medicine, Chicago, IL.
Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, TX.
Female Pelvic Med Reconstr Surg. 2020 Dec 1;26(12):e83-e90. doi: 10.1097/SPV.0000000000000928.
The aim of this study was to determine the level and types of training Accreditation Council for Graduate Medical Education-accredited programs use for female pelvic medicine and reconstructive surgery (FPMRS) fellows' education on lower urinary tract injuries (LUTIs).
Two surveys were developed to assess the need for LUTI curriculum from both program director (PD) and fellow vantages through a multistage process, including review by knowledgeable colleagues, cognitive interviews, and pilot testing. Surveys were distributed in an electronic link via e-mail to graduating fellows and program directors from each of the 58 Accreditation Council for Graduate Medical Education-accredited FPMRS programs.
Thirty-four graduating FPMRS fellows (71%) and 39 FPMRS PDs (67%) completed the survey. Both PDs and fellows responded that both the evaluation and management of LUTI were necessary to FPMRS training. The majority of PDs use a combination of didactics and hands-on learning in the operating room (60% and 71%). Only 40% and 30% incorporate simulation into the curriculum to address LUTI. Graduating fellows report low numbers of procedures to evaluate and manage LUTI. Specifically, only 15% of fellows graduate with greater than 2 ureteral reimplantations and 44% graduate with no minimally invasive abdominal vesicovaginal fistula repairs. The majority of graduating fellows reported feeling prepared to evaluate for LUTI, but nearly one third do not feel ready to independently manage LUTI upon graduation.
FPMRS PDs and fellows agree that the evaluation and management of LUTI are important; however, most programs use only didactics and hands-on learning in the operating room with extremely low case volumes, leading to decreased proficiency.
本研究旨在确定经住院医师规范化培训认证委员会（Accreditation Council for Graduate Medical Education）认证的项目为女性盆底医学和重建外科（Female Pelvic Medicine and Reconstructive Surgery，FPMRS）学员提供女性下尿路损伤（Lower Urinary Tract Injuries，LUTIs）教育的培训水平和类型。
通过多阶段流程，包括由知识渊博的同事审查、认知访谈和试点测试，开发了两项调查，以从项目主任（Program Director，PD）和研究员的角度评估 LUTI 课程的需求。调查通过电子邮件的电子链接分发给每个 58 个经住院医师规范化培训认证委员会认证的 FPMRS 项目的即将毕业的研究员和项目主任。
34 名即将毕业的 FPMRS 研究员（71%）和 39 名 FPMRS PD（67%）完成了调查。PD 和研究员均表示，LUTI 的评估和管理对 FPMRS 培训都是必要的。大多数 PD 采用课堂教学和手术室动手学习相结合的方法（60%和 71%）。只有 40%和 30%的人将模拟纳入课程，以解决 LUTI 问题。即将毕业的研究员报告说，评估和管理 LUTI 的手术数量较少。具体来说，只有 15%的研究员进行的输尿管再植术多于 2 次，而 44%的研究员没有进行微创性腹部膀胱阴道瘘修补术。大多数即将毕业的研究员报告说他们有信心评估 LUTI，但近三分之一的人毕业后认为自己没有准备好独立管理 LUTI。
FPMRS PD 和研究员一致认为，LUTI 的评估和管理很重要；然而，大多数项目仅在手术室中使用课堂教学和动手学习，并且手术量极低，导致熟练程度降低。
